Importance of Patience

The COVID-19 pandemic has been raging for two years now, and although we appear to be approaching the “new normal” as far as living with the virus is concerned, experts throughout the world are cautiously guarded in declaring that the pandemic will soon be over. Given the emergence of several COVID-19 variants since the original Wuhan strain, with each one seemingly more virulent than the previous ones, such a perspective of experts is understandable, particularly in light of the rapid spread of the highly transmissible Omicron variant.

NAVIGATING FROM PANDEMIC TO “NEW NORMAL”

In the Philippines, healthcare professionals (i.e., physicians, nurses, medical technologists, and other allied medical workers) remain at the forefront of battling COVID-19 and providing Filipinos with high-quality medical services, often at the risk of their own health and safety. As president of the Philippine College of Physicians (PCP), Ma. Encarnita “Maricar” B. Limpin, MD is leveraging her medical expertise, experience, and advocacy to preach patience, as we navigate the intricate path from pandemic to “new normal.” A graduate of the University of Santo Tomas (UST) Faculty of Medicine and Surgery and currently affiliated with the Philippine Heart Center, Dr. Limpin reiterates that we should “take our time so that we can reach the finish line” of this pandemic.

As of March 1, 2022, daily COVID-19 cases in the country have been continuously decreasing, with the positivity rate below five percent; all other metrics (e.g., average daily attack rate, hospitalization/ICU rates) generally indicate that the majority of the Philippines is now at low risk. However, Dr. Limpin’s primary concern is the haste by which the government would want to downgrade COVID-19 alert levels and eventually open the economy.

“We hope that [the number of cases] will continue to go down. But para kasing medyo nagmamadali tayo sa pag-downgrade ng alert levels (It seems that we are in a bit of a hurry to downgrade alert levels). Our worry, for us healthcare professionals, is baka tumaas ulit (the numbers may go up again).” And as we have experienced in the last two years, once cases begin to go up, lockdowns become inevitable as the government’s most convenient measure to prevent the further spread of the virus.

“I don’t think the Philippines can afford to have another lockdown. ‘Wag sana masyado magmadali na mag-loosen up (Better wait a bit longer before loosening up). Anyway we’re going there. Why can’t we wait a little bit longer?”

PREPARATION IS KEY

Apart from espousing patience, Dr. Limpin stresses the need to prepare better for the eventual relaxation of various restrictions to ensure the safety of workplaces and the people, particularly workers. “Otherwise, parehas lang (we’ll just repeat the past). We will just have a see-saw battle with COVID-19,” she explains.

Foremost among the considerations is the provision of adequate transportation, in which the private sector is expected to play an important role, particularly by providing transport services to their employees. Public transportation systems are expected to be overcrowded, and Dr. Limpin is worried that overcrowding in jeepneys and buses will be sources of super spreaders. She also suggests that private companies stagger the schedule of employees to prevent overcrowding not only in offices but also in public transportation and public spaces. Dr. Limpin likewise has recommendations for public and private schools. “Siguraduhin nila na well ventilated ‘yung mga classroom (Make sure that the classrooms are well ventilated), particularly airconditioned rooms to prevent transmission of disease. We do not want anyone to get infected with the virus.”

Dr. Limpin explains that these preparations for what will eventually be the “new normal” envisioned by doctors will definitely include wearing of masks for an extended period. “Kasi mukhang (Because it seems like) the virus will be with us, like the flu virus. Until such a time when we see that, similar to flu, nobody is really dying from COVID-19, then that’s the time when we will probably consider taking off the mask. For now, kailangan natin talaga magmask (masking up is a necessity).”

VARIANTS, BOOSTERS, AND ADDRESSING VACCINE HESITANCY

Health protocols aside, Dr. Limpin is convinced that we have a “moral obligation to get ourselves vaccinated to help control the pandemic and prevent the spread of the virus. That is our public health responsibility.” Given that the 70 percent target for herd immunity is yet to be achieved in the country, she reiterates all the more the importance of vaccination, especially to prevent the development of more mutations and variants. Evidently, the emergence of such variants as Delta and Omicron has wreaked havoc not only on the country’s healthcare system but also the economy, as the plan to finally open up had been delayed several times. “We have to take note that the majority of those mutations or variants developed in unvaccinated populations,” she stresses.

Another area of concern that Dr. Limpin thinks should be addressed is the slow pace of administering booster shots. She attributes this to the inability or difficulty of those eligible to receive boosters, particularly senior citizens, to go to vaccination sites owing to the recent Omicron-driven surge. Others were infected, preventing them from immediately having the boosters, while there are still those who, for reasons relatively unknown to Dr. Limpin, simply refused to get the booster shots. In terms of the main vaccination program (adults), she explains that hesitancy has been generally observed in provinces, specifically in far-flung areas.

Add the start of vaccination for the 5–11 and 12–17 age groups and Dr. Limpin thinks that the focus of the government’s vaccination program is spread too thinly. “Palagay ko dapat medyo may plano talaga on how to implement the rollout. Hindi pwede ‘yung kalimutan mo ‘yung iba kasi nafo-focus ka sa isa. Kailangan sabay-sabay lahat sila (There should really be a plan on how to implement the rollout. We can’t focus on one group at the expense of others. It has to be simultaneous).”

On the part of PCP, Dr. Limpin shares that they are preparing to launch a campaign that will target areas with low vaccination rates. She adds that this program is also aimed at healthcare workers’ training on how to answer the public’s vaccination-related questions. The PCP’s objective is to provide consistent and reliable information that they can disseminate to the public.

THE “POLITICS” OF THE PANDEMIC

Inevitably, discussions on the COVID-19 pandemic, vaccination, and the state of the healthcare system and workers will lead to the “politics” plaguing the government’s pandemic response, prompting healthcare workers to speak up.

“We speak up and be the voice for our fellow healthcare workers. Some really cannot speak out. So, we are the ones who are probably courageous enough to speak, kahit minsan napapagalitan kami (although at times we get reprimanded),” Dr. Limpin shares. And speaking up included a few instances of calling for a “medical time out,” presenting views on upgrading or downgrading alert levels, and even increases in salaries and allowances of healthcare workers. Indeed, there were instances when healthcare workers, including Dr. Limpin herself, were castigated and berated by government officials for voicing their concerns. However, she reiterates that more than criticizing, what the PCP and other health workers offer are possible solutions and suggestions to end the pandemic. “The solutions that we give out are based on science, on rigorous data. Not just data but rigorous data. The best evidence we can have.”

Dr. Limpin adds that although government officials “hear us, sometimes they don’t listen” and reiterates that “when it comes to health, I think there is no other people to go to except for us.” She is quick to explain, though, that their “objective and motive is nothing else but to ensure that we will be able to survive and overcome the challenges of the pandemic. Hindi ‘yung personal, not for personal gain. In fact, I’ve been doing this without getting anything in return.”

PUBLIC HEALTH RESPONSIBILITY

Despite the challenging situation, Dr. Limpin and the PCP remain steadfast in looking after the welfare of their members, given that all of them have been affected emotionally, mentally, and psychologically by the pandemic. She adds that an important aspect that should not be overlooked during the pandemic is mental health. “We’ve realized that it’s not just about COVID-19, but also the mental health status of our fellow healthcare workers. Lalo na noong start ng (especially at the start of the) pandemic, everybody was scared.”

Dr. Limpin continuously serves as an example and guides her younger colleagues as they go through their duties. “So kailangan nandoon kami, na mga senior sa kanila (We, their seniors, have to be there) to show them that just like them, although we are scared, we have to face our responsibility. We cannot run away from our responsibility.” She underscores the importance of shared public health responsibility, given that “we still don’t know everything about the pandemic, particularly the first few months.” Dr. Limpin reiterates that doctors are still learning about COVID-19, from what the Chinese did (and apply it to Filipino patients), and the best methods to manage patients.

A LITTLE MORE PATIENT

Two years since the start of the pandemic, Dr. Limpin implores the public to be a “little more patient,” especially in terms of the difficult task of addressing personal needs. “We understand that each and every person has their own lives to live but we need to be able to live a dignified life. And a life that is free from diseases and wala kaming magagawa (we are helpless) without the help of the public.” Dr. Limpin explains the need for the public’s help and not to run away from our respective public health responsibilities, particularly taking responsibility for ourselves and our behavior. Lastly, she reminds us of the need to discern right from wrong and to always do the right thing.