Pandemics Across Time: Mapping the Timeline of COVID-19 and Cholera by EROL GABRIEL SOLIMAN

Key Events

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Government Response

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Public Health Measures

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Impact on Society

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Cholera Epidemic

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COVID-19 Pandemic

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/ FIRST CASE / MANILA - MARCH 14, 1902

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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.

/FIRST CASE / MANILA – January 30, 2020

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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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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.

Government Response

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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.

Quarantine measures

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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.

EXPERIMENTAL MEDICAL TREATMENTS

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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.

SEARCH AND SURVEILLANCE

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

SANITARY MEASURE

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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.

FAMINE

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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.

QUARANTINE MEASURES

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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.

CONTACT TRACING

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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.

Compare and Contrast

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Policy changes

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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.

Socio Economic and Cultural barriers

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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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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.

Insights

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Health literate

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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.

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.