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DIVIDED RESPONSE DISSECTING METRO MANILA LGU’S RESPONSES TO COVID-19 Enrico Berdos, Juan Miguel Casiño, Robyn Isabelle Cortez
President
Rodrigo Duterte placed Metro Manila (MM) under a onemonth enhanced community quarantine (ECQ) on March 15 to minimize the spread of the new coronavirus disease (COVID-19), forcing cities in the National Capital Region (NCR) to implement curfews, social distancing, and transport freeze.
COVID-19 is an infectious respiratory disease first identified on November 2019 in Hubei province, China. It has infected over 1.4 million people and resulted in over 81,500 deaths worldwide, according to the World Health Organization’s update as of April 9. As of April 9, 54.24 percent of cases in the Philippines are concentrated
in the NCR. Reports from MM’s local government units (LGUs) dated April 7 to 9 show NCR has a total of 2,211 cases and 252 deaths. Days after Duterte’s announcement, the LGUs had to conceptualize and implement different initiatives to prevent the spread of the virus in their areas
and help their constituents cope with difficulties caused by the ECQ. LGUs’ aid to constituents Most LGUs in the region have distributed relief goods, financial assistance, disinfection drives, and mobile markets to their constituents, with notable efforts from some cities and municipalities. RESPONSE
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communicated clearly and transparently to the LGUs’ residents?
In terms of food aid, Valenzuela employed a food voucher system, while Pateros residents reported receiving six kilograms of rice and 14 canned goods per household. Some cities such as Makati, Pasig, and Manila have rolled out one-time financial assistance to target recipients such as drivers, workers, and senior citizens. According to Philippine Statistics Authority (PSA) Assistant Secretary Rosalinda Bautista, a family of five can survive with a minimum monthly wage of P10,727. A worker’s minimum wage rate in Manila ranges from P500 to P537, according to the Department of Labor and Employment. Jeepney, tricycle and UV Express drivers earn from P300 to P1,000 daily. Assuming that the financial assistance provided by these cities’ LGUs is a one-time aid, the recipients receive almost a week’s worth of daily wages, but still less than the PSA’s monthly family living wage. Almost all LGUs in MM, except Pateros, have carried out disinfection and sanitation drives through their respective towns and barangays to ensure schools and roads remain clean to aid in the fight against COVID-19. Schools such as the Padre Burgos Elementary School in Pasay, San Juan Science High School, Pateros Elementary School, and hotels in Valenzuela and Quezon City have been converted into isolation facilities for persons under monitoring (PUMs) and persons under investigation (PUIs). Health Initiatives and Testing Projects related to resolving the COVID-19 health crisis include the accreditation of testing centers, establishment of quarantine areas and isolation units, and free testing. Early on, Marikina Mayor Marcy Teodoro pushed for the establishment of a COVID-19 testing center in his area. After the Department of Health (DOH) rejected Marikina’s first testing center proposal on March 26 due to location issues, the city then proceeded to build a new testing center building with DOH’s approval. Cities such as Caloocan, Navotas, and Taguig have put up health centers where those who have COVID-19 symptoms or travel histories can get medical attention. Meanwhile, Muntinlupa, Pateros, Pasay, Quezon City, San Juan, and Valenzuela have designated quarantine areas and isolation units for PUIs and PUMs to minimize the spread of the disease. The processing of tests in MM has been carried out primarily by five accredited testing centers: the Research Institute for Tropical Medicine in Muntinlupa, San Lazaro Hospital and University of the Philippines National Institutes of Health in Manila, and Lung Center of the Philippines and St. Luke’s Medical Center in Quezon City. Among the most recent additions to the accredited testing
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Transparency Each LGU posts on their respective Facebook pages to update their constituents of programs being undertaken to alleviate financial and food shortages brought about by the pandemic. Among them, Navotas has shown to be transparent compared to its counterparts. The city’s Facebook page provides daily updates on the number of relief goods distributed in various barangays, as well as daily reminders on which areas are getting visited by their mobile market program. Pasig does not often post on which areas have been covered by relief goods operations, but they do give daily updates on their mobile palengke program, COVID-19 health reminders, and other related projects. Makati, Parañaque, and Taguig have been proactive in sharing which areas have been given financial and food aid, but their updates are often filled with comments from residents saying they have not received relief goods or cash assistance yet. Manila, Caloocan, and Pasay, which all have more than a hundred barangays, are struggling to provide aid in their areas, as shown by the lack of updates on relief efforts and feedback from their constituents. The municipality of Pateros does not often post its current operations against the virus nor provide daily updates on COVID-19 cases in their town.
centers is The Medical City, which has recently entered into a partnership with Valenzuela to facilitate mass testing within the LGU starting April 11. Valenzuela City Mayor Rex Gatchalian said the city government would be in charge of procuring the test, extraction, and swab kits which will be used by the hospital for their testing. Citing increases in the estimated daily capacity for testing, National Task Force (NTF) COVID-19 chief implementer Secretary Carlito Galvez Jr. said they plan to implement mass testing by April 14 at the earliest. Aside from formulating healthcentered responses, LGUs also had to ensure that essential travel remains unhindered. Implementation of the ECQ has suspended land, sea and air travel to and from Luzon to restrict human movement and therefore limit COVID-19 spread. Transportation The Department of Transportation (DOTr) allowed private vehicles carrying only one passenger to leave their homes to purchase basic necessities and medical supplies.
For those with no private vehicles, LGUs and national government offices alike provided their constituents affordable transportation. Of the 17 MM LGUs, 15 offer at least one form of public transport to carry frontliners, patients, and essential workers around their respective areas. In Pasay, transportation is not just limited to carrying people as two M35 trucks have also been provided for the delivery of medical supplies to various NCR hospitals. Both Manila and Pasig have taken to renting e-tricycles to provide transportation for medical workers, with the latter also launching a transportation service for patients. Complementing these local initiatives are those operated by national government offices such as the DOTr, the Armed Forces of the Philippines, and the Office of the Vice President, all of whom offer their own free transportation services for health workers and frontliners throughout the region. But are these efforts in terms of transportation, health, food supply, and financial aid
Assessment of the responses Whether through distributing relief goods or financial assistance, spearheading health-related initiatives, or organizing transportation for essential travel, all LGUs have done their part one way or another to assist their citizens in coping with the crisis. The overall response, however, has been varied at best. Without a coordinated masterplan for all the MM cities to execute in times of health crises, LGUs have no choice but to formulate and implement projects that consider their budget, their constituents’ needs, and judgment of elected local officials. Almost a month into the quarantine, the disparity between how Pateros provides six kilograms of rice and 14 canned goods compared to Pasay’s relief packs with two kilograms of rice and two to four cans of sardines, or how several residents in Quezon City and Manila claim they have not received relief goods could cause further unrest, especially in cities where LGUs are not as efficient in distributing essential help. Despite a lack of coordination in governance, LGUs are united in their desire to stop the spread of COVID-19 and help their constituents get through the ECQ. Only time and eventual feedback from the people, will tell whether such efforts prove effective. .#
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DIFFERENT
PROVINCIAL COUNTERMEASURES FOR COVID-19 Rita Galvez, Christina Quiambao, Laurice Sy
The coronavirus disease (COVID-19)
makes no distinction between province or metropolis, which gives additional challenges for local government units (LGUs) responding to the pandemic. Without an overarching plan from the national government, the countermeasures for COVID-19 falls unto LGUs. As of April 8, the Philippines has 3,870 confirmed cases. These regions have the highest number of confirmed cases: Calabarzon, Cagayan, Central Luzon, Central Visayas, and Davao. Calabarzon has 127 cases, the highest outside the National Capital Region. The endcov.ph tracker shows these provinces have the most confirmed cases: Rizal, Davao Del Sur, Cavite, Bulacan, Laguna, Cebu, Batangas, Nueva Ecija, Pampanga, and Cagayan. A confirmed case uses one kit to detect the virus and will use two to three later to confirm their recovery. The high demand leaves some provinces dependent on the Department of Health (DOH) and private sectors for test kits. Power company MORE Electric and Power Corp. donated 500 rapid test kits for Iloilo on top of the 5,000 test kits provided by DOH. Private water distribution company Metro Pacific Water donated P1.2 million to get more. Cavite Governor Jonvic Remulla plans to get 900 persons under investigation (PUIs) tested after the Holy Week using 20,000 test kits. Medical protocols and preventive measures Department of Interior and Local Government Secretary Eduardo Año ordered the creation of Barangay Health Emergency Response Teams to ensure all citizens are accounted for. But the lack of national directives and protocols in the earlier days of the pandemic forced provinces to ensure the safety of their constituents on their own.
Cagayan Valley relied on national government protocols for its supplies and personal protective equipment (PPEs). Requests for PPEs are sent via email and processed by DOH or its regional offices. Donations from the private sector are also consolidated by the Office of Civil Defense before being turned over to DOH for distribution. Health Undersecretary Maria Rosario Vergeire said the DOH has been able to release requested PPEs in the regions of Ilocos, Cagayan Valley, Apayao, Cordillera, Calabarzon, and Sorsogon. Cagayan was only able to receive these PPEs on April 1, two weeks after the implementation of Luzon-wide Enhanced Community Quarantine (ECQ). Davao del Sur proposed a budget of P20 million to buy PPEs for health workers and aid residents who lost income due to the ECQ. Since the Davao ECQ only took effect on
“
April 4, it has yet to announce and implement medical protocols and prevention programs for the province. Common preventive measures such as disinfecting public areas, constructing testing and quarantine facilities, providing housing for health workers, and procuring budget for PPEs have been adopted. Symptomatic persons in Bulacan are placed under a Barangay Unit Isolation and will await testing from a health official. Gov. Daniel Fernando said they will use the newly built extension building of the Bulacan Medical Center as its central quarantine facility to isolate those infected with COVID-19. Cavite, which has a laboratory capable of testing at De La Salle UniversityDasmariñas, awaits certification from DOH and Research Institute for Tropical Medicine. It is expecting certification by April 12.
The lack of national directives and protocols in the earlier days of the pandemic forced provinces to ensure the safety of their constituents on their own.
Cebu Governor Edgar Labella coordinates with the Fire Department for the disinfection of barangays and endorses housing initiatives of White Knight and Bradford Church Cebu which offers 40 free rooms for medical frontliners. Implementation of Safety Measures Several provinces have been put under lockdown, which includes checkpoints, curfews, and social distancing. Residents are instructed to stay at home with exceptions made only for those holding quarantine passes or providing needed services such as medical, funeral, food, banking, utility, or security services. Laguna has made a protocol stating that people are not allowed to leave their homes without wearing proper safety equipment. The Ilonggo city council was pushed to amend the existing antidiscrimination ordinance in order for its frontliners to be better protected against discrimination by businesses. LGUs and police forces have been quick to respond to those that violate safety guidelines. In Central Luzon, over 11,000 residents were arrested and fined for violating the ECQ in the first two weeks of lockdown. They were caught breaking curfew, smoking or drinking in prohibited places, and disregarding checkpoint rules. Criminal charges were also filed against Cavite Mayor Dino Reyes Chua and two others for allegedly spreading false information on a COVID-19 case in the city. Rappler reports Chua remains “unfazed” and is ready to defend himself in court, citing his Facebook post which continues to criticize LGUs’ responses. They face two months in jail and/or a fine of up to P1 million if they are found to have created, perpetrated, or spread false COUNTER-MEASURES
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information on the crisis in line with the Bayanihan to Heal as One Act. Relief Efforts Aurora’s official government website reported distribution of 7,000 food packs and predicts bringing the number up to 15,700 after the second wave of distribution. Technical Education and Skills Development Authority (TESDA) also distributed goods, obtained through volunteer work, to different parts of Cagayan Valley. Under the Bayanihan Act, the Department of Social Welfare and Development is set to aid the vulnerable. In Central Visayas, beneficiaries will receive P6,000 based on the region’s minimum wage of P404 multiplied by 15 days. Several LGUs have also established mobile markets for citizens and farmers, as in the case of Tacloban. This is to lessen crowds in wet markets and public establishments while the city is quarantined. LGUs have also taken initiatives to ensure that their frontliners are cared for. In Iloilo, the LGU and residents have worked together to provide temporary dorms for health care workers, shuttle services for nurses and doctors, and PPEs for frontliners. In order to provide respite to citizens, guidelines have also been implemented by the national government. A price freeze for basic necessities was implemented upon the declaration of a state of calamity. Under this, LGUs were encouraged to form teams which could help in ensuring that needed goods were not hoarded or overpriced. In Isabela, police were able to arrest two citizens who hoarded isopropyl alcohol with the intent of reselling this at a higher cost. Stringent policies, however, such as Bulacan’s “no food stub, no relief goods” has caused distress as in the case of a grandmother who broke down after relief operations skipped over her. This pandemic has disrupted life and everyone will be dealing with wounds left long after it’s gone. But with the tally for confirmed cases still running and the national responses still without the cohesion, provinces pay different costs in the pursuit of flattening the curve. #
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BATTLING UNPREPARED
Illustration by Aya Saunar
During a global health crisis, protecting
medical frontliners is equally important as saving the lives of the infected. The coronavirus disease (COVID-19) pandemic, which has infected more than 4,000 Filipinos, has started to take a heavy toll on the ones needed most to combat it — the health workers. However, President Rodrigo Duterte doesn’t seem to realize the gravity of their deaths. On a March 31 press briefing, Duterte expressed his gratitude to doctors, nurses, and other healthcare professionals battling on the frontlines of the pandemic. While acknowledging those who succumbed to the disease, he said, “Napakasuwerte nila. Namatay sila para sa bayan.” Duterte added service shall be the sole reason for one’s death, and that it would be “an honor to die for [the] country.” Although the President, in the same message, promised the
procurement of additional medical supplies, devices, and millions of protective items, the government’s late acquisition still needlessly exposed a number of frontliners to the highly-infectious disease. Last April 9, DOH reported that 252 health workers have contracted COVID-19, 152 of which are doctors while 63 are nurses. Earlier, the Private Hospitals Association of the Philippines said 21 of the country’s doctors have died from the disease while on service. The lack of personal protective equipment (PPEs) is to be blamed for their deaths. To view the death of health workers as martyrdom instead of a tragedy only goes to show how these deaths are often seen as trivial. Frontliners without adequate medical protective equipment during a national health crisis is similar to sending soldiers into battle without
Editorial Board
gears and weapons, bringing with them only their willingness to serve to combat a physical and dangerous enemy. Additionally, the government’s call for volunteer health workers only manifests how little they value their citizens. While health workers continue to put their lives at stake, a daily wage of 500 pesos is what was supposed to be given to them in return. However, after this drew flak from the public, DOH acknowledged the need for an increase as it does not equate with the risk these frontliners face doing their job. As the government continues to lag behind in their response, it is no surprise that many of the health workers are also forced to bring their pleas to social media and rely on private sectors and individuals for assistance. This crisis wouldn’t have happened if there had been a stronger sense of urgency. When the first
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case of COVID-19 was reported last January 30, the Duterte administration refused to take immediate action and order a travel ban for all travelers from China’s Hubei province, the epicenter of the outbreak. Prior to the confirmation of the first COVID-19 case, several organizations and lawmakers had already given recommendations to impose a travel ban from China to stop the entry of the new coronavirus strain. However, instead of prioritizing the Filipinos, the national government chose to dismiss the alarm all for keeping its diplomatic relations with China as it “would not be fair” to them. As health workers lie on the brink of death every day, more than anything, they deserve a safe and secure environment that would help them fulfill their duty to save lives, not one that would put an end to theirs. ##
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KRISIS presents UPJC’s take on the Philippine situation via news articles, news analyses, editorials and feature articles on current political issues
Ed Mercene Editor-in-Chief
Blanch Marie Ancla EDITORIAL Hannah Pagaduan BOARD Jo Comuyog VP for Academic Affairs
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IS PH READY FOR THE GLOBAL STANDARD OF MASS TESTING? Ed Mercene and Hannah Pagaduan
In an attempt to stop the spread of the coronavirus disease (COVID-19), countries have been implementing “mass testing” to their general population. But in the Philippines, the opposite is true. The planned mass testing is “targeted” to a certain population, the Department of Health (DOH) said April 4. Insufficient medical resources, lack of healthcare professionals and accredited testing centers, leave the Philippines lagging behind other countries in early virus detection. According to a tracker by the University of the Philippines (UP), around 6,000 individuals were tested by the first week of April, with more than 3,000 COVID-19 positive patients. With more than 100 million Filipinos, these figures barely scratch the surface.
Backlog on test kit production After the local transmission of the virus was confirmed early March, the Research Institute for Tropical Medicine (RITM) said the country initially had 2,000 test kits. Weeks later, 168,000 test kit donations poured out from China, Singapore and South Korea. These supplies combined, however, could not test even five percent or more than 5 million of the population, which the susceptible aged 65 and above comprise. Recently, the Philippine Red Cross completed its first testing lab with the capacity to process 3,000 tests a day. DOH reported April 6 that nearly 23,000 COVID-19 tests have already been conducted. However, this doesn’t mean one test is equivalent to one person, since those diagnosed with COVID-19 have to be tested at least three times. Aside from the confirmatory test, the patient must also be tested twice before being discharged from the hospital. In other countries, the production of kits and mass testing came right before the crisis shoot up in early March. As soon as Chinese scientists published the virus’ genetic sequence in January, at least four South Korean firms began to develop test kits. South Korea tested 10,000 people daily on-site and via drive-throughs, and had conducted over 190,000 tests by as early as March 9. Germany had already produced 4 million test kits by the end of February
after a local scientist, Olfert Landt, saw the similarity of the novel coronavirus to the 2003 Severe Acute Respiratory Syndrome. Who qualifies for testing? The National Task (NTF) against COVID-19
Force Chief
Implementer Carlito Galvez said the government is already preparing to carry out “massive testing” but only for Persons Under Monitoring (PUMs), Persons Under Investigation (PUIs) and health workers on the front lines of the pandemic.
On April 3, the Department of Health (DOH) announced it would conduct “mass testing” for high-risk suspected COVID-19 carriers starting April 14. The DOH has set protocols for coronavirus testing and classified TESTING
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7 patients with possible coronavirus infection in two: PUMs required to do a 14-day self-quarantine and PUIs who require hospitalization. PUIs with severe manifestations of symptoms, along with the vulnerable such as the elderly, pregnant women and immunocompromised persons, will be prioritized for the said testing. DOH recently amended its protocols and included health workers with either mild or critical symptoms as subject to testing. Next on the priority list are individuals showing mild symptoms, with irrelevant history of exposure or those of the vulnerable sector. They are followed by those who are asymptomatic or those without symptoms, but have relevant travel history. PH-made test kit Last March, scientists from the Philippine Genome Center and the UP Manila National Institutes of Health developed the first locally made test kits, the GenAmplify coronavirus detection kit. According to the Department of Science and Technology (DOST), the said test kit “aims to detect the 2019 novel coronavirus (SARS-CoV-2) with high specificity and efficiency through a one-step multiplex real-time polymerase chain reaction (PCR) platform.” The homegrown kits look to accommodate 120,000 tests — 26,000 of which were funded by DOST, while the remaining 94,000 are sold commercially by Manila HealthTek for P1,320 per kit. This is about six times cheaper than its foreign counterparts which cost P8,500 each. Additionally, the GenAmplify test kits are capable of quick detection of the virus in samples taken from patients. The results can be ready in two hours. As of April 8, the UP-NIHdeveloped test kit is among the 23 PCR-based COVID-19 test kits approved by DOH for commercial use. Testing is not an easy task Persons qualified for testing undergo either a reverse transcription polymerase chain reaction (RT-PCR) test or a rapid antibody-based test. An RT-PCR test is the most accurate test for COVID-19 and the virus SARSCoV-2 that causes it, according to DOH. The test starts with a “nasopharyngeal” swab, or a swab from the nose and throat. This swab collects mucus, saliva, bits of cells and, if present, viral RNA. Once the samples have been collected, they will be sent to a laboratory where scientists will apply certain chemicals to isolate the RNA. RNA, the genetic material used by SARS-CoV-2, will then be “reverse transcribed” into DNA. The polymerase chain reaction will make many copies of a target DNA if present fb.com/upjournalismclub/
in a sample. According to Dr. Edsel Maurice Salvaña, an infectious diseases specialist, “it [RT-PCR test] is so sensitive that it can detect one virus in a sample.” Salvaña said RT-PCR tests are “technically difficult to do” and a single PCR machine costs millions of pesos. But unlike GenAmplify, other RT-PCR tests take about three to six hours to run these tests and results can be expected in a day or two. An alternative testing method for coronavirus is the rapid antibody-based method or immunologic method. Unlike RTPCR tests, this testing method uses blood samples from a needlestick or a syringe extraction and yields results faster compared to genetic tests. However, the immunologic method can only determine whether antibodies — proteins produced by the immune system to fight viruses — are present after the said symptoms are shown. It cannot detect the virus itself. Two antibodies are detected through this test: IgM and IgG. IgM is produced earlier when someone is infected by the disease and can be detected in five to ten days from infection. Meanwhile, IgM is produced later and can take about 21 days before detection. This kind of testing method usually yields inaccurate results as antibodies don’t develop immediately. Food and Drug Association (FDA) Director General Eric Domingo said, “The body takes time to develop antibodies and this might give a negative result [known as false negative] for patients who have been infected but have not yet developed antibodies.” “A positive result due to cross reaction with other bacteria or viruses is also possible, which is why a confirmatory PCR-based test is still required.” Domingo said rapid antibodybased tests must be administered carefully and cautiously. “[Rapid test kits are] strictly for medical professional use only and not intended for personal use.” “The administration of the test and interpretation of results should be done by a trained health professional,” he added. As of April 7, DOH has accredited eleven testing centers for COVID-19 testing: eight in Luzon, two in Visayas and one in Mindanao. Other testing centers have yet to be accredited. As cases of COVID-19 continue to grow both in the country and globally, so too does the public’s collective fear and uncertainty. But the arrival of more than a hundred thousand test kits, the accreditation of several COVID-19 testing centers, and the development of local kits in the country may give the country a chance to finally pursue “mass testing.” ##
Chelsea Cruz contributed to the research. @upjournclub
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