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By Johnna Villaviray, Senior Reporter
AT the Ninoy Aquino International Airport (NAIA),
two sentinels stand watch–a soldier on guard against terrorists
and a doctor trying to stop the spread of a new killer flu virus
that has roiled up much of Asia.
SARS, or severe acute respiratory syndrome,
added another element to the slew of problems burdening Filipinos, a
nation so used to hardships and yearly disasters that many have
opted to just cross their fingers, hoping that the disease doesn’t
find its way to Philippine shores.
But what started initially as a daughter’s
desperate journey–from Toronto, Canada, to Pangasinan, and then
across Metro Manila, Tarlac and Baguio–to find a cure for her
terminally ill father turned out to be exactly what the government
tried to dodge with the establishment of a crisis team and the
deployment of government troops to help guard ports of entry against
infections.
Cardinal Jaime Sin called for special prayers to
Saint Rock, the patron saint of pestilence and incurable illness.
Health Secretary Manuel Dayrit tried to parry the disease by playing
around with uncertainties over SARS, describing initial infections
as “probable cases” and maintaining the Philippines was
untainted, until Filipino lawmakers boiled over and asked him to own
up.
On April 25 Dayrit grudgingly broke the bad news
to end public confusion: “All in all, we already have four
documented SARS cases in the country. Three of them are from abroad,
while one was a local transmission.”
“One of the gravest challenges we are facing
today is the SARS disease,” President Arroyo said. “I understand
the concern of our people, but I appeal to all to stay calm.”
The Philippine government would clarify later
that there were actually just three confirmed cases, a German, who
got infected elsewhere, got sick here and recovered and a Filipino
nurse, Adela Catalon, who caught the virus in Toronto, Canada,
returned home and rapidly developed coughing and other symptoms, and
perished. She rushed home to look for a doctor for her father, who
had colon cancer.
The father, Mauricio, later died of SARS and
their poor northern home village of Vacante in Alcala, Pangasinan,
was quarantined, raising fears that the Philippines could be
engulfed by a plague.
Amid the fumbles and fear, there is a bit of
good news: SARS has failed to spread so far in the Philippines in
the way that Hong Kong and China are being overwhelmed by deaths and
infections caused by the flu-like illness.
Is the government’s containment program
working? Has it something to do with the organic makeup of the virus
that stops it from flourishing in the Philippines’ intense
tropical heat? Or are Filipinos just plain lucky this time?
It could all be these, but nothing is certain
except that the campaign against SARS, like the war on terrorism,
requires money that the Philippines doesn’t have, sparking fears
of whether the government can effectively sustain the campaign
against the dreaded illness even in the medium term.
A World Health Organization May 9 advisory
spells out where much of the work should be focused: “In the
absence of effective drugs or a vaccine for SARS, control of this
disease relies on the rapid identification of cases and their
appropriate management, including the isolation of suspect and
probable cases and the management of their close contacts.”
That means a lot of expensive detecting machines
and equipment at ports of entry, backup treatment and quarantine
facilities.
In last Thursday’s Aviation Forum on the
Prevention and Containment of SARS held at the Mimosa Leisure Estate
in Clark Field, Pampanga, Southeast Asian airport managers agreed to
install fever-detecting machines and standardize procedures in
profiling SARS patients.
The Ninoy Aquino International Airport (NAIA),
prior to the forum, had ordered three units of thermal image
scanners costing $25,000 to $100,000 each. One has been installed at
the NAIA departure terminal while two more will be fitted at the
arrival section.
The possibility of installing those machines in
airports across the nation is at best uncertain.
SARS is the first real medical crisis to bedevil
the Philippines, although the country is a veteran of battling
periodic outbreaks of dengue and malaria.
“Importation [of cases] is extremely difficult
to prevent. You will always have people going through the cracks,”
acknowledged the WHO country director, Jean Marc Olive, alluding to
the generally faulty measures initially implemented by the
management of the NAIA.
Working on the experience of governments that
had to deal with SARS earlier, the NAIA management began
distributing questionnaires to arriving passengers that even the
Department of Health now acknowledges as too vague.
The NAIA management modified the questionnaire
to include more specific questions for easier profiling and an item
to countercheck the answer posted by the other travelers.
One item asks if the arriving passenger suffered
from any of the symptoms of SARS–high fever (above 38 degrees
Centigrade or 100 degrees Fahrenheit), cough, sore throat, shortness
of breath and difficulty in breathing. Another asks if the traveler
noticed other passengers exhibiting these symptoms.
Apart from the additional paperwork, departing
travelers also need to contend with two trips through the thermal
scanner since the machine almost always flashes the same number: 38.
“Two trips [to the thermal scanner] are needed
for an accurate reading. It’s standard,” explained Dr. Consrocia
Lim-Quizon, a spokesman for the health department’s anti-SARS
campaign.
This galore of anti-SARS plans and rhetoric
should translate into an effective shield against the disease on the
ground, but there is a glaring mismatch between strong words and
action.
Quarantine procedures demand that only
authorized personnel should have access to people being isolated,
but this was relaxed in the case of Adela’s father, who was cared
for by close relatives, some of whom got infected but eventually
recovered. Officials said they have to contend with local values and
tradition.
“It’s a tradition here in the Philippines
that your family helps you, takes care of the older ones and the
sick ones. It’s not recommended, but it’s a reality,” Olive
observed.
In the case of Adela Dalingay, the first
Filipino to die of SARS in Hong Kong, the government had to convince
her parents to agree to a cremation. The government subsidized the
couple’s trip to the former Crown Colony to witness the process,
and then quarantined them upon their return. The Dalingays belonged
to a tribe in Abra that has a treasured tradition of burying the
dead.
Quizon insisted that the government had been
vigilant against the menace that has infected over 7,000 people
worldwide and killed over 600, with the worst cases found in the
Philippines’ neighboring countries of China, Hong Kong and
Singapore. The Philippines has 12 cases to date with two deaths–Adela
and Mauricio.
“She wasn’t a SARS case when she came
here,” Quizon explained. “Now, we treat everybody suspect unless
proven otherwise.”
SARS first manifested in China’s Guangdong
province as cases of atypical pneumonia. Chinese authorities did not
warn the public and unwittingly allowed the disease to spread
rapidly through tourists who carried the virus overseas.
Olive supposed that contagion might not have
happened had Chinese authorities acknowledged the problem earlier.
But they shrugged, saying there was no analyzing what went wrong
when there were still many uncertain factors in the equation.
SARS has not spread much in the Philippines, but
some believe that the disease would not have caused as much damage
had the technology been at hand. Japan developed the diagnostic tool
to confirm if a person is suffering from SARS and distributed it to
countries like Vietnam and Singapore. The government has not placed
an order because the WHO is still uncertain over its effectiveness.
“When the WHO recommends, that’s when
we’ll order,” Quizon said.
This could have slowed down the Philippines’
response to SARS since the health department had to ship blood
samples to Tokyo for the necessary confirmatory tests.
“We’re learning and modifying as we go
along,” Quizon described the attitude assumed by government.
A blithe attitude was not what Taiwan
authorities assumed. Taiwan Health Minister Twu Shiing-jer resigned
from office on Friday to take responsibility for the spread of SARS,
which afflicted 308 with a death toll of 35.
Olive said Manila, with all its resource
limitations, attended to the problem as best it could. The
Philippines contributed 12 cases to the over 7,700 cases listed
globally to date. The Philippines was only mildly hit by SARS
compared to neighbors China (5,191 cases as of May 16), Hong Kong
(1,706 cases) and Taiwan (274 cases). Opulent Canada has 140 cases.
“It’s on top of the political agenda,”
Olive said of the government’s response to the menace.
“For the moment, all efforts [here] are
directed at preventing community transmission of SARS,” said
Olive, who sits in all policy meetings for SARS and makes sure that
the government follows the WHO prescription.
Olive blamed the inadequate dissemination of
information caused a panic–an increase in the demand for surgical
masks, the prices of which rose from P40 to about P400, although
very few wear them in public–when news that the disease has
arrived to the country. Government responded to the overpricing by
filing criminal charges against at least three retailers.
Health Secretary Manuel Dayrit, coming under
fire for the sloppy information campaign, designated Quizon as the
sole spokesman for government on the campaign against SARS, which
the International Air Transport Association (IATA) anticipates would
cost the industry $10 billion in losses.
But while there is a consensus in government on
the need to devote resources and attention to arrest the spread of
SARS, Olive observed that Manila seems to be torn between the task
and ensuring the country’s attractiveness for tourists and foreign
investments.
Foreign Secretary Blas Ople had wanted to ban
travel to Hong Kong and already made an initial announcement, but
the initiative was blocked by Tourism Secretary Richard Gordon who
was worried that posting a warning on Hong Kong would discourage
tourists from the Special Administrative Region from traveling here.
Gordon has not given an overview of how much the
tourism industry suffered since the outbreak of SARS.
“It has to be an effort of all secretaries in
government,” he said. “If we have SARS, and even more when we
have transmission to whole communities, that’s going to affect the
economy, it’s going to affect tourism.”
The Philippines is a disaster-prone country and
structures exist to address a multitude of crises. None of these
structures were developed to deal with a medical crisis, although it
helped Manila prepare for an aggressive containment procedure.
Quizon said the isolation rooms that house SARS
patients were ready as early as the start of the year to treat
victims of chemical or biological attacks.
In the wake of the impending attack by the
United States on Iraq, security experts had been warning that
extremist Muslim groups could retaliate against supporters of the
offensive.
President Arroyo had ordered the Department of
Health to identify hospitals–in this case the San Lazaro Hospital
and the Research Institute for Tropical Medicine–to respond to
these attacks.
Quizon acknowledged that the health department
has developed a sense of confidence in dealing with SARS, especially
now that there is a high possibility that the country would be
stricken off the WHO watchlist by May 20.
Vietnam cleared of SARS on April 28 after 65
days of battling the disease that afflicted 58 individuals and
killed five. Most of those infected were staff of the hospital,
which had been immediately isolated, that treated Vietnam’s first
SARS case.
On May 20 the Philippines would have been
battling the killer pneumonia for 41 days.
“We don’t know [if SARS reached its peak
here]. We have to be on our toes and be ready that an infection can
occur,” Olive said, emphasizing that a rich economy and fully
equipped hospitals are insufficient to combat SARS.
He underscored the basics–personal hygiene and
a health lifestyle–and the shared responsibility of the government
and the public in dealing with SARS.
In a country hypersensitive to limitations of
civil liberties, the specter of people with a runny nose and cough
being stopped at airports then forced to scary trips to hospital
isolation wards have raised concerns among pro-democracy advocates.
A group of human rights lawyers is reportedly making a study on how
to protect the basic rights of Filipinos from possible abuse amid
the paranoia over SARS.
That would not jell well with plans by
legislators seeking to strengthen the country’s antiquated
quarantine laws and empower officials to quarantine people at will
and charge those who will falsify health data on travel forms.
The country’s old quarantine law that provides
for a P2,000 fine against individuals who break quarantine rules.
In Geneva, scientists from 16 SARS-struck
countries agreed on Saturday that SARS-control measures appear to be
working and the prospects of fighting the disease seems not as
ominous considering the profusion of help offered by various
financing institutions.
The Asian Development Bank (ADB) has agreed to
an initial $2-million assistance to developing member countries
affected by SARS to be used for the training of health staff,
enhancement of surveillance and reporting systems and health
education and public information campaigns on awareness and self
protection. Another $3 million in grants will also be made
available, possibly as soon as two weeks.
The government, having set aside P1 billion for
the purchase of the necessary equipment to improve the treatment of
SARS cases and to prepare key regional hospitals for a similar
crisis, plans to use the amount the ADB is offering as a standby
fund.
About P75 million has already been released to
the health department for the acquisition of necessary equipment to
fight SARS and to finance the information campaign in the provinces.
The Department of the Interior and Local Government was also tapped
to lead a cleanup drive to ensure that the barangays will not be a
breeding ground for SARS and other infectious diseases.
Dr. Arturo Cabanban, director of the San Lazaro
Hospital, believes that future SARS cases will be easier to handle
now that the public is relatively familiar of it.
While Quizon looks forward to a “perfect”
hospital with a modern isolation room and adequate funding to
maintain operations and equipment, Cabanban wants the isolation
rooms to be fitted with television sets or other conveniences to
help patients while the time away.
“They’re not difficult to handle. Some of
them walk about. It would be nice if they could have something to do
[while in isolation],” Cabanban said.
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