The Gamechanger by Bien Eli Nillos, MD

COVID 19 was not the first pandemic in our human civilization’s history. In most recent times, prior to
COVID 19 pandemic, the 1918 Flu pandemic spread throughout the world and infected 500 million
people before killing an estimated 50 million people. It is known to be the deadliest Flu in history. The
1918 pandemic was due to an H1N1 virus that originated from birds. Many of those mortalities occurred
in younger age groups, young adults and elderly populations. The world then resorted to quarantines,
isolations, restrictions in public gatherings and heavy emphasis on personal hygiene and use of
disinfectants. Almost half a century later, this was followed by another Flu pandemic. The H2N2 Flu
pandemic of 1957, also referred to as the Asian Flu, killed 1.1 million people worldwide. This was
followed by an H3N2 1968 pandemic which was less deadly, yet it still killed 1 million people worldwide.
The latest prior to COVID 19 was the 2009 (H1N1)pdm09 pandemic. The 2009 Flu virus was different
from the 1918 H1N1, therefore younger populations did not have the antibodies to fight this virus. It
was found out that vaccination with seasonal flu vaccines offered little cross-protection against
(H1N1)pdm09 virus infection. Thus the race to develop a vaccine specific to this virus started and while a
monovalent (H1N1)pdm09 vaccine was produced, it was not available in large quantities until late
November of 2009.

It would seem perhaps that the previous pandemics would have given the world enough lessons to learn
to prepare for yet another pandemic. But in less than 11 years, a novel virus came to the scene and
caught everyone off guard. In the Philippines, like in most countries, there was muted confidence that
the virus won’t enter the territory and that if ever it finds its way in the country’s boundaries, the spread
could be controlled. However, The Philippines was among those countries that was hard hit by the covid
19 pandemic. Because it was novel, there was limited information about its characteristics and its
transmission. What the world knew at that time was this was a virus that seems to be transmitted
through droplets. Covid 19 symptoms apparently were similar with ordinary flu. It appeared that the
Philippines was managing the pandemic quite well especially at the early onset of the pandemic.
Nationwide lockdowns were enforced. Schools and work were suspended. Travels within the country
were restricted. Just like what was happening around the world, the country stood still, anxiously
waiting for this pandemic’s worse to pass. But the longer it took, the worse it got. At the second half of
2021, covid 19 cases in the Philippines increased to high levels. The country experienced waves upon
waves of surges in the number of those who were confirmed with COVID 19. The onset of 2022 showed
no sign of abatement.

Covid 19 unraveled the weakness in Philippine health care system. Throughout the pandemic, we have
seen the inadequacy in facilities that would cater to those who were infected. There were not enough
health workers, whether in the hospital or community level, to cater to the sick. The fragmentation in
the health care system especially in the referral system among health facilities, from primary to tertiary
levels, only compounded the worsening the pandemic. There was weak primary care in the Philippines
making the frontlines fragile therefore easily penetrable by this virus. Not to mention with politicians
and not health care professionals managing the Philippine health care systems decisions were political in
nature rather than a rational reflection of science. Even among health professionals, those in public
health were not well engaged, and the specialists were taking control in managing the pandemic, thus
resulting to an approach which was more biased towards hospital care rather than strengthening
community based primary health care where the transmission is happening. The shift of the frontlines
from the primary cares to the hospitals unnecessarily exposed our specialists and tertiary care givers to
huge risk. Many of them were our early victims of the pandemic. The burden on the end referral
facilities almost broke down the Philippine health care and made the management of the pandemic
more expensive. These inherent flaws in the system that has been pointed out in the past but never
rectified only made the pandemic worse in the Philippines. More than 65,000 were killed by this
pandemic in the Philippines and more than 4 million were infected as of December of 2022.

The arrival of the covid-19 vaccines became a light at the end of the tunnel. Finally, the human
population had a chance to fight the virus and the disease. Covid 19 pandemic brought the scientific
community together like never before. The unselfish collaboration and sharing of scientific information
led to a speedy reconstitution of a vaccine that could turn the tide against this virus. Scientists were able
to explore new forms of vaccines such as mRNA vaccines. This further propelled science many steps
ahead.

But the world now is different than the world back in the early 20 th century. The presence of the internet
and its offspring, the social media, has not only propagated knowledge and awareness across distances
in a speed of a nanosecond, it also exposed people to huge bombardments of misinformation and even
disinformation. The internet, with the easy access it provides, emboldened people to gain entitlement
not only to their opinion but regrettably to their own perceived facts as well. This Illusory truth effect
has been more evident during the pandemic as thousands fell victim to false information and even
conspiracy theories presented as truth. But even prior to the pandemic a lot of people have been proven
by the Internet as gullible and malleable in nature. Their credulity has only been extended during the
pandemic. Thus, like some parts of the world, the acceptance of the covid-19 vaccine in the Philippines
was protracted and grappling on the part of the health workers.

The COVID 19 pandemic has therefore challenged the insular thinking of the world. It has exposed so
many of its weaknesses. It has challenged the way people perceive their way of life. It has challenged
governments in their priorities and directions. We are seeing a normalization of the situation and while
we are not yet out of the woods, it is time for the world to start harvesting the lessons from COVID 19
pandemic, and governments must start thinking about how to economically recover and prepare for yet
another global catastrophe. Government must realize sooner than later that the keys to a resilient
population are strong social and economic foundations demonstrated by efficient health care system,
proactive political structures, and social stability. The world must start working towards these goals so
as not to waste the lessons COVID 19 has given us. The world should never be the same again after
COVID 19.