Timeline: Pandemics in Perspective - Cholera and Covid-19 by Alezandra Escaro

Public Health Measures

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Quarantine

Sanitation Protocols

Public Education and Campaign

Surveillance & House Burning

Isolation and Case Management

Cholera in Farola

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Cholera is a waterborne virus that first appeared in India in 1817 and has since caused seven pandemics. The Philippines is one of the countries most impacted by the sixth pandemic (1899–1923). The first cholera cases in the Philippines were discovered in the barrio of Farola, near the Pasig River, where many people live and work; the diseases were thought to have arrived on a Hong Kong vessel on March 14, 1902. Despite strict quarantine measures, the cholera outbreak in the Philippines lasted from 1902 to 1904, killing over 200,000 people.

Government Response

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Quarantine: Under American rule led by Interior Secretary Dean Worcester, quarantine measures were enforced employing both civilian and military personnel to contain its spread. Despite these efforts, the effectiveness of the measures was compromised as individuals found ways to evade restrictions under cover of night, and some movements of American troops inadvertently contributed to its transmission beyond Manila.

Inspections and Port Restriction

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House-to-house inspections were initiated, and residences confirmed to have cholera cases were subjected to incineration. Ports were tightly regulated and shut down to stem the spread and maintain sanitation; however, their efficacy was compromised as individuals persisted in passing through. The enforcement of quarantine measures and port restrictions also exacerbated poverty and led to food shortages, as the distribution of food was disrupted.

First COVID-19 case in the Philippines

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The novel coronavirus, known as COVID-19, is an airborne virus that originated in Wuhan, China, in 2019. The first documented case of COVID-19 in Manila, Philippines, occurred when a couple from Wuhan traveled to the country on January 21, 2020. The escalation of the disease outbreak in the Philippines became evident on March 6, 2020, when the first local community case was confirmed in Cainta, Rizal, involving a 62-year-old Filipino with no recent travel history abroad. Current statistics indicate that COVID-19 has claimed the lives of over 66,000 individuals in the Philippines.

Government Response

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Quarantine: President Rodrigo Duterte implemented enhanced community quarantine for the entire province of Luzon from March 16, 2020, to April 12, 2020, in an effort to curb the virus's spread. Stringent surveillance and measures were enforced, permitting individuals to venture outside only for essential items such as food, medicine, and basic necessities. Despite these efforts, the virus persisted, with cases rising from May to August 2020 in various regions beyond Metro Manila. Consequently, President Duterte instituted varying levels of quarantine measures in the affected regions.

Draconian measures

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During the COVID-19 pandemic, the Philippines enforced some of the strictest quarantine measures. President Duterte warned of punishment, including imprisonment, for those who disobeyed these measures, instilling fear among the populace. Police and military personnel were tasked with enforcing the quarantine, while the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) was primarily composed of former generals, lacking epidemiologists. The government's intense focus on virus containment worsened conditions for the poor, overshadowing their needs and livelihoods.

Public Health Measures

2023001021 — 2024-02-24 09:55:24 UTC

Case Isolation & Contact Tracing

Physical Distancing

Mandatory Use of Face Mask & Face Shield in Public

Quarantine

Mass Vaccination

Contribution to Medical Science

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Improvements in Sanitation and Public Health Infrastructure

Sanitary Programs such as investments in clean water supply systems, sewage treatment facilities, and hygiene education programs.
Vector Control a safety measure in which it aims to limit the contact to mammals, birds, insects or other arthropods which transmit disease pathogens.
Medical Science Discoveries

Germ Theory refers to the scientific idea that certain microbes, known as germs, are responsible for various diseases.

Contribution to Medical Science

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Rapid Vaccine Developments, CoVid-19 Vaccines such as;
- Pfizer-BioNTech from Mainz, Germany
- Moderna CoVid-19 Vaccine from Norwood, Massachusetts

Advancement in Testing Technologies
- Real-time reverse-transcription polymerase chain reaction（RT-PCR）
- Digital polymerase chain reaction (dPCR)
- Reverse-transcription loop-mediated isothermal amplification (RT-LAMP)
- CRISPR-based assays

Mortality Rate

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According to Heiser (1907), as per the official documents kept by the Philippine Islands Bureau of Health, the final case of cholera during the pandemic that started on March 20, 1902, was recorded on March 8, 1904. A total of 109,461 deaths and 166,252 cases for the 25-50 % mortality rate were documented throughout that time.

Economic Situation

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With the strict implementation of the quarantine during that period, there was an imbalance in its economic and agricultural situation. With rice and food shortages - regions are dependent on each other’s market goods, creating a high relationship between supply and demand in their markets. Sneaking and smuggling in places just to buy and sell agricultural goods - thus the spreading of the cholera—without minding the quarantine regulations that were enforced. After many months, the Filipino PMO and its American counterpart proposed to ease the quarantine restriction for the reason that it resulted in the country’s poor farm harvests, war collaterals hampered the farming system, parasites, pests, and insects eating up the farmer’s agricultural goods, and yet the quarantine measures restricted the farmers from tilling their farms. Nevertheless, tenants were still forced to pay up their annual rent even though their livelihood was confined by the quarantine outbreak.

Mortality Rate

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In accordance to WHO (2022), with 60,610 cumulative deaths out of 3,710,145 total cases of COVID-19, the Philippines is one of the hotspots for the virus in the Western Pacific Region.The Philippines had the most number of cases ever recorded in January 2022 (215 508), after which there was a steady decline in cases. During the height of the pandemic in 2020, the DOH reported 1.8% of deaths and Case Fatality Rate (CFR) on the month of august. Additionally, according to a study (2022), Prior to the revelation of SARS-CoV-2 mutations, a sizable cohort of confirmed COVID-19 cases in the Philippines, an LMIC, was included in the report, which offers significant epidemiological data. The 18.2% in-hospital death rate that was reported was in line with local studies that were carried out at the same time. A countrywide multicenter trial with 10,881 patients revealed a 15.6% mortality rate, while a 200-patient cohort from the same institution reported a 17.5% mortality rate. The NCR government and private tertiary hospitals' mortality rates, which were 21% and 15%, respectively, roughly matched our findings. The underlying health infrastructures and policies in place may account for regional variations in mortality. For instance, the world's longest and harshest lockdown was imposed in the Philippines, which may have helped to slow the increase of cases. However, additional variables like inadequate healthcare-seeking behavior, underreporting, undertesting, and restricted access to COVID-19 services could have also had an impact on the death rates.

Economic Situation

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As stated in a study (2020), due to early mortality, reduced productivity, and workplace inactivity, the COVID-19 pandemic has directly impacted people's income. It has also generated a negative supply shock, slowing down manufacturing production as a result of disruptions to global supply chains and factory closures. The study also discussed that consumers generally altered their buying habits in addition to the effects on productive economic activities. This was mostly because of declining household income and finances, as well as the anxiety and terror that accompany the pandemic. Because fewer people are traveling, service sectors including tourism, hospitality, and transportation have seen severe losses.