History repeats itself: A comparative timeline of the Cholera Epidemic and COVID-19 Pandemic by DEBORAH JEI CATALUÑA

COVID-19 Pandemic (2019)

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Cholera Epidemic (1902)

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Key event

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December 31, 2019:
A number of pneumonia cases have been reported in Wuhan, Hubei Province, by the Wuhan Municipal Health Commission in China. Eventually, a novel coronavirus was discovered. (WHO, 2020)

President Duterte dismissed the threat posed by a highly contagious virus from China that may cause widespread infections in the Philippines. (Business World, 2021)
January 30, 2020:
The first case of COVID-19 was recorded in the Philippines with a Chinese citizen.
March 7, 2020:
The first case of COVID-19 that is detected from a local citizen. (Quisao et. al, 2021)
March 9, 2020:
The Department of Health confirmed the local COVID-19 transmission in the Philippines, prompting President Rodrigo Duterte to proclaim a state of public health emergency. (Xinhua, 2020)

Key event

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1817:
The first global cholera epidemic, when the disease traveled from India to southern Russia and other Asian nations including China and Japan via trade routes. (UK Parliament, n.d.)
March 20, 1902:
The start of the outbreak of Cholera in the Philippines.

Government Response

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March 15, 2020:
Implementation of "community quarantine" as a limitation measure to control the spread of the virus. Also putting curfews in different places, monitoring social gatherings, and controlling business activities. (Jiang et. al, 2022)
2020:
The Social Amelioration Program (SAP) aimed to assist 82% of the nation's population, which included elderly citizens, people with disabilities, single parents, Filipino workers in distress abroad, indigenous people, the homeless, farmers, fishermen, self-employed individuals, and informal settlers. The program lasted 2 months with cash grants varying in amount from ₱5,000 to ₱8,000 per month. The initiative was able to reach 98% of the target families by the end of November. (Southeast Asia Development Solutions, 2021)
2020:
LGUs used their reserve funds to organize the disinfection operation and supply home relief supplies, primarily food like rice and canned foods. (Gutierrez, 2020)

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The start of the pandemic and the epidemic became a major problem for the country especially for the government during both timelines. This reflects the level of unpreparedness that the government had as they are not equipped enough to face such problems, thus, the number of unexpected problems that occurred and the impacts it had on the country. Aside from this, the incompetence and belittling of the government during the first months of the pandemic resulted to the lack of preparations. From this, it is evident how despite the difference in time, the country still is taken aback when faced with a health crisis, hence, the need for further improvements.

Government Response

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March 1902:
A quarantine was imposed in Manila to stop the spread of the disease, and inspectors visited home to house across the city at all hours of the day and night to ensure that no cholera cases went undiscovered.

Guards posted around homes and communities of cholera victims to ensure isolation, a strong effort to sanitize the areas, and the deployment of smudge pots to keep insects and flies away were implemented. (Gillett, 1995)
April 16, 1902:
General Malvar surrendered from the US forces as cholera would spread around Laguna if he had decided otherwise. (Ileto, 1988)

Public Health Response

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May 11, 2020:
Promotion of cleaning and hygiene tips to combat the spread of the virus. (UNICEF, 2020)
December 15, 2020:
The government imposed the mandatory use of face masks and face shields in public areas in order to control the spread of the virus. (Presidential Communication Office, 2020)
March 1, 2021:
To mitigate the unprecedented health, social, and economic damage of COVID-19, the Philippines undertook a nationwide vaccination program to manage the effects of the global pandemic. The goal was to vaccinate 70 million of the people by the end of the year. (Caple et. al, 2022)

Public Health Response

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1902:
The Philippine Board of Health was forced to block all of the city's shallow wells and have a few new ones driven to a depth of 700–1,000 feet when cholera struck Manila.

Medical officers were mandated to establish municipal boards in areas where none previously existed, stop stream pollution, and notify their division chiefs of any cholera cases.

The American school teachers were instructed by the Philippine Board of Health to inform their fellow citizens about the causes of cholera and preventative measures. (Gillett, 1995)

Impact on Society

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The pandemic contributed to greater inequality in urban areas and was especially hard on low-income urban households.
People have lost their jobs and means of livelihood as a result of lockdowns and social distancing measures, making it difficult for them to pay for housing and food. One of the primary routes out of poverty for low-income children has been cut off by the closure of the schools. (Kharas et. al, 2021)
Due to social restraints brought on by the COVID-19 pandemic, people were forced to adjust to isolation, which raised the likelihood of family violence, sadness, anxiety, and post-traumatic stress disorders.(Hosseinzadeh, 2022)

Impact on Economy

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Over 83% of families in 10 cities in Metro Manila and 4 cities in Cebu reported a decrease in income, approximately 34% claimed to have lost their source of income entirely. Additionally, 33% skip their meals due to lack of money.
The Philippines' National Economic Development Authority announced a 9.5% total drop in GDP for 2020, with the largest decline occurring in the second quarter during which the most severe lockdown or community quarantine was in place. (Javier, 2022)

Impact on Society

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1902:
Due to the continuous number of cholera victims in Calamba, Laguna, agricultural flow like rice plantations was affected as a supposedly medical aid to inhibit the disease which somehow, did no good as the domino effect of starvation and famine health risks for Filipinos became now the primary cause of death.

Despite efforts to minimize suffering, the reality of starvation and disease remained. Surrender became a matter of survival as food supplies dwindled and the threat of death loomed. (Ileto, 1998)

Impact on Economy

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Internal trade was halted by the exact quarantine regulations intended to stop the spread of cholera, thus weakening the Philippine economy. (Gillett, 1995)
Calamba was rice-dependent on neighboring towns of Cabuyao and Binan for a while. (Ileto, 1988)

Challenges faced

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April 2021: Unpaid benefits and a shortage of medical-grade personal protective equipment (PPE) are other issues facing workers. (Amnesty International, 2021)
August 2021: According to an emergency medicine specialist, individuals in the Philippines are waiting two to three days to be admitted from the emergency room to a ward specifically designated for Covid-19 cases as the number of coronavirus cases rises. A number of major hospitals in Metro Manila, including St. Luke's Medical Centre, The Medical City, National Kidney and Transplant Institute, Adventist Medical Center, and Medical Centre Manila, have already filled up to capacity with Covid-19 patients. (The Straits Times, 2021)

Challenges faced

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Lack of knowledge, crowdedness, poor living conditions, and poverty have all been linked to the spread Cholera.
1903: The Philippine Board of Health encountered challenges in locating sufficient space to separate those who had come into contact with Cholera as well as in providing beds for those who could not be maintained in their own homes. (Gillett, 1995)

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Both the pandemic and epidemic that occurred in the Philippines in different timelines had both governments implement quarantine to control the spread of disease. However, a difference in the cholera epidemic was that there were just limited responses that the government could give to those who were affected due to the lack of facilities and other different priorities the people had. Aside from this, they also lacked sufficient knowledge on the appropriate measures to take during these kinds of health crisis. On the other hand, during the COVID 19 pandemic, there were more effective government responses which helped many of the affected people. This includes the cash aids, supplies, and food which were provided by the government.

Furthermore, the pandemic response was not near perfect, it still had a lot of flaws in terms of consistency and distribution to all Filipinos. However, this was still an improvement in comparison to what occurred during the cholera outbreak as the lessons during the epidemic such as sanitation and hygiene were carried out during the latest pandemic.

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From the two major health crisis the country experienced, the dissemination of health information was the topmost similarity of public health response. In addition to this, an immense improvement in the response during the pandemic is evident, PPEs and vaccination programs that didn’t exist during the 19th century paved the way to a better handling of the virus. Furthermore, this goes to show how much the country has evolved in terms of access to knowledge and supplies when combating an epidemic or pandemic. Resulting to a more effective public health response.

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In both the epidemic and pandemic, the Philippines encountered a crisis in the availability of healthcare facilities to accommodate the infected victims. Aside from this, there had been a crisis of health workers being underpaid along with the lack of supply of PPEs that could protect them from the virus. From this, it is apparent that in both periods, the country is still unable to handle a health crisis that could potentially lead to a mass of patients due to its insufficient equipment and facilities. Highlighting the need for improvement in the country’s healthcare system.

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Both the epidemic and pandemic in the Philippines caused a disruption in the functioning of society as a whole. These resulted in the increase of poverty rate and prevalence of starvation among Filipinos, especially those that belong to low-income households. Aside from this, psychological effects were more experienced during the pandemic due to the prolonged mandated community lock down. Hence, resulting to lasting impacts on the mental wellness of the majority. From this, it is evident that the country is still vulnerable and is receiving insufficient protection from the government when faced with a major health crisis like a pandemic. Implying that the country still has a long way to go to be considered prepared to face another health crisis.

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The country’s economy took a downfall resulting in the suffering of many individuals during the pandemic and epidemic. Since the country and the government are not equipped for these situations, they failed to take control of the economy of the country during times of crisis. Hence, devising an aid or solution to one of the country’s biggest challenges will prepare the country to be more ready for potential pandemics in the future, thus, having the ability to maintain and increase the economy even during a crisis. Also resulting to the decrease of suffering for the people.

Reference List

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Key Event

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July 21, 2023:
President Marcos Jr. lifts the state of Public Health Emergency throughout the Philippines due to COVID-19. (National Archives of the Philippines, 2023)
The COVID-19 pandemic in the Philippines reports 4,140,383 cases, 66,864 deaths, and 4,067,381 recoveries. (Worldometer, 2024)

Key Event

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March 8, 1904:
The end of the cholera outbreak in the Philippines.
The cholera epidemic in the Philippines during the 19th century reports 166,252 cases, with 109,461 deaths. (Heiser, 1907)

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Both the pandemic and epidemic in the country had a huge impact from then until now. Due to the lack of health treatments in the past, the cholera epidemic was not approached well, resulting in the large number of deaths. On the other hand, the COVID 19 pandemic resulted in a higher number of people becoming infected than the cholera epidemic, however, reported less deaths.

In the period of the cholera epidemic facing poor hygiene and lack of health system and services to treat the infected were prioritized. Hence, after the epidemic, there has been an improvement in maintaining the environment clean and safe because of the lessons learned from the past. Aside from this, during the pandemic, the government learned to implement new protocols to reduce the risks of other possible outbreaks.