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• Volume 10, Issue 11
• The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA study): a protocol study
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• http://orcid.org/0000-0001-5621-1833 Adrian I Espiritu 1 , 2 ,
• http://orcid.org/0000-0003-1135-6400 Marie Charmaine C Sy 1 ,
• http://orcid.org/0000-0002-1241-8805 Veeda Michelle M Anlacan 1 ,
• http://orcid.org/0000-0001-5317-7369 Roland Dominic G Jamora 1
• 1 Department of Neurosciences , College of Medicine and Philippine General Hospital, University of the Philippines Manila , Manila , Philippines
• 2 Department of Clinical Epidemiology, College of Medicine , University of the Philippines Manila , Manila , Philippines
• Correspondence to Dr Adrian I Espiritu; aiespiritu{at}up.edu.ph

Introduction The SARS-CoV-2, virus that caused the COVID-19 global pandemic, possesses a neuroinvasive potential. Patients with COVID-19 infection present with neurological signs and symptoms aside from the usual respiratory affectation. Moreover, COVID-19 is associated with several neurological diseases and complications, which may eventually affect clinical outcomes.

Objectives The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA) study investigators will conduct a nationwide, multicentre study involving 37 institutions that aims to determine the neurological manifestations and factors associated with clinical outcomes in COVID-19 infection.

Methodology and analysis This is a retrospective cohort study (comparative between patients with and without neurological manifestations) via medical chart review involving adult patients with COVID-19 infection. Sample size was determined at 1342 patients. Demographic, clinical and neurological profiles will be obtained and summarised using descriptive statistics. Student’s t-test for two independent samples and χ 2 test will be used to determine differences between distributions. HRs and 95% CI will be used as an outcome measure. Kaplan-Meier curves will be constructed to plot the time to onset of mortality (survival), respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, length of ICU stay and length of hospital stay. The log-rank test will be employed to compare the Kaplan-Meier curves. Stratified analysis will be performed to identify confounders and effects modifiers. To compute for adjusted HR with 95% CI, crude HR of outcomes will be adjusted according to the prespecified possible confounders. Cox proportional regression models will be used to determine significant factors of outcomes. Testing for goodness of fit will also be done using Hosmer-Lemeshow test. Subgroup analysis will be performed for proven prespecified effect modifiers. The effects of missing data and outliers will also be evaluated in this study.

Ethics and dissemination This protocol was approved by the Single Joint Research Ethics Board of the Philippine Department of Health (SJREB-2020–24) and the institutional review board of the different study sites. The dissemination of results will be conducted through scientific/medical conferences and through journal publication. The lay versions of the results may be provided on request.

Trial registration number NCT04386083 .

• adult neurology
• epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2020-040944

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Strengths and limitations of this study

The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms Study is a nationwide, multicentre, retrospective, cohort study with 37 Philippine sites.

Full spectrum of neurological manifestations of COVID-19 will be collected.

Retrospective gathering of data offers virtually no risk of COVID-19 infection to data collectors.

Data from COVID-19 patients who did not go to the hospital are unobtainable.

Recoding bias is inherent due to the retrospective nature of the study.

Introduction

The COVID-19 has been identified as the cause of an outbreak of respiratory illness in Wuhan, Hubei Province, China, in December 2019. 1 The COVID-19 pandemic has reached the Philippines with most of its cases found in the National Capital Region (NCR). 2 The major clinical features of COVID-19 include fever, cough, shortness of breath, myalgia, headache and diarrhoea. 3 The outcomes of this disease lead to prolonged hospital stay, intensive care unit (ICU) admission, dependence on invasive mechanical ventilation, respiratory failure and mortality. 4 The specific pathogen that causes this clinical syndrome has been named SARS-CoV-2, which is phylogenetically similar to SARS-CoV. 4 Like the SARS-CoV strain, SARS-CoV-2 may possess a similar neuroinvasive potential. 5

A study on cases with COVID-19 found that about 36.4% of patients displayed neurological manifestations of the central nervous system (CNS) and peripheral nervous system (PNS). 6 The associated spectrum of symptoms and signs were substantially broad such as altered mental status, headache, cognitive impairment, agitation, dysexecutive syndrome, seizures, corticospinal tract signs, dysgeusia, extraocular movement abnormalities and myalgia. 7–12 Several reports were published on neurological disorders associated with patients with COVID-19, including cerebrovascular disorders, encephalopathy, hypoxic brain injury, frequent convulsive seizures and inflammatory CNS syndromes like encephalitis, meningitis, acute disseminated encephalomyelitis and Guillain-Barre syndrome. 7–16 However, the estimates of the occurrences of these manifestations were based on studies with a relatively small sample size. Furthermore, the current description of COVID-19 neurological features are hampered to some extent by exceedingly variable reporting; thus, defining causality between this infection and certain neurological manifestations is crucial since this may lead to considerable complications. 17 An Italian observational study protocol on neurological manifestations has also been published to further document and corroborate these findings. 18

Epidemiological data on the proportions and spectrum of non-respiratory symptoms and complications may be essential to increase the recognition of clinicians of the possibility of COVID-19 infection in the presence of other symptoms, particularly neurological manifestations. With this information, the probabilities of diagnosing COVID-19 disease may be strengthened depending on the presence of certain neurological manifestations. Furthermore, knowledge of other unrecognised symptoms and complications may allow early diagnosis that may permit early institution of personal protective equipment and proper contact precautions. Lastly, the presence of neurological manifestations may be used for estimating the risk of certain important clinical outcomes for better and well-informed clinical decisions in patients with COVID-19 disease.

To address this lack of important information in the overall management of patients with COVID-19, we organised a research study entitled ‘The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA Study)’.

This quantitative, retrospective cohort, multicentre study aims: (1) to determine the demographic, clinical and neurological profile of patients with COVID-19 disease in the Philippines; (2) to determine the frequency of neurological symptoms and new-onset neurological disorders/complications in patients with COVID-19 disease; (3) to determine the neurological manifestations that are significant factors of mortality, respiratory failure, duration of ventilator dependence, ICU admission, length of ICU stay and length of hospital stay among patients with COVID-19 disease; (4) to determine if there is significant difference between COVID-19 patients with neurological manifestations compared with those COVID-19 patients without neurological manifestations in terms of mortality, respiratory failure, duration of ventilator dependence, ICU admission, length of ICU stay and length of hospital stay; and (5) to determine the likelihood of mortality, respiratory failure and ICU admission, including the likelihood of longer duration of ventilator dependence and length of ICU and hospital stay in COVID-19 patients with neurological manifestations compared with those without neurological manifestations.

Scope, limitations and delimitations

The study will include confirmed cases of COVID-19 from the 37 participating institutions in the Philippines. Every country has its own healthcare system, whose level of development and strategies ultimately affect patient outcomes. Thus, the results of this study cannot be accurately generalised to other settings. In addition, patients with ages ≤18 years will be excluded in from this study. These younger patients may have different characteristics and outcomes; therefore, yielded estimates for adults in this study may not be applicable to this population subgroup. Moreover, this study will collect data from the patient records of patients with COVID-19; thus, data from patients with mild symptoms who did not go to the hospital and those who had spontaneous resolution of symptoms despite true infection with COVID-19 are unobtainable.

Methodology

To improve the quality of reporting of this study, the guidelines issued by the Strengthening the Reporting of Observational Studies in Epidemiology Initiative will be followed. 19

Study design

The study will be conducted using a retrospective cohort (comparative) design (see figure 1 ).

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Schematic diagram of the study flow.

Study sites and duration

We will conduct a nationwide, multicentre study involving 37 institutions in the Philippines (see figure 2 ). Most of these study sites can be found in the NCR, which remains to be the epicentre of the COVID-19 pandemic. 2 We will collect data for 6 months after institutional review board approval for every site.

Location of 37 study sites of the Philippine CORONA study.

Patient selection and cohort description

The cases will be identified using the designated COVID-19 censuses of all the participating centres. A total enumeration of patients with confirmed COVID-19 disease will be done in this study.

The cases identified should satisfy the following inclusion criteria: (A) adult patients at least 19 years of age; (B) cases confirmed by testing approved patient samples (ie, nasal swab, sputum and bronchoalveolar lavage fluid) employing real-time reverse transcription PCR (rRT-PCR) 20 from COVID-19 testing centres accredited by the Department of Health (DOH) of the Philippines, with clinical symptoms and signs attributable to COVID-19 disease (ie, respiratory as well as non-respiratory clinical signs and symptoms) 21 ; and (C) cases with disposition (ie, discharged stable/recovered, home/discharged against medical advice, transferred to other hospital or died) at the end of the study period. Cases with conditions or diseases caused by other organisms (ie, bacteria, other viruses, fungi and so on) or caused by other pathologies unrelated to COVID-19 disease (ie, trauma) will be excluded.

The first cohort will involve patients with confirmed COVID-19 infection who presented with any neurological manifestation/s (ie, symptoms or complications/disorder). The comparator cohort will compose of patients with confirmed COVID-19 infection without neurological manifestation/s.

Sample size calculation

We looked into the mortality outcome measure for the purposes of sample size computation. Following the cohort study of Khaledifar et al , 22 the sample size was calculated using the following parameters: two-sided 95% significance level (1 – α); 80% power (1 – β); unexposed/exposed ratio of 1; 5% of unexposed with outcome (case fatality rate from COVID19-Philippines Dashboard Tracker (PH) 23 as of 8 April 2020); and assumed risk ratio 2 (to see a two-fold increase in risk of mortality when neurological symptoms are present).

When these values were plugged in to the formula for cohort studies, 24 a minimum sample size of 1118 is required. To account for possible incomplete data, the sample was adjusted for 20% more. This means that the total sample size required is 1342 patients, which will be gathered from the participating centres.

Data collection

We formulated an electronic data collection form using Epi Info Software (V.7.2.2.16). The forms will be pilot-tested, and a formal data collection workshop will be conducted to ensure collection accuracy. The data will be obtained from the review of the medical records.

The following pertinent data will be obtained: (A) demographic data; (B) other clinical profile data/comorbidities; (C) neurological history; (D) date of illness onset; (E) respiratory and constitutional symptoms associated with COVID-19; (F) COVID-19 disease severity 25 at nadir; (G) data if neurological manifestation/s were present at onset prior to respiratory symptoms and the specific neurological manifestation/s present at onset; (H) neurological symptoms; (i) date of neurological symptom onset; (J) new-onset neurological disorders or complications; (K) date of new neurological disorder or complication onset; (L) imaging done; (M) cerebrospinal fluid analysis; (N) electrophysiological studies; (O) treatment given; (P) antibiotics given; (Q) neurological interventions given; (R) date of mortality and cause/s of mortality; (S) date of respiratory failure onset, date of mechanical ventilator cessation and cause/s of respiratory failure; (T) date of first day of ICU admission, date of discharge from ICU and indication/s for ICU admission; (U) other neurological outcomes at discharge; (V) date of hospital discharge; and (W) final disposition. See table 1 for the summary of the data to be collected for this study.

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Data to be collected in this study

Main outcomes considered

The following patient outcomes will be considered for this study:

Mortality (binary outcome): defined as the patients with confirmed COVID-19 who died.

Respiratory failure (binary outcome): defined as the patients with confirmed COVID-19 who experienced clinical symptoms and signs of respiratory insufficiency. Clinically, this condition may manifest as tachypnoea/sign of increased work of breathing (ie, respiratory rate of ≥22), abnormal blood gases (ie, hypoxaemia as evidenced by partial pressure of oxygen (PaO 2 ) <60 or hypercapnia by partial pressure of carbon dioxide of >45), or requiring oxygen supplementation (ie, PaO 2 <60 or ratio of PaO 2 /fraction of inspired oxygen (P/F ratio)) <300).

Duration of ventilator dependence (continuous outcome): defined as the number of days from initiation of assisted ventilation to cessation of mechanical ventilator use.

ICU admission (binary outcome): defined as the patients with confirmed COVID-19 admitted to an ICU or ICU-comparable setting.

Length of ICU stay (continuous outcome): defined as the number of days admitted in the ICU or ICU-comparable setting.

Length of hospital stay (continuous outcome): defined as the number of days from admission to discharge.

Data analysis plan

Statistical analysis will be performed using Stata V.7.2.2.16.

Demographic, clinical and neurological profiles will be summarised using descriptive statistics, in which categorical variables will be expressed as frequencies with corresponding percentages, and continuous variables will be pooled using means (SD).

Student’s t-test for two independent samples and χ 2 test will be used to determine differences between distributions.

HRs and 95% CI will be used as an outcome measure. Kaplan-Meier curves will be constructed to plot the time to onset of mortality (survival), respiratory failure, ICU admission, duration of ventilator dependence (recategorised binary form), length of ICU stay (recategorised binary form) and length of hospital stay (recategorised binary form). Log-rank test will be employed to compare the Kaplan-Meier curves. Stratified analysis will be performed to identify confounders and effects modifiers. To compute for adjusted HR with 95% CI, crude HR of outcomes at discrete time points will be adjusted for prespecified possible confounders such as age, history of cardiovascular or cerebrovascular disease, hypertension, diabetes mellitus, and respiratory disease, COVID-19 disease severity at nadir, and other significant confounding factors.

Cox proportional regression models will be used to determine significant factors of outcomes. Testing for goodness of fit will be done using Hosmer-Lemeshow test. Likelihood ratio tests and other information criteria (Akaike Information Criterion or Bayesian Information Criterion) will be used to refine the final model. Statistical significance will be considered if the 95% CI of HR or adjusted HR did not include the number one. A p value <0.05 (two tailed) is set for other analyses.

Subgroup analyses will be performed for proven prespecified effect modifiers. The following variables will be considered for subgroup analyses: age (19–64 years vs ≥65 years), sex, body mass index (<18.5 vs 18.5–22.9 vs ≥23 kg/m 2 ), with history of cardiovascular or cerebrovascular disease (presence or absence), hypertension (presence or absence), diabetes mellitus (presence or absence), respiratory disease (presence or absence), smoking status (smoker or non-smoker) and COVID-19 disease severity (mild, severe or critical disease).

The effects of missing data will be explored. All efforts will be exerted to minimise missing and spurious data. Validity of the submitted electronic data collection will be monitored and reviewed weekly to prevent missing or inaccurate input of data. Multiple imputations will be performed for missing data when possible. To check for robustness of results, analysis done for patients with complete data will be compared with the analysis with the imputed data.

The effects of outliers will also be assessed. Outliers will be assessed by z-score or boxplot. A cut-off of 3 SD from the mean can also be used. To check for robustness of results, analysis done with outliers will be compared with the analysis without the outliers.

Study organisational structure

A steering committee (AIE, MCCS, VMMA and RDGJ) was formed to direct and provide appropriate scientific, technical and methodological assistance to study site investigators and collaborators (see figure 3 ). Central administrative coordination, data management, administrative support, documentation of progress reports, data analyses and interpretation and journal publication are the main responsibilities of the steering committee. Study site investigators and collaborators are responsible for the proper collection and recording of data including the duty to maintain the confidentiality of information and the privacy of all identified patients for all the phases of the research processes.

Organisational structure of oversight of the Philippine CORONA Study.

This section is highlighted as part of the required formatting amendments by the Journal.

Ethics and dissemination

This research will adhere to the Philippine National Ethical Guidelines for Health and Health-related Research 2017. 26 This study is an observational, cohort study and will not allocate any type of intervention. The medical records of the identified patients will be reviewed retrospectively. To protect the privacy of the participant, the data collection forms will not contain any information (ie, names and institutional patient number) that could determine the identity of the patients. A sequential code will be recorded for each patient in the following format: AAA-BBB where AAA will pertain to the three-digit code randomly assigned to each study site; BBB will pertain to the sequential case number assigned by each study site. Each participating centre will designate a password-protected laptop for data collection; the password is known only to the study site.

This protocol was approved by the following institutional review boards: Single Joint Research Ethics Board of the DOH, Philippines (SJREB-2020-24); Asian Hospital and Medical Center, Muntinlupa City (2020- 010-A); Baguio General Hospital and Medical Center (BGHMC), Baguio City (BGHMC-ERC-2020-13); Cagayan Valley Medical Center (CVMC), Tuguegarao City; Capitol Medical Center, Quezon City; Cardinal Santos Medical Center (CSMC), San Juan City (CSMC REC 2020-020); Chong Hua Hospital, Cebu City (IRB 2420–04); De La Salle Medical and Health Sciences Institute (DLSMHSI), Cavite (2020-23-02-A); East Avenue Medical Center (EAMC), Quezon City (EAMC IERB 2020-38); Jose R. Reyes Memorial Medical Center, Manila; Jose B. Lingad Memorial Regional Hospital, San Fernando, Pampanga; Dr. Jose N. Rodriguez Memorial Hospital, Caloocan City; Lung Center of the Philippines (LCP), Quezon City (LCP-CT-010–2020); Manila Doctors Hospital, Manila (MDH IRB 2020-006); Makati Medical Center, Makati City (MMC IRB 2020–054); Manila Medical Center, Manila (MMERC 2020-09); Northern Mindanao Medical Center, Cagayan de Oro City (025-2020); Quirino Memorial Medical Center (QMMC), Quezon City (QMMC REB GCS 2020-28); Ospital ng Makati, Makati City; University of the Philippines – Philippine General Hospital (UP-PGH), Manila (2020-314-01 SJREB); Philippine Heart Center, Quezon City; Research Institute for Tropical Medicine, Muntinlupa City (RITM IRB 2020-16); San Lazaro Hospital, Manila; San Juan De Dios Educational Foundation Inc – Hospital, Pasay City (SJRIB 2020-0006); Southern Isabela Medical Center, Santiago City (2020-03); Southern Philippines Medical Center (SPMC), Davao City (P20062001); St. Luke’s Medical Center, Quezon City (SL-20116); St. Luke’s Medical Center, Bonifacio Global City, Taguig City (SL-20116); Southern Philippines Medical Center, Davao City; The Medical City, Pasig City; University of Santo Tomas Hospital, Manila (UST-REC-2020-04-071-MD); University of the East Ramon Magsaysay Memorial Medical Center, Inc, Quezon City (0835/E/2020/063); Veterans Memorial Medical Center (VMMC), Quezon City (VMMC-2020-025) and Vicente Sotto Memorial Medical Center, Cebu City (VSMMC-REC-O-2020–048).

The dissemination of results will be conducted through scientific/medical conferences and through journal publication. Only the aggregate results of the study shall be disseminated. The lay versions of the results may be provided on request.

Protocol registration and technical review approval

This protocol was registered in the ClinicalTrials.gov website. It has received technical review board approvals from the Department of Neurosciences, Philippine General Hospital and College of Medicine, University of the Philippines Manila, from the Cardinal Santos Medical Center (San Juan City) and from the Research Center for Clinical Epidemiology and Biostatistics, De La Salle Medical and Health Sciences Institute (Dasmariñas, Cavite).

Acknowledgments

We would like to thank Almira Abigail Doreen O Apor, MD, of the Department of Neurosciences, Philippine General Hospital, Philippines, for illustrating figure 2 for this publication.

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VMMA and RDGJ are joint senior authors.

AIE and MCCS are joint first authors.

Twitter @neuroaidz, @JamoraRoland

Collaborators The Philippine CORONA Study Group Collaborators: Maritoni C Abbariao, Joshua Emmanuel E Abejero, Ryndell G Alava, Robert A Barja, Dante P Bornales, Maria Teresa A Cañete, Ma. Alma E Carandang-Concepcion, Joseree-Ann S Catindig, Maria Epifania V Collantes, Evram V Corral, Ma. Lourdes P Corrales-Joson, Romulus Emmanuel H Cruz, Marita B Dantes, Ma. Caridad V Desquitado, Cid Czarina E Diesta, Carissa Paz C Dioquino, Maritzie R Eribal, Romulo U Esagunde, Rosalina B Espiritu-Picar, Valmarie S Estrada, Manolo Kristoffer C Flores, Dan Neftalie A Juangco, Muktader A Kalbi, Annabelle Y Lao-Reyes, Lina C Laxamana, Corina Maria Socorro A Macalintal, Maria Victoria G Manuel, Jennifer Justice F Manzano, Ma. Socorro C Martinez, Generaldo D Maylem, Marc Conrad C Molina, Marietta C Olaivar, Marissa T Ong, Arnold Angelo M Pineda, Joanne B Robles, Artemio A Roxas Jr, Jo Ann R Soliven, Arturo F Surdilla, Noreen Jhoanna C Tangcuangco-Trinidad, Rosalia A Teleg, Jarungchai Anton S Vatanagul and Maricar P Yumul.

Contributors All authors conceived the idea and wrote the initial drafts and revisions of the protocol. All authors made substantial contributions in this protocol for intellectual content.

Funding Philippine Neurological Association (Grant/Award Number: N/A). Expanded Hospital Research Office, Philippine General Hospital (Grant/Award Number: N/A).

Disclaimer Our funding sources had no role in the design of the protocol, and will not be involved during the methodological execution, data analyses and interpretation and decision to submit or to publish the study results.

Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Premium Statistic Changes in purchase amount spend in-store due to COVID Philippines 2021
• Premium Statistic Frequency of in-store shopping after COVID restrictions Philippines 2021

Share of first time shoppers on social media SEA 2021

Share of first time shoppers on social media in Southeast Asia in 2021, by country

Changes in preferred retail channels due to COVID in the Philippines 2021

Changes in preferred retail channels due to COVID-19 in the Philippines as of June 2021

Change in in-store shopping frequency due to COVID in the Philippines 2021

Change in frequency of shopping in physical stores due to COVID-19 in the Philippines as of June 2021

Changes in preferred times to shop due to COVID Philippines 2021

Changes in preferred times to go shopping due to COVID in the Philippines as of June 2021

Changes in purchase amount spend in-store due to COVID Philippines 2021

Changes in average spend per purchase from a physical store due to COVID-19 in the Philippines as of June 2021

Frequency of in-store shopping after COVID restrictions Philippines 2021

Frequency of in-store shopping after COVID-19 restrictions are lifted in the Philippines as of June 2021

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• Published: 21 September 2021

Local government responses for COVID-19 management in the Philippines

• Dylan Antonio S. Talabis 1 , 2 ,
• Ariel L. Babierra 1 , 2 ,
• Christian Alvin H. Buhat 1 , 2 ,
• Destiny S. Lutero 1 , 2 ,
• Kemuel M. Quindala III 1 , 2 &
• Jomar F. Rabajante 1 , 2 , 3  

BMC Public Health volume  21 , Article number:  1711 ( 2021 ) Cite this article

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Responses of subnational government units are crucial in the containment of the spread of pathogens in a country. To mitigate the impact of the COVID-19 pandemic, the Philippine national government through its Inter-Agency Task Force on Emerging Infectious Diseases outlined different quarantine measures wherein each level has a corresponding degree of rigidity from keeping only the essential businesses open to allowing all establishments to operate at a certain capacity. Other measures also involve prohibiting individuals at a certain age bracket from going outside of their homes. The local government units (LGUs)–municipalities and provinces–can adopt any of these measures depending on the extent of the pandemic in their locality. The purpose is to keep the number of infections and mortality at bay while minimizing the economic impact of the pandemic. Some LGUs have demonstrated a remarkable response to the COVID-19 pandemic. The purpose of this study is to identify notable non-pharmaceutical interventions of these outlying LGUs in the country using quantitative methods.

Data were taken from public databases such as Philippine Department of Health, Philippine Statistics Authority Census, and Google Community Mobility Reports. These are normalized using Z-transform. For each locality, infection and mortality data (dataset Y ) were compared to the economic, health, and demographic data (dataset X ) using Euclidean metric d =( x − y ) 2 , where x ∈ X and y ∈ Y . If a data pair ( x , y ) exceeds, by two standard deviations, the mean of the Euclidean metric values between the sets X and Y , the pair is assumed to be a ‘good’ outlier.

Our results showed that cluster of cities and provinces in Central Luzon (Region III), CALABARZON (Region IV-A), the National Capital Region (NCR), and Central Visayas (Region VII) are the ‘good’ outliers with respect to factors such as working population, population density, ICU beds, doctors on quarantine, number of frontliners and gross regional domestic product. Among metropolitan cities, Davao was a ‘good’ outlier with respect to demographic factors.

Conclusions

Strict border control, early implementation of lockdowns, establishment of quarantine facilities, effective communication to the public, and monitoring efforts were the defining factors that helped these LGUs curtail the harm that was brought by the pandemic. If these policies are to be standardized, it would help any country’s preparedness for future health emergencies.

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Introduction

Since the emergence of the COVID-19 pandemic, the number of cases have already reached 82 million worldwide at the end of 2020. In the Philippines, the number of cases exceeded 473,000. As countries around the world face the continuing threat of the COVID-19 pandemic, national governments and health ministries formulate, implement and revise health policies and standards based on recommendations by world health organization (WHO), experiences of other countries, and on-the-ground experiences. Early health measures were primarily aimed at preventing and reducing transmission in populations at risk. These measures differ in scale and speed among countries, as some countries have more resources and are more prepared in terms of healthcare capacity and availability of stringent policies [ 1 , 2 ].

During the first months of the pandemic, several countries struggled to find tolerable, if not the most effective, measures to ‘flatten’ the COVID-19 epidemic curve so that health facilities will not be overwhelmed [ 3 , 4 ]. In responding to the threat of the pandemic, public health policies included epidemiological and socio-economic factors. The success or failure of these policies exposed the strengths or weaknesses of governments as well as the range of inequalities in the society [ 5 , 6 ].

As national governments implemented large-scale ‘blanket’ policies to control the pandemic, local government units (LGUs) have to consider granular policies as well as real-time interventions to address differences in the local COVID-19 transmission dynamics due to heterogeneity and diversity in communities. Some policies in place, such as voluntary physical distancing, wearing of face masks and face shields, mass testing, and school closures, could be effective in one locality but not in another [ 7 – 9 ]. Subnational governments like LGUs are confronted with a health crisis that have economic, social and fiscal impact. While urban areas have been hot spots of the COVID-19 pandemic, there are health facilities that are already well in placed as compared to less developed and deprived rural communities [ 10 ]. The importance of local narratives in addressing subnational concerns are apparent from published experiences in the United States [ 11 ], China [ 12 , 13 ], and India [ 14 ].

In the Philippines, the Inter-Agency Task Force on Emerging Infectious Diseases (IATF) was convened by the national government in January 2020 to monitor a viral outbreak in Wuhan, China. The first case of local transmission of COVID-19 was confirmed on March 7, 2020. Following this, on March 8, the entire country was placed under a State of Public Health Emergency. By March 25, the IATF released a National Action Plan to control the spread of COVID-19. A community quarantine was initially put in place for the national capital region (NCR) starting March 13, 2020 and it was expanded to the whole island of Luzon by March 17. The initial quarantine was extended up to April 30 [ 5 , 15 ]. Several quarantine protocols were then implemented based on evaluation of IATF:

Community Quarantine (CQ) refers to restrictions in mobility between quarantined areas.

In Enhanced Community Quarantine (ECQ), strict home quarantine is implemented and movement of residents is limited to access essential goods and services. Public transportation is suspended. Only economic activities related to essential and utility services are allowed. There is heightened presence of uniformed personnel to enforce community quarantine protocols.

Modified Enhanced Community Quarantine (MECQ) is implemented as a transition phase between ECQ and GCQ. Strict home quarantine and suspension of public transportation are still in place. Mobility restrictions are relaxed for work-related activities. Government offices operates under a skeleton workforce. Manufacturing facilities are allowed to operate with up to 50% of the workforce. Transportation services are only allowed for essential goods and services.

In General Community Quarantine (GCQ), individuals from less susceptible age groups and without health risks are allowed to move within quarantined zones. Public transportation can operate at reduced vehicle capacity observing physical distancing. Government offices may be at full work capacity or under alternative work arrangements. Up to 50% of the workforce in industries (except for leisure and amusement) are allowed to work.

Modified General Community Quarantine (MGCQ) refers to the transition phase between GCQ and the New Normal. All persons are allowed outside their residences. Socio-economic activities are allowed with minimum public health standard.

LGUs are tasked to adopt, coordinate, and implement guidelines concerning COVID-19 in accordance with provincial and local quarantine protocols released by the national government [ 16 ].

In this study, we identified economic and demographic factors that are correlated with epidemiological metrics related to COVID-19, specifically to the number of infected cases and number of deaths [ 17 , 18 ]. At the regional, provincial, and city levels, we investigated the localities that differ with the other localities, and determined the possible reasons why they are outliers compared to the average practices of the others.

We categorized the data into economic, health, and demographic components (See Table  1 ). In the economic setting, we considered the number of people employed and the number of work hours. The number of health facilities provides an insight into the health system of a locality. Population and population density, as well as age distribution and mobility, were used as the demographic indicators. The data (as of November 10, 2020) from these seven factors were analyzed and compared to the number of deaths and cumulative cases in cities, provinces or regions in the Philippines to determine the outlier.

The Philippine government’s administrative structure and the availability of the data affected its range for each factor. Regional data were obtained for the economic component. For the health and demographic components, data from cities and provinces were retrieved from the sources. Due to the NCR exhibiting the highest figures in all key components, an investigation was conducted to identify an outlier among its cities. The z -transform

where x is the actual data, μ is the mean and σ is the standard deviation were applied to normalize the dataset. Two sets of normalized data X and Y were compared by assigning to each pair ( x , y ), where x ∈ X and y ∈ Y , its Euclidean metric d given by d =( x − y ) 2 . Here, the Y ’s are the number of COVID-19 cases and deaths, and X ’s are the other demographic indicators. Since 95% of the data fall within two standard deviations from the mean, this will be the threshold in determining an outlier. This means that if a data pair ( x , y ) exceeds, by two standard deviations, the mean of the Euclidean metric values between the sets X and Y , the pair is assumed to be an outlier.

To identify a good outlier, a bias computation was performed. In this procedure, Y represents the normalized data set for the number of deaths or the number of cases while X represents the normalized data set for every factor that were considered in this study. The bias is computed using the metric

for all x in X and y in Y . To categorize a city, province, or region as a good outlier, the bias corresponding to this locality must exceed two standard deviations from the mean of all the bias computations between the sets X and Y .

Results and discussion

The data used were the reported COVID-19 cases and deaths in the Philippines as of November 10, 2020 which is 240 days since community lockdowns were implemented in the country. Figure  1 shows the different lockdowns implemented per province since March 15. It can be seen that ECQ was implemented in Luzon and major cities in the country in the first few weeks since March 15, and slowly eased into either GCQ or MGCQ as time progressed. By August, the most stringent lockdown was MECQ in the National Capital Region (NCR) and some nearby provinces. Places under MECQ on September were Iloilo City, Bacolod City, and Lanao del Sur, with the last province as the lone community to be placed under MECQ the month after. By November 1, 2020, communities were either placed under GCQ or MGCQ.

COVID-19 community quarantines in Regions III, IVA and VII

Comparison of economic, health, and demographic components and COVID-19 parameters

The economic, health and demographic components were compared to COVID-19 cases and deaths. These comparisons were done for different community levels (regional, provincial, city/metropolitan) (See Tables  2 , 3 , and 4 ). Figure  2 summarizes the correlation of components to COVID-19 cases and deaths at the regional level. In all components, correlations with other parameters to both COVID-19 cases and deaths are close. Every component except Residential Mobility and GRDP have slightly higher correlation coefficient for COVID-19 cases as compared to COVID-19 deaths.

Correlation of components to COVID-19 cases and deaths at the regional level

Among the components, the number of ICU beds component has the highest correlation with COVID-19 parameters. This makes sense as this is one of the first-degree measures of COVID-19 transmission. Population density comes in second, followed by mean hours worked and working population, which are all related to how developed the region is economy-wise. Regions having larger population density also have a huge working population and longer working hours [ 24 ]. Thus, having a huge population density implies high chance of having contact with each other [ 25 , 26 ]. Another component with high correlation to the cases and deaths is the number of doctors on quarantine, which can be looked at two ways; (i) huge infection rate in the region which is the reason the doctors got exposed or are on quarantine, and (ii) lots of doctors on quarantine which resulted to less frontliners taking care of the infected individuals. All definitions of mobility and the GDP are not strongly correlated to any of the COVID-19 measures.

In each data set, outliers were identified depending on their distance from the mean. For simplicity, we denote components that are compared with COVID-19 cases by (C) and with COVID-19 deaths by (D). The summary of outliers among regions in the Philippines is shown in Figs.  3 and 4 . Data is classified according to groups of component. In each outlier region, non-pharmaceutical interventions (NPI) implemented and their timing are identified.

Outliers among regions in the Philippines with respect to COVID-19 cases

Outliers among regions in the Philippines with respect to COVID-19 deaths

Region III is an outlier in terms of working population (C) and the number of ICU beds (C) (see Fig.  5 and Table  5 ). This means that considering the working population of the region, the number of COVID-19 infections are better than that of other regions. Same goes with the number of ICU beds in relation to COVID-19 deaths. Region III is comprised of Aurora, Bataan, Nueva Ecija, Pampanga, Tarlac, Zambales, and Bulacan. This good performance might be attributed to their performance especially on their programs against COVID-19. As early as March 2020, the region had been under a community lockdown together with other regions in Luzon. Being the closest to NCR, Bulacan has been the most likely to have high number of COVID-19 cases in the region. But the province responded by opening infection control centers which offer free healthcare, meals, and rooms for moderate-severe COVID-19 patients [ 27 ]. They have also implemented strict monitoring of entry-exit borders, organization of provincial task force and incident command center, establishment of provincial quarantine facilities for returning overseas Filipino workers, mandated municipal quarantine facilities for asymptomatic cases, and mass testing, among others [ 27 ]. Most of which have been proven effective in reducing the number of COVID-19 cases and deaths [ 28 ].

Outliers among the provinces in Luzon with respect to COVID-19 cases and deaths

Outliers among the provinces in Visayas with respect to COVID-19 cases and deaths

Outliers among the provinces in Mindanao with respect to COVID-19 cases and deaths

Region IV-A is an outlier in terms of population and working population (D) and doctors on quarantine (D) (see Fig.  5 and Table  5 ). Considering their population and working population, the COVID-19 death statistics show better results compared to other regions. Same goes with the number of doctors in the region which are in quarantine in relation to the reported COVID-19 deaths. This shows that the region is doing well in terms of decreasing the COVID-19 fatalities compared to other regions in terms of populations and doctors on quarantine. Region IV-A is comprised of Batangas, Cavite, Laguna, Quezon, and Rizal. Same with Region III, they have been under the community lockdown since March of last year. Provinces of the region such as Rizal have been proactive in responding to the epidemic as they have already suspended classes and distributed face masks even before the nationwide lockdown [ 29 ]. Despite being hit by natural calamities, the region still continue ramping up the response to the pandemic through cash assistance, first aid kits, and spreading awareness [ 30 ].

An interesting result is that NCR, the center of the country and the most densely populated, is a good outlier in terms of GRDP (C) and GRDP (D). Cities in the region launched various programs in order to combat the disease. They have launched mass testings with Quezon City, Taguig City, and Caloocan City starting as early as April 2020. Pasig City started an on-the-go market called Jeepalengke. Navotas, Malabon, and Caloocan recorded the lowest attack rate of the virus. Caloocan city had good strategies for zoning, isolation and even in finding ways to be more effective and efficient. Other programs also include color-coded quarantine pass, and quarantine bands. It is also possible that NCR may just have a very high GRDP compared to other regions. A breakdown of the outliers within NCR can be seen in Fig.  8 .

Outliers in the national capital region with respect to COVID-19 cases and deaths

Region VII is also an outlier in terms of population density (D) and frontliners (D) (see Fig.  6 and Table  5 ). This means that given the population density and the number of frontliners in the region, their COVID-related deaths in the region is better than the rest of the country. This region consists of four provinces (Cebu, Bohol, Negros Oriental, and Siquijor) and three highly urbanized cities (Cebu City, Lapu-Lapu City, and Mandaue City), referred to as metropolitan Cebu. This significant decline may be explained by how the local government responded after they were placed in stricter community quarantine measures despite the rest of the country easing in to more lenient measures. Due to the longer and stricter quarantine in Cebu, the lockdown had a greater impact here than in other areas where restrictions were eased earlier [ 31 ]. Dumaguete was one of the destinations of the first COVID case in the Philippines [ 32 ], their local government was able to keep infections at bay early on. Siquijor was also COVID-19-free for 6 months [ 33 ]. The compounded efforts of the different provinces in the region can account for the region being identified as an outlier.

Among the metropolitan cities, Davao came out as a good outlier in terms of population (C) and working population (C) (see Figs.  7 , 9 , and Table  5 ). This result may be attributed to their early campaign on consistent communication of COVID-19-related concerns to the public [ 34 ]. They were also able to set up transportation for essential workers early on [ 35 ].

Outliers among metropolitan areas in the Philippines with respect to COVID-19 cases and deaths

This study identified outliers in each data group and determined the NPIs implemented in the locality. Economic, health and demographic components were used to identify these outliers. For the regional data, three regions in Luzon and one in Visayas were identified as outliers. Apart from the minimum IATF recommended NPIs, various NPIs were implemented by different regions in containing the spread of COVID-19 in their areas. Some of these NPIs were also implemented in other localities yet these other localities did not come out as outliers. This means that one practice cannot be the sole explanation in determining an outlier. The compounding effects of practices and their timing of implementation are seen to have influenced the results. A deeper analysis of daily data for different trends in the epidemic curve is considered for future research.

Correlation tables, outliers and community quarantine timeline

Availability of data and materials.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

JFR is supported by the Abdus Salam International Centre for Theoretical Physics Associateship Scheme.

This research is funded by the UP System through the UP Resilience Institute.

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Dylan Antonio S. Talabis, Ariel L. Babierra, Christian Alvin H. Buhat, Destiny S. Lutero, Kemuel M. Quindala III & Jomar F. Rabajante

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S. Talabis, D.A., Babierra, A.L., H. Buhat, C.A. et al. Local government responses for COVID-19 management in the Philippines. BMC Public Health 21 , 1711 (2021). https://doi.org/10.1186/s12889-021-11746-0

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Building a Better Normal under COVID-19: Harnessing Digital Technologies in the Philippines

E-commerce activities in the Philippines accelerated during the pandemic.

Gato Borrero/World Bank

When COVID-19 was declared a pandemic in February 2020, containment measures made digitalization essential for economic and social resilience. The Philippines, unfortunately, has not been able to leverage digital technologies to their full extent because of poor access to affordable and high-quality internet and long-held analog practices. Consumers experience slower download speeds and pay more than many of their ASEAN peers. These gaps contribute to a digital divide in the country with about 57 percent of households not having internet access in 2018, and thus, unable to reap the benefits of digitalization. This analytical report articulated this digital divide in the context of the COVID-19 crisis, that has contributed to unequal access to services delivered via the internet. For example, the shift to remote learning has left poorer children with limited internet access falling behind their wealthier, more connected counterparts. Moreover, work-from-home arrangement has been difficult for workers with unreliable internet connection.

A World Bank team embarked on a study to assess the state of the digital economy in the Philippines, identify the key challenges to digital adoption, and provide policy recommendations to improve the enabling environment. The study deep dived into the key areas of the digital economy including on digital infrastructure, digital payments, logistics and taxation, and the business environment. Policy dialogues and dissemination activities ensured that the recommendations reached the relevant government counterparts.   

The multifaceted nature of the digital economy required close collaboration with different government stakeholders. Effective client relation led to the establishment of the Philippines Digital Economy Steering Committee in early 2019. The committee consisted of representatives from key government agencies to lead cross-agency coordination and the clearance of the report’s recommendations. Direct engagement with the steering committee raised the likely implementation of the policy recommendations.

Sharing drafts with counterparts ahead of the report’s completion signaled the urgency of the digitalization agenda. Dissemination also included roundtable discussions and bilateral dialogues, which contributed not only to new engagements, but also provided an opportunity to obtain feedback on preliminary findings. The report was jointly launched by the World Bank and the National Economic and Development Authority, bringing together a diverse set of audiences including the public sector, private sector, development partners, academia, and civil society. 

The effective partnership between the World Bank and the Philippines Digital Economy Steering Committee, coordinated by the National Economic and Development Authority, delivered notable results:

• Informed government’s policy actions. Poor digital performance indicators are tied to the inadequacy of the country’s digital infrastructure. To address the gap, the study recommended the promotion of common infrastructure sharing and improving the ease of doing business. In May 2020, the Department of Information and Communications Technology (DICT) issued a circular on the co-location and sharing of passive telecommunication tower infrastructure for macro cell sites. Four months later, the initiative was complemented by the joint memorandum circular on the streamlined guidance for the issuances of permits, licenses, and certificates for the construction of shared passive telecommunications tower infrastructure. These policy developments resulted in the DICT issuance of provisional certificates to 23 independent tower companies in September 2020.
• Institutionalized initiatives beyond the report delivery. The report informed government plans and programs such as the logistics part of the Department of Trade and Industry’s E-commerce Philippines Roadmap 2022. Likewise, the joint World Bank-Philippine Statistics Authority (PSA) measured the size of the digital economy, and came up with a methodology to capture the digital economy from the system of national accounts. The exercise built capacity for the PSA to conduct the measurement itself.
• Opened new areas for Bank engagements. Select chapters of the report contributed to new engagements including a just-in-time support on taxation of e-commerce in the Philippines, a review of the status of government digital platforms, and a Digital Philippines Advisory Services Reimbursable Advisory Services (RAS).  The report also provided inputs on the competitiveness pillar of the second operation of the Philippines Promoting Competitiveness and Enhancing Resilience to Natural Disasters Development Policy Operation series. 

Bank Group Contribution

The International Bank for Reconstruction and Development (IBRD) financed the analytical study with a resource envelope totaling US$336,883 spread over two years.

The Philippines Digital Economy Report 2020 was undertaken in collaboration with the Philippines Digital Economy Steering Committee consisting of key government stakeholders including the National Economic and Development Authority, Department of Finance, Department of Budget and Management, Department of Trade and Industry, Department of Information and Communications Technology, Department of Science and Technology, Philippine Competition Commission, Philippine Statistics Authority, and the Bangko Sentral ng Pilipinas.

Moving Forward

Supporting the growth of the digital economy has emerged as a key priority of the government, where the collaboration with the World Bank continues beyond the publication of the report.

• The chapter on digital infrastructure contributed to dialogues that resulted in a two-year Digital Philippines Advisory Services RAS with the DICT. The RAS program covers digital government implementation options, legal and regulatory framework review, digital workforce analysis, and a digital Philippines monitoring and evaluation framework.
• Following the joint work on measuring the size of the digital economy, the PSA plans to institutionalize the digital economy measurement initiative to become part of its regular work program.
• As a follow up to the report, a World Bank team plans to conduct a technology adoption survey of firms to understand the extent, opportunities, and challenges of firm usage of digital technology in the Philippines.
• There are other concurrent World Bank studies and operations with digital angles and components such as the Philippines Customs Modernization project which looks into the automation of customs’ systems and processes, and the Philippines Beneficiary FIRST Social Protection project which looks into digital tools to transform social protection delivery in the country.
• The report has been discussed with development partners, garnering support for the initiatives in this space. This can open up further opportunities for collaboration and support to the government in pursuing their digital transformation initiatives.

“This Philippines Digital Economy Report launch comes at an opportune time as the country navigates through the pandemic. […] We really needed to fast-track these reform agenda.  As relevant as this report is given the current environment, what is more anticipated are the subsequent public and private endeavored initiatives that will lay down the fundamentals to allow for an accelerate digital transformation in the country.”  - Dr. Rosemarie Edillon, Undersecretary for National Development Policy and Planning, National Economic and Development Authority , during the launch of the Philippines Digital Economy Report

• Full Report: Philippines Digital Economy Report 2020 : A Better Normal Under COVID-19: Digitalizing the Philippine Economy Now
• Press Release: Harnessing Digital Technologies Can Help Philippines Overcome Impact of Pandemic, Hasten Recovery National Economic and Development Authority
• Infographic: In a world of shocks, going digital would help the Philippines

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• Published: 30 March 2022

OCTA as an independent science advice provider for COVID-19 in the Philippines

• Benjamin M. Vallejo Jr 1 &
• Rodrigo Angelo C. Ong 1  

Humanities and Social Sciences Communications volume  9 , Article number:  104 ( 2022 ) Cite this article

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We comment on science advice in the political context of the Philippines during the COVID 19 pandemic. We focus on the independent science advisor OCTA Research, whose publicly available epidemiological forecasts have attracted media and government attention. The Philippines government adopted a COVID-19 suppression or “flattening of the curve” policy. As such, it required epidemiological forecasts from science advisors as more scientific information on SARS CoV 2 and COVID 19 became available from April to December 2020. The independent think-tank, OCTA Research has emerged the leading independent science information advisor for the public and government. The factors that made OCTA Research as the dominant science advice source are examined, the diversity of scientific evidence, processes of evidence synthesis and, of evidence brokerage for political decision makers We then describe the dynamics between the government, academic science research and science advisory actors and the problem of science advice role conflation. We then propose approaches for a largely independent government science advisory system for the Philippines given these political dynamics.

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Introduction.

Pandemic science before COVID 19 presumed “predictable challenges” (Lipsitch et al., 2009 ) that informs government response especially in planning for containment interventions such as lockdowns. The success of government response is in the public perception of a positive outcome and this is reducing the number of infections. The COVID 19 pandemic is a crisis in which the orderly functioning of social and political institutions are placed into disorder and uncertainty (Boin et al., 2016 ). In political institutions this may be a threat to accepted political power arrangements and requires a response which because of their urgency, are occasions for political leaders to demonstrate leadership. However, to do so they will have to rely on actors who provide science, economic and social information and advice. In many cases these actors are within the government bureaucracy itself, as specialized agencies. Academic research institutions also provide advice. Civil society organizations with science and technology advocacies may provide advice. Science advice provided by civil society organizations, citizen science advocacy organizations and non-government think tanks are independent science advice providers. These organizations are a feature of the technical and science advice ecosystems of liberal democracies.

How governments use science advice and decide in a crisis strengthens political legitimacy. In the United Kingdom with its formal structures of government science advice such as the Science Advisory Group for Emergencies (SAGE) a key outcome is lowering SARS CoV 2 transmission (R) rate and the way this can be achieved is to institute a lockdown. SAGE was placed in a high degree of public, media and political scrutiny in its recommendations. While formal science advice structures may work well in countries with a large and well-established science community, in countries with small science communities, independent science advice actors may be more effective than formal science advice actors.

Previous studies on the use of science advice by governments have revealed a dichotomy. Knowledge producers (e.g., academic science community) perceive high uncertainty in scientific results and consequentially become guarded in their science advice or even dispense with it in recognition of their political costs. In contrast knowledge users (e.g. politicians and science advisors in government) perceive less uncertainty in science advice and require assurances in outcomes (MacKenzie, 1993 ). This present challenges for science advice practitioners since differentiating the roles of science knowledge generation and science knowledge users, both of which can be played by academic scientists, can be conflated, and may result in political risks and opportunities.

To remedy this conflation, science advice mechanisms emphasizing independent knowledge brokerage (Gluckman, 2016a ) define a particular role for scientists in listing down science informed options for politicians and policy makers. These roles have their theoretical basis from post-normal science approaches (Funtowicz and Ravetz, 1993 , 1994 ; Ravetz, 1999 ) which place a premium on managing uncertainty in crises through consensus building and identifying of science informed policy options. The science advice “knowledge broker” will not be functioning as part of the knowledge generation constituency but in a purely advisory capacity identifying policy options. This is the model promoted by the International Network for Government Science Advice (INGSA). This also insulates the science advisor from undue political interference.

However, in countries where the science community is small and politically underrepresented, performing these well-defined functions will be difficult due to a lack of experts and the range of scientific expertise they can provide. In small science communities, the problems of role conflation become more apparent and may place the science advisor prone to political pressure. Vallejo and Ong ( 2020 ) reviewed the Philippines government response and science advice for COVID 19 from when the World Health Organization (WHO) advised UN member states of a pandemic health emergency on January 6 to April 30, 2020 when the Philippines government began relaxing quarantine regulations. They noted the roles of various science advice knowledge generation actors such as individual scientists, academe, national science academies and organizations and how these were eventually considered by the Inter Agency Task Force on Emerging Infectious Diseases (IATF-EID) which is the government’s policy recommending body for COVID 19 suppression. Of these advisory actors, the private and independent OCTA Research Group hereafter referred to as OCTA, which consists of a multi-disciplinary team of academics from the medical, social, economic, environmental, and mathematical sciences mostly from the University of the Philippines, became the most prominent source of government science advice with its proactive but unsolicited provision of government science advice.

Because of this engagement, like SAGE in the UK, OCTA became a focus of intense media, public, and political interest and could represent an effective modality for independent science advice especially in newly industrialized countries where the science community is small but gaining a larger base of expertise. While science advice in this context may involve a conflation of science advice roles, we look into this conflation and their political dynamics in pandemic uncertainty and how consensus was formed in COVID 19 policy advice. This paper explores on how independent science advice has proved to be the chief source science advice in a polarized political environment in a Southeast Asian nation from the start of the pandemic in January 2020–October 2021.

The Philippine science advice ecosystem

Science advice in the Philippines takes on formal (with government mandate), informal (without government mandate) solicited and unsolicited modalities. Formal science advice to the President of the Philippines is provided by the National Academy of Science and Technology (NAST) by virtue of Presidential Executive Order Number 812. The government solicits science advice from the NAST which provides advice as position or white papers to cabinet for consideration. The NAST is not a wholly independent body from government. It is attached to the Department of Science and Technology (DOST) for administrative and fiscal purposes.

Other sources of science advice are from the universities such as the University of the Philippines (UP). The UP is designated by charter (Republic Act Number 8500) as the national, research and graduate university. This mandates it to provide science advice to the government. Academics in their individual capacities, as members of think-tanks or civil society organizations provide unsolicited and informal science advice to government through the publication of scientific and position papers as well as technical reports. Academics who are part of non-government science academies such as the Philippine American Academy of Science and Engineering (PAASE) provide similar advice. The science advice system in the Philippines is diverse with each actor having its own political and development advocacy. The system is largely ad hoc and informal, and science advice are largely unsolicited. This dynamic determines its role with the government. Also, when these science advice actors are consulted by the government, they are all primuses inter pares in dealing with political actors in government. Members of the science advisory bodies are mostly active academics. They are all knowledge producers and users at the same time.

There are few studies that directly examine the politics of science advice and uncertainty in the Philippines, and these are in disaster risk reduction management (DRRM). This can serve as a template for analysis for the COVID 19 pandemic in the Philippines which has been construed by government and the public as a global disaster. The strengths and weaknesses of the present science advisory system may be seen in DRRM advice.

DRRM as a framework for government science advice in the Philippines

Disasters which have affected the Philippines in the first decade of the 21st century such as Typhoon Ketsana (Philippine name “Ondoy”) in 2009 which flooded much of the National Capital Region, have resulted in several studies investigating the resilience of urban communities and how science advice is used in crafting urban resilience policies and governance. This disaster was also the major impetus for disaster legislation with enactment of the DRRM law (Republic Act Number 10121). This law institutionalizes and mainstream the development of capacities in disaster management at every level of governance, disaster risk reduction in physical and land-use planning, budget, infrastructure, education, health, environment, housing, and other sectors. The law also institutes the establishment of DRRM councils at each level of government. The councils are composed of members from government departments, the armed forces and police, civil society, humanitarian agencies but most notably, does not include academic research scientists. Science advice is given by CSOs but that is in accordance with their particular advocacies and their political objectives.

A study commissioned by the independent think tank Odi.org and by researchers of De La Salle University in Manila (Pellini et al., 2013 ) concluded that there is a “low uptake of research and analysis” to inform local decision in DRRM. It also identified a reactionary response to disasters rather than a response to disaster risks. Formal and informal science advice is most effective in local government if local executives prioritize risk reduction with consensus building at the local level. In general, formal, and informal science advice is less effective at the national level. The Philippine science advisory ecosystem is focused on formal science advice at the national level and thus the effectiveness of science advice is placed into question. The disaster-prone province of Albay is held as an example where science advice is more effective at a devolved level from the national (Bankoff and Hilhorst, 2009 ; Pellini et al., 2013 ).

At the lower levels of governance, informal science advice is predominant and is provided by science advice actors such as non-government organizations (NGO) or by civil society organizations (CSO). While NGOs, CSOs and, the government communicate using a consensus vocabulary (Funtowicz and Ravetz, 1994 ) in DRRM, differing risk perceptions have resulted in different domains of political engagement (Bankoff and Hilhorst, 2009 ) tied to different interpretations of the risk vocabulary in terms of political costs. And so the dominant paradigm remains disaster reactive with a general trend in “dampening uncertainties” (Pearce, 2020 ) in order to come up with positive political outcomes for the science advisors and the government.

While the present DRRM law institutionalizes consultation and collaboration, the law does not mandate a science or technical advisor to sit on DRRM councils at each level of governance. This is one possible reason for the “low uptake of research and analysis” at higher levels of governance while at lower levels of governance, science advice is provided by CSO and other advocacy organizations in an independent and ad hoc manner as they are more effective in establishing collaborative relationships with local government executives and councils.

IATF-EID and OCTA Research as an independent science advisor

Vallejo and Ong ( 2020 ) review the timeline for the Philippines government COVID 19 response, the formation of the Inter-agency Task Force on Emerging Infectious Diseases (IATF-EID), the science advisory ecosystem, and how the science community began to dispense informal science advice for consideration by IATF-EID. IATF-EID is the government’s policy recommending body for COVID 19 suppression and is composed of members from the cabinet and health agencies of the government. Informal science advice initially came from individual or groups of academics modeling the initial epidemiological trajectory of COVID 19. The IATF-EID is not a science evidence synthesizing or peer review body. It must rely on many science advisory actors as consultants. The University of the Philippines COVID 19 Pandemic Response Team is a major actor as its scientists are well known in the medical and disaster sciences. But it was OCTA which is composed mainly of academics from the University of the Philippines and the University of Santo Tomas. OCTA that has emerged as the leading government science advice actor for COVID 19.

OCTA bills itself as a “polling, research and consultancy firm”(Fig. 1 ). That OCTA has been identified in media reports as the “University of the Philippines OCTA Research group” is to be expected as academic credibility is a premium in the Philippines as like in other countries (Doubleday and Wilsdon, 2012 ). This however can constrain its political relationship with government science advice actors and so OCTA had to publish disclaimers that while it is composed of mostly University of the Philippines academics, it claims to be an independent entity. OCTA’s polling function is separate from its science advice advocacy which is performed by volunteer scientists as testified by OCTA President Ranjit S Rye to the Philippine Congress Committee on Public Accountability on 3 October 2021. The polling function is supported by paid subscribers while the science advice advocacy is supported by unpaid volunteers. Volunteer OCTA epidemiological modelers and policy analysts have provided robust estimates on the COVID 19 reproductive number R0, positivity rates, hospital capacity and attack rates at the national, provincial, and local government levels every fortnight beginning April 27, 2020. It has since issued 76 advisories and updates (Fig. 2 ). Local and provincial governments have used their forecasts in deciding quarantine and lockdown policies in their jurisdictions. OCTA publicly released these forecasts in academic websites, institutional media and social media. This allowed for public vetting and extended peer review with other independent scientists validating its forecast estimates. Some independent scientists contest methodologies and OCTA has appropriately responded to these.

OCTA is a primarily polling organization but has taken on COVID-19 monitoring, forecasting and advice services.

An OCTA COVID-19 forecast update (7 March 2021).

OCTA like other science advice actors, based its epidemiological analyses on the Philippines Department of Health (DOH) Data Drop whose data quality was publicly perceived as poor even though steps have been taken to improve data quality. The DOH in the interest of transparency began Data Drop on April 15, 2020. Data Drop has information on the number of active cases, recovered cases, and hospital admissions. With Data Drop, OCTA was able to issue its first epidemiological forecast.

OCTA does not belong to the formal structures of science advice in the Philippines but is part of the informal science advice community. Its volunteer experts are publicly known. OCTA has emerged as the leading information and science advice provider for the public. How did it become the leading source of science advice and often cited by social and mainstream media and acknowledged by government?

Uncertainty perception in COVID-19 suppression and the political context of role conflation

OCTA became the leading source of science advice when by publishing weekly forecasts on COVID-19 epidemiological trends, it reduced public perception of uncertainty of the pandemic. The bulletins estimated national and regional R0, attack rates, hospital capacity and ICU bed capacity. While most countries worldwide have adopted suppression as the main strategy (Allen et al., 2020 ) a few countries most notably New Zealand, adopting a COVID 19 elimination strategy. The Philippines decided on a suppression policy or a strategy of “flattening the curve” which necessitated lockdowns with the outcome of reducing R0 and COVID-19 hospital admissions.

The most socially and economically disruptive intervention is lockdown with is tied with the uncertainty of lifting quarantine (Caulkins et al., 2020 ). The Philippines instituted a national lockdown beginning 14 March 2020 and instituted a graded system of “community quarantine” which allowed for almost cessation of economic activity and mobility in enhanced community quarantine (ECQ), a modified enhanced community quarantine (MECQ) which allows for the opening of critical services and a limited operation of public transport, to a near open economy and unimpeded local mobility in modified general community quarantine (MGCQ) and a low risk general community quarantine (GCQ) which allows for most economic activities subject to health protocols (Vallejo and Ong, 2020 ) which regulated mobility between quarantine zones.

It is in lockdown policies that uncertainty perception takes on a large political dimension (Gluckman, 2016b ; Pearce, 2020 ). Science advisors have to provide forecasts on the trajectory of R0 for politicians to make a decision on tightening or relaxing of quarantine. In this manner OCTA has provided not only the quarantine grade option but the best option while recognizing that the constraint to lessening the perception of uncertainty lies on data quality itself (Johns, 2020 ). OCTA has raised this concern questions on the accuracy and timeliness of DOH’s Data Drop. In doing so, it has done multiple scenario models to assess the accuracy of data. If the government takes on lockdown as the main strategy for COVID 19 suppression, then it must ensure that science advisory actors are able to deal with the multiple uncertainties that data quality will generate. Science advisory actors can be both knowledge generators and users and this conflation has several consequences such as a tension between knowledge production and use which is called as the “uncertainty monster” (Van der Sluijs, 2005 ).

OCTA it its business model has role conflation. While its polling services are paid for by subscribers, the science advice advocacy function in COVID-19 is volunteer based. This conflation was questioned by members of Congress. Thus, the political context for OCTA is within the problem of role conflation in science in a particular political and academic context which may be the norm in developing countries. The politics of conflation in science advice in the UK was demonstrated when two esteemed epidemiologists belonging to two research groups, Professor Neil Ferguson of the Imperial College London (ICL) and Professor John Edmunds of the London School of Hygiene and Tropical Medicine (LSHTM) released R0 estimates to the public. ICL and LSHTM provided advisories to media and the UK government SAGE, with two different estimates for R0. The ICL estimate (2.0–2.6) were earlier made known to media while the LSHTM estimate (2.7–3.99) underwent peer review and was published in Lancet Public Health (Davies et al., 2020 ). The two estimates became the focus of controversy as the UK Chief Science Advisor Professor Patrick Vallance echoed Edmund’s claim of a case doubling time of 5–6 days. The SAGE consensus was 3–4 days, thus necessitating a sooner rather than later lockdown. The question on when to impose a lockdown is also a political matter. This placed SAGE and its established protocols of keeping experts anonymous under public criticism and scrutiny.

Pearce ( 2020 ) reviews the problem of role conflation of knowledge providers (the modelers) and the knowledge users (government) if they occupy both positions at the same time. Edmunds is a SAGE member (knowledge user) as well as a producer of science information as an academic. This conflation of roles resulted in the “dampening of uncertainties” for political reasons. The government is not acutely aware that this ultimately stems from poor data quality and the resulting scientific uncertainty has great political costs (UP COVID-19 Pandemic Response Team, 2020 ).

Similarly, OCTA has faced questions in its R0 estimates which differs from estimates by other scientists. OCTA’s estimates are higher (2.3) than what government initially used (2.1) in characterizing the surge in cases beginning Feb 2021. With R0 and positivity rates increasing, OCTA recommended an ECQ for the 2021 Easter break which was extended to a MECQ until 30 April 2021 (CNN Philippines, 2021 ). Like in the UK, this will affect policy decision making based on doubling time and the allocation of health resources. But unlike in the UK where there is a formal process of science peer review, in the ad hoc nature of science advice review in the Philippines, much of this “open peer review” by academics was on social media thus giving a polarizing political environment in policy decision.

OCTA has long been aware of the problem of role conflation which is a problem in a country with a small national science community. The national science community is small with only 189 scientists per million people. It thus has sought the expertise of overseas Filipino scientists to expand its advisory bench and to reduce possible role conflation. The overseas scientists are not associated with government health research agencies and so could act more independently. This was a strategy to deal with the possibility of “dampening of evidence”. The Presidential Spokesperson Mr. Harry Roque said that OCTA should cease reporting results to the public and rather send these “privately” to government (Manila Bulletin, 2020 ; Philippine Star, 2020 ). Roque is misconstruing the role of OCTA as a formal government science advisory body when it is not. The statements of the government spokesman may reflect debates in cabinet about the necessity and role of government science advice in and outside of government and their political costs. IATF-EID has its own experts as internal government science advisors. However, their advice must still be subject to peer review and so a mechanism must be found for these experts to compare forecasts with independent advisors such as OCTA. This will minimize public perception that the government silencing OCTA to dampen uncertainties for political outcomes. Public trust in government science advice has always been low if there is no transparency (Dommett and Pearce, 2019 ).

OCTA forecasts have been criticized by government economic planners especially in tourism (Philippine Daily Inquirer, 2020 ) as the forecasts directly affect plans to reopen important economic sectors. Some criticism is apparently political (Manila Times, 2020 ) and implies alienation of OCTA from its academic institutional linkage base. OCTA forecasts have been more and more adopted by the IATF-EID (ABS-CBN, 2021 ) This is a political dynamic for science advice actors sitting in government. Internal science advice actors will have to deal with populist interests in government and their advice may be “written off” (Boin et al., 2016 ). Independent science advice actors do not want their government science advice to be written off and so are likely to take the public route in presenting their synthesis of evidence and options.

Pandemic policy response is all about the management of multiple epidemiological uncertainties. This is when inability of government to manage it became apparent when doctors through the Healthcare Professionals Alliance Against COVID-19 (HPAAC), an organization which is comprised of the component and affiliate societies of the Philippine Medical Association admonished the government to increase quarantine restrictions from General Community Quarantine to Modified Enhanced Community Quarantine for a period of 2 weeks in August to allow the health workers to recover from exhaustion (One News, 2020 ). This is due to the surge in new cases and the overburdening of the healthcare capacity which OCTA earlier forecasted (David et al., 2020 ). The threat of a “doctors strike” would have been politically damaging to the government and the President decided to heed the doctors’ request.

The Philippines response is not very different from response of the majority of 22 countries examined by INGSA’s COVID 19 policy tracker (Allen et al., 2020 ), where these countries embarked on a monitoring and surveillance policy from January to March 2020. The INGSA study also shows that few countries have utilized internal and external formal science advisory bodies in the first 3 months of the pandemic. The Philippines is not one of the countries which INGSA tracked but similarly it started to seek the advice of individual experts by March 2020. Many of these experts posted their unsolicited science advice on social media.

Like most of the 22 INGSA tracked countries, after the 3rd month of the pandemic, the Philippines enacted legislation to deal with the social and economic impact of lockdowns. But this has not yet resulted in legislation passed in the Philippines Congress to deal with developing and improving systems for pandemic response through research and development initiatives although the late Senator Miriam Defensor Santiago filed Senate Bill 1573 “Pandemic and All Hazards Act” in September 2013 (Senate of the Philippines 16th Congress, 2013 ) in response to MERS and Senator Manny Villar in April 2008 filed Senate Bill 2198 “The Pandemic Preparedness Act” (Senate of the Philippines 14th Congress, 2008 ). Both bills institute a Pandemic Emergency Fund and mandates a Pandemic Emergency Council or Task Force, roughly along the lines of the DRRM Law. Defensor-Santiago’s bill was refiled by Senator Grace Poe as Senate Bill 1450 “An Act Strengthening National Preparedness and Response to Public Health Emergencies by Creating a Center for Disease Control” during the first session of the 18th Congress on 27 April 2020 (Senate of the Philippines 18th Congress, 2020 ). Poe’s bill updates Defensor-Santiago’s bill by proposing the creation of Center for Disease Control

These bills have not been enacted into law. The Philippines also did not enact legislation or executive on creating or strengthening science advisory capacity which 12 of the 22 countries INGSA tracked did. However, a senator has recently approached OCTA for policy input in developing formal crisis science advice legislation.

Prospects for independent government science advice in the Philippines

The Philippines government’s COVID 19 suppression policy is based on science informed advice. However, this has been provided informally by individual experts consulted by IATF-EID and this advice is not subjected to formal peer review. This has exposed experts to political criticism and attack as their identities and roles have been spun by media and government media spokespersons as integral to IATF-EID. At least one expert has resigned from providing science advice due to possible conflicts of interests. In this science advice gap, entered OCTA Research in the second quarter of 2020 and continued to 2021 and 2022.

The informal science advice actors more often give their forecasts directly to the media while the formal actors give it to the government agency that commissioned it. The government uses the evidence in determining what quarantine status to implement nationally and regionally through the recommendation of the IATF-EID.

The government’s policy decisions on COVID 19 suppression are chiefly based on a single statistical estimate, R0 but more recently has included positivity rate and hospital capacity. Science advisory bodies must defend R0 and the other estimates to the government and in the public sphere. The estimates will have incorporated all statistical uncertainties in this number. OCTA has done this by publicly reporting low, moderate and high R0 scenarios and the consequent projections for new cases, hospital utilization and attack rates at the national, regional and local government level. The government has used these estimates in its monthly policy responses.

Considering that both use the same DOH Data Drop dataset, dissonance between OCTA and government scientists’ recommendations have been reported in print, broadcast, and social media. This involves largely the differences in interpreting the framework of quarantine status and risks, with government experts tending to question OCTA’s projections with a very conservative precautionary interpretation of evidence. One doctor with the IATF-EID has accuses OCTA of using “erroneous” and “incomplete” data (Kho, 2021 ). This dissonance has led politicians to label OCTA as “alarmist” (David, 2021 ).

OCTA is a knowledge producer in science advice since it constructs DOH epidemiological data into models informed by epidemiological theory. Even if OCTA has decided to remain completely independent as a science advisory body, it is not completely insulated from political attack. Political attack is a result of perceived role conflation in the science advice ecosystem and process which is exacerbated by the nature of uncertainty in science advice leading to accusations of OCTA being “alarmist. OCTA was misconstrued by the government as its own knowledge producer and its critics demanded that it be completely alienated from its academic institutional linkages. OCTA’s weakness and the weakness of the Philippines crisis science advisory system overall, is the lack of external and extended peer review. This is a consequence of a small science community where there are few actors who can perform this role with citizen scientists. In a postnormal science advisory environment, the role of extended peer review is important in validating policy options and creating public consensus.

OCTA has recently partnered with Go Negosyo, a small and medium business entrepreneurship (SME) advocacy, headed by Presidential advisor for entrepreneurship, Joey Concepcion. Mr. Concepcion has a minister’s portfolio. OCTA in this arrangement will provide data analytics services and science advice for SMEs for a business friendly COVID exit policy with a safe reopening of the economy based on vaccination prioritization strategies (Cordero, 2021 ). This move also evidences OCTA’s influence in setting new policy directions in government’s adoption of a new quarantine classification system of Alert Levels, an idea first proposed by OCTA Fellow and medical molecular biologist Rev Dr. Nicanor Austriaco OP and mathematical modeler Dr. Fredegusto Guido David. This is a political move on OCTA’s part to deflect critics in Congress as the business sector has a large political clout in government.

While a pandemic crisis like COVID 19 gives political leaders an advantageous occasion to demonstrate personal leadership, their constituencies will tend to expect a more personalistic crisis management. In this independent science advice plays a crucial political dynamic by building public trust, ensuring reliable statistical estimates reviewed by the academic science community, and managing political advantages and risks. These are all in the context of epidemiological uncertainties. In the Philippines, public criticism of the pandemic response is fierce due to the primarily law and order policing approach which raised concerns on human rights violations (Hapal, 2021 ) as well as those cases began to rise in the first quarter of 2021 (Robles and Robles, 2021 ). The failure to deal with uncertainties in science without effective science advice may entail large political costs. Managing public perception and the use of government scientific and technical advice is a delicate balancing act in liberal democracies. The press and media will report and scrutinize science informed decisions while shaping public opinion of crisis decisions. Academic science and civil society organizations not part of the advisory system provide another level of scrutiny and critique. Social media has extremely broadened the venue for public scrutiny and, open or extended peer review of crisis decisions.

These realities were not faced by political leaders as recently as 30 years ago. However unfair or unrealistic the critique by constituencies and the press, public expectation is real in political terms. And while politicians can “write off” certain social and political sectors in deciding which crisis response is best, this is no longer tenable in democracies in the 21st century.

In these realities emerge new actors of engaged independent academic science advisors such as OCTA. It has certainly played the role of a knowledge generator and to some extent a knowledge broker. And like any science advice actor, OCTA was not immune to political attack, and this would suggest that SAGE with its embeddedness in the administrative and ministerial structures in the UK, largely missing in the Philippines (Berse, 2020 ), will be subject to great political interference which may limit its effectiveness. Political interference may masquerade as technical in nature (Smallman, 2020 ).

The Philippines government response to COVID 19 has been described as “deficient in strategic agility” (Aguilar Jr, 2020 ) partly due to its inability to mobilize scientific expertise and synthesize science informed advice options in governance. Thus, a plausible proposal to strengthen science advice is in reframing the DRRM policy and advisory structures and applying these to crisis in order to strengthen science advice capacity at all levels of governance. As Berse ( 2020 ) suggests “tweaking the National Disaster Risk Reduction and Management Council structure, which has a seat for an academic representative, might do the trick. This national set-up is replicated by law at the provincial, city and municipal levels”.

Berse also suggests that an academic should be appointed to sit at each of these councils. The major constraint is that there are very few academics willing to sit as this will expose them to political criticism and interference. If academics are appointed, then their expertise should not be unduly constrained by political interference. They should be backed by several researchers and citizen scientists coming from multiple disciplines in reviewing science informed policies. More and more citizen scientists have come up with science advice which for consistency of policy should be reviewed in extended consensus by scientists and stakeholders (Funtowicz and Ravetz, 1993 ; Marshall and Picou, 2008 ).

The closed and elitist system of science advice in the Philippines with its handful of actors, mainly appointed by government, are inordinately prone to political pressure. This necessitates the role of independent science advisors. Independent science advisors can act as a “challenge function” to government experts whose recommendation if ignored contributes to further erosion of public trust in government (Dommett and Pearce, 2019 ). Independent science advice when framed in the context of parliamentary democracy can be likened to “shadow cabinets” in this way they provide a check, balance and review of science evidence and is called “shadow science advice” (Pielke, 2020 )

As pandemics and other environmentally related public health emergencies are expected to be more frequent in the 21st century, the public will be less tolerant of social and political instability and demand a clear science informed response from their politicians. However, most politicians do not have enough scientific and technical competency to do so and so will have to rely on science informed advice which has degrees of outcome uncertainty (Gluckman, 2016b ). If science informed options are ignored for political gains, this is not a result of broken science advice and knowledge generation systems but a dysfunctional political and governance system. The huge cost in life and economic opportunity left by the pandemic demands functional government informed by science advice.

Furthermore, any government to cement its legacy must find a COVID 19 crisis exit strategy after the operational aspects such as a mass vaccination strategy have been met and the social, health (Dickens et al., 2020 ), economic and political situation has been stabilized (Gilbert et al., 2020 ). In COVID 19, this is a gradual relaxation of lockdown and quarantine (Leung and Wu, 2020 ) with the roll out of vaccines.

Vaccination is the main COVID-19 exit strategy of the government (Congress of the Philippines, 2021 ) and given the large existing vaccine hesitancy of 46% as OCTA estimated in February 2021 (Tomacruz, 2021 ), there is a need to increase public confidence on vaccines (Vergara et al., 2021 ). Public distrust of vaccines became a major public health concern due to the Dengvaxia vaccine rollout controversy in November 2017 when Sanofi publicly released a warning that vaccination posed a risk if given to people who never had a dengue infection (Larson et al., 2019 ). The political impact was damaging to the Benigno Aquino III presidential administration, which rolled out the vaccine in 2016 before Aquino III’s term ended. The drop in vaccine confidence was significant, from 93% in 2015 to 32% in 2018. The new presidential administration of Rodrigo Duterte placed the blame on Aquino III, and this resulted in social and political polarization, loss of trust in the public health system which have continued in the COVID-19 pandemic. The “blame game” is political risk in any liberal democracy. This can be a long drawn out affair where government will have to establish accountability and the “blame game” is expected with various independent boards and blue ribbon committees setting the narrative (Boin et al., 2016 ). In the Philippines, several hearings in the House and Senate in which Sanofi and previous Department of Health leadership were called to give testimonies, further worsened political and social polarization to vaccination. These independent boards, blue ribbon committees and fact-finding investigations, however, are prone to agency capture by ruling party politics. This is evident in the Philippines. The government exit strategy for COVID-19 is clouded by these polarizations. OCTA will be expected by the public to provide government science advice on vaccination policies, and this will have great political costs for independent science advice. As vaccination in the Philippines has become a political issue more than as a public health issue, other think tanks and academic research institutions which have investigated Dengvaxia, and vaccine compliance have been more guarded as not to attract undue negative political comment. OCTA to its credit, has successfully navigated political risks in its COVID-19 forecasts and in a political move, has allied with a SME advocacy headed by a close Presidential advisor on economic affairs. OCTA can continue to maintain its credibility by periodically issuing forecasts and policy option recommendations and reducing social and political polarizations through consensus building with the public, government, and science community. Here is where the independent science advice actors will have a place, and that is to set the objective bases for science informed policy decisions while recognizing the political dynamic. How independent science advice will result in lasting policy impacts in the Philippines remains to be seen. The government and the public have relied on OCTA forecasts because of OCTA’s increasing presence in broadcast, print, and social media. This is evidence of the effective science communication strategy of the organization. But with the Government increasingly using OCTA’s forecasts and policy recommendations, this is evidence that government science advice has political dividends and risks which may affect politicians’ political standing with the electorate in the 2022 election.

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Acknowledgements

The authors thank the University of the Philippines Bayanihan Research Grants for COVID-19 for funding support. We also thank Assistant Professor Ranjit Singh and Dr. Fredegusto Guido David of OCTA Research for providing OCTA COVID-19 forecasts and epidemiological model and Mr. Fil Elefante for proofreading. Many thanks also to Prof. Roger Pielke at the University of Colorado at Boulder and EsCAPE ( www.escapecovid19.org ) for encouraging the publication of this paper.

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Vallejo, B.M., Ong, R.A.C. OCTA as an independent science advice provider for COVID-19 in the Philippines. Humanit Soc Sci Commun 9 , 104 (2022). https://doi.org/10.1057/s41599-022-01112-9

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A topic modeling analysis on the early phase of COVID-19 response in the Philippines

Affiliations.

• 1 Division of Environment and Sustainability, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, 100025, Hong Kong SAR.
• 2 Information Technology and Computer Education Department, Leyte Normal University, Tacloban City, Leyte, 6500, Philippines.
• 3 Accident and Emergency Department, King's College Hospital: Princess Royal University Hospital Site, Farnborough Common, Kent, BR6 8ND, United Kingdom.
• PMID: 34123718
• PMCID: PMC8179722
• DOI: 10.1016/j.ijdrr.2021.102367

Like many others across the globe, Filipinos continue to suffer from the COVID-19 pandemic. To shed light on how the Philippines initially managed the disease, our paper analyzed the early phase of the government's pandemic response. Using machine learning, we compiled the official press releases issued by the Department of Health from early January to mid-April 2020 where a total of 283,560 datasets amounting to 2.5 megabytes (Mb) were analyzed using the Latent Dirichlet Allocation (LDA) algorithm. Our results revealed five latent themes: the highest effort (40%) centered on "Nationwide Reporting of COVID-19 Status", while "Contact Tracing of Suspected and Infected Individuals" had the least focus at only 11.68%- indicating a lack of priority in this area. Our findings suggest that while the government was ill-prepared in the early phase of the pandemic, it exerted efforts in rearranging its fiscal and operational priorities toward the management of the disease. However, we emphasize that this article should be read and understood with caution. More than a year has already passed since the outbreak in the country and many (in)actions and challenges have adversely impacted its response. These include the Duterte administration's securitization and militarization of pandemic response and its apparent failure to find a balance between the lives and livelihoods of Filipinos, to name a few. We strongly recommend that other scholars study the various aspects of the government's response, i.e., economic, peace and security, agriculture, and business, to assess better how the country responded and continually responds to the pandemic.

Keywords: COVID-19; Government response; Machine learning; Pandemic; Philippines.

© 2021 Elsevier Ltd. All rights reserved.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Global COVID-19 data as of…

Global COVID-19 data as of May 2020 based on CSSE-JHU online dashboard.

Design algorithm process utilizing modified…

Design algorithm process utilizing modified KDD used by the authors.

Press release topic probability made…

Press release topic probability made by the authors.

Screenshot of the web design…

Screenshot of the web design of the COVID-19 CORe Portal taken by the…

Pictures of locally-made COVID-19 testing…

Pictures of locally-made COVID-19 testing kit (left) and the GINHAWA ventilator (right) compiled…

Apps and platforms used for…

Apps and platforms used for COVID-19 contact tracing from January to April 2020…

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6 in 10 Filipinos now willing to get vaccinated vs COVID-19 – Octa Research

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RAMP UP VACCINATION. Hundreds of Quezon City residents troop to the city hall on July 30, 2021 to get a dose of a COVID-19 vaccine.

More than a year into the pandemic, more Filipinos are now willing to get vaccinated against COVID-19, according to a survey released by the Octa Research group on Friday, October 22.

The survey showed that 61% or 6 in 10 Filipinos were willing to get vaccinated against the deadly virus when asked during the polling period.

The survey was conducted from September 11 to 16, when the country was experiencing a surge in COVID-19 infections driven by the highly transmissible COVID-19 Delta variant.

“This number includes the 36% of adult Filipino who were already vaccinated and the 24% of respondents who are willing to get vaccinated,” the Octa team said.

NEWS UPDATE: 6 in 10 Filipinos are now willing to get vaccinated against COVID-19, Octa Research survey shows. The survey was conducted from September 11 to 16 when the country was experiencing surge in infections driven by the highly-transmissible Delta. @rapplerdotcom pic.twitter.com/zSJyTUHJeP — Bonz Magsambol (@bnzmagsambol) October 22, 2021

In July, a similar survey was done by Pulse Asia, which said that 4 in 10 or 43% of respondents would say “yes” to getting inoculated with a COVID-19 vaccine if the shot was available during the polling period.

However, the Octa Research survey also showed that 22% of adult Filipinos were not willing to be vaccinated during the survey period.

The group noted that vaccine hesitancy was highest in the Visayas at 32%, followed by Balance Luzon at 24% and Mindanao at 19%.

“Vaccine hesitancy is lowest in the NCR (National Capital Region) at 5%,” the Octa team said.

The group conducted face-to-face interviews with 1,200 Filipinos aged 18 years old and above for its survey fieldwork. The survey has a 95% confidence level with a ±2% margin of error. 

While the percentage of Filipinos willing to get vaccinated against COVID-19 significantly increased, safety concerns about the vaccine are the top reason why 65% of those unwilling don’t want to get the shots.

• Uncertainty about safety of vaccines – 14%
• Not sure if vaccines are effective – 9%
• COVID-19 vaccines are not needed to fight COVID-19 – 7%
• COVID-19 vaccines can cause death – 5%

According to pandemic task force officials, the country now has enough supply of the COVID-19 vaccines as the Philippines expanded coverage to the general adult population. The problem has now shifted to logistical challenges.

Vaccine czar Carlito Galvez Jr. said that logistical challenges are hampering the rollout of doses from the regional level down to municipalities where vaccines are deployed.

“We notice that the deployment before arriving [in] vaccination sites takes more or less seven to eight or seven to nine days,” he said in Filipino. 

Why are COVID-19 vaccinations in the Philippines slowing down?

As of October 19, around 25.97% of the country’s population had received the first of two doses of a COVID-19 vaccine. Around 22.41% of the population had received both jabs or single-dose vaccines.

Be updated with the Philippines’ COVID-19 vaccination drive through the trackers below.

TRACKER: The Philippines’ COVID-19 vaccine distribution

SCHEDULE: Philippines’ COVID-19 vaccine deliveries

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First COVID-19 infections in the Philippines: a case report

Edna m. edrada.

1 San Lazaro Hospital, Manila, Philippines

Edmundo B. Lopez

Jose benito villarama, eumelia p. salva villarama, bren f. dagoc, chris smith.

2 School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan

3 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Ana Ria Sayo

Jeffrey a. verona, jamie trifalgar-arches, jezreel lazaro, ellen grace m. balinas, elizabeth freda o. telan, myvie galon, carl hill n. florida, tatsuya ukawa, annavi marie g. villaneuva, nobuo saito.

4 Department of Microbiology, Faculty of Medicine, Oita University, Oita, Japan

Jean Raphael Nepomuceno

Koya ariyoshi.

5 Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan

Celia Carlos

6 Research Institute for Tropical Medicine, Alabang, Philippines

Amalea Dulcene Nicolasora

Rontgene m. solante, associated data.

The novel coronavirus (COVID-19) is responsible for more fatalities than the SARS coronavirus, despite being in the initial stage of a global pandemic. The first suspected case in the Philippines was investigated on January 22, 2020, and 633 suspected cases were reported as of March 1. We describe the clinical and epidemiological aspects of the first two confirmed COVID-19 cases in the Philippines, both admitted to the national infectious disease referral hospital in Manila.

Case presentation

Both patients were previously healthy Chinese nationals on vacation in the Philippines travelling as a couple during January 2020. Patient 1, a 39-year-old female, had symptoms of cough and sore throat and was admitted to San Lazaro Hospital in Manila on January 25. Physical examination was unremarkable. Influenza B , human coronavirus 229E, Staphylococcus aureus and Klebsiella pneumoniae were detected by PCR on initial nasopharyngeal/oropharyngeal (NPS/OPS) swabs. On January 30, SARS-CoV-2 viral RNA was reported to be detected by PCR on the initial swabs and she was identified as the first confirmed COVID-19 case in the Philippines. Her symptoms resolved, and she was discharged. Patient 2, a 44-year-old male, had symptoms of fever, cough, and chills. Influenza B and Streptococcus pneumoniae were detected by PCR on initial NPS/OPS swabs. He was treated for community-acquired pneumonia with intravenous antibiotics, but his condition deteriorated and he required intubation. On January 31, SARS-CoV-2 viral RNA was reported to be detected by PCR on the initial swabs, and he was identified as the 2nd confirmed COVID-19 infection in the Philippines. On February 1, the patient’s condition deteriorated, and following a cardiac arrest, it was not possible to revive him. He was thus confirmed as the first COVID-19 death outside of China.

Conclusions

This case report highlights several important clinical and public health issues. Despite both patients being young adults with no significant past medical history, they had very different clinical courses, illustrating how COVID-19 can present with a wide spectrum of disease. As of March 1, there have been three confirmed COVID-19 cases in the Philippines. Continued vigilance is required to identify new cases.

The novel coronavirus 2019 (COVID-19) is responsible for more fatalities than the severe acute respiratory syndrome (SARS) coronavirus, despite being in the initial stage of a global pandemic. It is thought that the index case occurred on December 8, 2019, in Wuhan, China [ 1 ]. Since then, cases have been exported to other Chinese cities, as well as internationally, highlighting concern of a global outbreak [ 2 ]. The first suspected case in the Philippines was investigated on January 22, 2020, and 633 suspected cases have been reported as of March 1. Of them, 183 were in the National Capital Region of Manila, of whom many were admitted to San Lazaro Hospital (SLH) in Manila, the national infectious disease referral hospital [ 3 , 4 ]. We describe the epidemiologic and clinical characteristics of the first two confirmed COVID-19 cases in the Philippines, including the first death outside China.

In this case report, we describe two cases: patient 1, the first confirmed COVID-19 case, and patient 2, the second confirmed case, even though the symptoms of patient 2 started first. The cases are presented based on reports from the clinicians involved in patient care and results of investigations available to them at the time. Figure ​ Figure1 1 shows a timeline of symptoms for both patients according to the day of illness and day of hospitalisation.

Timeline of symptoms according to day of illness and day of hospitalisation

History prior to hospitalisation

Both patients were Chinese nationals on vacation in the Philippines travelling as a couple. They had no known comorbidities and reported no history of smoking. Patient 2, a 44-year-old male, reported fever on January 18, 2020, whilst the couple were residing in Wuhan, China. It was reported that he was in contact with someone that was unwell in Wuhan, but not that he had visited the seafood market. During January 20 to 25, they travelled from Wuhan via Hong Kong to several locations in the Philippines (Fig. ​ (Fig.2). 2 ). Patient 1, a 39-year-old female, developed cough and sore throat on January 21. Due to persistence of symptoms of patient 2, they travelled to Manila on January 25. In Manila, patient 2 was denied entry to a hotel because he was febrile and both patients were transferred to San Lazaro Hospital (SLH), the national referral hospital for infectious diseases [ 4 ]. On admission, patient 2 was classified as a COVID-19 person under investigation (PUI) based on his travel history and fever [ 2 ] and was transferred to a designated isolation area with negative pressure rooms. Patient 1 did not fit the PUI criteria due to absence of fever, but was also isolated because of possible exposure.

Travels of patient 1 and 2

Clinical course of patient 1

On admission to the ward on January 25 (illness day 5), patient 1 complained of a dry cough, but the sore throat had improved. She was awake and conversant with a blood pressure of 110/80, HR 84, RR 18 and temperature 36.8 °C. Her chest was clear. The remainder of the physical examination was unremarkable. Nasopharyngeal and oropharyngeal swab (NPS/ORS) specimens were collected and sent to the Research Institute for Tropical Medicine (RITM) in Muntinlupa City [ 5 ]. A chest radiograph was reported as unremarkable (Fig. ​ (Fig.3 3 ).

Posteroanterior chest radiograph of patient 1, 27 January 2020 (illness day 7). Unremarkable

On January 27, the results were released of a commercially available respiratory pathogen multiplex real-time PCR for detection of pathogen genes on the NPS/OPS samples (FTD Respiratory pathogens 33, Fast Track Diagnostics) at the RITM Molecular Biology Laboratory. These assays reported detection of Influenza B viral RNA, human coronavirus 229E viral RNA, Staphylococcus aureus DNA and Klebsiella pneumoniae DNA. A 10-day course of oseltamivir 75 mg BID was given on the basis of the influenza result. The NPS/OPS specimen was then sent by RITM to the Victorian Infectious Disease Reference Laboratory (VIDRL) in Melbourne, Australia, for COVID-19 testing [ 6 ].

On January 29, further NPS/ORS specimens were collected and sent to the RITM. On January 30, the result of the initial NPS/OPS sent to VIDRL reported detection of 2019-nCoV (subsequently termed SARS-CoV-2) viral RNA by real-time PCR. The patient was thus identified by the Department of Health as the first confirmed COVID-19 case in the Philippines [ 6 ].

On illness days 6 to 10, she remained afebrile with minimal cough and clear breath sounds. During this time, real-time PCR for detecting SARS-CoV-2 was established at the RITM using the Corman et al. protocol [ 7 ]. Further NPS/OPS specimens collected on January 29 (reported on January 31) and January 31 (reported on February 2) also reported detection of SARS-CoV-2 viral RNA. On illness day 11, the patient reported resolution of symptoms. She remained afebrile and clinically stable apart from two episodes of loose watery stool on illness day 12. Further samples were collected on February 2 and 4. On February 8 (illness day 19), she was discharged when SARS-CoV-2 was no longer detected on an NPS/OPS sample.

Clinical course of patient 2

In contrast, patient 2 experienced a more severe clinical course. On admission (illness day 8), he reported fever, cough and chills. On examination, he was awake and conversant with a temperature of 38.3 °C, blood pressure of 110/80, HR 84, RR 18, and SpO 2 of 96% on room air. His chest was clear. The remainder of the physical examination was unremarkable.

A working diagnosis of community-acquired pneumonia and COVID-19 suspect was made. He was started on ceftriaxone 2 g intravenously (IV) once daily (OD) and azithromycin 500 mg OD. NPS/ORS specimens were collected and sent to the RITM. On January 27, the results of a respiratory pathogen real-time PCR detection panel performed at RITM on the NPS/OPS samples were released, reporting detection of Influenza B viral RNA and Streptococcus pneumoniae DNA. The NPS/OPS samples were sent to the VIDRL for additional testing. Oseltamivir 75 mg BID was commenced on the basis of the influenza result.

During illness days 9 and 10, his fever continued with occasional non-productive cough. He remained clinically stable apart from intermittent SpO 2 desaturations of 93–97% on 2–3 L/min of oxygen. On illness day 11, he developed increasing dyspnoea with reduced SpO 2 at 88% despite 8 L/min of oxygen via a face mask and haemoptysis and was noted to have bilateral chest crepitations. A chest radiograph was reported as showing hazy infiltrates in both lung fields consistent with pneumonia (Fig. ​ (Fig.4). 4 ). Meropenem 2 g IV three times a day (TDS) was commenced.

Posteroanterior chest radiograph of patient 2, 27 January 2020 (illness day 10). Hazy infiltrates in both lung fields consistent with pneumonia

On illness day 12, he became increasingly dyspnoeic, hypoxic and agitated and was intubated and sedated with a midazolam drip. An endotracheal aspirate (ETA) and a further NPS/OPS were collected and sent to the RITM. Vancomycin, 30 mg/kg loading dose followed by 25 mg/kg BD, was commenced with a working diagnosis of severe community-acquired pneumonia due to Streptococcus pneumoniae secondary to Influenza B infection, plus consideration of COVID-19 pending the ETA result. A complete blood count showed values within the normal range (Table ​ (Table1). 1 ). On illness day 13, he continued to be febrile (38.5–40.0 °C) with bibasal crackles. Vital signs were stable with adequate urine output. A chest radiograph was reported as showing worsening of pneumonia (Fig. ​ (Fig.5 5 ).

Clinical laboratory results and vital signs

NPS/OPS nasopharyngeal/ oropharyngeal swab, ETA endotracheal aspirate

*NPS/OPS—result from RITM was received on February 2 and reported detection of SARS-CoV-2 viral RNA

**NPS/OPS—result from VIDRL was received on February 4 and reported detection of SARS-CoV-2 viral RNA

Posteroanterior chest radiograph of patient 2, 30 January 2020 (illness day 13). Endotracheal tube in situ approximately 2 cm above the carina. There is worsening of the previously noted pneumonia

On illness day 14, increased crepitations in both lung fields were noted. Blood cultures showed no growth after 24 h of incubation. An HIV test was non-reactive. On this day, the RITM reported detection of SARS-CoV-2 viral RNA by real-time PCR from the NPS/OPS taken on illness day 12 and hence the 2nd confirmed COVID-19 infection in the Philippines. This result was later confirmed on February 4 on the initial admission sample sent to VIDRL.

On the morning of illness day 15, the patient remained febrile at 40 °C, with BP 110/70, HR 95, RR 30, SpO 2 99% with 80% FiO2, and adequate urine output. However, the patient’s condition deteriorated with the formation of thick sputum and blood clots in the ET tube. Despite frequent suctioning, the patient’s condition deteriorated. He was noted to have laboured breathing followed by a cardiac arrest. Despite several rounds of cardiopulmonary resuscitation, it was not possible to revive the patient. He was thus confirmed as the first COVID-19 death outside of China.

Discussion and conclusion

This case report describes the first two confirmed cases of COVID-10 in the Philippines and highlights several important clinical and public health issues. Despite both patients being young adults with no significant past medical history, they had very different clinical courses, illustrating how COVID-19 can present with a wide spectrum of disease [ 8 ]. Whilst patient 1 had a mild uncomplicated illness consistent with an upper respiratory tract infection and recovery, patient 2 developed a severe pneumonia and died.

One possible explanation for the differing clinical courses is the presence of co-infection. In both patients, the real-time PCR detection panel was reported to be positive for multiple pathogens. The Staphylococcus aureus and Klebsiella pneumoniae detected in patient 1 most likely represent bacterial colonisation, and it is unclear to what extent her presentation was due to influenza or COVID-19 or both. Patient 2 tested positive for COVID-19, Influenza B , and Streptococcus pneumoniae , all of which can cause respiratory infection and severe pneumonia. Unfortunately, sputum culture was not possible due to biosafety concerns. It is unclear which pathogen was the leading cause of death, but previous research has shown that outcomes of acute viral respiratory infection are worse if multiple pathogens are present [ 9 ]. This highlights the importance of testing for other respiratory pathogens in addition to COVID-19 in order to optimise antimicrobial therapy.

Patient 2 developed increasing dyspnoea on day 11 of illness, similar to the first COVID-19 case in the USA, where mild symptoms were initially reported with progression to pneumonia on day 9 of illness [ 10 ]. The median time from illness onset to dyspnoea in a case series in Wuhan was 8 days (range 5–13) [ 11 ]. The explanation for patient 2’s worsening condition and development of haemoptysis was progression of pneumonia rather than acute respiratory distress syndrome or pulmonary embolism, but it was not possible to perform a CT scan, additional laboratory tests or an autopsy to further assess this. Although he was treated with broad-spectrum antimicrobials, it is not clear if the outcome would have been better in a high-resource setting. Both patients were treated with oseltamivir in view of positive results for Influenza B . Further studies are required to establish the optimal treatment and role of antiviral medication for patients with suspected or confirmed COVID-19 infection.

Our cases contrast with the US case in terms of the relative paucity of lab data and time to receive results. Limited in-house testing was undertaken due to biosafety concerns. In the case of patient 2, the diagnosis of COVID-19 was not made until a day before the patient died. This was because SARS-2-CoV testing was being established in the Philippines at the time that the patients were admitted, and initial samples had to be sent to Australia. Although the delay of diagnosis is unlikely to have altered management, expansion of COVID-19 diagnostics including multiplex panels for other respiratory pathogens is urgently needed for prompt diagnosis of patients for screening of hospital personnel or other contacts.

Three SLH hospital staff who were caring for the patients developed symptoms and themselves became PUIs, but were later discharged following negative SARS-CoV-2 testing and symptom resolution. This highlights the risk of an outbreak in the hospital, or a ‘super-spreader’ scenario, as was observed in other settings during the early stages of the SARS coronavirus infections in 2003 [ 12 ]. In the case of SARS, as with COVID-19, SLH managed two cases and was able to contain the infection without further spread [ 13 ].

The third confirmed COVID-19 case was announced on February 3 from a sample taken on January 23, also a Chinese national who had travelled from Wuhan. She recovered and returned to China on January 31. Contact tracing has been undertaken of all three patients [ 14 ]. Despite travel to several locations in the Philippines whilst experiencing symptoms, as of March 1, there has not been any confirmed local transmission arising from these cases and the number of PUIs has decreased [ 3 ]. However, as infection can be mild or subclinical, local transmission cannot be excluded. Increasing the number of laboratories able to perform SARS-CoV-2 testing would allow better surveillance and improve detection of COVID-19 cases.

In conclusion, as of March 1, there have been three confirmed COVID-19 cases in the Philippines including the first death outside of China. No local transmission has been confirmed. Continued vigilance is required to identify new cases.

Acknowledgements

We are very grateful to the patients for allowing us to prepare and publish this case report.

Abbreviations

Authors’ contributions

All of the authors contributed to the writing of this case report. The authors read and approved the final manuscript.

Not applicable

Availability of data and materials

Ethics approval and consent to participate.

This case report was not part of a research study, and hence, ethical approval was not sought. Written consent was obtained from patient 1 and on behalf of patient 2.

Consent for publication

Written consent for the preparation and publication of a case report was provided by patient 1 and on behalf of patient 2, following discussion with his brother.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Learning from PH Red Cross’ vital contribution in hurdling Covid-19 pandemic

Where were you when the first Covid-19 lockdown was announced?

For us baby boomers, this question brings to mind two milestone experiences that happened in succession 50 years earlier: The first man-on-the-moon landing by Neil Armstrong on July 20, 1969, the day after Gloria Diaz became Miss Universe. Fast forward to Friday, March 13, 2020. The government announced that effective Monday, March 16, enhanced community quarantine (ECQ) would be in force in Metro Manila and nationwide.

On May 5, 2023 – or 13 months ago today – the World Health Organization (WHO) declared the end of Covid-19 as a “public health issue of international concern.”

Last week, the Philippine Red Cross (PRC) hosted a World Disasters Report Forum coinciding with the visit of Kate Foster, president of the International Federation of Red Cross and Red Crescent Societies (IFRC). Ms. Foster congratulated the PRC for its outstanding work in controlling the spread of the pandemic.

PRC Chairman Richard J. Gordon recalled how the PRC proactively mobilized massive logistical resources, in collaboration with IFRC, to respond to the unprecedented public health crisis.

When the pandemic broke out, only the Research Institute for Tropical Medicine (RITM), an attached agency of the Department of Health (DOH) had the capability to conduct testing for the presence of genetic material – ribonucleic acid or RNA of SARS-CoV-2, the virus that causes Covid-19 – through the Real-Time Polymerase Chain Reaction (RT-PCR) test that analyzed upper respiratory specimen.

In April 2020, one month after the government imposed the first lockdown, or enhanced community quarantine (ECQ), the Philippine Red Cross established its first molecular laboratory for Covid-19 testing.

From this initial facility, the PRC set up molecular laboratories in other parts of Metro Manila, Subic, Clark, Batangas, Cebu, Negros Occidental, Zamboanga, Cagayan de Oro, Isabela, Surigao del Norte, Iloilo and Cotabato. According to Dr. Gwen Pang, secretary general, PRC conducted 5.7 million swab and saliva tests for Covid-19 between April 2020 and June 2023.

“All the Red Cross molecular laboratories that are now up and running, and those that are soon to open are capable of testing other communicable viruses aside from Covid. We can also test tuberculosis, human immunodeficiency viruses or HIV, dengue, malaria, hepatitis, leptospirosis and Zika, among other diseases,” according to Chairman Gordon, in an interview with Bombo Radyo in June 2020. As reported by the Philippine News Agency, he said that it will also be “repurposed for our blood centers and facilities to address the demand for blood.”

The PRC deployed the entire range of its facilities and resources – molecular laboratories, emergency field hospitals, isolation facilities, convalescent plasma center, Bakuna Buses, and Bakuna Centers – in a comprehensive effort to help achieve “herd immunity,” which is generally defined as attainment of a 70 percent vaccination rate.

During the Omicron variant outbreak in January 2022, I personally witnessed and experienced the readiness and efficiency of the PRC’s response network that enabled members of our family and household to immediately settle into the treat-and-recover mode after the initial shock of realizing that we had been infected. Thankfully, too, this turned out to be a mild variant that needed only five to seven days of isolation and medication to pan out.

According to a report of Wiley Online Library on public health challenges that was published on Jan. 31, 2023: “As of November 2022, 65 percent of Filipinos have been vaccinated, nearing the 70 percent target. Despite this progress, vaccination efforts in the Philippines remain challenged with vaccine hesitancy, unequal distribution, and limitations of the cold chain logistics.” It is reasonable to project that herd immunity was attained by the time the WHO declared in May 2023 the end of Covid-19 as a “public health issue of international concern.”

At a panel discussion that followed Chairman Gordon’s report in last week’s PRC forum, the audience found out more about how the response mechanisms for staving off the massive disaster brought on by the pandemic were set into motion.

Dr. Paulyn Jean Ubial, head of PRC’s molecular laboratory Covid-19 response narrated how the testing facilities were set up in Metro Manila and key provincial cities. Dean Charlotte Chong of UP Manila that includes the UP College of Medicine recalled the heroism of 130 medical interns who opted to stay and work at the Philippine General Hospital despite being instructed to go home at the onset of the pandemic.

Dr. Rizzy Alejandro, who was then Chief Public Health Officer of Ayala Healthcare, shared her experience in witnessing ground-zero response activities at the PGH. She recalled that from only 4,500 tests in April 2020, PRC ramped this up to 30,000 tests in June and 90,000 tests in August. She also recalled how some of the country’s biggest firms demonstrated their corporate social responsibility during the crisis.

To appreciate the impact of Chairman Gordon and the PRC’s herculean efforts, let’s refer to a documented academic critique.     

Three researchers from the UP College of Science’s Science, Technology and Society – namely, Professor Benjamin Vallejo, Jr., Dr. Rodrigo Angelo Ong, and Assistant Professor Ranjit Singh Rye – assessed the effectiveness of Covid-19 policies in stemming the pandemic’s tide and in shielding citizens and communities from its lethal effects.

Government policy decisions from 180 countries, including the Philippines, were tracked daily since Jan. 1, 2020 to Dec. 31, 2022, and standardized in the Oxford Covid-19 Government Response Tracker (OxCGRT) Variation in Government Advice data set. These were aggregated into four indices: Government Response Index, Stringency Index, Containment and Health Index, and Economic Support Index.

As reviewed in the UP College of Science Journal: “The STS scientists were able to determine that stringent pandemic policies — including lockdowns, quarantines, stay-at-home ordinances, and travel restrictions — were effective in containing the pandemic within the first 60 days. These are all dependent on law enforcement and a securitized approach.” 

The review noted that “the government was least effective” in the aspects of contact tracing and testing to promptly contain clusters of infections after the easing of lockdowns and the resumption of limited mobility. Also deemed effective was the conduct of travel health checks such as requiring proof of vaccination and antigen tests that reduced infection risk across provincial and international borders. Other interventions such as mask-wearing and social distancing “while significantly effective at the local level, were not significantly effective at the national level” due to “the differing levels of citizen compliance in communities.”

Harnessing the combined power of volunteers, logistics, and information technology, the PRC continues to render unmatched public service, true to its motto: Always First, Always Ready, Always There!

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IFRC chief Forbes calls Philippine Red Cross a case study for success in fighting Covid-19

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THE world was not prepared for Covid-19, and there is an urgent need to be ready when the next public health emergency comes.

This was the gist of the World Disasters Report Forum presented on May 30 at Makati Shangri-La by the Philippine Red Cross (PRC) and International Federation of Red Cross and Red Crescent Societies (IFRC), in cooperation with the Australian Government and the United Nations (UN) Philippines.

The report highlighted the need for preparedness, “both the ways preparedness ahead of Covid-19 was inadequate, and how to prepare more effectively for future public health emergencies. We must now prepare our societies for the next public health emergency. Being truly prepared, therefore, means being ready to prevent, respond and recover, and to learn lessons for next time.”

In the report, IFRC Secretary-General Jagan Chapagain pointed out that preparedness is based on the principles of trust, equity, and local action.

Speaking at the forum,  IFRC president Kate Forbes acknowledged PRC’s successful fight against the pandemic. “Our previous model of technical support and asset deployment from the Federation and other National Societies…was no longer effective. We needed to change. We needed to rewrite our playbook. This is where the Philippine Red Cross led the way. It is the case study for success in connecting with and empowering local communities. The Philippine Red Cross has been successful at working in local communities for decades. When the COVID-19 pandemic struck, the Philippine Red Cross had the tools, resources, and network to help communities. As you can read in the report, the PRC anticipated the needs of communities, it leveraged their trust, and implemented local action that kept communities safe.”

PRC Chairman and CEO Richard J. Gordon recalled how the support of PRC’s corporate partners and its 2 million volunteers allowed the Philippines’ largest humanitarian organization to save lives amid the onslaught of Covid-19.  

He said: “We have it in us as a country…to meet every challenge, bear every burden or suffering. But when we get together, especially when we have leaders we can follow, and instead of saying it’s not my problem, we say I’ll be part of the solution…”

Other speakers at the forum were PRC Secretary-General Dr. Gwen Pang, UN Philippines Resident coordinator Gustavo Gonzales, Australian Embassy in the Philippines Counsellor Thanh Le, IFRC Asia Pacific Regional Director Alexander Matheou, and IFRC Philippine Delegation Program Coordinator Gopal Mukherjee.

The forum panelists included Dr. Paulyn Jean Ubial, Molecular Laboratory Head of PRC’s Covid-19 Response; Dr. Charlotte Chiong, Dean of the University of the Philippines College of Medicine; Dr. Maria Clarissa Alejandro, CEO of Healthway QualiMed; Ms. Oyunsaikhan Dendevnorov, Unicef representative to the Philippines; and Australian Embassy’s Dr. Thanh Le. Dr. Eric Tayag was the moderator.

Related Topics

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• disaster response
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COVID-19: Who's at higher risk of serious symptoms?

Advanced age and some health conditions can raise the risk of serious COVID-19 (coronavirus disease 2019) illness.

Many people with COVID-19, also called coronavirus disease 2019, recover at home. But for some, COVID-19 can be a serious illness. Some people may need care in the hospital, treatment in the intensive care unit and the need for breathing help. In some people, severe COVID-19 illness can lead to death.

What raises the risk of severe or critical COVID-19 illness?

The risk for serious COVID-19 illness depends on your health status, age and activities. Your risk also depends on other factors. This includes where you live, work or learn, how easy it is for you to get medical care, and your economic stability.

If you have more than one risk factor, your risk goes up with each one.

Age raises the risk of serious COVID-19

People age 65 and older and babies younger than 6 months have a higher than average risk of serious COVID-19 illness. Those age groups have the highest risk of needing hospital care for COVID-19.

Babies younger than 6 months aren't eligible for the COVID-19 vaccine, which adds to their risk. For older people, the challenge is that the immune system is less able to clear out germs as people age. Also, as people age, medical conditions that raise the risk of severe COVID-19 are more likely. In the U.S. as of March 2024, about 76% of all deaths from COVID-19 have been among people age 65 and older.

Aging plus disease raises the risk of serious COVID-19

Severe COVID-19 disease is more likely for people who have other health issues.

Some common diseases linked to aging are:

• Heart disease. Examples are heart failure or coronary artery disease.
• Diabetes mellitus. The risk is higher for both type 1 and type 2.
• Chronic lung diseases. This includes airway disease and conditions that damage lung tissue.
• Obesity. The risk goes up as body mass index (BMI) increases, with the highest risk for a BMI of 40 or greater.
• Chronic kidney disease. Especially if you are on dialysis.

These diseases become more common as people age. But they can affect people of any age. The risk of serious COVID-19 illness is linked to having one or more underlying medical condition.

Asthma, COPD, other lung diseases raise risk of severe COVID-19

Your risk of having more severe COVID-19 illness is higher if you have lung disease. Having moderate to severe asthma raises some risks of serious COVID-19 illness. It raises the risk of needing care in the hospital, including intensive care, and needing mechanical help breathing.

The risk of serious COVID-19 illness also is higher for people who have conditions that damage lung tissue over time. Examples are tuberculosis, cystic fibrosis, interstitial lung disease, bronchiectasis or COPD, which stands for chronic obstructive pulmonary disease. These diseases raise the risk of needing care in the hospital for COVID-19. Depending on the condition, the risk of needing intensive care and the risk of death from COVID-19 also may go up.

Other lung conditions, such as a history of pulmonary hypertension or pulmonary embolism affect a person's risk of serious illness after COVID-19. The risk of death may be higher after these conditions.

Cancer raises the risk of severe COVID-19

In general, people with cancer have a greater risk of getting serious COVID-19. People who have or had blood cancer may have a higher risk of being sick for longer, or getting sicker, with COVID-19 than people with solid tumors.

Having cancer raises the risk of needing care in the hospital, intensive care and the use of breathing support. Having blood cancer and getting COVID-19 raises the risk of death from the illness.

Treatment for blood cancer may raise the risk of severe COVID-19 but the research is still unclear. Cancer treatment may also affect your COVID-19 vaccine. Talk to your healthcare professional about additional shots and getting vaccinated after treatments that affect some immune cells.

Other conditions that raise the risk of severe COVID-19

If an organ or body system is already weakened by disease, infection with the COVID-19 virus can cause further damage. In other cases, medicine for the original condition can lower the immune system's response to the virus that causes COVID-19.

Many different diseases can raise the risk of severe COVID-19 illness.

• Brain and nervous system diseases, such as strokes.
• Chronic liver disease, specifically cirrhosis, nonalcoholic fatty liver disease, alcoholic liver disease and autoimmune hepatitis.
• HIV not well managed with medicine.
• Heart disease, including congenital heart disease and cardiomyopathies.
• Mood disorders or schizophrenia.
• Having received an organ or stem cell transplant.
• Sickle cell anemia and thalassemia blood disorders.

Other risk factors for severe COVID-19 are:

• Not getting enough physical activity.
• Pregnancy or having recently given birth.
• Use of medicines that lower the immune system's ability to respond to germs.

Also, as a general group, disability is linked to an increased risk of severe COVID-19. The risks are different depending on the disability.

• Down syndrome is linked to a higher risk of needing care in the hospital. The risk of death from severe COVID-19 also is higher than typical for people with Down syndrome.
• Attention deficit/hyperactivity disorder is linked to an increased risk of needing care in the hospital from severe COVID-19.
• Cerebral palsy is linked to an increased risk of needing care in the hospital from severe COVID-19.

These are not the only conditions that increase the risk of severe COVID-19. Talk to your healthcare professional if you have questions about your health and risk for getting a serious COVID-19 illness.

A COVID-19 vaccine can lower your risk of serious illness

The COVID-19 vaccine can lower the risk of death or serious illness caused by COVID-19. Your healthcare team may suggest added doses of COVID-19 vaccine if you have a moderately or seriously weakened immune system.

How else can you lower the risk of severe COVID-19?

Everyone can lower the risk of serious COVID-19 illness by working to prevent infection with the virus that causes COVID-19.

• Avoid close contact with anyone who is sick or has symptoms, if possible.
• Use fans, open windows or doors, and use filters to move the air and keep any germs from lingering.
• Wash your hands well and often with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer with at least 60% alcohol.
• Cough or sneeze into a tissue or your elbow. Then wash your hands.
• Clean and disinfect high-touch surfaces. For example, clean doorknobs, light switches, electronics and counters regularly.
• Spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.
• The U.S. Centers for Disease Control and Prevention recommends that people wear a mask in indoor public spaces if COVID-19 is spreading. This means if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.

These basic actions are even more important for people who have weakened immune systems, and their caregivers.

The FDA also has authorized the monoclonal antibody pemivibart (Pemgarda) to prevent COVID-19 in some people with weakened immune systems.

People can take other actions based on their risk factors.

• If you're at a higher risk of serious illness, talk to your healthcare professional about how best to protect yourself. Know what to do if you get sick so you can quickly start treatment.
• Lower your risk of COVID-19 complications by making sure that any health issues are well managed. This includes staying on track with managing medical conditions, going to all healthcare appointments and planning ahead to avoid running out of medicine. Keep taking medicines as suggested by your healthcare professional.
• Stay up to date on vaccines. This includes vaccines for flu, pneumonia and RSV. These vaccines won't prevent COVID-19. But becoming ill with a respiratory illness may worsen your outcome if you also catch COVID-19.

You may consider making a care plan. In the care plan, write your medical conditions, the medicine you take, and any special food or diet needs you have. The care plan also includes who you see for care and your emergency contacts.

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• Goldman L, et al., eds. COVID-19: Epidemiology, clinical manifestations, diagnosis, community prevention, and prognosis. In: Goldman-Cecil Medicine. 27th ed. Elsevier; 2024. https://www.clinicalkey.com. Accessed April 5, 2024.
• Regan JJ, et al. Use of Updated COVID-19 Vaccines 2023-2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices—United States, September 2023. MMWR. Morbidity and Mortality Weekly Report 2023; doi:10.15585/mmwr.mm7242e1.
• Underlying medical conditions associated with higher risk for severe COVID-19: Information for healthcare providers. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html. Accessed April 2, 2024.
• Stay up to date with COVID-19 vaccines. Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed April 2, 2024.
• COVID data tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#demographics. Accessed April 2, 2024.
• Najafabadi BT, et al. Obesity as an independent risk factor for COVID‐19 severity and mortality. Cochrane Database of Systematic Reviews. 2023; doi:10.1002/14651858.CD015201.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed April 2, 2024.
• AskMayoExpert. COVID-19: Outpatient management (adult). Mayo Clinic; 2023.
• Emergency use authorizations for drugs and non-vaccine biological products. U.S. Food and Drug Association. https://www.fda.gov/drugs/emergency-preparedness-drugs/emergency-use-authorizations-drugs-and-non-vaccine-biological-products. Accessed April 2, 2024.
• How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed April 2, 2024.
• COVID-19: What people with cancer should know. National Cancer Institute. https://www.cancer.gov/about-cancer/coronavirus/coronavirus-cancer-patient-information. Accessed April 2, 2024.
• Hygiene and respiratory viruses prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/hygiene.html. Accessed April 2, 2024.
• Preventing respiratory viruses. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/index.html. Accessed April 2, 2024.
• Maintaining a care plan. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/caregivers-month.html. Accessed April 2, 2024.
• COVID-19: What People with Cancer Should Know. National Cancer Institute. https://www.cancer.gov/about-cancer/coronavirus/coronavirus-cancer-patient-information. Accessed April 11, 2024.

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