COVID-19 infections in the Philippines are increasing once again in this seemingly nonstop pandemic, with an average of 8,850 new infections being reported each day. As of this writing, there have already been 1.66 million infections and more than 29,000 deaths in the Philippines alone. If you are wondering just how many 29,000 is, just try to imagine two full Mall of Asia Arenas. That's how many Filipinos have succumbed to COVID-19 already.
So, the rising number of COVID-19 cases particularly due to the Delta variant in the past month alone had prompted the government to impose lockdowns yet again, with the strictest enhanced community quarantine (ECQ) being imposed in Metro Manila, Laguna, Bataan, Iloilo City, and Cagayan de Oro. These are done supposedly to stop the spread of the coronavirus even when people know that it is vaccinations and not another round of lockdowns that are needed to fight the deadly virus.
If you are wondering just how many 29,000 is, just try to imagine two full Mall of Asia Arenas.
“We are looking at the COVID-19 Delta variant that is more easily transmissible, having the inherent capacity to infect more vulnerable people at a faster rate. The Delta variant appears to cause more severe symptoms, especially for those who are not fully vaccinated,” Dr. Ramon Jason Javier, a Family & Community Medicine – Tropical Medicine specialist, explained. “There are reports which also allege that the Delta variant may have the potential to ‘escape’ from the current COVID-19 vaccines and this can significantly contribute to the virulence of the Delta variant and, perhaps, even the Lambda and Kappa variants.”
Given all this, what, really, does the Delta variant and the prolonged lockdown that it had caused mean to the Philippine healthcare and economy? More importantly: how does this affect the community?
Resurgent virus overwhelms Philippine healthcare institutions
The increasing number of cases exhausts the healthcare system as more people are being admitted to hospitals, especially in the National Capital Region (NCR).
According to Javier, "In Cebu, there is a shortage of oxygen tanks because of the sudden rise in patients with acute respiratory distress syndrome. In the NCR, healthcare workers, despite being fully vaccinated, still get infected with COVID-19, although their clinical manifestations are less severe compared to those who are unvaccinated. In other government tertiary hospitals, pediatric patients (who remain unvaccinated) are being admitted to intensive care units supposedly because of severe COVID-19. In addition, medications such as antivirals and steroids and other therapeutic modalities such as extracorporeal membrane oxygenation are not readily available and accessible to many Filipinos.”
We have heard stories of babies being delivered in parking lots of hospitals because the mother was unable to have an RT-PCR facilitated...
Both St. Luke's Medical Center and the Medical City, for instance, announced on August 9 that their COVID-19 wards and critical care units have already reached full capacity, hence they can no longer take in new patients anymore. St. Luke's was also more direct in requesting new patients to consider other healthcare institutions instead. Prior to these announcements, Department of Health (DOH) data had also shown that 13 other hospitals in Metro Manila have already reached 100-percent utilization of their bed capacity.
This greatly affects patients with non-COVID-19-related medical needs because they are no longer being properly attended to. "Patients with non-communicable diseases, those for elective surgery, and even pregnant women in labor are sometimes not admitted in hospitals because of stringent health protocols being implemented amid the rising cases of COVID-19 in the country," Javier shared. "We have heard stories of babies being delivered in parking lots of hospitals because the mother was unable to have an RT-PCR facilitated, which is now a requirement for admission in most hospitals."
It is not a secret anymore that many healthcare workers, particularly in government healthcare facilities, are not receiving the actual financial incentives that not only do they deserve but were also promised to them by the government. "Hazard payments of medical frontline workers have not been fully paid to date and they still continue to provide healthcare services in non-ideal work environments, which can be physically, emotionally, and psychologically draining," Javier noted.
Despite these heroic deeds and personal sacrifices, the medical frontline workers are not given due importance and recognition by the national government. This, however, is not the same with how the government takes care of the military and uniformed personnel, who are being showered with financial bonuses and other incentives for their patriotism.
Prolonged lockdown shocks labor workers, economy
A prolonged lockdown caused by the more transmissible Delta variant, of course, comes at a price. While it puts people in a relatively safer place away from the deadly virus, it also poses risks in people’s living situation and the economy in general.
Economist Jeff Arapoc, an assistant professor at the University of the Philippines Los Baños and co-founder of Usapang Econ, said, "We’ve seen how these lockdowns affected our economy last year. We experienced our first recession in 29 years in 2020. We also recorded the highest quarterly GDP contraction of 16.9% in the second quarter last year. This is not surprising given that strict lockdowns are designed to reduce people’s mobility to contain the virus, but it comes at a price. Due to these lockdowns, some businesses – particularly micro, small, and medium enterprises – were forced to shut down. Last year, our unemployment rate had also skyrocketed to 10.3%.”
Arapoc noted, "Unfortunately, given all the catastrophic impacts of these lockdowns on our economy from the first surges, I think it is safe to say that we have not really controlled the COVID-19 outbreak through these lockdowns."
The real dilemma would be how long our economy can endure these shocks given that the Delta variant is more contagious than the strain from previous surges.
The series of lockdowns will again impact the economy and cause “shocks” to the people the way the first surges did. “People's inability to come to work or do business operations due to lockdown is a supply shock, while joblessness that reduces people's ability to buy goods and services is a demand shock,” Arapoc explained. “These problems that we are currently facing are no different from what we experienced from the previous surges. The real dilemma would be how long our economy can endure these shocks given that the Delta variant is more contagious than the strain from previous surges.”
The imposition of new lockdowns will result in lost production output of about P150 billion ($3 billion) per week, affect more than 600,000 workers, and increase the number of poor people by about 250,000, National Economic & Development Authority Chief and Socioeconomic Planning Secretary Karl Kendrick Chua said in a report. These numbers, of course, do not look good for a country that already grapples with a 7.7% unemployment rate (or equivalent to 3.76 million Filipinos) as of June 2021, and an estimated 21% national poverty rate in 2020.
Occupational health physician and general practitioner Lester Mico Danganan attested to the effects of these quarantine classifications on the people that these lockdowns affect the most. He shared, "I have received relatively more consults relating to anxiety and even somatic manifestations of mental health-related conditions. The average patient who comes from the working sector has already been burdened by using most of their allowed sick days and leaves in instances when they have to quarantine or when they are exposed to someone with COVID-19 or, worse, when infected."
The majority of Danganan's patients prioritize job security and tenure as well as their financial income more than their health. "It is heartbreaking, truly, to see people prioritize being able to work and earn money despite the health risks just to provide stability for themselves and their families. Employees would often ask me about preventive measures how to protect their families; sometimes they even feel guilty when a member gets infected and they feel they cannot do anything about it."
Why COVID-19 vaccine is more important than ever
The obvious most effective COVID-19 response that the Philippines and the world should focus on is not forced lockdowns without concrete pandemic action plans, and certainly not military or police force, but a stronger vaccination drive. It is only when we reach herd immunity can we truly achieve peace from coronavirus.
As of August 5, 12.4 million Filipinos (or 11.6% of the population) have already received their first shot of the vaccine, while 10.7 million Filipinos (or 9.9% of the population) are fully vaccinated. Given these numbers and the current rate, herd immunity is estimated to be achieved in March 2022, or seven months from now.
Javier, the Family & Community Medicine - Tropical Medicine specialist, said that while many local government units particularly in Metro Manila had diligently prepared for the vaccination campaign and prioritized healthcare workers, geriatric population, and persons with comorbidities, the truth of the matter remains that there is an apparent shortage of vaccines throughout the country.
This is not an issue of vaccine hesitancy anymore on the part of the general public.... People are storming vaccination sites only to be turned down due to inadequate vaccine supplies.
"This is not an issue of vaccine hesitancy anymore on the part of the general public, as previously hypothesized by DOH, as the root of the low national COVID-19 vaccination coverage. Over the past few days this August, people are storming vaccination sites only to be turned down due to inadequate vaccine supplies," Javier said.
If vaccine unavailability continues, and if the government will not take immediate action to procure more vaccines to inoculate more Filipinos, we can expect more people to overwhelm vaccination sites to get their shots, especially with the Delta variant scare. This is exactly what happened on August 5 across several inoculation hubs in Manila; the Manila police estimated that the turnout could go as high as 22,000 people, when a vaccination site can only provide an average of 1,000 to 2,000 shots per site.
Javier also noted that COVID-19 disinformation and the inconsistent declarations and announcements of political leaders regarding policies on COVID-19 prevention and control are contributing to the problem. "WHO highlights the pivotal role of effective leadership and governance as an essential building block of a responsive healthcare system – a factor which, unfortunately, is not exactly stellar at DOH and the national government alike," Javier commented.
He adds, “If we are to win over COVID-19, there is an urgent need for all sectors to collectively work together and forget about political colors and rivalry for now to promptly procure the needed vaccines and to expedite administration of vaccines to as many people to achieve herd immunity.”
Leaders should impose medical solutions, ‘individual responsibility’
For Arapoc, the economist, this pandemic highlights the problem of economic inequality. "We can say that that the poor have always been the most vulnerable group in this health crisis. While other people are able to adapt from this pandemic through work-from-home or remote learning set-up, this is not the case for the poor who do not have the necessary devices and internet connection to continue their work or studies at home."
He adds, "It is also unfortunate that there is no allocated budget for ayuda or financial aid in the 2021 General Appropriations Act that was passed last year." This, of course, prompts the government to incur more debts. The Philippines’s total outstanding debt had already reached an all-time-high P11.07 trillion as of end-May, which is up by P79.8 billion from end-April.
We can say that that the poor have always been the most vulnerable group in this health crisis.
There is a growing consensus among economists around the globe about the role of fiscal stimulus to save the economy from the negative impacts of COVID-19. "The 2021 budget looks like it was still designed to finance a pre-pandemic era. In fact, 25% of the P1.5 trillion budget for 2021 is still allotted to big-ticket infrastructure projects or the Build Build Build, while the proportion of the budget for social services like education, health, and cash transfer (or the ayuda) remains relatively small," he noted.
Danganan, the occupational health physician, meanwhile, called on public and private institutions to impose individual responsibility among their people already, given that the government does not seem to be so keen in providing full support to the people, especially labor workers.
"At this point, employers should be able to provide flexible working arrangements however applicable and should be able to understand the challenges in the work-from-home setup. Employers should adjust their expectations and anticipate the challenges that this prolonged lockdown will pose to the well-being of their employees," Danganan said.
He adds that infection control and strict compliance to health protocols must be upheld at all times, "but never to the point that we lose our empathy just for the sake of compliance. Employers should have already disseminated information that debunks myths and provides facts to empower their employees to make an informed decision. Employers must also exhaust their resources in helping their employees have access to the COVID-19 vaccine and medications."
At this point, private and public institutions should step up already and call the shots in protecting their people, Danganan said.
The Philippines will successfully combat COVID-19 through effective individual-based and population-based services that will champion holistic patient-centered, family-focused, community-oriented management.
Javier emphasized the importance of believing in hard science, including mathematical models and data analytics, especially amid a global health crisis. "We have heard public health advocates adamantly shout, 'Solusyong medikal, hindi militar' (Medical, not military, solutions). As a democratic country, our national leaders must be humble enough to listen to the real scientific experts and heed their evidence-based advice," Javier said. "The Philippines will successfully combat COVID-19 through effective individual-based and population-based services that will champion holistic patient-centered, family-focused, community-oriented management."
Juju Z. Baluyot is a Manila-based writer who has written in-depth special reports, news features, and opinion-editorial pieces for a wide range of publications in the Philippines.