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In March 1902,  Manila faced a grave threat as cholera arrived aboard a vessel from Hong Kong. Efforts to contain the outbreak failed, despite stringent measures. The disease spread rapidly, evading containment and reaching distant corners of the archipelago. Despite concerted efforts, the outbreak persisted, claiming countless lives and devastating communities.

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- January 30 marks the beginning of the covid ¬– 19 pandemic in the country as a 38-year-old woman from Wuhan, China arrived in the Philippines via Hongkong was reported and confirmed to be infected by the virus. Travel restrictions was recommended considering the first confirmed case.

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By 19 March, the chief quarantine officer issued an order “forbidding the importation” of vegetables as well as a directive to health officials to “be on the lookout for persons suffering from bowel trouble of a suspicious character⁴.”

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The disease cholera is an infection of the small intestines that leads to diarrhea, vomiting and muscle cramps. It is caused by a bacterium called vibrio cholera that can be transmitted by unsanitary water or food. Persons infected with the disease may suffer severe dehydration and electrolyte imbalance, which may, in turn, result into death. The mortality rate for the disease is anything from 5% to 50%, depending on the availability of treatment ¹.

Occasionally, cholera epidemics worldwide reach pandemic levels, i.e. spread over a large region, multiple continents or even worldwide. The first pandemic to reach the Philippines was the one of 1852-1860, during the Spanish era ². There were passing references to this in the barrio histories of Batangas called Historical Data ³, so we know that the pandemic affected the province as well.

There is more available documentation on the sixth global pandemic which raged through the Philippines, including Batangas, from 1902-1904; and it is to this that we now devote our attention.

On 8 March 1902, American health officials in the Philippines received word that a strain of Asiatic cholera had appeared in Guangzhou, China; and that five days later it was also reported in Hong Kong. By 19 March, the chief quarantine officer issued an order "forbidding the importation" of vegetables as well as a directive to health officials to "be on the lookout for persons suffering from bowel trouble of a suspicious character ⁴."

Despite these measures, the cholera somehow managed to slip through. The following day, the Board of Health was informed by the San Juan de Dios Hospital that two patients were exhibiting symptoms of Asiatic cholera. By 22 March, the presence of the disease was confirmed. Despite efforts by American officials to contain the spread of the disease, before long it did so, in communities along the Pasig River, including Manila.

Quarantine guards were stationed "on all roads, paths and streams leading out from Manila" to prevent the disease from spreading to the provinces, but it did so, anyway. It was likely brought along with them by people who slipped quarantine by riding bancas or crossed fields instead of using roads to get out of Manila.

On 24 May, the first case of cholera infection in Batangas was confirmed in the town of Bauan. Before long, the disease started to spread. By July, cases were confirmed in the towns of Balayan, Batangas, Lipa, Taal, Lemery, Ibaan, San Juan de Bocboc, Tanauan and San Jose ⁵.

By 1 September, 3,093 people had been afflicted; and of this number, a total of 2,340 would die for a staggering 75% mortality rate. These were just the cases that were officially reported and recorded.

How the cholera spread so swiftly was likely due to a number of factors. First, there was a "scarcity of doctors in the province ⁶ " which, in turn, made diagnosis and treatment not just of cholera difficult. Sanitary conditions were also understandably poor by present-day standards, and water for drinking and personal hygiene was fetched in many cases from open wells or rivers. In fact, when the Americans first tried to control the disease in Manila by distributing distilled water, many among the uneducated suspected that they were being poisoned.

When the first case of cholera was confirmed in Batangas, it had been just a month or so since Batangueños were allowed to return to their homes from the concentration camps, where they were forced to live by the United States Army since December of the previous year. The forced concentration was a tactical move to prevent the civilian population from supporting the guerrilla efforts of General Miguel Malvar's forces.

After studying burial records in the towns of Lipa and Batangas, the historian Glenn A. May conjectured that "the zones (i.e. concentration camps) were unhealthy places to live (in) and that the number of deaths was extraordinarily high during the months of concentration ⁷."

In other words, the general state of health among Batangueños after their release from the concentration camps would have been poor, particularly in the face of a raging pandemic. This state of poor health would have continued even after the end of concentration because farms upon which families depended for subsistence had been neglected while people were in the camps. There would have been food shortages.

While the disease raged, the Board of Health decreed that no funeral services over the dead would be allowed in the churches of Batangas as a precaution against its spread. As a workaround, church services were held without the bodies of the deceased, which were often sent straight to the cemetery for burial.

In time, measures undertaken by the Board of Health would result in a decline of the disease's spread. Among others, these included an educational campaign about how to avoid becoming infected by the disease; the distribution of free distilled water; a ban on the sale of food items deemed likely to carry the disease; and the quarantine of infected localities ⁸.

Overall, however, by the time the Board of Health declared that the disease had disappeared from Luzon in 1904, in Batangas the final number of reported cases was 3,433 with 2,718 deaths. The mortality rate was a staggering 79%. There would be more outbreaks of the disease in the country in the coming years, but certainly not of the same scale as the pandemic that raged from 1902-1904.

¹ " Cholera," Wikipedia.
² " Cholera outbreaks and pandemics," Wikipedia.
³ The so-called " Historical Data" were local histories written by teachers as required by the administration of President Elpidio Quirino. These are available in digital format at the web site of the National Library of the Philippines.
⁴ Along with other details of this article, from " Third Annual Report of the Philippine Commission, Part 1," published 1902 by the Bureau of Insular Affairs.
⁵ " Report on cholera in the Philippines for the three weeks ended July 12, 1902," by J. C. Perry, published September 1902.
⁶ Along with other details of this article, from " Annual Report of the War Department, Volume XI," published 1905 by the United States War Department.
⁷ " The Zones of Batangas," by Glen A. May, published in "The Philippine Studies," 1981.
⁸ Along with other details of this article, from " A History of the Asiatic Cholera in the Philippine Islands," by Dean C. Worcester, published 1908.

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The Deadly 1902 Cholera Epidemic in the Philippines, with Special Interest on Its Consequences in Batangas - Batangas History, Culture and Folklore

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The second worldwide cholera pandemic to hit Batangas was the one that raged from 1902-1904.

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On 10 December of the previous year, all ports had been closed as part of General J. Franklin Bell's all-out effort to force Malvar's capitulation. After wartime measures ceased in April 1902, as the ports remained closed, no cholera cases appeared. Upon lifting of restrictions, the government's response failed to contain cholera. Disparities in healthcare access exacerbated its impact, particularly among the lower classes in Manila.

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The Philippine government, led by the Interagency Task Force (IATF) on Emerging Infectious Diseases chaired by the Department of Health (DOH), initiated a comprehensive response to COVID-19 through the National Action Plan (NAP). The Department of Health promptly designated COVID-19 as a nationally notifiable disease, ensuring data collection for informed response measures. WHO collaborated with DOH in disseminating COVID-19 risk information through various media channels. Additionally, the DOH and the Department of Interior and Local Government worked together to formulate policies for establishing healthcare provider networks, spanning from primary care with telemedicine to tertiary care linked to referral hospitals, in preparation for managing COVID-19 cases.

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Exactly 100 days have passed since the first confirmed COVID-19 case was announced in the Philippines on 30 January 2020, with a 38-year old female from Wuhan testing positive for the novel coronavirus. On the same day, on the other side of the world at the WHO headquarters in Geneva, WHO activated the highest level of alert by declaring COVID-19 as a public health emergency of international concern.

The Philippine government mounted a multi-sectoral response to the COVID-19, through the Interagency Task Force (IATF) on Emerging Infectious Diseases chaired by the Department of Health (DOH). Through the National Action Plan (NAP) on COVID-19, the government aims to contain the spread of COVID-19 and mitigate its socioeconomic impacts.

The Philippines implemented various actions including a community quarantine in Metro Manila which expanded to Luzon as well as other parts of the country; expanded its testing capacity from one national reference laboratory with the Research Institute of Tropical Medicine (RITM) to 23 licensed testing labs across the country; worked towards ensuring that its health care system can handle surge capacity, including for financing of services and management of cases needing isolation, quarantine and hospitalization; and addressed the social and economic impact to the community including by providing social amelioration to low income families.

The World Health Organization (WHO) has been working with Ministries of Health worldwide to prepare and respond to COVID-19. In the Philippines, WHO country office in the Philippines and its partners have been working with the Department of Health and subnational authorities to respond to the pandemic. The country level response is done with support from the WHO regional office and headquarters.

Surveillance

Surveillance is a critical component and is used to detect cases of COVID-19 as well as to understand the disease dynamics and trends and identify hotspots of disease transmission. The Department of Health included COVID-19 in the list of nationally notifiable diseases early in the outbreak to ensure that information was being collected to guide appropriate response actions. Existing surveillance systems were capitalized upon to speed up identification of cases as well as identify unusual clusters. Laboratory confirmation is a critical component of the surveillance system but cannot be the only sources of information. The non-specific symptoms and the novel nature of the disease means that the DOH, with support from WHO, are looking at all available information sources to guide response decision making. WHO also provided technical assistance to selected local government units to strengthen field surveillance for timely data for action at the local level.

Contact tracing

Contact tracing is crucial to the response. It is a system to detect and isolate cases and identify close contacts who will be advised for quarantine. It allows the investigation the system to tracjk the chain of infections as well as the settings, places, events or other avenues that where transmission have occurred or may have been amplified. A major bottleneck to doing this is the availability of timely and complete information from the hospitals for suspected, probable and confirmed COVID-19 cases. WHO assisted the DOH Epidemiology Bureau in developing COVID KAYA, a case and contact tracing reporting system for epidemiology and surveillance officers, health care providers and laboratory-based users, expanding the capacity of the previous COVID-19 information system. WHO also continued to support the government to establish the system and improve capacity for contact tracing at the city and municipal levels.

The COVID KAYA interface available on Google play store. Photo: WHO/G. Maramag

Infection prevention and control

Patients and health workers must be protected from the possible transmission of COVID-19 inside health facilities. Infection prevention and control (IPC) is vital in minimizing the harm caused by the spread of infection in these facilities. In the early part of the response, WHO supported the DOH with the provision of personal protective equipment (PPE) for health workers. To strengthen IPC, WHO and DOH developed modules and conducted online IPC training of trainers for frontline health workers in health care and community settings. The training has since been rolled out more widely by partners USAID-MTaPS and UNICEF to cover over 5,500 health workers to date.

Screenshot of the IPC for COVID-19 webinar for home and community settings conducted by UNICEF. Photo: WHO/J. Kitong

Laboratory and therapeutics access

Laboratory testing for COVID-19 is critical to be able to rapidly identify, treat and isolate the positive patients, and be able to see the bigger picture of how many people are infected and ultimately stop the transmission of the virus. Since the beginning of the response, WHO provided support to the DOH's Research Institute for Tropical Medicine with laboratory supplies and extraction kits. WHO also assisted the DOH in the accreditation of COVID-19 testing laboratories. To date, 23 real-time reverse transcription polymerase chain reaction (rRT-PCR) laboratories nationwide are now conducting COVID-19 diagnostic tests. The Philippines has also recently joined the WHO Solidarity trial to find effective COVID-19 treatment.

A lab worker at the Research Institute for Tropical Medicine prepares the samples for rRT-PCR testing. Photo: WHO/F. Tanggol

Clinical care

With a new disease, there are a lot of unknowns regarding the proper clinical management of suspect and confirmed cases. But when clinicians are armed with the necessary knowledge and skills to care for sick patients, the more the patients are likely to recover. WHO supported the frontline health workers through a webinar series on clinical management, providing up-to-date WHO clinical perspectives. At the same time, WHO also supported the DOH and the Department of Interior and Local Government in preparing policies to form health care provider networks for COVID-19, from primary care that includes telemedicine and community management, to tertiary care linking to referral hospitals.

A screenshot of the webinar series on clinical management. Photo: WHO/A. Domingo

Non-pharmaceutical interventions and mental health

Non-pharmaceutical interventions (NPIs) refer to public health measures, which are not related to medicines or vaccines, that people and communities can do to prevent the spread of infections like COVID-19. These interventions involve personal protective measures, environmental measures, physical distancing measures and travel-related measures. WHO supported the DOH in the development of a policy on NPIs as well as assisted in rapid assessment on local government capacity on NPIs and policy-gap analysis.

In times of extreme experiences brought by COVID-19, it is likely that people feel fearful and anxious. Providing mental health and psychosocial support (MHPSS) during the time of COVID-19 pandemic is important. WHO assisted the DOH in developing policy guidance and advice on integrating MHPSS within health and social services and increasing access to care to these services.

Virtual coordination with the health sector mental health and psychosocial support partners. Photo: WHO/J. Vergara

Risk communication and community engagement

Effective communication and engagement with communities is essential for people to understand the situation, know the situation and practice protective measures to protect their health, their family and the larger community. WHO supported and amplified DOH messaging by releasing various communication materials on the risk of COVID-19 and how people can protect themselves through social media and traditional media. WHO also worked with partners such as UNICEF and OCHA in reaching vulnerable groups, getting their feedback and understanding their information needs.

A CFSI representative chats with a participant to get her feedback on the COVID-19 response and information needs at the communities. Photo: CFSI

Logistics support

With lots of moving equipment and supplies required for COVID-19, logistics support is an important part of the response. WHO provided technical support to the DOH in the recalibration of PPE requirements by using WHO projection tools, provided cost estimates, and advised on streamlining the distribution flow of PPEs and other essential supplies. WHO also supported DOH in the development of a commodities dashboard that provides real-time PPE stocks at the facility level, as well as assisted in building an information system for tracking essential COVID-19 commodities.

A screenshot of the DOH commodities dashboard supported by WHO. Photo: WHO/D. Garcia

Subnational operations support

Aside from national support to the DOH, WHO is also providing subnational support in the Philippines by working with the DOH Field Implementation and Coordination Team (FICT) and the Centers for Health Development (CHDs) at the regional level. WHO conducted scoping missions in 10 out of 16 regions outside the National Capital Region to assess the needs and capacity of CHDs in responding to COVID-19. WHO staff have also been deployed in specific high-risk subnational areas in the country to provide technical support for the response. At the same time, contact tracing in subnational areas is also being strengthened with WHO, DOH Epidemiology Bureau, and UP College of Nursing developing a training programme and learning resource materials on contact tracing to build the capacity of epidemiology and surveillance officers and local contact tracing teams.

WHO staff meet visit the Regional Interagency Task Force of Cordillera Region to discuss the regional response to COVID-19. Photo: WHO/R. Santos

Responding to outbreaks in high risk areas

Closed settings like prisons and hospitals have seen clusters of confirmed cases. WHO, the DOH Epidemiology Bureau and the International Committee of the Red Cross (ICRC) worked with prison authorities and hospitals in joint contact tracing and infection prevention and control investigations. The teams provided them with guidance to prevent the further spread of infection to ensure the protection of persons deprived of liberty, hospital patients and people with mental health conditions.

WHO also supported the strengthening of community-based interventions and social support and addressing the needs of specific populations such as people with pre-existing mental and substance use disorders.

A team from WHO, DOH and ICRC visit a detention facility. Photo: WHO/H. Doroteo

Moving forward with the response

Much more needs to be done to break the chain of COVID-19 transmission. Some of the challenges that the Philippines continues to face are containing transmission of infection, mitigating the impact in high risks communities and confined settings, as well as ensuring the uniform enforcement of non-pharmaceutical interventions that are already in place. The continuation of the community quarantine will have substantial social and economic impact and thus a heightened effort to control transmission of infections through rigorous contact tracing, isolation of cases, quarantine of contacts while ensuring timely and adequate treatment to save lives will continue to be the primary public health measure. In addition, while the government is exerting all its efforts in this current situation, it also needs to prepare its health systems for surge capacity in the event that a wide-scale community transmission occurs.

In the next few days, the government will carefully consider the next steps, especially on deciding whether or not the communty quarantine will be lifted or levels of quarantine will be differentiated based on the situation of provinces. WHO strongly recommends that when the government considers adjusting public health and social measures in the context of COVID-19 the following requirements must be in place:

1. COVID-19 transmission is controlled through two complementary approaches - breaking chains of transmission by detecting, isolating, testing and treating cases and quarantining contacts and monitoring hot spots of disease circulation

2. Sufficient public health workforce and health system capacities are in place

3. Outbreak risks in high-vulnerability settings are minimized

4. Preventive measures are established in workplaces

5. Capacity to manage the risk of exporting and importing cases from communities with high risks of transmission

6. Communities are fully engaged

View an infographic on WHO Philippines' support to the COVID-19 response in the Philippines here.

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100 days of COVID-19 in the Philippines: How WHO supported the Philippine response

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The World Health Organization (WHO) has been working with Ministries of Health worldwide to prepare and respond to COVID-19. In the Philippines, WHO country office in the Philippines and its partners have been working with the Department of Health and subnational authorities to respond to the pandemic.

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were imposed in response to the cholera outbreak as part of containment efforts when it was discovered in the Farola district. Nevertheless, the sickness rapidly spread across the confined population. To prevent further spread while preserving their quality of life, the citizens were placed in detention camps.

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The cholera war involved experimental medical treatments. Army surgeons experimented with drugs like benzozone, despite their limited effectiveness and adverse effects on patients.

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Worcester conducted search and surveillance operations by organizing platoons of inspectors led by surgeons from the army volunteer brigades

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Challenges arose in enforcing measures consistently across different segments of society. Some American inspectors didn't treat the Filipinos well and enforced rules too harshly, which led to resentment and even violence.

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There are numerous accounts of how quarantine lines disrupted the flow of food from surplus to dependent towns in the provinces of Rizal, Laguna, and Batangas.

It was ultimately a choice between dying of hunger or dying of cholera.

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Instead of complying with government directives to report any cases of cholera, frightened residents hid the sick, disposed of dead bodies in waterways, or fled with the disease, contributing to its rapid spread to other districts. This mass migration from the city to provincial towns facilitated the quick transmission of the disease.

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On March 8, Duterte issued Proclamation No. 922, declaring a public health emergency as COVID-19 cases in the country reached 24. Subsequently, on March 12, Metro Manila underwent community quarantine as the government intensified efforts to curb the spread of SARS-CoV-2. From March 15 to April 14, domestic land, air, and sea travel to and from Metro Manila were suspended. Additionally, on April 3, the government mandated mask-wearing in public areas, particularly in Luzon, which was under a month-long lockdown.

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for rapid detection and assessment of cases as well as for identification of people who have been exposed to them for efficient prevention of resurgence.

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On March 25, as the cases worsened, the residents were moved to the San Lazaro detention camp.

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During public health crises, such as the cholera endemic and the COVID-19 pandemic, governments have demonstrated a need to adapt policies to suit the prevailing circumstances. For instance, during the cholera epidemic, strict burial regulations were relaxed due to religious prejudices against cremation, reflecting the government's responsiveness to cultural sensitivities. Similarly, in the current COVID-19 pandemic, lockdown measures and quarantine protocols have been modified in response to evolving circumstances and public sentiment, highlighting the importance of incorporating community feedback and scientific evidence into policy decisions.

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In 1882, the death toll in Manila reached 13,000–34,000. The Insular Board of Health made two decisions: one was to bury the bodies in seven-foot-deep graves and place them in iron coffins that were hermetically sealed, and the second was cremation.

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Many people objected to these acts for financial and/or religious reasons. Not many Filipinos have the money to buy the coffins needed to bury the dead during an outbreak. Meanwhile, burning remains would be a major wrong from a religious sense, according to both Spaniards and Filipinos.

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Cultural and religious beliefs have long influenced responses to public health measures, a dynamic evident during historical epidemics like cholera and persisting in contemporary contexts. During the cholera epidemic, resistance to cremation and strict burial regulations reflected deep-seated cultural and religious beliefs surrounding death rites. Similarly, today, cultural norms and religious practices may clash with public health recommendations, complicating efforts to combat diseases like COVID-19. Funeral customs, such as burial ceremonies or cremations, hold profound significance across cultures, often representing sacred rituals for honoring the deceased. Mandating cremation during public health emergencies may thus face resistance rooted in the need to uphold these traditions. Furthermore, recommendations for social distancing and restrictions on gatherings may challenge cultural norms centered around communal interaction, leading some to resist such measures to preserve traditional practices.

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the strictest lockdown imposed from

March to April 2020 had the most severe repercussions to the economy.

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On May 21, the Social Weather Stations (SWS) revealed that a higher number of Filipinos reported experiencing involuntary hunger amid the COVID-19 lockdown.

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MANILA, Philippines - The number of Filipinos who were hungry because of lack of available food nearly doubled while most areas were under the COVID-19 lockdowns, a survey from Social Weather Stations (SWS) noted.

SWS on Thursday said that 16.7 percent of the respondents or 3.9 million families - surveyed virtually from May 4 to 10 - experienced involuntary hunger in the past three months. This is a huge spike compared to the 8.8 percent involuntary hunger rates recorded last December 2019.

This is also the highest hunger rate registered under President Rodrigo Duterte's term, and highest since a 22.0 percent in September 2014.

According to the survey results, the hunger rate rose in all localities, but the sharpest increase was recorded in Metro Manila - the epicenter of the COVID-19 pandemic.

For the past three months, hunger rates in Metro Manila were at an alarming 20.8 percent, from just 9.3 percent in December 2019. This means that one of five Metro Manila residents or an estimated 693,000 families experienced involuntary hunger from February to April.

Moderate hunger in Metro Manila, explained by SWS as hunger only once or a few times in the last three months, rose from 7.3 percent to 19.4 percent. Ironically though, severe hunger or those who experienced hunger often or always during the said period fell, from 2.0 percent to 1.4 percent.

In Balance Luzon, the hunger rates rose from 6.3 percent to 12.6 percent (1.4 million families), from 9.3 percent to 14.6 percent (436,000 families) in the Visayas, and from 12.7 percent to 24.2 percent (709,000 families) in Mindanao.

Social aid not enough?

The recent survey also provided a follow-up question for the respondents, asking them whether their families have received any form of assistance like food packs since the COVID-19 pandemic started.

According to SWS, 99 percent said that their family received some food to cope with the crisis, opening questions whether government aid is not sufficient - especially since 99 percent of the respondents also noted that they received food packs from government.

"Government was the most common source of food-help at 99%, followed by relatives at 22%, private groups or institutions like churches and non-government organizations (NGOs) at 16%, friends at 10%, and private individuals at 8%," SWS said.

The survey also showed that the poor are more vulnerable to lockdown measures, as hunger was higher among people with fewer years of formal education: 21.1 percent among non-elementary graduates, 24.4 percent in elementary graduates.

In comparison, only 16.5 percent of high school graduates and 6.9 percent of college graduates experienced hunger in the last three months.

After Luzon and other areas were placed under an enhanced community quarantine, work - except for essential frontline services - was suspended in a bid to limit local coronavirus transmissions.

But the move has left people who rely on daily earnings and whose jobs cannot adjust to a work-from-home scheme without any income through the lockdown.

The government has implemented programs to aid families affected by the quarantine measures, like the social amelioration program which was supposed to grant 18 million families aid ranging from P5,000 to P8,000. However, several households have complained that they have yet to receive cash aid from the government.

SWS explained that they conducted the survey through mobile phones and computer-assisted telephone interviewing of 4,010 working-age Filipinos, as the lockdown measures made it difficult to conduct face-to-face interviews.

There were 294 respondents from the National Capital Region, 1,645 from Balance Luzon (or Luzon outside of Metro Manila), 792 from the Visayas, and 1,279 from Mindanao.

SWS says they are maintaining sampling error margins of ±2% for national percentages, ±6% for Metro Manila, ±2 for Balance Luzon, ±3% Visayas, and ±3% in Mindanao.

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Number of hungry Filipinos almost doubles as pandemic rages - SWS

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MANILA, Philippines - The number of Filipinos who were hungry because of lack of available food nearly doubled while most areas were under the COVID-19 lockdowns, a survey from Social Weather

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During both outbreaks, health literacy was a major problem because Filipinos valued superstitious health beliefs and myths above scientifically proven health practices. People were more likely to trust false information than to listen to medical professionals' recommendations. Nevertheless, this is not the only reason for the rise of COVID-19 or cholera cases. Instead, certain policies like the use of metal coffins during the cholera outbreak, the restricted access to basic medical treatment during the COVID-19 pandemic, and the strict quarantine regulations failed to consider the lower class's financial situation. Low-wage employees depend on their daily jobs because of no-work pay policies. When companies close their doors, the economy slows down. These people can find themselves suddenly without a way to pay for necessities, especially health care. Health care is accessible to those who can afford it. Several people delayed or refrained from obtaining medical attention during the epidemic because they were worried about the expense. Sadly, Filipinos in their own country have limited access to health care compared to foreign nationals such as the Chinese and Americans during the cholera epidemic. It was hard for Filipinos to comply with such regulations as the use of metal coffins because they can't afford it.

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A significant factor behind the rising number of unwell individuals in the Philippines is the low health literacy rate among Filipinos, particularly in underprivileged areas. On an individual level, it is important to be health literate and educated to be equipped with knowledgable about preventive measures, transmission modes, and the importance of vaccination. Healthcare literacy is providing individuals with medical knowledge (Santiago, 2019). Health-literate people are better able to make decisions that affect their health. If Filipinos can understand health information fluently, they can be a key stakeholder to the government to effectively implement health regulations.

Santiago. (2019). Health Literacy for All Filipinos. Philippine Medical Association.

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Addressing socioeconomic disparities towards health equity

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Addressing socioeconomic disparities towards health equity

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When implementing Government policies, it is important to consider all stakeholders especially the underprivileged. It is not right to solely blame the failure of health on the people who are composed of superstitious and illiterate to health. The health policy should be based on scientific measures and address socioeconomic disparities. Focusing on the root causes of socioeconomic inequality enhances the equity and accessibility of healthcare so that underprivileged populations can comply with health interventions.

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April 12 - The first local, targeted virus mass testing in Metro Manila officially began.

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MANILA, Philippines - The first localized, targeted COVID-19 mass testing began in Valenzuela City on Saturday, with the procedure being administered for free to medical front-liners, returning overseas Filipino workers and residents being monitored for coronavirus symptoms.

The family members of two nurses earlier found positive for the virus were among the first to be tested using South Korean-made kits approved by the Food and Drug Administration, Mayor Rex Gatchalian said in a press briefing.

The samples taken will be subjected to confirmatory tests at The Medical City (TMC) in Pasig City. The hospital can accommodate a minimum of 25 samples from Valenzuela in a day, and can produce results two days from the time the samples are submitted, Gatchalian said.

The tests were the result of an agreement reached by the Valenzuela City government and the private hospital on April 3. At that time, the TMC was only one step away from being accredited as a laboratory by the Department of Health (DOH).

Polymerase chain reaction

TMC's laboratory uses a polymerase chain reaction machine that is compatible with the test kits procured by the city government. Each test costs a total of P5,100, including the P2,500 laboratory processing fee. The cost of each test will be shouldered by the city government.

Sen. Sherwin Gatchalian, the mayor's brother who also helped facilitate the testing in Valenzuela, said local government units must rise to the challenge "in the next 18 days (the remaining period of the Luzon lockdown) to ramp up the volume of mass testing all the way up to 10,000 tests a day.

"That is a very important milestone because if we can't do this, we [can] not assess the real situation of the country," the senator said, noting that the limited number of DOH-accredited laboratories remained a problem.

Meanwhile, Quezon City, which so far has the largest number of COVID-19 cases among local government units, is also set to begin community-based testing next week.

The local health department chief, Dr. Esperanza Arias, said the city would be using the initial 1,300 test kits provided by the DOH.

After this, the city government will get an additional batch of 1,500 test kits through a partnership with the Philippine Red Cross, she said.

According to Dr. Rolando Cruz, head of the department's epidemiology and surveillance unit, only people showing COVID-19 symptoms would be tested in Quezon City.

"We will test people with cough and colds, influenza-like symptoms or those experiencing flu and acute respiratory infection," Cruz said.

Temporary isolation sites

Those who will test positive, along with residents from urban poor communities who are monitored for symptoms, will be referred to the city's temporary isolation sites that were set up to relieve hospitals that have already reached full capacity.

The Quezon City testing centers will be equipped with swab booths that will limit the need for personal protective equipment. The samples will then be sent to the Research Institute for Tropical Medicine (RITM) for testing.

Arias said the results can be expected in two to three days.

"Right now, only RITM runs the tests, that's why it will take that long. But we are setting up partnerships [also] with Red Cross, St. Luke's [Medical Center] and the Lung Center [of the Philippines]," Arias said.

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The first localized, targeted COVID-19 mass testing began in Valenzuela City on Saturday, with the procedure being administered for free to medical front-liners, returning overseas Filipino workers and residents being monitored for coronavirus symptoms.