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ICU, short for intensive care unit, has become an often-read and heard term during the pandemic. This is especially true among the elderly and those with co-morbidities who were the hardest hit by COVID-19. As a result, ICU bed utilization rates rose to unprecedented levels, preventing them from taking in more patients. Hence, lockdowns were implemented to curb the spread of the virus, and ease the burden of the local health care system.

 

What are ICUs?

The United Kingdom’s National Health Service defines ICUs as “specialist hospital wards that provide treatment and monitoring for people who are very ill.” The ICUs are equipped with special monitoring equipment and health professionals specifically trained to handle critical cases. Sometimes, ICUs are called intensive therapy units (ITUs).

According the journal entitled “ABC of Intensive Care” archived in the US National Library of Medicine, intensive care is reserved for the following patients:

 

Photo by Anna Shvets from Pexels

Some common equipment that can be found in the ICU includes:

Early admission to the ICU is critical as this increases the chance for full recovery.

 

The State of Hospitals in the PH

In the Philippines, health facilities are classified based on ownership. According to data from the Department of Health (DOH), there are more private hospitals (60%) than government-owned ones (40%). Majority of public hospitals are managed by the DOH, while the rest are run by local government units (LGUs) and other government agencies. More than half of Philippine hospitals are at only Level-1, which means their capacities are limited— comparable to those in infirmaries.

The World Health Organization (WHO)  states the following ideal characteristics of a hospital:

The number of hospital beds indicates the availability of health care. WHO recommends 20 hospital beds for every 10,000 people. But as of 2014, the Philippines only had 9.9 beds per10,000 population

Sadly, the DOH reported that except for NCR, Northern Mindanao, Southern Mindanao and Cordillera Administrative Region (CAR), all the other regions do not have enough beds in relation to their populations. The Autonomous Region for Muslim Mindanao (ARMM) has the lowest bed count at .17 beds per 1,000 population.

 

Photo from Philippine News Agency

 

ICU Beds in the PH

In measuring critical care bed capacity in Asian countries, the ABC of Intensive Care study used the ICU bed definition outlined by the World Federation of Societies of Intensive and Critical Care Medicine. According to the WFSICCM, ICU beds should have at least a Level-1 capacity with the following traits:

According to the report, the Philippines is one of the only four countries in the surveyed regions that does not have an official definition of an ICU. The study, conducted from September 2017 to 2019, found that there were more ICU beds in private hospitals than public hospitals in the Philippines. Critical care beds which includes ICU and Immediate Care Unit (IMCU) beds amount to only 2,335 in the country. This is equivalent to 2.2 beds per 10,000 population. 

Adding to the problem is that there is no clear distinction between ICU and IMCU in the Philippines. This study states that IMCU caters to patients that need more advanced care than in a general ward, but does not have the same high level of expertise as an ICU. 

In conclusion, the medical journal on ICUs stated that critical care bed capacity is evidently lower in countries with low and lower-middle income economies.

 

COVID-19 and ICU Beds

The pandemic shone a light on the lack of ICU beds in the country. With the health care system unable to handle an influx of critical cases of COVID-19, many patients were not able to access vital services, leading to an increase in deaths. As of writing, more than 42,000 COVID deaths are recorded in the Philippines.

To help address this issue, the United States Embassy turned over ICU beds and vaccine cold storage units this 2021. DOH also reported that it had been steadily increasing its ICU beds, oxygen supply and isolation beds since March 2021. 

Still, pandemic or not, the health care sector needs to be prioritized. In 2016, only 4.4% of the country’s GDP was spent on health according to the ABC of Intensive Care. Health remains to be a valuable human right, and we must take to heart the difficult lessons COVID-19 brings—preparedness being one of them. 

Latest data from the Department of Health (DOH) stated that at least 2.6 million Filipinos have been fully vaccinated against COVID-19. According to herdimmunity.ph, this is only 3.76% of the 70-million population the government aims to vaccinate this year to achieve herd immunity. The website says that at the current average rate of 216,451 daily vaccinations, herd immunity will be reached in 1.6 years, or in February 2023. For us to achieve herd immunity by the end of the year, the government needs to ramp up its vaccination 3.3 times its current rate.

Herd immunity or population immunity is defined by the World Health Organization (WHO) as the “indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection.” To better understand how we can reach this goal faster, the pilot online episode of Panayam sa Panahon TV featured the experts—health reform advocate Dr. Anthony Leachon and Dr. Noel Bernardo from the Philippine Red Cross.

 

(photo from Quezon City Hall’s Facebook page)

 

Why PH is falling behind in the global vaccination drive

When the COVID-19 vaccines still weren’t available, governments resorted to lockdowns to stop the spread of disease. But now, countries like the United Kingdom and the United States have freed up their economies, thanks to systematic and rapid vaccination programs. In a recent segment of Panahon TV called Buhay Pandemya, which featured a Filipino caregiver in Jerusalem in Israel, maskless locals can be seen flocking to the streets and celebrating the return of normalcy. Israel was one of the countries that started their vaccination early, which began last December 2020.

But the scenario in the Philippines is a different story. Though cases in the National Capitol Region (NCR) have been somewhat contained, other areas are experiencing surges. Lockdowns and quarantines are still in place, keeping the economy from fully recovering. If we already know the tried-and-tested formula of mass vaccination as the main key to herd immunity, why then are we still behind in the immunization drive? Our experts chalked it up to three main reasons.

 

  1. Lack of vaccine supply

Based on Our World in Data’s latest report, the Philippines ranks 8th among the 10 ASEAN countries in terms of vaccine rollout. During the interview, Dr. Bernardo expressed surprise over his discovery that out of the 3,700 approved vaccination sites in the country, only 1,700 are active. “Based on my experience on the ground with the different LGUs and the bakuna centers of the Philippine Red Cross, a big factor is the lack of vaccines,” he said in Filipino. “Bakuna centers don’t receive enough vaccines. Other LGUs (local government units) can only operate half-days.” Dr. Leachon was quick to agree. “If you don’t have vaccines, it doesn’t matter if you have vaccination sites. People will still have no access to vaccination.” 

 

  1. Lack of organization

With data gathered from DOH, the National Task Force Against COVID-19, the Inter-Agency Task Force and news outlets, Herdimmunity.ph states that we currently have over 17 million vaccine doses, “enough to fully vaccinate 12.47% of the target population.” If such is the case, why is the vaccination still slow?

Dr. Leachon pointed out that LGUs have varying levels of governance, with some more organized than the others. Because best practices are not adopted by all LGUs, they also have varying levels of success, making it harder for the country to reach herd immunity.

Meanwhile, Dr. Bernardo said that we should attack the issue with a “system approach”. He cited how a simple step such as securing a vaccination schedule has become problematic. “People shouldn’t have to walk in like chance passengers. When we schedule them, we know that number one, they fully consent to the vaccination. Second, they should know their vaccine brand so they can manage their expectations. That way, we avoid overcrowding. Third, our supply should cope with our demand. If people leave the site disappointed because of the hassle or lack of vaccine, then they will recount their bad experience to others. But if their experience is positive, others will be motivated to be vaccinated.” 

 In January this year, a Pulse Asia Survey resulted in 4 out of 10 Filipinos not wanting to get vaccinated. According to Bernardo, the survey was repeated in March. This time, the figure climbed up to 6 out of 10 Filipinos refusing vaccination. “There must be something about the people’s experience in the bakuna centers that increased hesitancy—which we must address right away. Because even if the government promised a flood of vaccines eventually coming in, will people agree to be vaccinated?”

 

  1. Vaccine Hesitancy

According to DOH, 9% or over 100,000 of vaccinees who received their first dose missed out on their second dose. According to Dr. Leachon, apart from disorderly systems that discouraged Filipinos, this may be also attributed to the lack of information, leading to decreased awareness. “Maybe they don’t know where they will go to for their second dose. Different vaccine brands have different durations between the two doses. Vaccinees should be given a checklist that includes all the info they need, including when they should return.” 

Leachon also suggested massive info campaigns on the possible adverse effects of the vaccine, and the mode of registration. “Online registration is very difficult for the elderly and the poor. Why should we make it hard for them? We need to have a faster registration process.” Another common complaint among registrants is the slow response of LGUs. 

Recently, the issue of vaccine brands became even more heated when hundreds of Indonesian health workers became infected with COVID-19 after being fully vaccinated with Sinovac. Recently, 10 Indonesian doctors died despite their complete inoculation with the Chinese vaccine. Until now, China has not provided large-scale data on Sinovac’s effectiveness against the Delta variant.  “Our life is all about choices,” Dr. Leachon said. “We choose our spouse, clothes, food. So, it’s even more important to choose what is injected into our bodies. When we don’t give people choices, we’ll have a hard time convincing them to get vaccinated.” 

According to WHO, the Sinovac vaccine, in a phase 3 trial in Brazil “showed that two doses, administered at an interval of 14 days, had an efficacy of 51% against symptomatic SARS-CoV-2 infection.” With vaccine brands such as Pfizer and Moderna having an efficacy of 90% or more, some Filipinos are thinking twice about being inoculated with Sinovac. “About 70% of our vaccine inventory is Sinovac. What we’ve seen in Parañaque and Manila wherein residents flocked to the vaccination sites that gave out Pfizer is a sign that Filipinos are brand-conscious. They know their health is on the line. They value the quality, efficacy and safety of the vaccine,” Leachon said.

 

“Bakuna bus”—a partnership of the Philippine Red Cross and UBE Express

 

Ways to improve the vaccination drive

Once the main issue of vaccine supply is addressed, our interviewees suggested the following to ramp up our vaccination drive: 

 

  1. Prioritize urban areas that drive the national economy.

ABS-CBN Data Analytics Head Edson Guido recently tweeted that though COVID-19 cases in NCR are decreasing, only 7.4% of its population are fully vaccinated. Dr. Leachon suggested that prioritizing the NCR Plus Bubble can help the country achieve herd immunity faster. “We shouldn’t spread the vaccine supply thinly across the country, especially those with no cold-chain facilities. For example, we’re expecting 40 million doses of Pfizer, which will fully vaccinate 20 million people. It’s better to prioritize super metro areas like NCR Plus, which has a population of around 26 million—and 70% of that is 18 million. If herd immunity is achieved in NCR Plus, we can open our economy in time for December 2021.”

 

  1. Make vaccines more accessible.

Although mega vaccination sites may work, Dr. Leachon pointed out that these are available only in selected areas. He believes that small but multiple vaccination sites may be more efficient. “Mega vaccination sites are prone to bottlenecks and may be superspreading events. Vaccination sites should be convenient for the elderly and those with comorbidities. These sites should be many and close to residents, who can be vaccinated faster because they don’t have to worry about transportation. Because the crowd is spread out among multiple sites, waiting time is reduced.” Dr. Leachon suggested taking inspiration from successful countries, which mobilized malls, drugstores and other convenient stores which have cold-chain infrastructure in the vaccination drive.

Dr. Bernardo agreed that the solution lies in community-based vaccination sites. “We really have to bring the vaccine closer to our people, so they will be encouraged. If every barangay has a mini-vaccination site which can only accommodate 20 people a day, that can already make a big difference.” He also enjoined the government to give vaccination leaves for employees. “In bakuna centers I’ve visited, I asked those who weren’t able to get their second dose what happened. They told me it’s because they couldn’t file a leave. We have to consider living factors like this.”

To help more Filipinos be vaccinated, Red Cross Philippines has partnered with UBE Express in employing mobile vaccination buses to reach far-flung areas that do not have cold-chain facilities. “We are ready to partner with national agencies, LGUs, NGOs and private sectors to maximize this initiative and utilize all the logistical support that Red Cross could offer. When the vaccines arrive, we will go to places not accessible to health workers and NGOs.” 

 

  1. Strengthen governance.

One important aspect of good governance, especially in our country, is disaster preparedness. Currently, we are in the middle of the rainy season, which may pose challenges in the vaccination drive. “First, vaccination programs are usually done in open courts, gyms and other large open spaces, which have good ventilation. But when it rains, these outdoor areas will be affected,” Dr. Leachon explained. “Second, you need to separate evacuation centers for typhoon victims, isolation and quarantine facilities, and vaccination sites. Because the moment people from these areas mix, this can be super-spreading event.” Another concern is power outages that may affect cold-chain facilities.

Government responsiveness is also important in gaining public trust and cooperation. “For example, we know that the reason why the cases are not going down is because we lack contact tracing. But the governments don’t respond to this. The same way with surveys done by SWS and DOH, which showed the participants’ preferred vaccine brands and their perceived effects. You have to execute a program based on what the citizens want, or else you will be doing the same thing all over again, but expecting a different result,” said Dr. Leachon.

 

Marmick Julian, a proud vaccinee in Parañaque, displays his injected arm. (photo by Robi Robles)

 

Achieving herd immunity

Dr. Bernardo believes that promoting vaccine confidence is an important step toward herd immunity. “The first vaccine brand we received should’ve been the best and most trusted.  But a lot of doubts and issues were involved in our first vaccine—which was one of the main reasons of vaccine hesitancy.” To promote vaccine confidence, Dr. Bernardo stressed the need for better communicators. “There was a comms group that suggested that we relate vaccination to family. When you get yourself vaccinated, it’s a sign of love for your family and friends.”

As to achieving herd immunity this year, Dr. Bernardo was skeptical but hopeful. “We need 500,000 vaccinations a day if we want to have a happy Christmas this year.” Meanwhile, Dr. Leachon still emphasized the importance of vaccine efficacy. “We can only achieve herd immunity when the vaccines from Pfizer, Moderna and AstraZeneca arrive. We need to step up to the plate in the next 3 months and revisit our strategies,” he ended.

Watch Panayam sa Panahon TV’s Herd Immunity: Kailan at Paano Natin Ito Maaabot?

 

During the early months of the pandemic last year, the demand for ginger surged all over the world. But due to the virus, import shipments of goods including ginger were delayed. Because the supply could not meet the demand, ginger prices drastically rose in many countries. According to this article, these include Ethiopia, wherein the “wonder root” was sold almost three times more than its original price.

The focused interest in ginger came when global health authorities were still churning out initial information on COVID-19. At the same time, social media blazed with claims of ginger being a COVID-19 cure. This prompted the World Health Organization (WHO) to nullify such claims, stating that “There is no scientific evidence that black pepper, honey and ginger protect from COVID-19 infection. In general, however, some spices are considered to have properties that may be beneficial for health.”

The National Academies of Sciences, Engineering and Medicine goes further by saying that 

“Viral infections spread in your body when the virus enters your cells and makes copies of itself and then those copies enter new cells and repeat the process. Ginger will not destroy the virus in your body or stop the copying process.”

This article stated that during a press briefing, Executive Director of WHO Health Emergencies Program Michael Ryan acknowledged that herbal teas such as ginger are beneficial. Still, he warned against false statements that may lead to pandemic risks. “Anything that makes one feel better, anything that provides that reassurance and anything that you believe can help your health that’s not dangerous certainly has a positive impact on your health, but it’s a different thing to say that something is effective in treating the disease,” he said.

 

 

Powers of Ginger

For centuries, ginger has been an important part of Filipino cuisine and folk medicine. This comes as no surprise because ginger originated in Maritime Southeast Asia, which includes the Philippines. During the spice trade in 1500 BC, ginger even reached Europe and was used by ancient Greeks and Romans.

Ginger is a popular ingredient of our local dishes such as tinola, arroz caldo and pinakbet, and is known to effectively eliminate fishy odors in seafood-based recipes. But when it comes to home remedies for colds and sore throat, one of the most popular is salabat, traditionally made from boiled fresh ginger.

In a Panahon TV interview with Gab Labrador, a nutrition officer at the National Nutrition Council, he explained in a mix of Filipino and English that ginger became popular during the pandemic because “it helps reduce inflammation brought by respiratory diseases.” In fact, a 2008 study by the Common Cold Center at the Cardiff University in Wales  concluded that hot drinks like salabat can soothe “runny nose, cough, sneezing, sore throat, chills and fatigue” better than beverages in room temperature.

 

Labrador also shared ginger’s other health benefits:

But is there such a thing as ingesting too much ginger? Labrador said that though the effects of eating excess ginger are rare, they are still possible. “It can lead to an upset stomach and heart burn. There may be some people who are allergic to spices like ginger. The allergy manifests through skin inflammation.” He also added that ginger may interact with some drugs. “These are the anticoagulants or blood thinners. If you’re taking these drugs, you might want to ask your doctor if you can still take ginger tea.” To avoid complications, Labrador recommended limiting the salabat we drink to one cup a day.

 

 

Staying Healthy During the Pandemic and Beyond

Though ginger is undoubtedly beneficial to our bodies, staying healthy this pandemic is still all about avoiding exposure to the virus. “That’s basically following health protocols— social distancing, proper hygiene…and it’s better for the population to take the vaccine once it’s offered to them,” said Labrador. 

Echoing WHO, Labrador is all for taking salabat if it makes people feel better. But he warned, “It’s not really good to brand natural remedy as a cure of a certain disease. So, it’s still better to get proper medical action from a medical professional during these times.” Moreover, we can strengthen our immune system by having a holistic approach toward health “Number one is to eat a variety of foods including fruits and vegetables every day. Prioritize natural and fresh foods over highly-processed or fast food. We also want to maintain a physically active lifestyle during these times. Just go to the internet and search for body weight exercises that you can do. That can definitely help us in improving our immune system and maintain a healthy weight which…in the long run, will benefit us.”

 

 

How to Prepare Salabat

Labrador gives these steps in preparing your own throat-soothing ginger tea:

 

Watch our interview with Gab Labrador here.

A year after the pandemic, the World Health Organization updated its health advisory last April, stating that COVID-19 may be acquired through airborne transmission. This is in addition to the droplet transmission, which was previously the widely recognized mode of spreading the virus.

But what does this new discovery entail? Panahon TV sought the advice of Dr. Rontgene Solante, chairman of the Adult Infectious Diseases and Tropical Medicine Department at the San Lazaro Hospital, and a member of the Vaccine Expert Panel of the Department of Science and Technology.

 

Droplet vs Airborne Transmission

Dr. Solante mentioned that the COVID-19 virus is expelled through coughing, sneezing, or talking. The Centers for Disease Control and Prevention (CDC) adds to this list by stating that “People release respiratory fluids during exhalation (e.g., quiet breathing, speaking, singing, exercise, coughing, sneezing) in the form of droplets across a spectrum of sizes. These droplets carry virus and transmit infection.”  

 “The droplet is composed of virus particles within the saliva,” explained Dr. Solante in a mix of English and Filipino. “This means it’s much bigger and heavier. When you cough or sneeze, the droplet can travel up to 3 feet. It falls quickly on surfaces.” It’s because of these reasons why COVID-19 prevention involves regular hand washing and regularly disinfecting frequently-touched surfaces.

On the other hand, COVID 19’s airborne transmission involves the aerosolized form of the virus. “Why is it aerosolized? It’s because when you cough, you expel not just droplets but also tinier particles. These particles are lighter so they stay in the air longer. This is what we call airborne.”

While droplets are most infectious within a 3-feet or 1-meter distance between people, the airborne particles, which can remain suspended in the air for up to two to three hours, may infect people within an 8-feet distance.  

According to the World Health Organization (WHO), medical procedures and treatments that produce aerosols may also transmit COVID-19. These include endotracheal intubation, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, and disconnecting the patient from the ventilator. 

The CDC states that the higher the amount of virus a person is exposed to, the higher the risk of infection. Through the airborne transmission, you are more likely to catch COVID-19 when the following factors are present:

 

Though bikers are required to wear face masks, they do not have to wear face shields as these pose safety risks according to the Department of Health. (photo by Jire Carreon)

 

What Airborne Means

“Airborne diseases are easily transmitted when you are not wearing the proper face mask, when ventilation is very poor, and more importantly, when you are in a closed space,” warned Dr. Solante.  Tuberculosis is an example of an airborne disease. “The reason why the Philippines has a high case of Tuberculosis is because many of us live in communities with houses built close to each other. When one has this disease, he or she is likely to transmit it to family members. In a way, this is similar to COVID-19, which easily spreads within the household because of the droplet and airborne modes of transmission.”

The fact that COVID-19 is airborne and may be transmitted beyond 6 feet only means that more than ever, we need to be vigilant about health protocols, and stay in well-ventilated areas. Dr. Solante said, “Chances are, if you are in a room without ventilation or with poor ventilation, the virus can stay longer— for about 3 hours. The minute you remove your face mask or face shield, then you can get the virus within 15 minutes of staying in that closed space.” 

But what does proper ventilation mean? Dr. Solante said this is achieved when air inside the room is able to flow out, while air outside the room is able to flow in. “Without air ventilation, the aerosolized virus can stay in the air for two to three hours. But if you open the windows, and there’s ventilation, the virus will only be airborne for less than 15 or 30 minutes, as long as there are only a few people inside the room.”

 

Sign inside a jeepney. This year, face shields were also required inside public transportation. (photo by Paul Michael Caisip)

 

How to Prevent Airborne Transmission of COVID-19

Dr. Solante offers these prevention tips in various settings:

 

At home

 

In the office

 

In Public Transport

 

In a nutshell, Dr. Solante gives these 5 important tips during the pandemic:

  1. Practice regular hand washing.
  2. Wear your face mask and face shield.
  3. Maintain a physical distance of six feet or more.
  4. Avoid crowded areas.
  5. Only visit places with good ventilation.

 

Though the airborne transmission is cause for alarm, following health protocols is still an effective countermeasure. Complying to guidelines set by health experts and being vaccinated are still your best bets in safeguarding your health and that of other people.

 

*interview by Trisha Garin

Watch Panahon TV’s interview with Dr. Solante here.

 

In a recent public address, Vaccine Czar Carlito Galvez stated that over 3 million Filipinos have been vaccinated since March 1, 2021. But it is still a far cry from the 70 million the government targets to vaccinate by the end of this year to achieve herd immunity. 

The Department of Health (DOH) stated its plans to inoculate 100,000 to 200,000 individuals daily once vaccine supplies become stable. But from the 7 million vaccine doses received by the country so far, over 3 million have only been administered nationwide. A tweet from ABS-CBN Data Analytics Head Edson Guido two days ago (May 19, 2021) further brought to light how far the country is from herd immunity. He stated that at the rate we are going, the 70-million target will be achieved in 3 years, and not this year. “We still have a long way to go,” Guido tweeted. “To reach the target of 70 million by end of 2021, the average should be around 600,000 daily. That’s 5.5 times the current pace. We need more vaccines.”

 

(screenshot from Twitter)

 

Adding to the challenges of vaccine supply and vaccination processes is the sensitivity of some vaccine brands. To ensure their  safety and efficacy, they need to be maintained in very low temperatures in every step of the way— from their arrival in the airport to storage and delivery. With the country’s limited infrastructure especially in remote areas, vaccine quality may suffer, and along with it, the health of many Filipinos.

 

Fr. Nic in the Providence College laboratory (Courtesy: Providence College)

 

Developing a Different COVID-19 Vaccine

Such issues are what a new type of COVID-19 vaccine hopes to resolve. Fr. Nicanor “Nic” Austriaco, who is developing this product, has taken his cue from oral vaccines such as the one for polio. “It’s not unusual to have oral vaccines,” he explained. “In the Philippines, we have 110 million people in 7,000 islands, and we have to bring the vaccine to them. Right now, all the (COVID-19) vaccines require very cold refrigerators. I want to develop a vaccine that is shelf-stable. In other words, you can put it on the shelf without the need for refrigeration, and it would still last.”

Biology and theology are Fr. Nic’s fields of expertise, having been trained in molecular biology at the Massachusetts Institute Technology (MIT) in the U.S. more than two decades ago. Currently, he is a professor at both the Providence College in Rhode Island and our very own University of Santo Tomas. He is also a fellow at OCTA Research, an independent and interdisciplinary research group of faculty members that has been providing pandemic data for the country.

The vaccine Fr. Nic and his team are developing is yeast-based, with a shelf life of two years even without refrigeration. “The idea is that we take probiotic yeast, which you can buy in drugstores, and we genetically engineered it. We changed it so that it will produce the spike protein of the SARS-CoV-2 virus. This spike protein is the part of the virus that Pfizer, Moderna , AstraZeneca, Gamaleya all put into your body. So, we are just changing the delivery system.” The yeast, which could be drunk or taken in pill form, would stay in the intestines and produce the spike protein, which would trigger the body’s immune system.

Despite the promising benefits of this oral COVID-19 vaccine, Fr. Nic warned that it may take 6 months to a year before it can be released to the public. “This is why I call this a second- generation vaccine. The expectation is we’re going to be vaccinated nearly every year or nearly every other year. So to save the Philippine government [from spending] billions of pesos to be paid every year to foreign companies, we’re trying to develop a vaccine for the Philippines that is relatively cheap but safe and efficacious.” 

Fr. Nic named the oral vaccine development as Project Pag-asa, precisely because he hopes to give hope to Filipinos, especially the poor. “I read a story about a Filipino jeepney driver who lost his job, who lost his house because of the first ECQ, and I realized that we  have to protect the poor—the poorest kababayans. The first-generation ones will be great for them but if we do this every year for a long time, we need a vaccine that would be easily accessible to our poor kababayans.”

Like other vaccine developers, Fr. Nic’s team is developing two versions of the oral vaccine—one for the original COVID-19 strain, and one for the other variants. Regarding questions on the oral vaccine dosage, Fr. Nic said that it would depend on the clinical trial. Once the yeast is developed, the first step is to do animal testing. “Once the animal testing is done— if that is successful— then we have to go to clinical trials in the Philippines. So, there are still many steps that we need to do before we can make it available to the public.”

 

Developing the COVID-19 oral vaccine (Courtesy: Providence College)

 

Importance of Vaccination

Fr. Nic has already been vaccinated with the Moderna vaccine in the States. He was part of the priority list because he resided in a community of priests, which had elderly members. “The side effects can be rough, especially after the second dose. I was very sick for about one day. I had headache, body ache, fatigue, chills for many hours. But after that day, it was gone.”

Still, Fr. Nic reiterated that the sick feeling after vaccination is a sign that the vaccine is working. “It’s your body fighting the vaccine already. That is why the second dose is worse than the first dose. The older you are, the easier the side effects, If you are young, you can be really, really, really sick because you have a stronger immune system. So, the immune system fights back stronger and you feel sick more— but only for one day. And if you had COVID before, especially if you didn’t know you had COVID, the first dose would be harder than the second dose.”

As for those hesitating to get vaccinated, Fr. Nic said, “I’m one of them who have been vaccinated against COVID-19. I can now walk around  the city. I can get on a plane. I can visit other people. It is the quickest way to end the pandemic, right? I am sure you are tired of ECQ. You are tired of lockdown. The only way we can stop this is if all the Filipino adults—70 million adults choose to be vaccinated.” 

For Fr. Nic, vaccination is not only a self-protective measure, but also a caring decision. 

“Why do we get vaccinated? We get vaccinated to protect ourselves, but more importantly, to protect those around us who are more vulnerable to the disease. When I was being injected by the second dose, I thought ah, my mom is safe now. I was so concerned about my mother’s well-being. She’s a senior citizen, so every time I visit her [in Manila], I was worried that I would secretly bring the virus to her. Now, I know she is safe because I am vaccinated. We are vaccinated not only to protect ourselves but also to protect our parents and our grandparents. Those are really important to understand, especially in the Philippines.”

 

* interview by Blueberrie Recto

Watch Panahon TV’s interview with Fr. Nic here.

Sometimes, it only takes a small step to spark a movement. 

When 26-year-old Ana Patricia “Patreng” Non decided to start a community pantry near her home in Maginhawa Street, Quezon City, it was because she wanted to help. “My small business was affected because of the lockdown,” she explained in Filipino in a Panahon TV interview. “But even if I didn’t have any income, I could still eat three times a day. I thought of those whose livelihoods depended on being out on the streets. They needed support.”

Soon, news about Patreng’s Maginhawa Community Pantry, fashioned from a bamboo cart, spread like wildfire. People came in droves, dropping off food donations, and getting food. The initiative was so popular that even the German Ambassador to the Philippines Anke Reiffenstuel dropped by to donate goods. She tweeted that she was “deeply impressed by the solidary spirit of the Filipinos.”

 

Patreng and her bamboo cart of donated goods (photo from AP Non)

 

Maginhawa Community Pantry’s Evolution

To accommodate the growing volume of crowd and donations, the pantry relocated to a bigger space at the Teacher’s Village East Barangay Hall. Quezon City authorities were called in to maintain health protocols. But the line continued to grow, extending all the way to Philcoa along Commonwealth Avenue. Senior citizens, though prohibited to go out of their homes, joined the queue. To get in line early, people broke curfew.

To address these challenges and to meet the needs of community pantries that mushroomed in the area and all over the country  (as far as Mindanao), the Maginhawa Community Pantry recently announced that it would no longer serve beneficiaries. Instead, the pantry has evolved into a drop-off point for donations, which will be distributed among other pantries and places that needed aid. This decentralizing move seeks to promote better barangay coordination and observation of health protocols, and to spread out the crowd lining up for goods.

 

Inspired by Patreng’s initiative, UP Campus residents set up their own community pantry. (photo by Mary Jhoy Aap)

 

Ensuring Safety in Community Pantries

Though initiating community pantries is commendable, organizers should always remember that the country is still grappling with the pandemic. Safety and Preparedness Advocate Martin Aguda Jr. explained in Filipino, “Each time you go out—whether you’re an organizer, a volunteer, a donor or a beneficiary—you are at risk for COVID-19, especially in crowded community pantries.”

On the day when a senior citizen collapsed and died while waiting in line at a community pantry, the Quezon City government released its Community Pantry Guidelines to minimize health risks. Aguda also offers these tips:

 

Map out a risk management plan. Recognize the risks of your endeavor. How will these affect everyone involved? “You have to check the risks and you have to put in your safety measures,” stressed Aguda. The risk management plan involves wisely choosing the pantry’s location, which will largely depend on the crowd volume you are capable of handling. “Is this an area that will draw in crowds? You need to survey the place because from there, you can gauge your expected crowd.”

 

Check if your resources are enough. Make sure that the amount of goods you will be distributing matches the expected number of beneficiaries. “When the people outnumber the goods, that will result in long lines and extended waiting time. The longer people wait in line, the more they are exposed to other people and the risk of COVID,” shared Aguda. Limited resources may also cause people to forego discipline and cause a stampede.

 

Ensure the safety of everyone involved. Aside from making sure everyone is wearing a mask and a face shield, and is practicing physical distancing, organizers should also check the pantry’s surroundings. Aguda explains, “The location should be away from traffic to prevent accidents. Physical distancing can be enforced through physical markers. Enlist the help of safety officers or barangay officials to ensure that lines and health protocols are followed.” Aguda also suggested to set early operation hours so people don’t have to wait under the heat of the sun. This reduces the risk of heat stroke and dehydration.

 

Regularly brief the crowd. Reminding the crowd to follow health protocols cannot be made often enough. Because there’s always a fresh batch of people joining the line, always reiterate the measures to ensure their safety. Set an example by wearing PPEs and following physical distancing. Provide alcohol for public use.

 

“It all boils down to planning. We all want to help, but we don’t want to deal with unintended consequences,” warned Aguda. He advised people going to community pantries to also bring drinking water and umbrellas. “Learn to be practical. Remember your health is at risk.” 

In turn, Aguda advised organizers to never let their guards down. “You need to protect yourself  because you are interacting with different people. Don’t remove your mask at any time. Your volunteerism is a noble act, but you can still help others by ensuring your own safety,” he ended.

 

Watch Panahon TV’s full interview with Martin Aguda Jr. here.

For those who want to donate to the Maginhawa Community Pantry, visit its Facebook page.

 

Only a week to go before the end of April when the government will decide whether to change or maintain the current MECQ (Modified Enhanced Community Quarantine) status in NCR Plus. But with the Department of Health’s report on having 66% of the country’s ICU beds solely for COVID-19 patients already utilized, it is clear that the healthcare system still needs more time to recover. In fact, PGH (Philippine General Hospital) spokesperson Dr. Jonas del Rosario stated, “Extension of MECQ will probably help in further decreasing the transmission, and then fewer people will get hospitalized.”

As of writing, the World Health Organization (WHO) has recorded over 143 million confirmed cases of COVID-19, and over 3 million deaths worldwide. Because this scenario may be difficult to imagine, Dr. Anna Lisa Ong-Lim, division chief of the Department of Pediatrics’ Infectious and Tropical Disease in PGH offers this explanation: “That means every man, woman and child who lives in the Philippines has tested positive. When you talk about the deaths, that’s kind of saying that everybody in Quezon City has died of COVID.” She added that she wouldn’t be surprised if the DOH’s current tally of over 971,000 cases hit 1 million very soon. As of April 22, the country’s total active cases are almost 108,000 with over 16,000 deaths.

With NCR hospitals in almost-full capacity, alarming stories of patients having to go outside of Metro Manila to seek medical care abound. But with DOH stating that more than 97% of current COVID-19 cases are mild and asymptomatic, home care may be feasible. To learn more about this, The Sanctuario de San Antonio Parish Team held the webinar entitled What to Do When COVID Hits Home with Dr. Ong-Lim as guest speaker.

 

 

When COVID Homecare is Feasible

In March last year, WHO began releasing homecare guidelines for mild cases when “in-patient care is unavailable or unsafe”, which is currently the case in NCR. To determine which cases are eligible for home care, Dr. Ong-Lim proposes asking three questions:

 

  1. DOES THE PATIENT QUALIFY FOR HOME CARE?

According to WHO, the following cases qualify for home care:

 

Dr. Ong-Lim expounds on this by saying that the patient should not have difficulty in breathing to qualify for home care. This can be concluded when the patient is able to do the following:

 

  1. IS THE HOME SETTING SUITABLE FOR HOME CARE?

Though both isolation and quarantine seek to limit the patient’s movement to avoid passing on the virus, Dr. Ong-Lim enumerated their differences. 

 

ISOLATIONQUARANTINE
For someone who tested positive for COVID-19For someone who had been in close contact with a positive case
Duration is about 10 days  

Duration is 14 days

 

Patient should have no fever or symptoms for at least 3 days before he/she is discharged from isolation.Quarantined person should watch out for symptoms, check temperatures, and avoid contact with others, especially those at high risk.

 

Physical requirements for home care include:

 

Additional tips for infection prevention in the home include:

 

  1. CAN THE PATIENT BE PROPERLY MONITORED AT HOME?

Aside from having no risk factors and being below 60 years old, the caregiver should also also be reliable. This ensures the accuracy of information that will be relayed to the healthcare professional. 

According to Dr. Ong-Lim, the caregiver should be equipped to do the following:

 

The Centers for Disease Control and Prevention (CDC) states that these signs merit emergency medical attention:

 

Dr. Ong-Lim added that patients with mild to moderate disease without risk factors could take about 10 days to recover. The important thing is that the patient should be improving, and not progressing toward severe or critical illness. When the latter happens, the patient needs to be transferred to a hospital.

 

 

A Side Note on Ivermectin

So far, three hospitals in the country have secured permission to use ivermectin against COVID-19. Oral ivermectin, which was previously used in the Philippines only for parasite infestations among animals, is now allowed by the Food and Drug Authority (FDA), under a special permission, to be given to COVID patients. Currently, ivermectin clinical trials in the country are underway.

However, health experts including the FDA and WHO have been vocal against the use of the drug, citing that there isn’t enough evidence to prove that its effectivity against COVID-19. About this, Dr. Ong-Lim said,Even if there are scientific publications saying that there is evidence for it, unfortunately, the studies are affected by the fact that they involved different kinds of populations. Ivermectin in those trials may have been used with other interventions, so it’s very difficult to isolate and say that the effect is solely due to ivermectin.” 

Aside from its lack of efficacy, health experts are also concerned about ivermectin’s possible toxicity. “Is it right to put our faith into something that needs more sound evidence?” Dr. Ong-Lim asked in Filipino. “We need more evidence before we can trust it. Otherwise, we have misplaced faith. We need to understand what we’re really afraid of. We’re afraid of getting sick. How can we prevent that? By just utilizing your mask and shield properly, your distancing, your circulation, and your time of interaction— if you put that all together, the numbers supporting prevention with the proper use of your PPEs is much, much higher than any intervention, whether that’s ivermectin or even some of the vaccines.”

 

Watch the full webinar here.

 

As the Philippines continues its COVID-19 vaccination drive, its active cases have spiked past 86,000, including  the country’s highest single-day increase since the pandemic began. A year after lockdown was declared, the health system is, once again, overwhelmed. 

While the Department of Health’s hospital referral system is swamped with calls about new cases, 30 hospitals in NCR have declared full bed capacities for COVID-19 patients. COVID-19 variants have been detected in all cities in Metro Manila, prompting the government to place the area as well as Cavite, Laguna, Rizal and Bulacan in a bubble from March 22 to April 4. Within this period, only essential travel will be allowed into and out of these places. 

More than ever, faster and more efficient processes need to be in place, especially since only over 500,000 have so far been inoculated—less than 1% of the 70 million targeted to achieve herd immunity this year. To better understand this issue, we discuss key points of an online  discussion held by the Women’s Business Council of the Philippines, featuring health-sector heavyweights such as Former Health Secretary Dr. Esperanza Cabral; Dr. Susan Pineda-Mercado, director of Food Systems and Resiliency at the Hawaii Institute for Public; and Dr. Tony Leachon, chairman of Kilusang Kontra-COVID. 

 

The Parañaque government began its vaccination of senior citizens last March 22, 2019

 

The Need for Vaccines

In the online talk held last February, Dr. Cabral expressed her pro-vaccination views, stating how the Centers for Disease Control and Prevention (CDC) listed vaccination as one of the 10 greatest public health achievements of the 21st century. “Vaccines have gone to develop into the most life-saving medical advancement in history,” she said.

Meanwhile, Dr. Mercado explained how the COVID-19 vaccination could protect one’s health. “You get a tiny bit of the virus, and that will stimulate the development of the antibodies. It helps you recognize the enemy because if you get natural  exposure, your disease will not be moderate or even severe.” 

With mass vaccination enabling majority of the population to develop a considerable degree of immunity against COVID-19, Dr. Cabral stated the following possible benefits:

 

 “Why are vaccines important to us? They are important to us because if there is a vaccine for a disease, it will prevent that severe disease and death from it,” Dr. Cabral said. “It will prevent symptomatic disease and importantly, it will also prevent the transmission of disease to others.”

 

Dr. Grace Pagayon-Uy received her first jab of AstraZeneca as part of the QC government’s vaccine rollout for health care workers this week.

 

The Importance of Starting Early

But as Dr. Mercado stated, mass vaccination does not guarantee an immediate victory against the virus. The changes are likely to be felt gradually, which is why early intervention is key. Dr. Cabral enumerated these results of Israel’s early vaccination drive, which started in January:

To guarantee early vaccination, Dr. Leachon shared that acquisition of vaccines should start as early as the phase 2 of clinical trials—which is what Vietnam, China, India and South Korea did. He presented a projection of good economic growth among these countries. Meanwhile, poor pandemic response resulted in the plummeting economies of the US, Brazil and the UK.

 

AstraZeneca vaccine arrive in the Philippines from the COVAX facility last March 4. (Photo from National Task Force Against COVID-19)

 

On the Flip Side: Anti-Vaxxers

The World Health Organization included “vaccine hesitancy” in one of the top global health threats in 2019. WHO stated, “Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.”

 

WHO identified the possible reasons for vaccine refusal:

 

Throughout history, anti-vaxxers—the term used for those who oppose vaccines—have cited various side-effects from vaccines. These included infertility, brain damage, and most recently, autism, which some claimed were an effect of the MMR (measles, mumps and rubella) vaccine for children. This resulted in a decline in MMR vaccinations, which, in turn, resulted in an emergence of measles and mumps in Europe and North America, which had not seen these diseases for many years. According to the CDC, studies have dispelled the claim linking vaccinations to autism.

 

Dr. Gladys Lacuna-Mendoza gets her first dose of Sinovac vaccine. According to Sec. Carlito Galvez, chief implementer of the National Task Force Against COVID-19, almost 24% of the country’s 1.7 million health workers have been vaccinated. 

 

Convincing the Skeptics

A recent survey from OCTA Research revealed that 46% of Filipinos are unwilling to get inoculated against COVID-19 even if the vaccine was proven safe and effective. To combat this massive vaccine hesitancy, Dr. Cabral urged the government to use “trustworthy and trusted talking heads, and use language that people can easily understand.” Messages should also be balanced and consistent, and widely reiterated across all platforms.

Dr. Leachon even warned that future travel might require COVID-19 immunity passports. “This is important to economic recovery and that’s why we need to have vaccination. The Philippines will be isolated from the rest of the world if we will not be vaccinated— tourists will hesitate to come, the international business people will not travel, Filipinos may not be given passes to travel abroad, thus curtailing business activities and even family leisure and travel. Our competitiveness will sink even further in the rankings.”

But even with vaccination, Leachon said health measures should still be improved such as contact tracing, quarantine and isolation facilities, and even government messaging. “We should invest in health care so we can prepare for the next pandemic. We have to take better care of our health care workers.” 

Still, even if public acceptance of vaccination improves, the slow arrival and rollout of COVID-19 vaccines remain a major hindrance. All the health experts in the online discussion agreed that right now, there is no room for complacency. To save lives and the economy, vaccination needs to be a priority. “The economy will never recover as long as the virus is not controlled. And if you don’t understand that, then we’re part of the problem,” ended Dr. Leachon.

Donna May Lina at Agay Llanera

 

Dahil buong mundo ay abala sa pagpuksa ng COVID-19, laging laman ng balita ang pagpapabakuna laban sa sakit na ito. Ayon sa Bloomberg, ang Estados Unidos ang nangunguna sa dami ng mga nabakunahan. Pumapalo sa halos 2.5 milyon ang natuturukan ng COVID-19 vaccine sa U.S. kada araw.

Simula nang inumpisahan ng Pilipinas ang vaccination drive nito n’ung March 1, higit sa 240,000 ang nabakunahan nang mga Pilipino. Ngunit bukod sa mabagal na pagdating ng mga vaccine, hadlang sa malawakang vaccination ang kawalan ng tiwala ng mga Pilipino sa vaccine. Ayon sa isang survey, 46% ng mga Pilipino ay hindi papayag mabigyan ng COVID-19 vaccine kahit na napatunayan itong ligtas at epektibo.

 

Kasaysayan ng Bakuna  

Pinaniniwalaan na ang English physician na si Edward Jenner ang unang nagsagawa ng matagumpay na pagpapabakuna. Pagkatapos niyang turukan ng smallpox virus ang isang bata, nagkaroong ang pasyente ng immunity sa nasabing sakit. Nang nagkaroon na ng mass vaccination, tuluyan nang naiwaksi mula sa mundo ang small pox noong 1979.

Ayon sa Centers for Disease Control and Prevention (CDC), mahalaga ang childhood vaccines o ‘yung mga bakunang ibinibigay sa mga sanggol at bata sa pag-iwas sa sumusunod na mga sakit:

 

 

Ang mga bakuna ay nagbibigay proteksyon, hindi lang sa indibiduwal, kungdi pati rin sa buong komunidad.

 

Ano ang Herd Immunity?

Inilalarawan ng World Health Organization (WHO) ang herd immunity bilang indirektang proteksyon laban sa isang nakahahawang sakit. Maaaring magkaroon ng immunity ang isang populasyon mula sa pagpapabakuna o dati nang pagkakasakit. Dahil posibleng mabiktima ng COVID-19 nang higit sa isang beses, inirerekomenda ng WHO ang pagpapabakuna laban dito upang makamit ang herd immunity.

 

Para hindi dapuan ng matinding COVID-19 ang malaking bahagi ng populasyon, isinasagawa ng mga bansa ang malawakang vaccination. Herd immunity rin ang layunin ng pamahalaan ng Pilipinas kaya inanunsyo nito ang planong mabakunahan ang 70 milyong Pilipino sa loob ng isang taon.

 

COVID-19 Vaccination Plan sa Pilipinas

Noong Pebrero, inilabas ng Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) ang priority list o ‘yung pagkakahanay ng mga mababakunahan.

 

Source: Philippine News Agency (PNA)

 

Ayon sa Philippine National Deployment and Vaccination Plan for COVID-19 Vaccines, nakakalap na ang pamahalaan ng ₱82.5 billion. Ilalan ito sa pagbili ng mga vaccine at iba pang mga gastusin sa pagbabakuna.

 

Source: DOH

 

Nabanggit ni Department of Finance (DOF) Secretary Carlos Dominguez III na posibleng umabot sa ₱1,300 ang pagbabakuna sa bawat indibiduwal. Dagdag pa niya, mga 57 milyong Pilipino ang makikinabang sa ₱75-bilyong pondong inilaan ng pamahalaan sa pamimili ng mga vaccine. Ang natitirang populasyon ay paggagastusan ng mga LGU (local government unit) at pribadong sektor. Sa ilalim ng Bayanihan to Recover as One Act, pumirma ng kontrata ang lokal na pamahalaan, LGU at mga 300 pribadong kumpanya upang bumili ng 17 milyong dosis mula sa  British pharmaceutical company na AstraZeneca. Ayon kay Joey Conception, ang Presidential Adviser for Entrepreneurship, kalahati ng mga dosis na bibilhin ng pribadong sektor ay ibibigay sa  gobyerno, habang ang kalahati ay mapupunta sa mga empleyado ng mga kumpanya.

 

Nationwide Vaccination Drive 

Sources: DOH, WHO, PNA

 

Higit sa 480,000 dosis ng AstraZeneca vaccine ang ibinigay ng COVAX facility sa Pilipinas. (Photo: National Task Force Against COVID-19)

 

Base sa tinatayang datos ng paglago ng populasyon mula sa Philippine Statistics Authority, bumuo ang pamahalaan ng three-year vaccination plan mula 2021 hanggang 2023. Inaasahan na sa 2022, maaari nang mabakunahan ang mga 16 years old pababa, habang meron nang COVID-19 vaccine para sa mga sanggol sa 2023. Ang mga binakunahan ngayong 2021 ay bibigyan pa ng booster shots sa susunod na mga taon.

 

Source: DOH

 

Pagkamit ng Herd Immunity

Kahit hindi pa alam ng WHO ang eksaktong porsyento ng isang populasyon na dapat mabakunahan upang makamit ang herd immunity, layunin ng pamahalaan ang mabigyan ng COVID-19 vaccine ang 70 milyong mga Pilipino ngayong 2021. Pero dalawang dosis ang kailangan para makumpleto ang pagpapabakuna— ibig sabihin, 140 milyong dosis ang dapat maiturok ngayong taon.

 

 

Base sa mga bilang na ito, dapat bilisan ng pamahalaan ang pagbabakuna para magkaroon ng herd immunity sa bansa—lalo na’t kailangang kailangan na ito ng ating ekonomiya.

Matagal pang haharapin ng bansa ang pandemya, at hindi pa natin alam kung kailan ito matatapos. Ngunit isang bagay ang maliwang: hangga’t hindi pa nababakunahan ang 70 milyong mga Pilipino, kailangan ng ibayong pag-iingat ngayong tumataas muli ang mga kaso ng COVID-19 sa bansa.

Tumatakbo ang oras, pero habang wala pang bakuna ang karamihan ng mga Pilipino, dapat sundin ang mga hakbang upang masiguro ang pansariling kalusugan at kaligtasan. Sa ganitong paraan pa lang natin maiiwasan ang sakit na patuloy na dumadagdag sa 2 milyong bilang na namamatay sa buong mundo.