COVID-19 pandemic in the Philippines
The COVID-19 pandemic in the Philippines is part of the worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2. The virus reached the Philippines on January 30, 2020, when the first case of the disease was confirmed in Metro Manila. It involved a 38-year-old Chinese woman who was confined in San Lazaro Hospital in Manila. The second case was confirmed on February 2, involving a 44-year-old Chinese man who died a day earlier, which was also the first confirmed death from the disease outside mainland China.
After over a month without recording any cases, the Philippines confirmed its first local transmission on March 7, 2020. Since then, the virus spread to the country with at least one case being recorded in the country's 17 regions. Socio-economic status has been associated with the prevalence of COVID-19 cases across the country.
As of August 2, 2020, there have been 103,185 confirmed cases of the disease in the country. Out of these cases, 65,557 recoveries and 2,059 deaths were recorded. It has the second highest number of confirmed cases in Southeast Asia, behind Indonesia, and ranks 10th in Asia and 25th in the world. The largest single-day increase in the number of confirmed cases was reported on August 2, when the Department of Health announced 5,032 new cases.
The Philippines had a slightly lower testing capacity than its neighbors in Southeast Asia especially during the first months of the pandemic in the country. COVID-19 tests had to be taken outside the country due to the lack of testing kits. This also has led to a controversy involving several government officials who were reported to have undergone COVID-19 tests without qualifying to the DOH's triage algorithm. By the end of January 2020, the Research Institute for Tropical Medicine in Muntinlupa, Metro Manila began its testing operations and became the country's first subnational laboratory. Several laboratories have been accredited by the DOH since then. As of July 31, the country has 96 [|subnational laboratories] capable of detecting the virus and has conducted a total of 1,534,319 tests from more than 1,433,544 unique individuals.
Timeline
January–February 2020 – first cases
The Philippines reported its first suspected case of COVID-19 in January 2020. It involved a 5-year-old boy in Cebu, who arrived in the country on January 12 with his mother. At that time, the Philippines has no capability to conduct tests to confirm suspected COVID-19 cases. The boy tested positive for "non-specific pancoronavirus assay" by the RITM in Muntinlupa, and samples from the boy were sent to the Victorian Infectious Disease Reference Laboratory in Melbourne, Australia, for confirmatory testing to determine the specific coronavirus strain. The boy tested negative for COVID-19 but several suspected cases were reported in various parts of the country.The RITM developed capability to conduct confirmatory tests for COVID-19 in response to the emergence of suspected COVID-19 cases. It started conducting confirmatory tests on January 30.
The first case of COVID-19 in the Philippines was confirmed on the same day. The diagnosed patient was a 38-year-old Chinese woman from Wuhan, who had arrived in Manila from Hong Kong on January 21. She was admitted to the San Lazaro Hospital in Manila on January 25 after she sought a consultation due to a mild cough. At the time of the confirmation announcement, the Chinese woman was already asymptomatic.
The second case was confirmed on February 2, a 44-year-old Chinese male who was the companion of the first case. His death on February 1 was the first recorded outside China. He suffered from coinfection with influenza and Streptococcus pneumoniae.
On February 5, the DOH confirmed a third case in a 60-year-old Chinese woman who flew into Cebu City from Hong Kong on January 20 before she traveled to Bohol where she consulted a doctor at a private hospital on January 22, due to fever and rhinitis. Samples taken from the patient on January 24 returned a negative result, but the DOH was notified on February 3 that samples taken from the patient on January 23 tested positive for the virus. The patient upon recovery on January 31 was allowed to go home to China.
March 2020 – early spread
After a month of reporting no new cases, on March 6, the DOH announced two cases consisting of two Filipinos. One is a 48-year-old man with a travel history to Japan, returning on February 25 and reported symptoms on March 3. The other is a 60-year-old man with a history of hypertension and diabetes who experienced symptoms on February 25 and was admitted to a hospital on March 1 when he experienced pneumonia. He had last visited a Muslim prayer hall in San Juan. The DOH confirmed that the fifth case had no travel history outside the Philippines and is, therefore, the first case of local transmission. A sixth case was later confirmed, that of a 59-year-old woman who is the wife of the fifth case. Since then, the Department of Health recorded a continuous increase in the number of COVID-19 cases in the country.Cases abroad involving foreigners with travel history in the Philippines were reported in early March 2020. The first three recorded cases involving an Australian, a Japanese, and a Taiwanese national had a history of visiting the Philippines in February 2020. Though it was unconfirmed whether or not they had contracted the virus while in the Philippines, speculations arose on undetected local transmissions in the country due to prior confirmation of the Philippines' first case of local transmission.
Retrospective studies has been made to determine the strain of virus responsible for causing community outbreak of COVID-19 in the Philippines since March 2020. In May 2020, Edsel Salvaña, director of the Institute of Molecular Biology and Biotechnology and member of the IATF-EID, said that the strain responsible for the COVID-19 outbreak in the country that started in March 2020 is closely related to the strain affecting India at the time. The virus strain's family tree is said by Salvaña to have appeared in China and Australia.In a July 2020 webinar led by Cynthia Saloma, Executive Director of the UP Philippine Genome Center two hypotheses was presented regarding the source of the March 2020 outbreak in the Philippines. Genetic sequence analysis of samples collected from Philippine General Hospital patients from March 22–28 suggest that there are at least two sources of viral transmission in the Philippines; China, mainly from Shanghai and from Japan specifically through repatriated Filipino seafarers of the Diamond Princess cruise ship.
Several measures were imposed to mitigate the spread of the disease in the country, including bans on travel to mainland China, Hong Kong, Macau, and South Korea. On March 7, 2020, the Department of Health raised its "Code Red Sub-Level 1," with a recommendation to the President of the Philippines to impose a "public health emergency" authorizing the DOH to mobilize resources for the procurement of safety gear and the imposition of preventive quarantine measures. On March 9, President Rodrigo Duterte issued Proclamation No. 922, declaring the country under a state of public health emergency.
On March 12, President Duterte declared "Code Red Sub-Level 2," issuing a partial lockdown on Metro Manila to prevent a nationwide spread of COVID-19. The lockdowns were expanded on March 16, placing the entirety of Luzon under an "enhanced community quarantine". Other local governments outside Luzon followed in implementing similar lockdowns. On March 17, President Duterte issued Proclamation No. 929, declaring the Philippines under a state of calamity for a tentative period of six months.
Additional facilities started to conduct confirmatory testing. On March 20, four facilities, namely the Southern Philippines Medical Center in Davao City, Vicente Sotto Memorial Medical Center in Cebu City, Baguio General Hospital and Medical Center in Benguet, and the San Lazaro Hospital in Manila, began conducting tests as well augmenting the RITM. Other facilities began operations as well in the following days.
On March 25, the President signed the Bayanihan to Heal as One Act, which gave him additional powers to handle the outbreak.
April 2020 – quarantine extensions
President Duterte on April 7 accepted the recommendation of the Inter-Agency Task Force on Emerging Infectious Diseases to extend the ECQ in Luzon until April 30.On April 17, it was reported that the country has been able to bring down the viral disease' reproduction number to 0.65 from 1.5, which means that the average number of people a person can infect decreased from more than one to less than one. Recent data at the time suggest that the country is doing better in "flattening the curve", but was warned of "resurgence" and must ramp up mass testing in order to isolate cases and avoid further transmission of COVID-19.
Sometime in late April, local government units were no longer authorized to impose quarantine measures without the consent of the IATF-EID. Prior to that period, LGUs could impose such measures in coordination with the Department of the Interior and Local Government.
May 2020 – easing lockdowns
The ECQ in Luzon was extended until May 15 in some areas. This includes Metro Manila, Calabarzon, Central Luzon, Pangasinan, and Benguet. ECQ measures were also extended in the provinces of Iloilo and Cebu as well as in Davao City. Other areas were downgraded or placed under general community quarantine.After May 15, the Philippine government revised its quarantine classifications in correspondence on earlier announcement that "Science and Economics will be considered for any changes of the lockdown measures." A modified enhanced community quarantine was applied to Metro Manila, Laguna, and Cebu City, while a GCQ was raised to 41 provinces and 10 cities with moderate risk. Meanwhile, 40 provinces and 11 cities that were considered "low-risk areas" were supposed to be released from community quarantine measures, but were eventually upgraded to a "modified general community quarantine" after a reportedly "honest mistake" from the national government and requests from respective LGUs.
Once again, the Philippine government revised its announcements and declared the entire country under GCQ, while Metro Manila, Laguna, and Cebu City continued to implement an MECQ. This is temporary until guidelines of MGCQ for low-risk areas is finalized. The IATF-EID is also reportedly considering the reclassification of provinces and cities in Central Luzon as "high-risk areas" under MECQ.
After receiving petitions from LGUs, the IATF-EID revised its quarantine policies yet again. Cebu City and Mandaue were placed under ECQ, while Metro Manila, Laguna, and Central Luzon are all on MECQ. The remaining parts of the country are still on GCQ.
Cases
Summary
Among the confirmed cases, most of the patients are in their 30s, and the majority are male.The oldest person to have recovered from COVID-19 in the Philippines is reportedly a 95-year-old man from Mandaluyong, while the oldest to die from the disease in Western Visayas was a 94-year-old man from Miag-ao, Iloilo. The youngest patient to recover was a 16-day-old boy from Quezon City, whereas the youngest death due to complications from COVID-19 was a 29-day-old infant from the province of Batangas.
By region
Metro Manila
Cordillera
Ilocos Region
Cagayan Valley
Central Luzon
Calabarzon
Mimaropa
Bicol Region
Western Visayas
Central Visayas
Eastern Visayas
Zamboanga Peninsula
Northern Mindanao
Davao Region
Soccsksargen
Caraga
Bangsamoro
By demographic
Front line workers
As of July 28, there have been 4,691 health care workers that tested positive for COVID-19. 36 out of these cases were fatal. On the early months of the pandemic in the country, the number of health care workers infected by the virus was significantly higher compared to the infection rate of other health care workers in the Western Pacific Region.In the Philippine National Police, there have been 2,084 police officers that tested positive for the disease with 10 reported fatalities. According to Brigadier General Edgar Arevallo, Spokesman of the Armed Forces of the Philippines, there are 44 COVID-infected military men recorded as of May 20. There are also 160 members of the Presidential Security Group who tested positive to COVID-19, said PSG Commander Colonel Jesus Durante III.
Locally stranded individuals
The arrival of locally stranded individuals on their home provinces has been associated to new clusters of the disease in previously least affected regions.Repatriates
As of July 31, 4,412 out of 210,777 returning overseas Filipinos have tested positive for the disease.Overseas Filipinos
The Department of Foreign Affairs provides information regarding the number of Filipino nationals abroad to have contracted COVID-19. The DFA keeps an official tally of confirmed Filipino COVID-19 cases per region instead of by country. As of August 2, there have been 9,569 overseas Filipinos from in 71 countries and territories that tested positive for COVID-19. This count is not included in the national tally of cases by the DOH.Suspected cases
The DOH previously used the designation "patients under investigation" and "persons under monitoring" to manage suspected and confirmed cases. PUIs involved individuals who had a travel history to Wuhan but by February 3, the DOH has expanded the scope of PUIs to include individuals who had a travel history to any part of China. "Persons under monitoring" are asymptomatic individuals with known history of exposure to another person with confirmed COVID-19 infection.On April 11, the DOH revised its terminology for PUIs; "suspect" and "probable" cases. Suspect cases involves individuals exhibiting flu-like symptoms and has a history of travel to areas with reported local transmission within 14 days prior to the manifestation of their symptoms. Someone with fever, cough or shortness of breath who is above 60 years old, pregnant, with other underlying illness, or a health worker could also be considered as a suspect case. Patients admitted to a hospital due to severe symptoms caused by an undetermined lung disease could also be tagged as a suspect case. Probable cases involves persons who underwent testing with results that need further validation, and those who were tested but whose test were not facilitated in an official laboratory for a reverse transcription polymerase chain reaction test.
The usage of the PUM designation has since been discontinued. It was reasoned that it is assumed that the general public has been exposed to COVID-19 due to local or community transmission already ongoing in several parts of the Philippines.
As of July 14, there have been 38,909 suspected cases in the country.
Medical response
Hospital admission policy
The DOH has issued a reminder, that Level 2 and 3 hospitals cannot deny admittance of people suspected or confirmed to have COVID-19 infection and refusal of admission is a "violation of the signed Performance Commitment and shall be dealt with by the PhilHealth accordingly". The department said that Level 2 and 3 hospitals can accommodate individuals with mild COVID-19 symptoms while individuals in a serious or critical condition may be transferred to one of the DOH's three main referral hospitals, which was increased over time to 75 designated hospitals as of April 13 with a combined bed capacity of 3,194.On March 16, the DOH announced a revision on their protocol on hospital admission for COVID-19 positive patients. A week prior, the DOH has began sending both asymptomatic patients and individuals with mild symptoms back on their homes for quarantine and continued health monitoring until they have been deemed recovered. Priority are given to high-risk patients or those with severe symptoms for hospital admission.
Drug therapy and vaccine development
The Philippines, with at least 45 other countries, has joined the World Health Organization 's Solidarity trial to study the effectivity of certain drugs in treating COVID-19 patients. Dr. Marissa Alejandrija of the Philippine Society of Microbiology and Infectious Disease is the Philippines' representative in the study with Health Undersecretary Maria Rosario Vergeire as the official liaison of the DOH in the multinational study.The Department of Science and Technology announced that it is seeking bilateral collaboration with other countries such as China, Russia, South Korea, Taiwan, and the United Kingdom on endeavors related to the vaccine development for COVID-19. President Rodrigo Duterte declared a bounty for anyone who could produce a vaccine against COVID-19, an amount later increased to .
The Philippine Council on Health Research and Development at the DOST plans to distribute an undisclosed "functional food," while Presidential Spokesman Harry Roque also revealed that the DOST, Philippine General Hospital, and the Ateneo de Manila University, are collaborating with the Duke–NUS Medical School in Singapore to evaluate the feasibility of lauric acid from virgin coconut oil, Vitex negundo, and Euphorbia hirta as a "dietary regimen supplement" to help COVID-19 patients combat the disease. A "functional food" or "dietary regimen supplement" is described as similar to how tawa-tawa is also used as a remedy against dengue by incorporating it to the diet of diagnosed patients.
Testing
Early COVID-19 testing in the Philippines was only limited to persons with travel history to countries with cases of local transmission and those with exposure to the individuals confirmed to have COVID-19. The testing protocols were revised sometime in mid-March 2020 to give priority to the testing of any individual with severe symptoms as well as to the elderly, pregnant and immunocompromised persons with at least mild symptoms. On March 30, symptomatic healthcare workers are also considered priority for testing.During his press briefing on May 19, Presidential Spokesperson Harry Roque said that the people aimed to be tested in the government's "expanded targeted testing" are as follows: " all symptomatic cases, all of those coming from abroad, all close contacts of confirmed cases that were found through contact tracing, and all of those who tested positive on rapid antibody tests." The government is also opting to test through benchmarks, by testing 1–2% of the Philippines' entire population and 10–12% of the disease's epicenter in the country, which is in Metro Manila.
In late March, some politicians and their relatives were reportedly tested for the virus despite not showing any symptoms, causing public backlash amidst a shortage of testing kits since it was against DOH guidelines to test asymptomatic individuals. The DOH responded to the public criticism by clarifying that, while there is "no policy for VIP treatment" with regard to testing for COVID-19 and that "all specimens are being processed on a first-in, first-out basis," it "extends courtesy" to front line government officials, specifically those involved in national security and public health. Some senators who were tested claim that they used rapid antibody tests not accredited by the DOH at that time.
Testing capacity
The country has conducted over a million tests as of July 14, 2020. There are currently 85 testing laboratories nationwide with 25,000 tests conducted daily as of July 9, 2020.On March 9, 2020, a total of 2,000 tests has been conducted at a rate of 200 to 250 people accommodated by tests per day. The testing capacity of the Philippine government has been expanded by late March 2020. As of March 23, the Research Institute for Tropical Medicine in Muntinlupa alone can test 600 people per day, other laboratories except for the facility of San Lazaro Hospital, Manila, can do 100 tests, while the said hospital can do 50 tests per day. By March 27, the release of test results conducted at the RITM takes five to seven days due to backlog, but the institute is committed to reducing the turnaround to two to three days. The DOH announced that the country will conduct targeted mass testing on April 14, which will be administered strictly for susceptible, probable, and high-risk patients, such as health workers, expectant mothers, and patients with other medical conditions. The country's testing continuously increased, except when RITM temporarily scaled down its operations from April 20–24 after 43 of its staffs tested positive for the virus.
The Philippines has the capability to conduct mass testing, either through reverse transcription polymerase chain reaction or rapid antibody testing, given the increased number and improving capacity of the country's accredited laboratories and the procurement of more testing kits. The first localized targeted mass testing began in Valenzuela, Metro Manila on April 11 Other local government units followed suit shortly after the Inter-Agency Task Force on Emerging Infectious Diseases adopted a resolution that commences 'a national government-enabled, local government unit-led, and people-centered response' to COVID-19.
Testing kits
The Food and Drug Administration has approved the usage of 75 PCR test kits, 79 rapid antibody testing kits, 53 immunoassay testing kits, and 7 other testing kits as of July 30.A locally developed PCR testing kit has been made by the National Institutes of Health at the University of the Philippines Manila. It is reportedly six times cheaper than its foreign counterparts. It was first approved for commercial use in April 2020 by the Food and Drug Administration but some kits were recalled in May by its manufacturer, after it was found out that testing using the kits yields indeterminate results 30 percent at the time. A month later, the testing kit were re-approved after its defects were fixed.
Testing facilities
Before January 30, there were no medical facilities in the country that can confirm cases of the virus. Before that date, the RITM conducted preliminary tests on suspected cases to determine if they are infected with a coronavirus but could not detect the new strain on patients. Samples from suspected cases with confirmed coronavirus infection had to be sent abroad to the Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia, for confirmatory testing specifically for SARS-CoV-2 strain.The National Task Force created the Task Force Test, Trace, Treat in which it established partnerships with private sectors to conduct mass testings. The Task Force cited the San Miguel Corporation as a pioneer in the move to open its own COVID-19 laboratory to initially test all of its 70,000 employees. As of July 4, the country now has 75 testing laboratories with a turnaround time of 72 hours. Of the said number, 49 are public labs while 26 are privately owned, including San Miguel's laboratory.
Testing backlogs
From May 29 to June 17, the DOH had reported backlogged cases, which were commonly referred to as "late cases", or cases that were validated by the Epidemiology Bureau more than four days after the initial release of test results. Late cases are being reported alongside new cases or "fresh cases", which corresponded to the cases that were validated three days within the release of test results. This change was implemented by the health department to clarify the sudden increase of cases in the country. The third largest single-day increase on the number of confirmed cases in the country has been accounted to the backlog in late June 2020, when 2,434 new cases were announced. 1,147 out of these cases were fresh cases and the remaining 1,287 were late cases. It surpassed the backlog in late May 2020, where 1,000 out of 1,046 cases were reported to be late cases.
Government response
Nationwide measures
The national government declared a state of calamity over all of the Philippines on March 16, 2020, by virtue of Proclamation No. 929 signed by President Rodrigo Duterte. The declaration brings into effect for six months the following:- price control of basic needs and commodities,
- granting interest-free loans,
- distribution of calamity funds,
- authorization of importation and receipt of donations, and
- hazard allowance for public health workers and government personnel in the fields of science and technology.
Bayanihan to Heal as One Act
In the House of Representatives, the bill was introduced as House Bill No. 6616 with House Speaker Alan Peter Cayetano of Pateros–Taguig as its principal sponsor and was defended on the floor by Deputy Speaker Luis Raymund Villafuerte of Camarines Sur's 2nd district. In the Senate of the Philippines, the bill was introduced as Senate Bill No. 1418 with Senate President Tito Sotto and Senator Pia Cayetano as its principal sponsors.
The House version of the bill passed the House of Representatives in a 284–9 vote without abstentions, while its Senate version unanimously passed the Senate. President Duterte signed the bill into law the following day.
Lockdowns
Given the rapidly increasing number of cases in the country, the government has initiated lockdowns aimed at preventing the spread of the disease.Travel restrictions
Travel of foreign nationals to the Philippines is banned with few exceptions since March 2020. The issuance of visas to all foreign national on March 19 was stopped and all visas already issued are voided except to those issued to families of Filipino nationals would remain valid. Three days later a travel ban was imposed on all foreign nationals, except spouses of Filipino citizens, and workers for international organizations and non-governmental organizations accredited in the country.Foreign aid
The government of China and the United States has pledged support to the Philippine government response against COVID-19. China announced that it would be donating medical supplies including 100,000 testing kits, 100,000 surgical masks, 10,000 N95 masks, and 10,000 sets of personal protective equipment. The United States Agency for International Development also pledged $2.7 million worth of aid to help the Philippines develop adequate testing capabilities, and ensure the availability of medical supplies through the agency's "on-the-ground partners". China's aid was received on March 21, 2020.On March 22, the DFA said that the Philippines would be receiving a donation from Singapore consisting of 3,000 testing kits and a polymerase chain reaction machine. In early April 2020, the DFA announced it received 20 units of testing kits, capable of 1,000 tests, from Brunei. The United Arab Emirates also donated medical supplies in May 2020.
On March 28, it was disclosed that some of the test kits made in China were only 40% accurate in testing for signs of the COVID-19 on an individual suspected to be infected with the disease. The test kits were donated by a private foundation.