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Cholera, caused by the bacterium Vibrio, is an acute diarrheal syndrome (Lopez, Macasaet, Ylade , etc., 2015)

Cholera has been linked to tidal seawater movements and seasonal climate changes, while outbreaks tend to happen close to water bodies during favorable weather conditions for bacteria growth. This suggests a connection between aquatic environments and the spread of cholera through fecal-oral transmission, a notion that has been widely accepted for a long time (Lopez, Macasaet, Ylade , etc., 2015).

Cholera spreads through the fecal-oral route, either directly from one person to another or indirectly through contaminated fluids from various sources like water, food, and potentially flies and objects carrying infectious particles (Lopez, Macasaet, Ylade , etc., 2015).

Individuals infected with cholera release V. cholerae bacteria in their feces. The duration of this release may last only one day for asymptomatic individuals who have been in contact with an infected person. However, in symptomatic patients, the bacteria can be present in the stool before the onset of illness and continue for up to 1 to 2 weeks afterward (Lopez, Macasaet, Ylade , etc., 2015).

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Worldwide

During the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India (WHO, 2023).

Six subsequent pandemics killed millions of people across all continents (WHO, 2023).

The first started in 1817, and subsequent pandemics began in 1829, 1852, 1863, 1881, 1889 and 1961, the last persisting until the present (WHO, 2023).

The current (seventh) pandemic started in South Asia in 1961 and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries (WHO, 2023).

Philippines

The initial documented cases of cholera originated from Pandacan, a neighborhood within Manila (WALLACE et al., 1964).

According to the official records on file at the Bureau of Health for the Philippine Islands, the last case of cholera of the pandemic which commenced March 20, 1902, was reported to have occurred March 8, 1904. During that period 166,252 cases, with 109,461 deaths, were reported (WALLACE et al., 1964).

From March 8, 1904, until Aug. 23, 1905, no cases are known to have occurred (WALLACE et al., 1964).

In the Philippines, diarrhoea was one of the top ten causes of death in 2011 (WALLACE et al., 1964).

San Lazaro Hospital is the only institution that accepted cholera patients in the Manila area (WALLACE et al., 1964).

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GOVERNMENT RESPONSE AND PUBLIC HEALTH MEASURES (CHOLERA)

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GOVERNMENT RESPONSE AND PUBLIC HEALTH MEASURES (CHOLERA)

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Before

Governor-General Valeriano Weyler denied the existence of cholera in Manila, despite documented evidence of 67,612 cholera-related deaths (Acevedo 2021).

Without assistance from the governor-general, the doctors assumed responsibility for managing the situation (Acevedo 2021).

When the outbreak occurred and cholera was identified, the unfortunate chief health officer was held responsible for not taking action (Acevedo 2021).

The Americans implemented prevention measures for cholera that shocked and scared the natives.

American forced hospitalization, burning of infected houses, and cremation of cadavers (Acevedo 2021).

Information concerning cholera is not readily available to the public, leading them to depend on their beliefs, superstitions, and cultural practices (Acevedo 2021).

Recently

Surveillance and Monitoring: The Department of Health (DOH) has set up a monitoring system to keep track of and identify cholera cases in the nation. This involves healthcare facilities reporting both suspected and confirmed cases, along with the deployment of rapid response teams to investigate and manage outbreaks (Department of Health, 2023).

Vaccination: The Department of Health (DOH) has organized vaccination efforts against cholera in areas with a high risk of the disease to stop its transmission (Department of Health, 2023).

Water, Sanitation, and Hygiene (WASH): The Department of Health (DOH) has put in place WASH measures in areas hit by cholera outbreaks. These measures involve ensuring access to clean water, building latrines, and encouraging handwashing and other hygiene habits (Department of Health, 2023).

Case Management: The Department of Health (DOH) has set up treatment facilities for individuals with cholera and has provided training to healthcare professionals on how to manage cholera cases (Department of Health, 2023).

Collaboration with Partners: The Department of Health (DOH) has partnered with global organizations, NGOs, and fellow government bodies to address cholera outbreaks. Collaborators include the World Health Organization (WHO), UNICEF, and the International Organization for Migration (IOM) (Department of Health, 2023).

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Impact of the Epidemic on the Phillipine Health care System

The government shifted its approach to combating cholera from using strict measures like the iron-hand clutch, which proved ineffective, to focusing on health promotion and education as a means to fight the disease (Acevedo 2021).

Health notices and newsletters, containing straightforward instructions to prevent cholera, were issued and distributed (Acevedo 2021).

Health officials from the Philippines received training in managing outbreaks and carrying out hygiene and sanitation initiatives within the community (Acevedo 2021).

The Health Board frequently released resolutions and bulletins advising the community on ways to stop the disease from spreading by emphasizing the importance of hygiene and cleanliness (Acevedo 2021).

The Economic Consequences of the Pandemic

The economy of the Philippines saw swift expansion during the 1950s, but this progress decelerated during the 1960s and 1970s. Economic performance in the 1980s was notably poor, primarily attributed to political turmoil, minimal savings and investment, and heavy reliance on imports (Willis, 1905).

Filipino people

The illness predominantly impacts youngsters, with 44% of the populace in the Philippines being under 14 years old. The illness has led to significant pain and loss of life, especially among communities that lack sufficient access to healthcare services .

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The final instance of cholera, starting on March 20, 1902, was documented to have happened on March 9, 1904. Throughout this time frame, a total of 166,252 cases were reported, resulting in 109,461 fatalities (Heiser, 1907).

Between March 8, 1904, and August 23, 1905, there are no recorded instances (Heiser, 1907).

For the two weeks leading up to August 23, there was a rise in the number of cases (Heiser, 1907).

On August 23, a case emerged in Bilibid Prison that displayed the characteristic clinical symptoms of cholera (Heiser, 1907).

On August 25th, a female American resident of the Grand Hotel within the walled city was assaulted and passed away shortly afterward (Heiser, 1907).

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The cholera outbreak and the COVID-19 pandemic in the Philippines have had significant impacts on public health. Cholera, caused by bacteria, is an acute diarrheal infection, while COVID-19, caused by a virus, affects the respiratory system. Both diseases spread through contaminated substances, with cholera transmitted through contaminated food or water, and COVID-19 primarily through respiratory droplets. Symptoms vary from mild to severe, and untreated severe cases can be fatal. Vaccines are available for both diseases and vaccination, along with hand hygiene and respiratory etiquette, can help prevent infection. It's crucial to understand that being vaccinated for one disease doesn't protect the other.

Containing cholera in the Philippines has been difficult because there was limited data on the disease and no systematic tracking of diarrheal diseases before 2008. However, the introduction of the Philippine Integrated Disease Surveillance and Response (PIDSR) system in 2008 and the Event-based Surveillance and Response (ESR) in 2010 have improved the availability of information for understanding the spread and location of cholera in the country.

The actions taken to control the spread of cholera have proven successful in identifying and examining suspected cases and outbreaks, as well as confirming the causes through laboratory testing. Nevertheless, public health officials encounter difficulties, such as inadequate access to clean water and sanitation, especially in densely populated slum areas and regions affected by conflict, famine, or natural calamities. These circumstances can strain healthcare systems and affect the delivery of proper medical care to cholera patients.

During the cholera epidemic in the Philippines, valuable lessons were gained regarding disease monitoring and confirmation. Systems like PIDSR and ESR played a crucial role in collecting data to understand cholera's spread and patterns. Moreover, the epidemic highlighted the necessity of tailored actions, including considering oral cholera vaccines in regions with high infection rates.

To wrap it up, addressing cholera in the Philippines has proven challenging, yet the utilization of PIDSR and ESR systems has introduced fresh data streams for evaluating cholera's spread and geographical patterns. The insights gained from the outbreak underscore the significance of monitoring, lab verification, and focused actions in managing and preventing cholera.

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The SARS-CoV-2 virus, a member of the coronavirus family that also includes viruses that cause the common cold and SARS (severe acute respiratory syndrome), is what causes COVID-19, also known as "Coronavirus Disease 2019" (Cascella et al., 2023).

The SARS-CoV-2 virus pathogen is what causes COVID-19, a contagious illness. The virus is highly transmissible through airborne viruses that originate from the coughs, sneezes, or conversations of infected individuals. Direct contact between contaminated objects and the face can result in transmission. (World Health Organization, 2020).

COVID-19 symptoms range from mild to severe respiratory illness, including fever, cough, and difficulty breathing (World Health Organization, 2023).

To slow the spread of the virus, the global community has implemented public health measures such as respirator use, quarantine, and hand sanitation, along with travel restrictions, whole lockdowns, and the creation and distribution of vaccines. (Filip et al., 2022)

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The first case in point of the pandemic was reported in January 2020 by a Chinese woman of 39 years old from Wuhan, China (Edrada et al., 2020).

On February 2, 2020, the initial COVID-19 fatality outside of China was officially documented.

Commencing on March 16, 2020, the Enhanced Community Quarantine (ECQ) was enforced by the Philippine government across Luzon, encompassing Metro Manila as well (Hapal, 2021)

Challenges afflicted the health system, including facilities that frequently reached capacity and healthcare personnel who struggled with PPE shortages.

To implement public health measures and deploy resources, the government passed the "Bayanihan to Heal As One Act" and its successor (Magno and Teehankee, 2022)

Despite the challenges, the vaccination campaign was launched in March 2021 and has since been extended to include supplementary doses.

The Philippines has progressively loosened restrictions in an effort to strike a balance between public health safety and economic recovery.

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GOVERNMENT RESPONSE AND PUBLIC HEALTH MEASURES (COVID-19)

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GOVERNMENT RESPONSE AND PUBLIC HEALTH MEASURES (COVID-19)

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Before

The Philippine government's response to the COVID-19 pandemic was characterized by strict measures aimed at controlling the virus's spread.

In March 2020, President Rodrigo Duterte placed Luzon, the country's largest and most populous island, under Enhanced Community Quarantine (ECQ), effectively a total lockdown.

This moves restricted movement, suspended work, public transportation, and educational operations, and mandated home quarantine for the majority of the population.

The government enacted the "Bayanihan to Heal As One Act" to facilitate the rapid deployment of resources for healthcare and economic relief efforts.

Public health measures were stringent, with the enforcement of mask-wearing, social distancing, and the establishment of quarantine facilities to isolate confirmed and suspected cases (Foo et al., 2022)

The country faced challenges, including healthcare system strain, PPE shortages, and economic disruptions.

After

The introduction of a tiered community quarantine system allowed for more localized and flexible responses to outbreaks.

A significant milestone was the commencement of the national vaccination campaign in March 2021, prioritizing healthcare workers, elderly citizens, and those with comorbidities, gradually expanding to include a broader segment of the population (Paloyo et al., 2021).

Public health measures were adjusted in response to the evolving situation, including updated guidelines on mask-wearing and social distancing, and the integration of digital contact tracing tools.

The government also focused on boosting healthcare capacity, securing vaccine supplies, and encouraging public compliance with health protocols to navigate the pandemic's challenges.

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Impact of the Pandemic on the Philippine Healthcare System

Healthcare facilities and hospitals were inundated, resulting in difficulties for COVID-19 patients and those with other medical conditions to access care. Healthcare personnel encountered heightened responsibilities, an increased risk of infection, and emotional strain (Gupta et al., 2021).

The Economic Consequences of the Pandemic

Lockdowns and restrictions had an impact on sectors like retail, hospitality, and tourism, which led to the closure of businesses and the loss of jobs (Mendoza, 2021).

Sectoral Education Disruptions

Technology was exposed as schools ceased operations and shifted to remote learning. The pandemic emphasized the criticality for inclusive and resilient educational technologies and approaches (Cruz and Esteban Jr., 2021).

Filipino People

Anxiety, tension, and social isolation have increased within the populace.

Social interactions and community support systems were disrupted by lockdowns. The prevalence of mental health concerns escalated, necessitating increased attention and allocation of resources to provide support (Tee et al., 2020).

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January 30, 2020: The Philippines confirmed its first case of COVID-19, a 39-year-old woman from Wuhan, China.

March 7, 2020: The first local transmission was confirmed.

March 16, 2020: Luzon, the largest and most populous island, was placed under Enhanced Community Quarantine (ECQ), effectively a lockdown.

Throughout 2020 and 2021: the country experienced waves of infections, notably with peaks influenced by the Delta variant in mid-2021.

March 1, 2021: The Philippines began its vaccination campaign.

2022-2023: Focus shifted towards vaccination efforts, managing outbreaks of new variants like Omicron, and gradually reopening the country.

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A strict approach like the Enhanced Community Quarantine (ECQ) can indicate if confinement is effective. It prevents the virus's spread, arming the healthcare system for some of its impacts. The "Bayanihan to Heal As One Act" shows how the country cooperated in fighting the pandemic by engaging in healthcare and economic growth. However, healthcare issues and the wealth disparity rendered the pandemic's consequences more unequally spread.

The Cholera Epidemic and COVID-19 Pandemic share similarities in terms of surveillance and monitoring, WASH measures, and case management. Cholera and COVID-19 also have government responses, healthcare facilities, and foreign partners working to prevent the disease's spread and provide preventive measures such as medical care to those who have contracted it. In line with this, there are certain variances between the two. COVID-19 is caused by the coronavirus, whereas cholera is caused by bacteria. During the COVID-19 pandemic, procedures such as Enhanced Community Quarantine (ECQ), lockdowns, face mask use, and travel restrictions are undertaken to limit contact with one another. The cholera epidemic has prompted hospitalization and the burning of infected houses, which is a major change from what has transpired with the pandemic we're experiencing.

This shows the ongoing challenges public health professionals have, such as assuring everyone receives the same vaccinations, fighting misinformation, and dealing with individuals who are tired of long-term limitations. The Philippines' COVID-19 pandemic response taught several lessons. Vaccinations should continue to be an integral part of pandemic control efforts, as they enable individuals to remain protected and immunized against contracting the virus. Public health approaches that have been sustained for an extended period must be modified to account for new information and conditions. Early and resolute actions can potentially preserve lives as the pandemic progresses, as they address not only the present crisis but also potential public health risks that may arise.

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