It took several months before many governments across the world took COVID-19 seriously. The virus spread and crossed borders before the World Health Organization called it a pandemic on March 11, 2020. In the Philippines, the battle began quite early with two doctors being among the first soldiers to grapple with the virus that stopped the world and dismantled normalcy.
“Wala na munang diet-diet. Baka ito na ang last meal natin.”
(Let’s not go on a diet just yet. This might just be our last meal.)
It was a joke she vividly remembers telling three years ago.
For infectious diseases specialist Dr. Myvie Galon, the remark was something they always made in jest. But deep inside, they knew that what was coming was no laughing matter, and that the punchline will eventually land as a gut punch.
It was late 2019, and Galon was working at the San Lazaro Hospital in Manila. News of a dangerous new coronavirus – crossing borders and taking lives – was something that had worried her and colleagues for weeks.
That worry soon turned into reality. As the world ushered in the new year, Galon and the hospital came face-to-face with the Philippines’ first COVID-19 patient at the San Lazaro Hospital.
Looking around the hospital she works for now in Cagayan de Oro City in Mindanao, Galon is effortlessly able to wear a smile -- something she could barely do two years ago.
It’s undeniable that things have taken a much better turn three years since COVID-19 was characterized by the World Health Organization as a pandemic, and since the Philippine government started implementing lockdowns to curb the spread of the respiratory disease.
But all the hardships and rollercoaster of emotions then remain vivid in her memory today.
The Philippines’ index case
A coordinated transfer from a private hospital to the San Lazaro Hospital where Galon was taking her last year of training as a medical fellow was actually the beginning of what may be considered the most challenging season for the country’s healthcare system.
As a Chinese man and his girlfriend were wheeled into the hospital's halls in January 2020, Galon remained calm and composed. But her instincts alerted her otherwise: all the symptoms she observed pointed toward the novel coronavirus.
“It was scary pero hindi pa siya gano'n ka big deal at that time kasi January, hindi pa siya talaga kalat. It was really challenging because the protocols kept changing everyday,” she said.
(It was scary but it wasn’t such a big deal then because back in January it wasn’t pervasive. It was really challenging because the protocols kept changing everyday.)
Based on an internationally published case report by their attending doctors, the Chinese couple had no comorbidities though the male patient already had a fever prior to their vacation to the Philippines on Jan. 21 of that year. The two travelled to Cebu and Dumaguete before deciding to fly back to Manila four days later after both of them developed cough and sore throat.
At that time, the Research Institute for Tropical Medicine could only detect pathogens like influenza B, human coronavirus, and staphylococcus aureus for the female patient. Her partner had influenza B and Streptococcus pneumoniae, the bacteria that causes pneumonia.
The absence then of a facility for COVID-19 RT-PCR testing meant the couple’s samples had to be sent all the way to the Victorian Infectious Disease Reference Laboratory in Australia to confirm whether or not they were positive for the novel pathogen.
The female patient’s confirmatory result was reported first, making her the country’s COVID-19 index case on Jan. 30 or nine days since they arrived in the Philippines.
While recuperating, she remained oblivious of the hard battle her partner was trying so hard to overcome in an isolation room not too far away.
Isolated in the intensive care unit with the male patient was another fellow in training, Dr. Bren Dagoc.
Speaking to ABS-CBN News recently, Dagoc said fear did not completely sink in during his first few days of being with the patient. He even described his first week in the ICU as similar to the feeling of having been pumped with caffeine – extremely active, fast-paced and busy.
“Nung una, parang mabilisan. Although nandun yung kaba, pero ginagawa mo pa rin yung trabaho mo, yung pagbibigay ng gamot, yung pagsaksak ng IV. Talagang tutok ka sa loob,” he shared.
(At first, everything was happening quickly. Although I felt nervous, but I still did my job, giving the right medication, IV administration. We were really concentrated in the ICU.)
Fear only struck when he was tasked to perform a procedure dreaded by many in the context of the new disease.
“Iyon ‘yong time na na-intubate yung lalaki. Ako yung nag-intubate. Naka ilang intubate kami kasi malaki siya eh. He’s obese, so nahirapan kami. Natatanggal. So in-intubate ulit yung pasyente, hanggang sa na-sedate na namin siya,” Dagoc said.
(That was the time when the male patient was intubated. I performed the intubation. We did it several times. It wasn't easy. He was obese so it was difficult for us to do it. The tube would come out so we had to do it again. We had to sedate him.)
A chest x-ray of the male patient showed that on Jan. 27 – his 10th day of illness – infiltrates consistent to pneumonia were evident in his lungs. After just three days, another x-ray revealed that his pneumonia had worsened.
Prior to intubating the male patient, Dagoc had already been experiencing symptoms of COVID. On Jan. 31, he was extracted from the ICU to be quarantined and treated as a person under investigation (PUI), a term coined for people with exposure to a positive case. It was a day later when he received news that made his entire body quiver.
“Namatay na pala siya. Ibang doctor ang nag-declare ng death," Dagoc said of his patient.
(He died. Another doctor declared his death.)
"Although negative na yung unang test ko, tinest pa nila ulit ako. Siyempre, natatakot ako pero wala kang magawa kasi trabaho mo yun eh," he added.
(Although I tested negative on the first test, they tested me a second time. I was scared but I really couldn’t do anything because it was my job.)
The death of the Chinese tourist was another first for the rapidly evolving health crisis. It was the Philippines' first COVID-19 fatality, and the first outside of mainland China, where the disease is believed to have first emerged.
His partner eventually recovered and returned to China.
Another Chinese tourist also tested positive but was also able to return home after beating the disease. Then, a lull in cases in the country followed.
Little did everyone realize that it was actually just the calm before a very long and tumultuous storm.
Peaks, troughs and a battered healthcare system
The daily announcement of newly confirmed COVID-19 cases began at the latter part of February 2020. From then on, daily numbers outcompeted the previous day’s figures.
By March 7, the Department of Health (DOH) announced the first local case of the disease – a man who had no travel history and no known contact with any foreign traveler.
As the government scrambled to put a mechanism in place that would slow down viral transmission, so did ordinary Filipinos who stormed to supermarkets to stock up on much needed supplies. It was an image that was eerily familiar – similar to those you only see in movies.
Three months since the virus first spread from China, global infections reached around 800,000, prompting the WHO to characterize COVID-19 as a pandemic.
“Dumating sa point na yung mga hospitals, they cannot accommodate the patient,” Galon recalled.
(It got to a point when hospitals can no longer accommodate patients.)
Working for the country’s referral hospital for infectious diseases at that time, Galon said occupancy rates were so high that a lot of days there were simply no beds to accommodate the influx of patients.
When this happened, doctors had to think smart and act fast to alleviate patients from their illness even if that meant having to manage the disease right inside the emergency room.
“Kahit anong gusto mong i-attend sila, pero nauubos yung hospital space as well as the manpower. Yung mga kasama mo, isa-isa na ring nagkakasakit.”
(Even though you wanted to attend to all of them, the hospital’s space and manpower just wasn’t enough. My colleagues were also getting sick one after the other.)
“After that, parang humupa. It was on and off. Yung stress level mo, umaakyat na naman 'pag nagse-surge siya kasi nga malaking factor talaga yung wala nang space yung mga hospitals.”
(After that, it waned just a little bit. It was on and off. Your stress level begins to rise again when another surge happens because you know the hospital doesn’t have enough space.)
From 2020 to 2022, the Philippines has experienced at least four peaks of SARS-CoV2 infections – the most heart wrenching of which would probably have to be the one in August 2020 where weekly cases reached over 14,000.
The rise in infections prompted the Healthcare Professionals Alliance Against COVID-19 to call for a “timeout” and a recalibration of government strategy in responding to the pandemic. It was a call supported by the DOH which eventually resulted in escalating to a modified general community quarantine, the second most stringent of community quarantines, in Metro Manila.
The peaks and troughs had inevitable impacts on the most important aspect of the healthcare system – its human resources. Galon confessed to having to make tough choices during a time when it was just too easy to decide on quitting.
“Honestly, meron talagang times na gusto mong tumigil na lang. Parang pinipilit mo na lang yung sarili mo to go to the hospital. But then of course, one factor is really that ito naman talaga yung pinipili naming work so we hang on to that oath,” she said.
(Honestly, there were times that you felt that you just wanted to stop what you’re doing. It’s like you’re just forcing yourself to go to the hospital. But then of course, one factor of not doing that is because this is the job we chose so we have to hang on to that oath.)
FROM THE ARCHIVE
But hope filled weary hearts as the highly anticipated monovalent COVID-19 vaccines arrived in the country in March 2021. For the first time since Filipinos imbibed stay-at-home orders, everyone scrambled for that much awaited schedule and flocked to schools and shopping malls to get two doses of the life-saving jab.
The succeeding surges were triggered by new variants of concern whose mutations in the spike protein allowed them to be more transmissible and immune-evasive.
After the Alpha and Beta-driven surge in April and May 2021, the country faced its most difficult surge yet.
The most virulent variant of concern – Delta – reached Philippine shores, wreaking havoc and overwhelming hospitals in September 2021.
While the Philippines did not necessarily experience the same gravity that India did, it was still bad enough that COVID-19 patients went through the agony of waiting in tents or open areas of hospital grounds just to be admitted.
Oxygen supplies ran low and funeral homes worked double time to cremate the deceased.
Like all peaks, trends eventually go down but only to rise back at record-breaking levels.
The year 2022 began with another surge caused by the latest variant of concern, omicron.
The steep rise in cases, fortunately, was also quick to subside – an answered prayer for a country whose economy has already been brought to its knees.
Just like health experts around the world confessed, more mutations and sub-variants of omicron emerged. The good news is that evidence doesn’t seem to suggest a more severe course of disease for newer sub-variants -- as long as an individual is vaccinated and boosted accordingly.
Even so, one question remains unanswered. When will the pandemic end?
Pandemic: Year four
The sight of empty gurneys, a calm stroll along hospital halls and a light conversation with patients and their families were all but an aspiration for Galon and Dagoc in the not-so-distant past.
As the pandemic rolls on over to its fourth year, things have definitely gotten better with case numbers remaining manageable for a lot of countries.
For several months now, the DOH has logged between 100 to 200 daily cases. And while sometimes weekly cases may see slight increases, the agency maintains these have no significant effects on the different indicators.
“Sa ngayon (For now), we can say everything is manageable. Our hospitals are able to manage our cases,” Health Officer-in-Charge Maria Rosario Vergeire said.
All local government units (LGU) are said to be observing a decline in hospital rates with a third of LGUs not reporting COVID-19 cases at all.
The government hopes to further reduce disease severity through the bivalent vaccines that are scheduled to arrive from the COVID-19 Vaccines Global Access (COVAX) Facility within the next few weeks. These will be used to boost immunity among those who have already received at least the primary series of monovalent jabs.
But the number of boosted individuals in the Philippines remains low compared to those who have received the primary series. This, despite the numerous campaigns launched in different parts of the country to drive booster uptake.
Latest figures from the DOH show that of the more than 79 million people who have received two jabs of a COVID vaccine, only close to 25 million have received a booster shot.
But an issue that continues to hound the government is vaccine wastage brought about by continued hesitancy. A recent Senate Blue Ribbon committee hearing confirmed that 44 million doses of vaccines have been wasted with another six million doses are expiring by the end of March.
Despite this, the DOH hopes the new vaccines will be received with the same level of eagerness as the monovalent vaccines in 2021, especially by the vulnerable population, to further reduce transmission and the possibility of mutations.
The WHO maintains that while many countries are now in a better position to combat the evolving pathogen, the fact remains that it continues to circulate intensely around the world.
From Feb. 6 to March 5 this year, 35,000 were reported to have died from COVID-19, something the world body says is still too high considering the availability of tools that help in suppressing transmission death.
The significant amount of deaths in the last few months made the WHO’s Emergency Committee recommend maintaining the status of COVID-19 as a global health emergency.
With science, evidence and data as their guides in maneuvering through the pandemic, the WHO has never really given an exact date as to when they see the emergency of COVID-19 ending.
But like all things that begin, an end is inevitable. The world will only get there though if governments do not abandon but instead strengthen the systems around surveillance, sequencing and clinical care pathways.
The WHO says if only this is done, the end of COVID-19’s emergency may happen within the year.
Three years since attending to the country’s first cases of COVID-19, Galon and Dagoc now practice medicine in different facilities in Mindanao.
Dagoc, now based in Butuan City, has outlived the fears brought about by the unknowns of the disease. Yet he admits there is still a lot of work for healthcare workers.
“Marami tayong aral na natutunan. As a doctor, hindi dapat humihinto ang pag-aaral. Kahit tapos na sa fellowship, we still have to learn alang-alang sa mga taong sineserbisyohan natin,” he said.
For Galon, the manageable situation bares another battle that they must overcome.
“Ang challenge naman ngayon sa infectious diseases, especially in infection control, is to continue educating people on the importance of wearing masks properly kasi hindi lang naman COVID-19 ang nape-prevent ng mask. Pati yung ibang respiratory diseases, bababa ang possibility na magkaroon dahil dito,” she explained.
(The challenge now in infectious diseases, especially in terms of infection control, is to continue educating people on the importance of wearing masks properly because it doesn’t just help prevent COVID but other diseases as well.)
Both doctors are now far from the once chaotic and unsettling wards of San Lazaro Hospital in the Philippine capital.
And while many can hardly wait to move on and forget this season that would eventually be marked in history, they remain grateful for the chance to serve Filipinos and that they lived through it.
“Experience is really one of the greatest teachers in life. Having my training at that time, the pandemic is probably the best lesson I can ever have,” Galon said.
While they hope that COVID-19 would be the last pandemic they’d experience in their lifetime, Galon and Dagoc share the same thought – that they would, without hesitation, don their personal protective equipment, rush to the trenches and care for every Filipino they can should another health threat emerge.
But for now, they’re effortlessly able to laugh off the remarks they once made in San Lazaro Hospital.
“It’s time to go on a diet at magpaliit ng katawan. Medyo lumaki tayo sa kakakain nitong pandemic,” they said with a chuckle.