Novel Coronavirus 2019 2

March 15
Cases increase by 29 bringing the total number to 140 confirmed COVID-19 cases in the Philippines. The Philippines currently has the highest case fatality rate.

March 16
Announcements stop midday as citizens wait apprehensively for news. Presidential spokesperson Salvador Panelo announces that President Duterte elevates the status to Enhanced Community Quarantine for the entire Luzon. Some information has previously been released about the enhanced community quarantine which stated that there would be absolutely no one allowed to leave the house, use transportation or even buy food/medicine. Essential items were to be distributed/delivered by each local government unit. Knowing this, groceries were once again crowded with panic buyers who wish to stock up before the immediate lockdown. By the time President Duterte made his speech, many things were still left unclear. The statement was a prerecorded video from the night before which was edited for brevity and clarity. The government made a follow-up announcement which went into greater detail about the new rules of the quarantine. News also came out of one senator Zubiri who tested positive despite being asymptomatic. He was tested twice despite the known shortage of test kits in the country. He was tested despite the Department of Health's own protocol that states as of now that all asymptomatic patients are not to be tested. Patient count is 142.

March 17
China officially closes its makeshift hospital as they gain control of the infection.

In the Philippines, President Duterte declares State of Calamity for the entire country due to COVID-19. 45 cases were added with the total of 187 cases, 4 recoveries and 12 deaths.

March 18
Had to go out today to withdraw salary for our factory workers. I had to risk traveling without knowing if I would be caught by the police/military forces or not. Was stopped by 2 checkpoints and they allowed me to go after seeing my IDs. Cases increased to 222. More politicians and actors/actresses turn out positive for COVID-19. Are more people getting special treatment and accessing the test kits before the public?

March 19
217 patients, 17 deaths, 8 recoveries. A mayor of Pasig City, Vico Sotto, trends on social media. People from both sides of the political sphere alike praise his actions for his own city such as his support for employees, transportation for frontliners and patients, the use of drones and other tools for sanitization, food provisions for his constituents, and transparency for all that he does. At around 10 PM, an announcement for a Presidential press conference was announced for that night. He finally went on air at around 1 AM. Duterte addressed mayors and warned them "Do not try to overdo things on what you want to do because that is not allowed.". This is despite previous instructions to LGUs to do their best in dealing with the pandemic. He threatened lawsuits for mayors who fail to comply. Though he never mentioned specific names, most people know it was an attack on the 30 year old mayor of Pasig City.

March 20
230 cases, 18 deaths, 8 recoveries.

March 21
307 cases, 19 deaths, 13 recoveries. This marks the biggest increase in confirmed cases by far in the country. More than 100,000 donations of test kits from other countries came in today. DOH warned the people to expect a spike in the number of cases in the coming week.

March 22
380 cases, 25 deaths, 15 recoveries. Joined the Lung Center of the Philippine's COVID Ask Force today. It's free online consultation to help decongest the hospitals. Really glad there's an avenue for us to help out even in this simple way. Thank you to the creators (schoolmates! <3)

March 23
462 cases, 33 deaths, 18 recoveries. Ask Force at full force today. I noticed that many people really are anxious on top of whatever disease they may have. Psych support is needed more than ever. We also got news today that the new bill was passed today: House Bill 6616 or An Act to Declare the Existence of a National Emergency Arising from the Coronavirus Disease 2019 (COVID-19) Situation has been approved by the House Committee of the Whole. Parts that stand out are statements of full control of businesses, budget and the overruling of decisions given by this document. Act>Constitution.

What a time.

Novel Coronavirus 2019 1

Documenting this crazy time.

Worldwide

December 31, 2019
The day pneumonia of unknown cause from Wuhan was first reported to the World Health Organization China. Several cases had been noticed by health care workers but it wasn't that alarming yet. The rest of the world was oblivious.

January 12, 2020
A laboratory in Wuhan, China released their genome sequence for the virus. They determined that the virus was of the same family as SARS and MERS-CoV, the new coronavirus. This was a crucial step for the various laboratories to follow suit on their research on the disease. Australia was among those who made remarkable breakthroughs on nCoV using these data. Eventually, they made valuable contributions towards vaccine creation.

January 30, 2020
The World Health Organization declared a State of Public Emergency of International Concern as more countries got infected. They denied it being a pandemic despite its seemingly fast spread. People were advised to do hand hygiene and maintain cleanliness. The novel coronavirus had a lower case fatality rate compared to other diseases like SARS and the influenza virus and was thus not as urgent a concern. However, due to massive media reporting, the public caused an uproar.

February 11, 2020
The virus was officially called COVID-19 for coronavirus disease.

The rest of Feb-March 2020
Several conferences and teams were gathered to expedite research on COVID-19 such as the Geneva conference, Munich conference, African union, etc. South Korea and Italy were among those whose cases considerably increased. Borders were closed around the world. Distress and panic consumed the public heightened by mass media misinformation and weak government support. On top of all that, racial discrimination and stigma became a worldwide issue. Several exceptions - Taiwan, Hong Kong, Vietnam, Japan - were among those whose efforts have mitigated the spread of disease. China's numbers continued to grow until it reached ~80,000 infected. Strong response to this crisis by different governments such as good healthcare response, immediate building of hospitals and other quarantine sites, decontamination, closed borders, closure of schools and public events eventually slowed it down.

March 12, 2020
The World Health Organization officially classified COVID-19 as a pandemic. Various countries ordered lockdown.

Philippines 

Response by President Duterte's administration to the COVID-19 had been remarkably slow. In the beginning, the country had 0 cases detected even as almost all countries surrounding it already had a growing number of cases. Tests had to be sourced from other countries such as Australia and Japan which meant that it would take longer to expect results. There was growing public unrest as more news about COVID-19 spread across the globe. Clamors for China flight bans were heard as more flights continue to come in from affected countries. This was initially ignored by the administration citing WHO's recommendation not to close borders. They also didn't want to offend / cause political conflict with China. The first case was finally announced on January 30 in the Philippines of a Chinese woman from Wuhan, China. The second case was detected on February 2 and was the husband of case 1 who eventually died in a hospital in Manila. On February 5, case 3 was identified. No more cases were added for about a month. In the meantime, a new test was being developed by UPPGH NIH led by Dr. Raul Destura. This test was meant to speed up local surveillance and would be more cost effective (a whopping P1320 vs P8500 per test). Several delays were seen prolonging the FDA approval. Current patients had to pay out of pocket until people complained to the DOH that they should cover these health expenses. An approximated P42000 for testing + P14000 for rooms + overhead expenses per Person Under Investigation (PUI) would eventually be covered by the PhilHealth system. President Duterte finally ordered travel bans on China, Hong Kong, Macau, and South Korea. Cases of foreigners (Taiwan and Australia) who traveled to the Philippines and went back to their countries tested positive for COVID-19. On March 5, 2 cases were detected in the Philippines. This was followed by case 6 on March 7 which was the first documented case of local transmission. On that same day, the Department of Health declared Code Red Sublevel 1. During this time, frontliners in hospitals and local health centers have had their resources depleted. People had begun panic buying masks, alcohol and other medical protective equipment that caused shortage. March 8 count increased to 10. On March 9, cases more than doubled to 24 and Duterte declared a state of public health emergency. March 10 cases increased to 33. On March 11, it was 49. On March 12, Duterte held a press conference announcing Code Red Sublevel 2 as well as a "lockdown" on Metro Manila from March 15-April 14. The official term for it was "community quarantine" which entailed more movement but more military presence to mitigate the spread of disease. People were still divided based on their political support for the president. It seemed that there were a lot of complaints about disaster communication, the side comments, and the lack of more information regarding a big move such as this lockdown but not a lockdown. This announcement had eventually leaked through social media groups (Viber, etc) even prior to President Duterte's announcement. Following this, grocery stores were packed with people who were panic buying. Several people made moves to leave and enter NCR before the border control. On that day, the case count was 52. On March 13, there were 64 confirmed cases with 6 deaths bringing our case fatality rate higher than most of the world.

March 14
47 cases, the most that was ever recorded in the Philippines, were added to the list today bringing the total number to 111. Until today, UP's locally developed PCR testing kit has not been utilized. Several announcements were made about having a curfew starting tonight at 12 MN to last for a month (8 PM to 5 AM). Military men were deployed to various checkpoints over Metro Manila. Talks about Martial Law circulated on social media platforms. People were uneasy. Conflicting announcements from government personnel were posted online, causing media outlets to retract previous announcements despite merely relaying what they have just heard from the same people. Parameters for the community quarantine have not yet been released in full. There was a lot of traffic again today especially at NLEX, SLEX areas from cars leaving NCR before the community quarantine takes place. This left many people stranded in airports, bus terminals, etc. Some cities have begun to implement more public sanitation measures and have advised the people to do social distancing. Public transportation will start to limit their capacity. Work has been suspended for almost all sectors. Malls will be closed; only groceries, drug stores and banks will remain open. All domestic travel in and out of NCR will be prohibited (land, sea, air). However, international flights that will be contained within Metro Manila and outgoing international flights will still be allowed. Work from home has been encouraged. As of today, there had been 912 Persons Under Investigation (PUIs): 694 being monitored, 209 admitted with 8 deaths and one entire nation that is very afraid.

Personally, I have not been going on duties in hospitals even as I was literally about to do so several times on January-February this year. Somehow, there was always an excuse to cancel these duties (someone got the spot ahead, late replies due to bad signal, previous engagements and ironically - colds). On hindsight, these same hospitals turned out to be among those holding COVID-19 positive patients so I was lucky in a way that it spared me the risk. Although yes, I still got sick for less than a week sometime on February, 2 weeks after a medical mission where a kid coughed directly on my face (at least that's where I think I got it from). I didn't wear a mask then because 1) I wasn't afraid of the coronavirus from this low SES community (this was back when only 3 cases confirmed all had travel history), 2) from previous experience, people in communities may get offended by their doctors wearing a mask while talking to them and 3) I was pretty sure it was just adenovirus or something my immune system could easily combat in 1 week. It took me 3 days to get over a sore throat (1st symptom), slight fever, fatigue, productive cough, and a horrible runny nose. I wasn't worried because I knew that even if there was the slightest chance it could have been COVID-19, my body could take it, as most of us below 60 years old can. We worry about the immunocompromised, the elderly, the ones with co-morbidities such as hypertension, diabetes, and cancer because they would be the ones who would have difficulty recovering. But while I worry for them, I have to admit that life until a certain point in February seemed almost semi-normal. I kept going about my daily activities. I did my work. I did chores. I finished tasks. I went out to see my friends. I kept myself active by working out. I took on more of those medical missions lol (wore a mask na). It seemed good and our low numbers kept us in a pretty little bubble of denial.

On the other hand, as a health care worker with an active exposure to social media, I too couldn't help but feel the impending sense of doom while watching the rest of the world panic during this pandemic. Cases continued to increase in other countries even as ours remained 0-3. I feared for my loved ones abroad. I feared for my friends who are on the frontlines with no more protective equipment because of a shortage (and hoarding!). Several of my doctor friends were exposed to and tested for COVID-19. News about residents, fellows, consultants being intubated circulated the news. I got apprehensive as I watched leadership take on a bigger role than it was able to handle abroad and here at home base. I watched how seemingly simple decisions at policy level had an instantaneous impact, sometimes at dire costs - lives. As days pass, the more frustrating it all becomes. Instead of clear communication, urgent response in all sectors and support for the national health system during a crisis, we get drunken speeches, whispers, political agendas, misplaced priorities (and budget!), increased military power/abuse of power, fear mongering, lack of monetary support for the working class. The "lockdown" starts 2 hours from now but I still don't know what to expect. Other countries have recommended it as it may curb the spread of the disease. We want to "flatten the curve", as public health experts say, so as to decrease its intensity. God knows the Philippines could not afford to handle a larger scale of this problem. If Italy, a first world country, was forced to bend the knee for this, what more the Filipino people? We barely have our current system down pat. A crisis such as this (if not contained early) will drive us to the ground.

COVID-19 is a virus that is not known to be deadly. In fact, the WHO estimates that the case fatality rate worldwide could be 3.4% or less. The disease weakens the immune system of someone who is immunocompromised, malnourished, unhealthy. We expect that with proper measures in place such as social distancing, hand washing, disinfecting (everything WHO and DOH reminds us to do), we will be able to overcome this. The reason for my concern is that people don't take it seriously. Several factors contribute to making this a public health emergency and with a scale as big as this, even the most harmless diseases can cause big chaos.

As I type all this down, I cannot believe that this is the reality we are faced with right now. I'm just hoping that something good will come out of this. Adversity brings out the best in people right? So let us sit tight, wash our hands, keep our distance, and hope for a better tomorrow. God bless us all.