Physicians strike a delicate balance when they deliver bad news. Their voice must be stern but caring—factual, honest, but also compassionate. They will look you in the eye and speak the many variations of: “This is our problem; these are the things we can do about it; let’s get this done.”
This morning, healthcare professionals representing 80 medical societies used this exact tone of voice—not with a patient, but with a Philippine nation afflicted with COVID-19. It is a country with many comorbidities: a sluggish and corrupt bureaucracy, an impoverished population, and an ill prepared healthcare system. And thus, we find ourselves here, in a Zoom call full of medical professionals and the media, talking about how to move forward. The President of the Philippine Medical Association, Dr. Jose P. Santiago Jr., begins by reading a statement.
“Healthcare workers are united in sounding off a distress signal to the nation. Our healthcare system has been overwhelmed,” declares the statement.
It continues: “Our healthcare workers are burnt out with the seemingly endless number of patients trooping to our hospitals for emergency care and admission. We are waging a losing battle against COVID-19, and we need to draw up a consolidated, definitive plan of action.”
The letter goes on, recommending that Mega Manila return to Enhanced Community Quarantine from August 1-15.The doctors refer to this proposed two-week ECQ as a “timeout.”
“Parang basketball lang ‘yan,” said Dr. Maricar Limpin, a member of the Philippine College of Physicians. “Nakikita na namin na natatalo na tayo sa battle na ito… so kailangan natin magtawag ng timeout para maka-regroup ang lahat ng nasa health sector at mapag-isipang mabuti: Paano ba natin mababago ang trend na ito?”
A lot of things can happen in an hour and a half. Over the course of the call, Presidential Spokesperson Harry Roque managed to release a statement. Part of it read: “The strict lockdown in Metro Manila has served its purpose, and we need to intensify other strategies,” implying that a government whose debt has ballooned to 9 trillion pesos can only do one thing at a time.
“I agree that we have to concentrate on other measures,” said Dr. Antonio Dans of the Philippine College of Physicians, in response to Roque’s statement. “The problem is that those other measures are not working. Yun ang nararanasan natin on the frontlines. We know it’s not working kasi dinadagsa na tayo. That’s why we’re issuing out this warning. Masasayang lang po kung mag-ECQ tayo at hindi tayo mag usap-usap at magplano kung ano bang babaguhin natin.”
Anyone who has ever been to a doctor’s clinic knows this: They always have recommendations after diagnosis, and this call was no different. The coalition suggests solutions for seven urgent problems: the lack of hospital workers, the failure to find and isolate cases, the failure to contact trace and quarantine, the failure to provide safe and adequate transportation, issues regarding workplace safety, public compliance with self-protection, and the lack of support for those whose livelihoods were affected by the pandemic. All of them spoke diplomatically—and with due deference to the Department of Health—but it seems that for many of the government’s initiatives against COVID, there are no other descriptors apart from “failure.”
The doctors had good, workable suggestions.
Dr. Aileen Espina from the Philippine Academy of Family Physicians spoke about a QR Code system that they used for surveillance in her hometown of Tacloban.
Dr. Dans, citing a lack of transport options in Mega Manila, which causes many unintended mass gatherings each and every day, recommended the government provide safe and efficient transport. He suggested centralizing the transport system and contracting buses and jeepneys on a daily basis.
“Payag na ang operators, eh. Yung gobyerno na lang ang walang plano,” he said.
The doctors reiterated a warning against reckless return-to-work practices. They criticized the practice of antibody testing as a prerequisite for back-to-work clearance, because it gives a false sense of security. Antibody tests detect antibodies, not the virus itself, they said. This means that such a practice may cause some COVID positives to behave as if they’re COVID negative, which exacerbates the problem.
After the webinar ended, there was near-immediate evidence that the government hears only what it wants to hear.
The Secretary of Trade and Industry, Ramon Lopez, sent a message to the media. “Cannot go back to ECQ,” the message said, arguing unemployment and poverty affect health too. In the same message, Lopez also managed to question the integrity of the entire medical community, doubting whether hospitals were actually overwhelmed. He said that the hospitalization rate is at a critical level “because hospitals were not allocating the mandated bed capacity for COVID-19 cases. DOH mandates 30% allocation for private and 50% for government hospitals.
It is a sad state of affairs that a Secretary of Trade can be rebutted by the very document he was rebutting. In the three-page letter sent by the coalition, they established that the hospitals are overwhelmed due to workforce deficiency, not bed allocation. The number of healthcare workers has been impacted due to “intermittent quarantine of personnel” and resignations. “Many have resigned because of fear, fatigue, and poor working conditions,” said the coalition’s statement. The document also made recommendations that address the loss of livelihood, to which the Secretary could have responded in a manner that was less reductive.
I am not a fan of hopelessness, but all of these factors paint a picture that is unsavory and utterly hopeless: COVID is beating the shit out of the Philippines, but the government insists that we’re winning, because we say so. There is no plan, as evidenced by the thousands of stranded LSIs in Rizal Memorial Stadium, some of whom have become the first cases of COVID in their home communities, and by irresponsible pronouncements that this situation will be over by December, reminiscent of the President’s promise to end crime within 3-6 months after taking office.
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If there is room for hope, it’s that President Duterte actually ordered the IATF to act on the concerns of the medical community. Roque said that the IATF would “hold discussions” regarding the coalition’s recommendations—which sounds respectful, until one realizes that it is the bureaucratic version of arguing with your doctor about why it hurts when you pee.
Throughout this pandemic, this administration and its supporters have repeatedly demonized the Filipino people. “This country does not have the worst President, but has the worst citizens,” they said early in the quarantine. The comments section of the Medical Community’s Zoom invite has been infested with the rotten rhetoric: “ECQ is not the solution, kundi disiplina,” said one faceless and friendless troll. The President himself has called for discipline and compliance in many an evening presser.
Now the tables have turned. In a country that is failing to heal as one, we have heard a loud and urgent recommendation from basically every medical society in the Philippines: Return to ECQ and actually do something about the pandemic. Doctor’s orders. And now we wait with bated breath to see if the government will comply. I guess soon we’ll see how they really feel about discipline.