Covid19handbook Final 04-05-2020 PDF

2 COVID-19 HANDBOOK OF CARE
UPDATED 5 APRIL 2020
Caring for family,

community,
and nation
READ THIS
T HE GLOBAL PANDEMIC caused by the coronavirus disease called COV-

ID-19 has caused havoc, suffering, and heroic sacrifices on the part of
millions in the Philippines and the world. The COVID-19 Handbook of
Care has been prepared to keep you up to date and informed about this highly
contagious disease. Only reported in December 2019, the virus that causes this
disease is completely novel, making it the wellspring of widespread rumors,
half-truths, and even hoaxes.
This handbook has been prepared for you by the Vibal editorial staff as
your guide on basic and research-based information on COVID-19 diagnosis,
caregiving, as well as health and community guidelines derived from Wuhan,
China, as well as other parts of the world.
It also provides at-a-glance summaries and situation reports, answers to
commonly asked questions, a glossary, and links to further research. Only
the most highly regarded sources have been used to compile this handbook.
Wherever possible, references have been made to original scientific or medical
research, which allows the reader to do further independent reading.
Please feel free to pass or remix this compendium of scientific and useful
information that can help protect yourself, your loved ones, the community,
and the nation. It is published under a Creative Commons license BY-NC-SA,
allowing you to share it alike with attribution for non-commercial purposes.
The handbook will be updated regularly in order that only the most accurate,
relevant, and verified information will be shared.
CONTENTS
OVERVIEW 5
1: COVID-19: THE BASICS 8
2: DIAGNOSING COVID-19 20
3: COVID-19 CARE GUIDELINES 28
4: COVID-19 AND GLOBAL SOCIOECONOMIC AND HEALTH ISSUES 40
5: ANSWERS TO COMMON COVID-19 QUESTIONS 61
APPENDICES
• COVID-19: A TIMELINE 69
• COVID-19 GLOSSARY 75
THE COVID-19 HANDBOOK OF CARE (UPDATED 5 APRIL 2020)

A 2020 compilation provided with a Creative Commons license BY-
SC-SA (Attribution + Noncommercial + Share Alike) by Vibal Group.
Inc. This handbook is freely shared and can be further disseminated
by the public for non-commercial purposes.
DISCLAIMER: This handbook contains information obtained from private, public and international
sources. The information provided in this book is provided purely for education and is not a sub-
stitute to any established medical or scientific treatment. The information is provided without any
representations or warranties, express or implied, of any approved therapeutic claims. The authors
and the publisher do not warrant or represent that the information contained therein is curative,
true, accurate, or complete. Furthermore, no medical advice should be taken from this text as an
alternative or substitute to medical advice from a doctor. The author and the publisher do not warrant
or represent the information contained therein is curative, true, accurate, or complete. Furthermore,
no medical advice should be taken from this text as an alternative or substitute to medical advice
from a doctor. The author and the publisher cannot assume responsibility for the reported benefits,
medicinal, or otherwise, or the consequences of readers’s use of the information. This compilation
is meant for general and educational use, as well as a springboard for the readers’s further studies.
Do not rely or use any information contained in this book as an alternative or substitute to medical
advice from a professional healthcare provider. If you have any existing health condition, do not use
any information in this book as an alternative or substitute to medical advice from a professional
healthcare provider. If you have any existing health condition, do not use any information in this
book as an alternative cure or substitute treatment. You should consult your doctor immediately,
especially if you are suffering from any major illness. Do not delay in seeking their medical help,
disregard their advice, or discontinue medical treatment because of any information supplied in this
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under applicable law, or exclude any of our liabilities that may not be excluded under applicable law.
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1253 G. Araneta Avenue, Quezon City, 1104 Philippines
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OVERVIEW
T HE WORLD HAS NEVER BEFORE EXPERIENCED a pandemic developing on

an epic scale such as that unleashed by a new type of virus, which is more
technically known as the severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) and causes the coronavirus disease called COVID-19.1 The disease
has spread worldwide at an alarming rate, infecting over 200,000 people across 181
countries and spreading rapidly with more infections occurring outside of China.2
First reported by Chinese hospitals in early December 2019 in Hubei province, Chi-
na, the disease quickly spread and within days had infected hundreds of people. In its
early stages, up to 140 cases of infection were reported daily. Soon, thousands more
were infected, which prompted government authorities to lock down Hubei’s capital
and transportation hub Wuhan as well as other surrounding cities on 23 January.3
The Chinese lockdown on the eve of the most significant holiday, the Chinese New
Year celebration, resulted in a slowdown of the exponential spread of the ailment within
China. A study published by the prestigious journal The Lancet revealed that the median
daily reproduction number in Wuhan declined from a factor of 2.35 before lockdown
to 1.05 a week after. It also found out that if the infection had spread outside Wuhan
proper, there was more than a 50% chance that the infection would take off within
that population if at least four independently introduced cases had been confirmed
within that locality.4
Chinese public health measures such as case management, tracking of individual
infections, contact tracing, and quarantining were immediately undertaken, while so-
1 “Naming the coronavirus disease (COVID-19) and the virus that causes it,” WHO, accessed 19 March
2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-
the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.
2 “Coronavirus COVID-19 Global Cases,” Center for Systems Science, John Hopkins University and
Medicine Coronavirus Resource Center, 5 April 2020, accessed 5 April 2020, https://coronavirus.jhu.
edu/map.html.
3 “WHO Director-General’s opening remarks at the technical briefing on 2019 novel coronavirus,” 6
February 2020, accessed 5 April 2020, https://www.youtube.com/watch?v=m0u7KCvJtjo.
4 Adam J. Kucharski, Timothy W. Russell, Charlie Diamond, Yang Liu, John Edmunds, Sebastian Funk,
and Rosalind M. Eggo, “Early dynamics of transmission and control of COVID-19: a mathematical modelling
study,” The Lancet Infectious Diseases, 11 March 2020, accessed 5 April 2020, https://www.thelancet.com/
journals/laninf/article/PIIS1473-3099(20)30144-4/fulltext.
5
6 THE COVID-19HANDBOOK 1253G.AranetaAvenue,QuezonCity,1104Philippines•http://www.vibalgroup.com
Daily status updates are kept cial distancing measures—characterized in the Western press as draconian—such as
by the Philippine Department lockdowns and the banning of public gatherings and transportation, came at a great
of Health to keep the public
informed about national
socioeconomic sacrifice on the part of the population and many public and civic in-
statistics on the pandemic. stitutions.
For the latest, visit https:// The enormous measures taken by the Chinese came too late, as travelers from
ncovtracker.doh.gov.ph/. This
China had brought the disease across many countries through international flights
interactive website allows
you to locate incidences worldwide. Within weeks, the virus had been detected in different countries including
of infection in your local Japan, Korea, Vietnam, Singapore, Australia, Malaysia, Thailand, Nepal, the United
community, the classification States, Canada and France.5 A study of Chinese infections compared with mobility and
of confirmed cases, as well
as monitor confirmed case sociotemporal data of 2.97 billion trips in 375 cities (provided through Chinese tech
trends, whether nationally or giants Tencent and Baidu) during the period of January 10 and February 8 posited
by age group. The COVID-19 that 86% of all infections in that period were due to undocumented contagion prior to
tracker was developed by
John Hopkins University and
the 23 January travel restrictions. Although the transmission rate of undocumented
Medicine. (DOH) infections was only 55% as compared to the higher transmission rate of documented
infections that ranged between 46% and up to 62%, “yet due to their greater numbers,
undocumented infections were the infection source of 79% of undocumented cases.”6
5 “WHO Director-General’s opening remarks at the technical briefing on 2019 novel coronavirus.”
6 Ruiyun Li, Sen Pei, Bin Chen, Yimeng Song, Tao Zhang, Wan Yang, and Jeffrey Shaman, “Substantial
undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2),” Sci-
ence, 16 March 2020, accessed 5 April 2020, https://science.sciencemag.org/content/early/2020/03/13/
science.abb3221.full.
7 COVID-19 HANDBOOK OVERVIEW
An important conclusion of this study was that the high proportion of the total in-
fection was mediated through this undocumented contagion, probably because many
of the disease carriers “were likely not symptomatic,” thus facilitating its rapid spread
throughout China. This indicated the need for a “radical increase in the identification
and isolation of currently undocumented infections.” It also predicted that due to its
rapid spread globally, the virus will eventually become endemic in human populations.
By the middle of March 2020, with over 60,000 cases of infection in Europe alone
and thousands more all over the world—despite the advances in medicine and health
systems in the 21st century, the COVID-19 outbreak was belatedly declared by the
WHO as a truly global pandemic, an alert that by this time had become symbolic.
This final declaration by the WHO sounded the alarm loud and clear for all countries
to take action and unite in the fight to find the best solution to what seems to be the
greatest challenge to public heath ahead. Vital to achieving promising results are the
understanding and personal actions of all concerned. This means imposing means for
early detection, protection, and treatment.
Of the Philippines’ first documented incidences of COVID-19, one of three corona-
virus-infected Chinese patients in February died of complications while the other two
fully recovered. This death was the first reported outside mainland China.7
Probably due to the early travel restrictions on flights from China, the Philippines
went weeks without recording new infections until 5 March. The number went up to
over 60 by 12 March.8 Local transmission of the disease also increased in number and
by 16 March, the total number of infected ballooned to 187, prompting President Rodrigo
Duterte to then place the entire country under a state of calamity. This declaration is
contained in Proclamation 929, which also put Luzon under an enhanced community
quarantine that took effect at 12 a.m. of 17 March 2020.
The president’s declaration stated that “All government agencies and LGUs are
directed to render full assistance, cooperate with each other, and mobilize necessary
resources to undertake critical, urgent and appropriate disaster response aid and
measures in a timely manner to curtail and eliminate the threat of Covid-19.”9
As of 4 April 2020, the Philippines confirmed, 3,094 infections with a total of 144
fatalities and 57 recoveries. It has been noted that a higher percentage of COVID-19
fatalities affected males over 60. 10
7 “Situational report on the coronavirus disease,” Philippine Department of Health,” 14 February 2020,
accessed 18 March 2020, https://www.doh.gov.ph/sites/default/files/health-update/covid-19-PhilSitua-
tionalReport-02142020.jpg.
8 Julia Mari Ornedo, “Philippines’ COVID-19 cases: Where, how and how old,” GMA News Online, 12 March
2020, accessed 18 March 2020, https://www.gmanetwork.com/news/news/nation/729432/philippines-
covid-19-cases-where-how-and-how-old/story/
9 “Philippines under state of calamity,” YahooNews, 17 March 2020, accessed 18 March 2020, https://
ph.news.yahoo.com/philippines-under-state-calamity-103900931.html.
10 “Coronavirus COVID-19 Global Cases,” Center for Systems Science, John Hopkins University and Medicine
Coronavirus Resource Center, 5 April 2020.
1 COVID-19:
THE BASICS
An illustration of the
membrane of the pathogen
COVID-19, whose surface is
punctured by club-like spikes,
which gives it the look of a
corona, thus leading to its
C ORONAVIRUSES (CoV) are a large family of viruses responsible for widely known
respiratory diseases that have caused epidemic outbreaks in recent years such
as the Severe Acute Respiratory Syndrome (SARS), the Middle East Respiratory
Syndrome (MERS), and the ongoing Coronavirus Disease 2019 (COVID-19). These virus-
es are endemic to many different species of animals, including camels, cattle, cats, and
name coronavirus.
bats. These viruses can be seemingly benign in animals, while in others they can cause
respiratory tract infections and diarrhea.1 Coronaviruses prove especially virulent when
they are transmitted among humans who can suffer a range of respiratory illnesses
ranging from flu-like symptoms to lung lesions and pneumonia.2 Its symptoms include
fever, a dry cough, a general feeling of fatigue, and breathing difficulties.
The name coronavirus comes from the Latin corona, meaning “crown” or “halo.” The
viruses have club-shaped protein spikes covering their surface which, when viewed
under an electron microscope, resembles a crown or solar corona. Coronaviruses
are found to be present among many mammals, with several known coronaviruses
circulating in them that have not yet infected humans. However, other types that infect
humans were first identified in the 1960s when they were discovered from the nasal
cavities of human patients with the common cold.3
Transmission
Some coronaviruses can be transmitted from animals to people,. Other studies on SARS
revealed its probable transmission from civet cats to humans, while MERS was traced
from dromedary camels to humans. The transmission between humans is thought to
1 Linda L. Saif, “Animal Coronaviruses: Lessons for Sars,” NCBI, accessed 5 April 2020, https://www.
ncbi.nlm.nih.gov/books/NBK92442/.
2 “The Coronavirus Outbreak,” The New York Times, accessed 5 April 2020, https://www.nytimes.com/
news-event/coronavirus.
3 Chloe Geller, Mihail Varbanov, and Raphael E. Duval, “Human coronaviruses: insights into environmental
resistance and its influence on the development of new antiseptic strategies,” Viruses 4, no. 11 (Novem-
ber 2012): 3044–68, accessed 5 April 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509683/.
8
Where does a cough go?
Coughs, along with
sneezes, play a key
role in transfering
respiratory diseases Can travel as fast as 80
km/h and expel almost
Small droplets may
3,000 droplets
float into ventilation
systems
The direct jet can
spray droplets Lighter drops can
around 1.8 m remain airborne and
travel further
Some droplets
settle on surfaces
What is in a cough? such as door
Can contain a knobs and tables
mixture of mucus,
phlegm, irritants
and fluids. It Can enter the
can also carry respiratory
infections such as tract of
coronaviruses another
A coronavirus may remain viable on person
inanimate surfaces for 1-9 days
An infographic showing occur among people in close contact via respiratory droplets generated by sneezing
how the SARS-CoV-2 virus and coughing.4 The viruses’ use their “spike” protein on their surface sto infect other
contained in droplets can
be shed through a cough or
cells, a process that is activated by a certain cell enzyme. This enzyme is found in lots
sneeze or create a thin film of human tissues, including the lungs, liver, and small intestines—which might explain
of pathogens on surfaces why these pathogens are easily transmitted to humans.5
and spread COVID-19. Vibal
infographic based on MIT
/ Lung.org / US CDC / The pathogen SARS-CoV-2 and the disease it causes, COVID-19
journalofhospitalinfection.com. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the seventh known
coronavirus to infect people, after 229E, NL63, OC43, HKU1, MERS-CoV, and the first
SARS-CoV.6 It is a “novel” virus, meaning it is a new virus that had not been previously
identified in humans. Its infection is called the Coronavirus Disease 2019 or COVID-19.
Initially called 2019-nCoV Acute Respiratory Disease, COVID-19 is a contagious disease
that causes flu-like symptoms such as dry cough, fever, fatigue, and shortness of breath.
In some cases the ailment may progress to pneumonia and multiple organ failures. As
seen in reports of several countries, the fatality rate may range from less than one and
up to three and even four percent per diagnosed cases. Because infections are belatedly
or haphazardly reported, the fatality rate can vary widely among countries. It can also
vary widely when categorized by age groups and health conditions.7
4 “Coronavirus Disease 2019,” Center for Disease Control and Prevention, accessed 5 April 2020, https://
www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html?CDC_AA_refVal=https%3A%2F%2Fw-
ww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Ftransmission.html.
5 Hua Li, et al., “Furin: a potential therapeutic target for COVID-19,” Preprint at ChinaXiv (2020), accessed
5 April 2020, http://chinaxiv.org/abs/202002.00062.
6 “Coronavirus,” US Center for Disease Control and Prevention, accessed 5 April 2020, https://www.cdc.
gov/coronavirus/types.html.
7 “Coronavirus disease 2019 (COVID-19) Situation Report – 46,” World Health Organization, 6 March
2020, accessed 5 April 2020, https://www.who.int/docs/default-source/coronaviruse/situation-re-
ports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2. A contrarian view of the epidemic’s fatality
Similar to other coronavirus diseases like MERS and SARS, COVID-19 is transmitted
between humans through respiratory droplets, which are often shed during coughing
and sneezing.8 Its symptoms generally manifest between two and 14 days, with an
average of five days after a person has been exposed. The infection can be initially
diagnosed from a combination of symptoms and risk factors. A positive laboratory
confirmation is obtained by taking a swab of the nose or throat areas, and then ana-
lyzing it for the existence of genetic markers of the virus. In addition, a chest CT scan
can speedily confirm its spread, especially in the upper respiratory system.
The virus was first reported in Hubei province (with its capital Wuhan), China, from
where it infected 82,574 Chinese and killed 3,333 (or a fatality rate of 4%) from Decem-
ber 2019. As reported by John Hopkins University as of 5 April 2020, 77,187 in China
have recovered (93%), while the US has become the second hardest-hit country in the
world, counting with 312,146 cases and 8,502 fatalities. Worldwide, the virus has sick-
ened 1,203,923 people and killed 64,795 in 181 countries as of 5 April 2020.9 After the
disease spread rapidly in Iran and Europe and other parts in the world, the World Health
Organization (WHO) initially declared the 2019–2020 coronavirus outbreak a “Public
Health Emergency of International Concern” and soon after, WHO raised its alert level
to a global pandemic.10 After local and community transmissions were reported in many
countries, travel bans were implemented to stem the spread of the disease.
The case study of China

Although the first public notification on the new virus was made on 31 December 2019,
its first known case was traced back to 1 December 2019 in Wuhan, Hubei, China. A
month later, the number of reported cases with infections of flu-like symptoms or
pneumonia rapidly increased. The Chinese government then alerted the World Health
Organization (WHO) that patients with a novel type of coronavirus were being treated
by its health authorities in Wuhan. An early investigation was launched, suggesting
that the source of the virus may have been linked to a seafood market in the city11 that
sold live animals, leading scientists and medical experts to suspect that it had been
transmitted via animals and that it was closely related to other coronaviruses like
coronaviruses in bats and pangolins as well as the first SARS-CoV.
On 11 January, Chinese state media reported its first patient to die from the disease.
During the early stages, the number of cases doubled approximately every seven and
rate is expressed by John P.A. Ioannidis, “A fiasco in the making? As the coronavirus pandemic takes
hold, we are making decisions without reliable data,” accessed 5 April 2020, https://www.statnews.
com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-de-
cisions-without-reliable-data/.
8 “Q & A on coronaviruses (COVID-19,” World Health Organization, accessed 5 April 2020, https://www.
who.int/news-room/q-a-detail/q-a-coronaviruses.
9 “Coronavirus COVID-19 Global Cases,” Center for System Science and Engineering, John Hopkins Universi-
ty and Medicine Coronavirus Resource Center, accessed 5 April 2020, https://coronavirus.jhu.edu/map.html.
10 “Statement on the second meeting of the International Health Regulations (2005) Emergency Committee
regarding the outbreak of novel coronavirus (2019-nCoV),” World Health Organization, 30 January 2020,
accessed 5 April 2020, https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-
meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-
of-novel-coronavirus-(2019-ncov).
11 “What Is Coronavirus?” John Hopkins Medicine, accessed 5 April 2020, https://www.hopkinsmedicine.
org/health/conditions-and-diseases/coronavirus.
11 COVID-19: THE BASICS
181 countries are currently a half days.12 January was a critical period when the virus spread to other Chinese
affected by the COVID-19 provinces due to the travel leading up to China’s biggest holiday—the Chinese New Year
pandemic. Bookmark the
John Hopkins Univeristy or the Chunyun period—with Wuhan being a transport hub and major rail interchange.13
COVID-19 tracker, an Days later, the Chinese government reported nearly 140 new cases in a day, including
interactive website where you two people in Beijing and one in Shenzhen, bringing the number of infected to 6,174
can keep abreast of global
and country statistics and
people by 20 January 2020. Three days later on New Year’s Eve, China implemented
monitor the actual trendline of a strict quarantine to stop the virus from further spreading, imposing a total lockdown
the infection curve. Copyright in Wuhan and other cities in Hubei province.14
2020 Johns Hopkins On 30 January, the worsening situation prompted the WHO to declare the outbreak to
University, all rights reserved.
be a Public Health Emergency of International Concern, a situation regarded as a public
health risk to other nations that required immediate national and international action.15
To stem the further spread of infection, measures were taken to effect extreme
social distancing and even complete lockdowns by authorities throughout China. Such
draconian steps led to curbed economic activity, which was confirmed by China’s
12 Qun Li, et. al., “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneu-
monia,” The New England Journal of Medicine (January 2020), accessed 5 April 2020, doi:10.1056/NEJ-
Moa2001316.
13 “Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), World Health
Organization, 16–24 February 2020, accessed 5 April 2020, https://www.who.int/docs/default-source/
coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.
14 “Wuhan lockdown ‘unprecedented’, shows commitment to contain virus: WHO representative in
China,” Reuters, 23 January 2020, accessed 5 April 2020, https://www.reuters.com/article/us-chi-
na-health-who-idUSKBN1ZM1G9.
15 “Statement on the second meeting,” WHO.
National Bureau of Statistics on 16 March 2020. It reported a set of daunting year-on-

year setbacks in the first two months of the calendar year: a 13.5% drop in industrial
production, a 20.5 % fall in consumption, and a decline of 13 percent in services pro-
duction, all enormous sacrifices for the sake of public health.16 However, these extreme
measures led to a landmark announcement with the report of 18 March 2020 when China
announced that it had recorded zero local infections, thus proving that the viral spread
could be stopped. However, another worrying development was also reported. Thirty-four
cases of infections are also registered, but this time from international arrivals, signaling
that public health may be once again threatened by a second wave of infections.17
Outside of China, the countries that have been most affected are the US, Spain, Italy,
Germany, France, Iran, United Kingdom, Turkey, Switzerland, and Belgium.
The spread in Asia

In South Korea, the first confirmed case was announced on 20 January 2020. A month
later, confirmed cases jumped to 346, which was mostly attributed to a patient who
participated in a local church activity. By 21 March, the country had about 8,652 cases
and 100 deaths, with a fatality rate of around 1 percent. Travel bans were imposed and
mass gatherings have been restricted since then.18 The quick countermeasures taken
by the South Korean government included efficient and rapid testing, rapid isolation,
and eventually, social distancing directives. The South Korean Center for Disease
Control and Prevention gives daily updates on the spread of the disease and even
sends smartphone alerts informing the public of an infected person’s previous move-
ments within the area, a move considered by some as an invasion of privacy, which
however has been the key in identifying infection clusters early on. Korea also pio-
neered drive-through and walk-through testing centers, allowing people to be rapidly
screened without burdening hospitals with the danger of contamination.19 Such alert
measures resulted in limiting new confirmed cases to less than 100 for three days in
a row, demonstrating the efficacy of their countermeasures.
In Japan, the first confirmed case was that of a 30-year-old Chinese national who
was tested positive on 16 January 2020.20 He had previously traveled to Wuhan. Two
weeks later, a dozen more contracted COVID-19. The government later on put the cruise
ship Diamond Princess—which left Yokohama with 3,700 passengers for a round-trip
cruise—in a quarantine, after some passengers exhibited symptoms of the disease.
16 “National Economy Withstood the Impact of COVID-19 in the First Two Months,” National Bureau of
Statistics of China, 16 March 2020, accessed 5 April 2020, http://www.stats.gov.cn/english/PressRe-
lease/202003/t20200316_1732244.html.
17 Javier C. Hernandez, “China hits a coronavirus milestone: No new local infections,” The New York
Times, accessed 5 April 2020, https://www.nytimes.com/2020/03/18/world/asia/china-coronavirus-ze-
ro-infections.html?action=click&module=RelatedLinks&pgtype=Article.
18 Ernesto Lodoño, Aimee Ortiz, Nancy Coleman, and Andrea Salcedo, “Coronavirus, travel restrictions
across the globe,” The New York Times, 16 March 2020, accessed 5 April 2020, https://www.nytimes.
com/article/coronavirus-travel-restrictions.html.
19 Nemo Kim, “COVID-19: South Koreans keep calm and carry on testing,” The Guardian, 18 March 2020,
accessed 5 April 2020, https://www.theguardian.com/world/2020/mar/18/covid-19-south-koreans-keep-
calm-and-carry-on-testing?CMP=Share_AndroidApp_Gmail.
20 “Japan confirms first case of infection from Wuhan coronavirus; Vietnam quarantine two tourists,”
The Straits Times, 16 January 2020, accessed 5 April 2020, https://www.straitstimes.com/asia/east-asia/
japan-confirms-first-case-of-infection-with-new-china-coronavirus.
Seven hundred twelve passengers later on tested positive for the virus21 as of 21 March.
Iran, on the other hand, reported its first confirmed cases of people with COVID-19
on 19 February 2020 in the famed pilgrimage city of Qom.22 The numbers jumped
rapidly to over 55,743 infections, with 3,453 deaths as of 5 April, making it the eighth
country after the US and Italy with the highest numbers of fatalities.23 Proving that
the virus reached up to the highest echelon of its government, the virus also infected
some senior government officials, including its deputy health minister Iraj Harirchi.24
Southeast Asia
Meanwhile, several Southeast Asian countries have strengthened their measures amid
the COVID-19 threat. Indonesia imposed international travel restrictions on Italy, Spain,
Germany, France, Britain, Switzerland, and Vatican City beginning 20 March. This moved
by the Thai government for all visitors from abroad. Travelers who visited China, Italy, Iran,
South Korea, and Macau for the past fourteen days will be quarantined. The government
ordered the airlines to check if the passengers have been to the mentioned countries within
the last fourteen days.
Malaysia, on the other hand, reached 3,483 confirmed COVID-19 cases, becoming the
fourth Asian country with the most number of infections.25 In an effort to stem the spread of
the disease, the Malaysian government banned the entry and transit of all foreign nationals
from 16 March. Further, all passengers from international flights, including Malaysian citizens,
have been asked to undergo a fourteen-day quarantine. Classes have been suspended and
government and private businesses, except those providing essential supplies and services,
have been closed.26 Indonesia also banned foreign arrivals, with the Philippines stopping
foreign arrivals on the island of Luzon.
North America
Cases have been confirmed in Antigua and Barbuda, the Bahamas, Canada, Costa Rica,
Cuba, the Dominican Republic, Guatemala, Honduras, Jamaica, Mexico, Panama, Saint
Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, the United States, Aruba,
the Cayman Islands, Curacao, Guadeloupe, Martinique, Saint Barthelemy, and Saint
Martin, with the United States having the most confirmed cases at around 312,237
21 “All passengers and crew leave virus-hit Diamond Princess cruise ship,” The Japan Times, 2 March
2020, accessed 5 April 2020, https://www.japantimes.co.jp/news/2020/03/02/national/coronavirus-di-
amond-princess-passengers-crew#.Xm8zFyN96uU.
22 “Iran reports its first 2 cases of the new coronavirus,” The New York Times, 19 February 2020, ac-
cessed 5 April 2020, https://archive.is/CuAQZ.
23 “Coronavirus COVID-19 Global Cases,” Center for System Science and Engineering, John Hopkins Uni-
versity, accessed 5 April 2020.
24 Farnaz Fassihi and Rick Gladstone, “Iran vice president is one of 7 officials to contract coronavirus,”
The New York Times, 4 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/02/27/
world/middleeast/coronavirus-iran-vice-president.html.
25 Gayatri Suroyo and Tom Allard, “Indonesia warns of escalating coronavirus cases, adds restrictions
on foreign travellers,” Reuters, 17 March 2020, accessed 5 April 2020, https://www.reuters.com/article/
health-coronavirus-indonesia-travel-int/indonesia-warns-of-escalating-coronavirus-cases-adds-restric-
tions-on-foreign-travellers-idUSKBN2141FL.
26 Gary Boyle, “All inbound air passengers must have COVID-free certificates,” Bangkok Post, 19 March
2020, accessed 5 April 2020, https://www.bangkokpost.com/learning/easy/1882225/all-inbound-air-pas-
sengers-must-have-covid-free-certificates#cxrecs_s.
by 5 April 2020.27 Hollywood actor Tom Hanks, TV host Chris Cuomo, pop icon Pink,
and NBA players like Rudy Gobert and Donovan Mitchell tested positive for COVID-19.
The Centers for Disease Control and Prevention (CDC), the leading national public
health institute of the United States, as well as the federal and state governments, has
taken measures for the containment of the disease, which include travel bans, community
mitigation strategies, mass dissemination of information, and medical assistance.28 US
President Donald Trump issued travel restrictions from China as early as 31 January.29
Increasingly the US government has issued ever more tightening restrictions on 29
February by expanding the travel ban on Iran, on 11 March restricting certain European
nationals from entering the US, and on 14 March banning foreign nationals from UK and
Ireland.30 By 5 April, forty-one US states, including California, Connecticut, New York,
New Jersey, and Connecticut had imposed stay-at-home regulations, while dozens of
the largest countries such as Russia and India decreed lockdowns that have affected
an unimaginable total of 4 billion people.
South America
As of 5 April all countries in South America, including the French overseas department
of French Guiana, had been seeded with infections, with Brazil having the most num-
ber of cases at around 10,360, followed by Chile with 4,161, and Ecuador with 3,465.31
The pandemic in Europe

The outbreak in Europe, however, was the final straw that led the WHO to declare
COVID-19 as a pandemic. The almost 60,000 confirmed cases in the continent as of
16 March 2020 was characterized as a 13-fold increase in the number of infected
and by then represented almost a third of the total number of cases worldwide.32 All
countries in Europe have at least one case of COVID-19 except for Montenegro. While
the increase in the number of infected people has slowed down in Asia, the opposite
is happening in Europe, making the continent an active center of the disease as of 13
March 2020, according to WHO.
After the first cases—two Chinese tourists in Rome—were confirmed on 31 January
2020, the number of infected in Italy immediately rose to over a thousand after a month.
It started with 16 confirmed cases in Lombardy, and then spread to nearby regions
in the country.33 By 16 March, there were already around 25,000 cases, making it the
27 “Coronavirus COVID-19 Global Cases,” Center for System Science and Engineering, John Hopkins University.
28 “Get your home ready,” US Center for Disease Control and Prevention, accessed 5 April 2020, https://
www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html.
29 Derrick Bryson Taylor, “A timeline of the virus,” The New York Times, 14 March 2020, accessed 5
April 2020, https://www.nytimes.com/article/coronavirus-timeline.html.
30 “Current Outbreak of Coronavirus Disease 2019,” Travel.State.Gov, 14 March 2020, accessed 5 April
2020, https://travel.state.gov/content/travel/en/traveladvisories/ea/covid-19-information.html.
31 “Coronavirus COVID-19 Global Cases,” Center for System Science and Engineering, John Hopkins Uni-
versity, 5 April 2020.
32 “WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020,” World
Health Organization, 11 March 2020, accessed 5 April 2020, https://www.who.int/dg/speeches/detail/
who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
33 Elisa Anzolin and Angelo Amante, “First Italian dies of coronavirus as outbreak flares in north,” Reu-
ters, 21 February 2020, accessed 5 April 2020, https://www.reuters.com/article/us-china-health-italy/
coronavirus-outbreak-grows-in-northern-italy-16-cases-reported-in-one-day-idUSKBN20F0UI. Numbers
updated from COVID-19 tracker of John Hopkins University.
A surveillance report of the

World Health Organization
on the number of COVID-19
cases reported in the
Western Pacific region as of
4 April 2020. Note that the
Philippines ranks number
5 in total number of cases,
while Vietnam with almost
the same population has
been more successful in
containing the spread to just
239. Note also that some
countries like Fiji and Papua
New Guinea are not able to
submit daily updates to WHO.
Source: https://reliefweb.
int/sites/reliefweb.int/files/
resources/20200404-sitrep-
75-covid-19.pdf.
country in Europe with the most number of infected—and the second-highest number
of positive cases as well as of deaths in the world, after mainland China. This prompted
Italian Prime Minister Guiseppe Conte to place the entire country under quarantine.34
In Spain, the first confirmed case of COVID-19 was a tourist from Germany who was
then admitted to University Hospital of the Nuestra Señora de Candelaria in Tenerife of
the Canary Islands on 31 January 2020. However, the spread of the virus was believed
to have occurred through a medical doctor from Lombardy, Italy, who was vacationing
in Tenerife and tested positive in the same university hospital. Soon enough, multiple
cases were detected on the island involving people who had come in contact with the
doctor.35 Cases in mainland Spain, which also swiftly increased, involved people who
had visited Italy at the time the outbreak in the country was just beginning. Spain had
one of the fastest rates of COVID-19 contagion in the world, prompting its government
to declare a state of emergency and follow the restrictive actions of France.36
In Germany, the first case was confirmed in Bavaria on 27 January 2020. Multiple
cases were then introduced by travelers from Italy, China, and Iran in the state of
Baden-Württemberg.37 As of 5 April, there were already 96,092 cases of infection in
the country.38 From a more benign outlook, German authorities have taken increasingly
restrictive measures, closing all schools and banning events of more than 50 people as
the disease took its toll around the country. Also, places of public congregations such
34 “Northern Italy quarantined 16 million people,” BBC News, 8 March 2020, accessed 5 April 2020,
https://www.bbc.com/news/world-middle-east-51787238.
35 “Tenerife, Spain hotel on coronavirus lockdown as Italian spreads Europe’s COVID-19 outbreak,” CBS
News, 25 February 2020, 16 March 2020, https://www.cbsnews.com/news/tenerife-spain-hotel-coro-
navirus-lock-down-italian-doctor-spreads-europe-covid-19-outbreak/.
36 Raphael Minder, “Spain becomes the latest epicenter of coronavirus after a faltering response,” The
New York Times, 13 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/13/world/
europe/spain-coronavirus-emergency.html.
37 “New coronavirus cases in Germany, one man in critical condition,” Reuters, 26 February 2020,
accessed 5 April 2020, https://www.reuters.com/article/us-china-health-germany-idUSKBN20J2K2.
A bar graph showing the as museums, cinemas, gyms, and nightclubs have been temporarily closed. The German
geographical distribution of chancellor Angela Merkel even took to outlawing overnight stays in hotels, an uncharac-
daily COVID-19 infections in
Europe and United Kingdom teristic and sudden turnaround for its once staunchly pan-European leader who also took
(color coded by country) as to gladly closing borders with Switzerland, Austria, Luxembourg, France, and Denmark.39
of 4 April 2020. Note the The most dramatic shift incurred in Britain, which had initially and some thought
increasng numbers of cases
being reported in Estonia,
callously regarded the disease as inevitably endemic to the human population and had
Iceland, and Romania, apart believed in the concept of “herd immunity,” which led their public health officials to
from the large numbers cynically plan for up to 60% of its population of 60 million to be exposed to the dread
already reported in Italy, disease. This very risky theory was based on letting a majority of its population acquire
France, Spain, and Germany.
Significant growing clusters immunity to the novel virus if it could be proven to induce a longer-term immunity, and
of transmission have been assuming that re-infections would not reoccur. However, after researchers at Imperial
reported in Portugal, Ireland, College of London had prepared a report modeling the ghastly prospect of 250,000
United Kingdom, and even
as far as Iceland. European
Britons dying by the end of June, Prime Minister Boris Johnson quickly turned around
Centre for Disease Protection and abandoned the policy of “mitigation,” and has turned to increasingly stringent
and Control, accessed 5 April regulations for social distancing and community isolation.
2020, https://www.ecdc.
europa.eu/en/cases-2019-
ncov-eueea. The debate over the perceived fatality rate
As of 5 April 2020, the death toll from COVID-19 has crossed 64,849 worldwide out of
1,204,782 confirmed cases, roughly a 5.4% fatality rate.40 The current number of deaths
39 Kim Hjelmgaard, “These countries are doing the best and worst jobs fighting coronavirus,” USA To-
day, 17 March 2020, accessed 5 April 2020, https://www.usatoday.com/story/news/world/2020/03/17/
coronavirus-how-countries-across-globe-responding-covid-19/5065867002/.
has surpassed the combined fatalities of other coronavirus-related diseases such as

SARS and MERS. The fatality rate varies from one to even 12.3 percent in the case
of Italy, a very worrisome trend.41 Older people and those with current and prevailing
conditions are most likely to succumb to the disease than the younger ones. However,
the fatality rate is likely to decrease as more widespread testing is carried, positive
carriers isolated, and medical personnel become more familiar with the diagnosis and
treatment of the disease’s symptoms.
In statistical terms, the perceived fatality rate is made less credible because the
numbers that have been pooled are taken only from the very tiny batch of those se-
riously ill as opposed to testing hundreds of thousands of people who exhibit little or
even no symptoms as had been done by South Korea.
Thus, there is much debate with regard to the assessment of COVID-19’s fatality rate
and the assessment of its risk. Although the scale of mortality of millions is hard to
grasp, several scientists have published estimates, such as that of Dr. James Lawler in
his projection of infection and fatality rates in the US alone. Under varying assumptions,
the study showed that an infection rate of 30% of the US population with a 0.5% fatality
rate would result in 480,000 deaths in a year, making it the third leading cause of deaths
behind cancer and heart disease. However, even at a conservative infection rate of 10%
of the population, the number of deaths would drop to 154,000, which, however, would
also be sizable.42 Another study by the US Centers for Disease Control and Prevention
prepared four scenarios, which ranged from a minimum of 200,000 and a catastrophic
1.7 million deaths, projecting an undue tragedy of epic proportions.
One of the more dire projections shook the US and UK governments, causing Pres-
ident Donald Trump and Prime Minister Boris Johnson to take action. Prepared by
the Imperial College of London under the team of Dr. Neil Ferguson, it predicted that
510,000 Britons and 2.2 million Americans would die if their two governments did not
introduce more stringent interventions.43
A strong contrarian view was expressed by John P.A. Ioannidis, who pointedly stat-
ed that “Reported case fatality rates, like the official 3.4% rate from the World Health
Organization, cause horror—and are meaningless. Patients who have been tested for
SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes.
As most health systems have limited testing capacity, selection bias may even worsen
in the near future. […] That huge range [of fatality rates] markedly affects how severe
the pandemic is and what should be done. A population-wide case fatality rate of 0.05%
is lower than seasonal influenza. If that is the true rate, locking down the world with
potentially tremendous social and financial consequences may be totally irrational. It’s
like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat,
the elephant accidentally jumps off a cliff and dies.”44
42 John Katz, Margot Sanger-Katz and Kevin Quealy, “Could coronavirus cause as many deaths as cancer
in the US? Putting estimates in context,” The New York Times, 16 March 2020, accessed 5 April 2020,
https://www.nytimes.com/interactive/2020/03/16/upshot/coronavirus-best-worst-death-toll-scenario.html.
43 Neil Ferguson, et al., “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mor-
tality and healthcare demand,” Imperial College of London, 16 March 2020, accessed 5 April 2020, https://
www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COV-
ID19-NPI-modelling-16-03-2020.pdf.
44 Ioannidis, “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions
without reliable data.”
The lack of a vaccine and the ethical issues that rage over it
Although various attempts have been made, a vaccine against COVID-19 does not
exist yet. A significant scientific achievement occurred on 10 January 2020, when a
Chinese research group led by Dr. Yong-Zhen Zhang of Fudan University, Shanghai,
released to the whole world the full sequencing of a coronavirus genome from a case
of a respiratory disease from the Wuhan outbreak.45 The sequence was subsequently
deposited in GenBank, allowing the worldwide community of researchers to analyze it.46
While research into developing a vaccine has been undertaken by various institutes,
the WHO said that its development in a year is realistically not possible.47 Thus, there
is a global race to develop it, with three countries pulling out all stops and pursuing
trials to stop COVID-19 by the end of this year. Oxford University began trials of the
vaccine in animals, hoping to test it on humans in April. Its research relies on a protein
that the new pathogen uses to infect its victims as well as using a harmless virus that
will not replicate and insert genetic material of SARS-CoV-2 into the human body.
Researchers at Kaiser Permanente Washington Health Research provided some glim-
mers of hope on 16 March 2020 when it took a vaccine called mRNA-1273 developed by
biotech company Moderna and conducted the first human trial of a COVID-19 vaccine
in the Seattle area on a very small sample of 45 volunteers. Because the experimental
vaccine will have to be subjected to extensive safety and efficacy tests, the final vaccine
will not be available to the general public for at least a year.48 Chinese biopharmaceutical
company CanSino Biologics trotted out its Ad5-nCoV vaccine for a phase-1 clinical trial
in humans on 17 March 2020. It was the first COVID-19 vaccine licensed for clinical trials
in China. Its efficacy rests on its ability to summon antibodies against the pathogen by
a taking a part of its genetic code and combining it with a harmless virus. When tested
in animals, the Chinese vaccine induced a strong immune response.49
Currently, there are 35 universities and large companies such as Johnson & John-
son, Inovio Pharmaceuticals, Arcturus Therapeutics, Germany’s BionTech and CureVac,
and UK’s GlaxoSmithKline are in the pre-clinical stages of vaccine development, aided
in large measure by the early Chinese efforts of sequencing the genetic material of the
SAR-CoV-2 virus.50 Many researchers have focused on analyzing the ACE2 enzyme
because of its key role in the transmission and progression of the disease.
One of the most pressing ethical issues that rage around vaccine development is
for whom it is. This issue surfaced when it was revealed that US officials offered $1
45 Edward C. Holmes, University of Sydney on behalf of the consortium led by Prof. Young-Zhen Zhang,
Fudan University, Shanghai, “Novel 2019 coronavirus genome,” Virology.org, 10 January 2020, accessed
5 April 2020, http://virological.org/t/novel-2019-coronavirus-genome/319.
46 “Severe acute respiratory syndrome coronavirus 2 isolate Wuhan-Hu-1, complete genome,” GenBank,
18 March 2020, accessed 5 April 2020, https://www.ncbi.nlm.nih.gov/nuccore/MN908947. Consult this
website for the full sequence of SARS-CoV-2.
47 Rob Grenfell and Trevor Drew, “Here’s why it’s taking so long to develop a vaccine for the new
coronavirus,” Science Alert, 17 ‘February 2020, accessed 5 April 2020, https://www.sciencealert.com/
who-says-a-coronavirus-vaccine-is-18-months-away.
48 Sarah Al-Arshani, “Photos capture the world’s first human trial of a COVID-19 vaccine,” Business Insider,
17 March 2020, accessed 5 April 2020, https://www.businessinsider.com/photos-show-worlds-first-hu-
man-trial-of-potential-coronavirus-vaccine-2020-3.
49 Kashimira Gander, “3 countries starting coronavirus vaccine trials in global race to stop COVID-19
before end of year,” Newsweek, 20 March 2020, accessed 5 April 2020, https://www.newsweek.com/
countries-coronavirus-vaccine-trials-covid-19-before-end-year-1493362.
50 Laura Spinney, “When will a coronavirus vaccine be ready?” The Guardian, 20 March 2020, https://
www.theguardian.com/world/2020/mar/20/when-will-a-coronavirus-vaccine-be-ready.
billion to German company CureVac to ensure that “any inoculation [of its promising
vaccine] would be available first, and perhaps exclusively, in the United States.” When
they were rebuffed by the company, the US lured the company’s chief executive Daniel
Menichella to work in the US.51
Medicinal treatment and pandering to false hope

Currently, there is no prescribed medicinal treatment to combat COVID-19. The essential
strategy for treating a COVID-19 patient is supportive care as it would be done for any
patient with severe viral pneumonia.52 The Emcrit COVID-19 Internet Book of Critical Care
has noted that a vast majority of patients will do fine without any therapy. However,
in more severe cases, experimental antiviral therapy has been attempted. In particular
chloroquine and hydroxychloroquine have been tried in China. A study limited to chloro-
quine used in vitro using cell lines demonstrated that “chloroquine can inhibit COVID-19
with a 50% inhibitory concentration of 1 uM, implying that therapeutic levels could be
achieved in humans.53 However, an earlier study conducted on mice during the original
SARS outbreak demonstrated chloroquine had no effect.54
Pandering to his political base, US Pres. Donald Trump falsely touted both drugs as
having been pre-approved for therapeutic uses against COVID-19 on 19 March 2020,
confusing people all over the world and inciting a global rush for the medicines, causing
their shortages from Nigeria to the Philippines, where they were widely available for ma-
A drug that offers promises laria, lupus, and rheumatic arthritis due to their anti-inflammatory effects, Minutes later,
or false hope? Sanofi’s Trump’s FDA commissioner Dr. Stephen Hahn walked back the boastful claim, which
Plaquenil, or generically
known as hydroxychloroquine, offered false hope to thousands of sufferers. The studies on the efficacy of those drugs
is commonly used to were not based on carefully monitored studies, which are the only guarantee for drug
treat malaria, lupus, and efficacy, as clarified by Dr. Anthony S. Fauci.55
rheumatoid arthritis. Some
studies in vitro or in animals The WHO has taken a more scientific and wider effort called SOLIDARITY to coordinate
have shown some efficacious and collect robust data of experimental thereapeutic medicines. It recommended four drug
effect. However, falsely regimens, whose use should be reported by participating hospitals. Instead of recom-
touting it as an approved
mending new drugs, it has looked to already developed drugs for other diseases with safe
drug against COVID-19
offers misplaced hope and profiles. These included anti-HIV antiviral remdesivir, the anti-malaria drug chloroquine
endangers its availability for and its cousin hydroxychloroquine, a combo treatment using two HIV drugs lopinavir and
those who presently use it as ritonavir, and another combination treatment using the latter two with interfereron-beta,
prescription medication for
more common ailments. an immune system booster.56
51 Katrin Bennhold and David E. Sanger, “US offered ‘large sum’ to German company for access to coro-
navirus vaccine research, German Officials Say,” The New York Times, 15 March 2020, accessed 5 April
2020, https://www.nytimes.com/2020/03/15/world/europe/cornonavirus-vaccine-us-germany.html.
52 “Key principle: Supportive care for viral pneumonia,” Internet Book of Critical Care, EMCRIT-RACC, 2
March 2020, accessed 5 April 2020, https://emcrit.org/ibcc/covid19/#key_principle:_supportive_care_
for_viral_pneumonia.
53 M. Wang, R. Cao, L. Zhang, X. Yang, et al., “Remdesivir and chloroquine effectively inhibit the recently
emerged novel coronavirus (2019-nCoV) in vitro,” Cell Research 3 (30 March 2020): 269–71, accessed 5
April 2020, https://www.ncbi.nlm.nih.gov/pubmed/32020029.
54 DL Bernard, Cw. Day, K. Bailey, et al., “Evaluation of immunomodulators, interferons and known in
vitro SARS-coV inhibitors for inhibition of SARS-coV replication in BALB/c mic,” Antiviral Chemistry
Chemotherapy 17, no. 5 (2006): 275–84.
55 Katie Thomas and Denise Grady, “Trump’s Embrace of Unproven drugs to treat coronavirus defies sci-
ence,” The New York Times, 20 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/20/
health/coronavirus-chloroquine-trump.html.
56 Kai Kupferschmidt and Jon Cohen, “Race to find COVID-19 treatments accelerates,” Science, 27 March
2020, accessed 5 April 2020, https://science.sciencemag.org/content/367/6485/1412.
2 DIAGNOSING COVID-19
I DENTIFYING INFECTED PERSONS as well as their possibly infected contacts is
a vital component in monitoring the extent of the contagious spread and strate-
gizing on ways of mitigating its spread. This chapter focuses on the transmission
of coronavirus disease 2019 (COVID-19), the disease’s signs and symptoms, and the
tests needed to confirm if a person is infected or not.
Transmission
Unlike the Middle East respiratory syndrome coronavirus (MERS-CoV) and the original
severe acute respiratory syndrome coronavirus (SARS-CoV), which are both com-
municated through fine respiratory droplets in the air, the transmission of COVID-19
occurs via large respiratory droplets.1
COVID-19 can be transmitted mainly in two ways: contact transmission and droplet
transmission. Contact transmission occurs when the respiratory secretions are trans-
ferred directly through physical contact with an infected patient, (i.e., handshaking and
touching) or indirectly by exposure to intermediate surfaces or objects that have been
contaminated with the virus. Droplet transmission, on the other hand, happens when
the virus is transferred by the respiratory secretions expelled by an infected individual
onto another person’s mucosal surfaces, such as the mouth, eyes, and nose.2
Large droplets settle quickly on the surface in which the secretions are generated.
Thus, the risk is limited to about two meters or six feet from the patient.3 There is no
certain period of how long the COVID-19 virus can thrive on surfaces, but the COVID-19
virus behaves similarly to other coronaviruses. According to preliminary studies of
coronaviruses, the virus may survive on surfaces for a few hours and even up to several
days. This may vary under different conditions (i.e., the type of surface, temperature,
1 Josh Farkas, “Transmission,” Emcrit Internet Book of Critical Care, accessed 5 April 2020, https://
emcrit.org/ibcc/covid19/#transmission
2 Shiu, et al., “Infection control for respiratory virus infections” and Shiu, et al., “Controversy around air-
borne versus droplet transmission of respiratory viruses: implication for infection prevention,” Current
Opinion in Infectious Diseases 32, 4 (2019): 373-374, https://emcrit.org/wp-content/uploads/2020/03/
tada2019.pdf; European Centre for Disease Prevention and Control. “Factsheet for health professionals
on coronaviruses,” accessed 5 April 2020, https://www.ecdc.europa.eu/en/factsheet-health-profes-
sionals-coronaviruses.
3 Josh Farkas, “Transmission,” Emcrit Internet Book of Critical Care, accessed 5 April 2020, https://
emcrit.org/ibcc/covid19/#transmission
20
or humidity of the environment.)4 When someone infected with coronavirus coughs,

he or she could emit large droplets that settle on surfaces in a room, thus creating a
thin film of pathogens. A study by Neeltje Doremalen et al. concluded that SARS-CoV-2
may live for roughly four days. It also discovered that there are high viral loads in the
upper respiratory tract and that an infected person can shed and transmit the virus
while asymptomatic. These findings echoed studies that had been undertaken of the
original SARS virus that was also associated with hospital-acquired infections and
other super-spreading events.5
More than 1.2 million worldwide infections prove the highly contagious nature of
human-to-human transmission of the coronavirus. However, the animal-human route
of transmission, as well as the specific animal source of the new coronavirus strain,
has not been confirmed by the World Health Organization. Moreover, there is no evi-
dence that a dog, cat, or any pet can transmit COVID-19 to humans.6
Currently, the known coronaviruses are zoonotic or transmissible from animals to
A infographic depicting the

transmission of the COVID-19
virus and the ways people can COVID-19
protect themselves against is mainly spread through
infection. (Vibal Group graphic droplets produced when an
licensed under BY-SA-NC) infected person
COUGH SNEEZES SPEAKS
How can we
protect ourselves?
Maintain a safe Avoid touching your Strengthen your immune

distance of about face, especially the system by getting enough
two meters or six eyes, nose, and rest, exercising, and having
feet when in public mouth. a healthy diet.
spaces.
Practice proper handwashing
with soap and water. You may
Clean surfaces with
also clean your hands with a
a disinfectanti to kill
hand sanitizer containing
any layer of virus
about 70% ethyl alcohol.
contamination.
4 “Q&A on Coronaviruses (COVID-19),” under “How long does the virus survive on surfaces?” World Health
Organization, accessed 5 April 2020, https://www.who.int/news-room/q-a-detail/q-a-coronaviruses.
5 Neeltje van Doremalen, Brenton Bushmaker, Dylan Morris, et al., “Aerosol and surface stability of
SARS-CoV-2 as compared with SARS=CoV-1,” The New England Journal of Medicine, 17 March 2020,
accessed 5 April 2020.
6 World Health Organization, “Q&A on Coronaviruses (COVID-19),” under “Can I catch COVID-19 from
my pet?”, accessed 5 April 2020, https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
22 THE COVID-19 HANDBOOK 1253 G. Araneta Avenue, Quezon City, 1104 Philippines • http://www.vibalgroup.com
An infographic depicting the

identified signs and symptoms COVID-19 SIGNS OTHER SY MPTOMS
of COVID-19 infection. (Vibal AND SYMPTOMS Upper res pi ra to ry
Group graphic licensed as sympto ms :
Early-stage symptoms
BY-SA-NC)
FEVER Dry Cough Hemoptysis
(Body temperature above 37.5ºC) Muscle Pain Difficulty in
breathing
DRY COUGH Chest tightness
Wet cough
(cough with
phlegm)
Sore Throat
Gastrointestinal Vomiting or nausea

symptoms (in rare cases)
humans. Many strains of coronaviruses commonly circulate in bats, specifically those

of the Rhinolophus bat sub-species, which are widely present in Southern China, and
across Asia, the Middle East, Africa, and Europe.7
Can pets transmit the pathogen to humans or vice versa? Currently there is no sci-
entific evidence yet of pets transmitting the virus to humans.8 However, people with
COVID-19 are cautioned to limit contact with their pets and other animals.
Signs and symptoms

A person infected with COVID-19 virus may show different signs and symptoms,
which may vary from one patient to another, and may also depend on the severity and
progression of the disease. The most common symptoms are fever (defined as body
temperature above 37.5 °C) and a dry cough.
In the first few days, a patient may show mild symptoms or none at all. The incu-
bation period, or the time in which a patient catches the virus and the appearance of
first symptoms, is estimated to be between five to six days.9 This delay is explained
7 “Novel Coronavirus (2019-nCoV) Situation Report-22,” under “Technical Focus: Zoonotic compo-
nent of 2019-nCoV and human-animal interface,” World Health Organization, 11 February 2020, https://
www.who.int/docs/default-source/coronaviruse/situation-reports/20200211-sitrep-22-ncov.pdf?s-
fvrsn=fb6d49b1_2.
8 A statement attributed to the World Organization for Animal Health by Natalie Lung, “Hong Kong Dog
Dies After Release From Coronavirus Quarantine,” Time, 18 March 2020, accessed 5 April 22 March
2020, https://time.com/5805524/hong-kong-dog-dies-after-coronavirus-quarantine/. However, Hong
Kong reported an isolated case of a dog, which initially tested as “weak positive” and subsequently died
but was not autopsied as reported by Dr. Chuang Shuk-Kwan of the Communicable Branch of the Centre
for Health Protection. See https://time.com/5805524/hong-kong-dog-dies-after-coronavirus-quaran-
tine/?playlistVideoId=6136852484001.
9 “Coronavirus disease 2019 (COVID-19) Situation Report-46,” under “Subject Focus: Q&A: Similar-
ities and differences – COVID 19 and Influenza,” World Health Organization, 6 March 2020, accessed
5 April 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-si-
trep-46-covid-19.pdf?sfvrsn=96b04adf_4.
by the clinical phenomenon in which the virus replicates inside the cells. At this stage,
the immune system response occurs, but the body fails to contain the virus.10 Most
dangerously, an asymptomatic COVID-19 patient, although he/she appears well, is still
considered a carrier and can transmit the virus during the incubation period.
As the disease advances and continuously spreads in the body, other respiratory
and constitutional symptoms manifest. The COVID-19 patient may experience muscle
pain (myalgia), fever, and headache as constitutional symptoms. Other respiratory
symptoms may include nasal congestion (rhinorrhea), runny nose, sore throat, diffi-
culty in breathing while at rest (which may lead to even dangerously low blood oxygen
levels or hypoxemia), chest tightness, dry cough, or coughing of blood or blood-stained
mucus (hemoptysis). There are also rare cases of gastrointestinal symptoms, such as
nausea or vomiting and diarrhea.11
People of all ages are prone to COVID-19. However, older persons and persons with
preexisting medical conditions, such as asthma, high blood pressure, heart disease,
lung disease, cancer, or diabetes, are more susceptible to develop serious illnesses
than others.12
Screening and testing for COVID-19

A patient may only experience a mild fever and cough in the early onset of COVID-19,
which are in fact common symptoms to other respiratory diseases and infections.
Thus, the World Health Organization and public health agencies defined a set criteria
for selecting which persons should be first investigated and isolated with a view to
monitoring their symptoms in a timely manner and to break the further chain of trans-
mission of the disease.
The key considerations include:
1. Recent travel to affected areas—people who have been to areas with community-based
transmission or with a high number of reported cases.
2. Contact with anyone with known COVID-19—people who have been exposed for a
prolonged period and with less than a two-meter or six-feet distance from an infected
patient.
3. Broader testing in the case of wider community transmission. Areas with a high number
of confirmed COVID-19 cases need community testing to further evaluate persons with
the symptoms of the coronavirus. In a time of rapidly emerging infections, alternative
diagnoses may also be rolled out such as CT scanning, apart from deploying available
testing kits. The assessment will also take into consideration certain extenuating cir-
10 Josh Farkas, “Biology,” Emcrit Internet Book of Critical Care, accessed 5 April 2020, https://emcrit.
org/ibcc/covid19/#biology
11 Josh Farkas, “Symptoms,” Emcrit Internet Book of Critical Care, accessed 5 April 2020, https://emcrit.
org/ibcc/covid19/#symptoms; World Health Organization, “Q&A on Coronaviruses (COVID-19),” under
“What are the symptoms of COVID-19?” accessed 5 April 2020, https://www.who.int/news-room/q-a-
detail/q-a-coronaviruses.
12 “Q&A on Coronaviruses (COVID-19),” under “What are the symptoms of COVID-19?” World Health
Organization, accessed 5 April 2020, https://www.who.int/news-room/q-a-detail/q-a-coronaviruses;
WHO, “Coronavirus disease (COVID-19) advice for the public: Myth busters,” under “Does the new coro-
navirus affect older people, or are younger people also susceptible?”, https://www.who.int/emergen-
cies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters.
Infographic specifying
which persons would be
tested for COVID-19 (Vibal
Group graphic licensed
under BY-SA-NC) Who gets tested for
COVID-19?
Persons who have Persons who have Persons who have

recent travel close contact with experienced symptoms
history from anyone with known of COVID-19 and reside
affected countries COVID-19. in areas with communi-
or communities. ty-based transmission.
cumstances such as if patients tested positive for influenza, it is would be less likely
that they acquired the influenza and coronavirus at the same time.13
Quarantine versus isolation

People who may have been exposed to an infectious agent or disease may be subjected
to quarantine, or a restriction of activities and a separation from healthy persons. A quar-
3 Components
antine is done for the purpose of monitoring of the and detecting the disease earlier.
symptoms
PPE, based on CDC
Undergoing mandated or voluntary quarantine
guidelines does not mean that the persons are infected.
Isolation, in contrast, is the separation of an ill person from others to prevent the
spread of an infection or contamination. If a person has a travel history or was exposed
Gear
to an infected person, and has symptoms
waterproof Facemaskof lower respiratory illness, then the person
gown and
will be isolated in a private room and observed Goggles
gloves • N95 mask orwith
a regard to his or her clinical status.14
or eyeshield
powered, air-purifying
respiratory (PAPR)
Testing and diagnosis • Surgical mask
Testing is the method of identifying if a suspected person has COVID-19. It is also done
to determine if a patient is cleared from the disease. First, a nose or throat swab is
taken. Care is taken by the diagnostic staff to make sure that there is a sufficiently
deep specimen. The test makes use of a molecular method that leverages a real-time
reverse transcription polymerase chain reaction (rRT-PCR) along with nucleic acid tests
to detect the genetic marker of the virus. One of the earliest PCR tests was developed
at Charité in Berlin, Germany, in January 2020, and was the basis of 250,000 kits
distributed by the World Health Organization.15 Another WHO-certified PCR test was
developed by South Korean Kogenebiotech on 28 January 2020. Several other Korean
FDA-approved tests developed by Solgent and Seegene powered the South Korean
government’s massive testing program,16 which included drive-through and walk-in
centers and guaranteed the most extensive testing ever conducted in any country.
13 Josh Farkas, “Screening & Selection for Investigation,” Emcrit Internet Book of Critical Care, accessed
5 April 2020, https://emcrit.org/ibcc/covid19/#screening_&_selection_for _investigation.
14 “Considerations for quarantine of individuals in the context of containment for coronavirus disease
(COVID-19),” World Health Organization, accessed 5 April 2019, https://www.who.int/publications-de-
tail/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-dis-
ease-(covid-19).
15 Cormac Sheridan, “Coronavirus and the race to distribute reliable diagnostics,” Nature Biotechnology,
19 February 2020.
16 Sei-im Jeong, “Korea approves 2 core COVID-19 detection kits for urgent use,” Korea Biomedical
Review, 28 February 2020, accessed 5 April 2020, oreabiomed.com/news/articleView.html?idxno=7561.
China’s BGI Group received one of the first certifications from China’s National Medi-
cal Product Administration for another PCR-based kit.17 One of the most heart-breaking
developments occurred in the United States, where the Centers for Disease Control
and Prevention sanctioned a genetic test from older versions of its approved test kits,
which resulted in inconclusive results and created a huge bottleneck at the CDC lab in
Atlanta. In March 2020, a leading American life sciences company LabCorp developed
LabCorp 2019 Novel Coronavirus NAA test, which was certified by the US FDA. The
test kit is purchased by hospitals for diagnosis. Specimens are sent back to LabCorp,
which takes three to four days to turn around results.18
According to the Philippine Department of Health, testing specimens such as nose and
throat swabs are done for free in hospitals. Members of PhilHealth Insurance may also
avail of a health packages worth 514 000, 516 000, up to 532 000 depending on the
severity of the developed pneumonia.19 The only available test kits are those that were
supplied by the WHO and are administered by the Research Institute of Tropical Medi-
cine (RITM). To expedite diagnosis, the Philippine FDA sanctioned a locally developed
COVID-19 testing kit, the COVID-19 Real-time Reverse Transcription Polymerase Chain
Reaction (rRT-PCR) detection kit, commercially known as “GenAmplify,” developed by
a team of experts from the University of the Philippines – National Institutes of Health
and the Department of Science and Technology.20 On April 3, this local test kit was
approved by the Philippine Food and Drug Administration (FDA).21
Apart from its main lab of RITM, the Department of Health has also designated five
subnational labortries and three other labororaties (UP National Institutes of Health,
WCMC, and Bicol Public Health Laboratories) to conduct the PCR-based tests. As of
31 March, the Philippine FDA has also approved 17 COVID-19 Test Kits based on the
genetic PCR method for commercial use. It has also approved five rapid test kits, which
detect antibodies present from blood extracted from a patient. The FDA advised that this
should be used with caution because this minutes-long test only measures antibodies
present in the bloodstream and not the viral load itself. This means that it may give
a negative result for patients already infected but have not yet developed antibodies.
Thus, rapid tests need to be confirmed with a PCR-based test.22
The Philippine FDA also encourages commercial importers to bring into the coun-
try other test kits that have been licensed in other countries, such as those approved
by their FDA counterparts in the United States, Japan, Singapore, South Korea, and
17 “BGI Sequencer, coronavirus molecular assays granted emergency use approval in China,” Genome
Web, 30 January 2020, accessed 5 April 2020, https://www.genomeweb.com/regulatory-news-fda-ap-
provals/bgi-sequencer-coronavirus-molecular-assays-granted-emergency-use#.XnNSPpMzYw9.
18 “2019 Novel Coronavirus, NAA,” LabCorp, accessed 5 April 2020, https://www.labcorp.com/
tests/139900/2019-novel-coronavirus-covid-19-naa.
19 “Testing for Coronavirus disease is free—Duque,” CNN Philippines, 11 March 2020, accessed 5 April
2020, https://www.cnnphilippines.com/news/2020/3/11/coronavirus-testing-free-.html.
20 “FDA clarifies availability of COVID-19 test kits in the country,” Philippine Food and Drug Administra-
tion, 15 March 2020, accessed 5 April 2020, https://www.fda.gov.ph/fda-clarifies-availabilty-of-covid-
19-test-kits-in-the-country/.
21 “FDA Allows Use of COVID-19 Test Kits Developed by Local Scientists,” Food and Drug Adminis-
tration Philippines, 9 March 2020, accessed 5 April 2020, https://www.fda.gov.ph/fda-allows-use-of-
covid-19-test-kits-developed-by-local-scientists/; Khalil Ismael Michael G. Quilinguing, “The Philippine
Genome Center: Stockpiling or COVID-19,” University of the Philippines, 10 March 2020, accessed 5 April
2020, https://pgc.up.edu.ph/the-philippine-genome-center-stockpiling-for-covid-19/.
22 “FDA approves rapid antibody test kits for COVID-19,” Food and Drug Administration Philippines, 30 March
2020, accessed 5 April 2020, https://www.fda.gov.ph/fda-approves-rapid-antibody-test-kits-for-covid-19/.
PRODUCT NAME MANUFACTURER DISTRIBUTOR
Nucleic acid detection kit for 2019 Shanghai GenoeDx Biotech Co., Ltd., Shanghai, China S & S Enterprise
NCoV
Novel coronavirus 2019-NCoV Beijing Applied Biological Technologies Co., Ltd, Sahar International
nucleic acid detection kit Changping District 102206 Beijing, People’s Republic
(fluorescence PCR method
AllplexTM 2019-nCoV Assay Seegene Inc., Seoul, Republic of Korea Endure Medical, Inc
SOLGENT DiaPlexQ™ Novel Solgent Co., Ltd., 3F, 32, Techno 6-ro, Yuseong-gu, Daejeon, Wellness Pro Incorporated,
Coronavirus (2019-nCoV) Detection South Korea Orthoplus Trading Corp.
Kit
Standard M nCoV Real-time SD Biosensor, Inc., C-4&5 Floor, 16, Deogyeong-daero H&B Pharma International Inc.
Detection Kit 1556beon-gil, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16690,
Republic of Korea
A*Star Fortitude Kit 2.0 (COVID-19 Accelerate Technologies Pte. Ltd., Chromos Building, Zuellig Pharma Corporation
Real-Time RT-PCR TEST) Singapore
The current list of COVID-19 Germany, or those already sanctioned by the World Health Organization.
test kits approved by the
Philippine FDA for commercial
use, accessed 5 April The debate over CT scans
2020, https://drive.google. Presently, experts have different opinions regarding the diagnostic value of a computed
com/open?id=1Dk8Kjb- tomography or CT scan23 in diagnosing COVID-19. According to a study by Chinese
Czk8g92HydWDRvg8K-
scientists, a CT scan can complement the RT-PCR tests in the diagnosis of COVID-19.24
ATp7gBez.
They examined the results of the CT scan and RT-PCR tests done in patients in Wuhan,
China, from 6 January to 6 February 2020 and based on their findings, they concluded
that a CT scan of the chest has high sensitivity in diagnosing COVID-1925 and can be
used as a complementary test in detecting the disease. Due to a shortage of testing kits,
Chinese doctors used CT findings as a primary diagnostic criterion since February 17.26
However, other experts are firm that while a chest CT scan is helpful in determining
and identifying abnormalities in the lungs, the results it generates are non-specific to
23 CT (computerized or computed tomography) scan is basically an X-ray procedure that “combines
many X-ray images with the aid of a computer to generate cross-sectional views and, if needed,
three-dimensional images of the internal organs and structures of the body,” Melissa Conrad Stöppler,
MD, “CT Scan (Computed Tomography, CAT Scan),” MedicineNet, accessed 5 April 2020, https://www.
medicinenet.com/cat_scan/article.htm#ct_scan_facts.
24 Tao Ai, et al., “Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COV-
ID-19) in China: A report of 1014 cases,” Radiology, 26 February 2020), accessed 5 April 2020,
https://pubs.rsna.org/doi/10.1148/radiol.2020200642?fbclid=IwAR1mDovBzWL38LwwVcbsSwhCVgx-
4Plaxrv6ci9WN9glV7DSzvSOARTtAfm4.
25 It means that, based on their findings, a CT scan can detect COVID-19-positive patients with a higher
percentage of probability.
26 Radiological Society of North America, “CT outperforms lab diagnosis for coronavirus infection,”
Healthcare-in-Europe, 28 February 2020, accessed 5 April 2020, https://healthcare-in-europe.com/en/
news/ct-outperforms-lab-diagnosis-for-coronavirus-infection.html.
COVID-19.27 A study published in The Lancet Infectious Diseases concluded that there is
more to discover about COVID-19 and the use of the CT scan in detecting the disease.28
Furthermore, the Royal College of Radiologists (RCR) in the UK maintains that as of
12 March, the CT scan had no role in the diagnostic assessment of persons who are
possibly COVID-19-positive.29 Meanwhile, the American College of Radiology (ACR)
has several recommendations to health professionals who would opt to use CT scan
in diagnosing COVID-19:
• CT scan should not be used to screen for or as a first-line test to diagnose

COVID-19.
• CT scan should be used sparingly and reserved for hospitalized, symptomatic
patients with specific clinical indications for CT. Appropriate infection control
procedures should be followed before scanning subsequent patients.
• Facilities may consider deploying portable radiography units in ambulatory care
facilities for use when CXRs are considered medically necessary. The surfaces
of these machines can be easily cleaned, avoiding the need to bring patients
into radiography rooms.
• Radiologists should familiarize themselves with the CT scan appearance of COV-
ID-19 infection in order to be able to identify findings consistent with infection
in patients imaged for other reasons.30
And as of 19 March, the ACR cautioned those who use CT scan results in diagnosing
COVID-19 that a normal CT scan result does not necessarily mean that a person is free
from the infection, and an abnormal result is not specific for diagnosis of the disease.31
27 It means that it can detect damages in the lungs, like pneumonia, but it cannot not present clear and
direct data that what it detects is COVID-19 and not other kinds of viral pneumonia.
28 Elaine Y.P. Lee, Min-Yen Ng, and Pek-Lan Khong, “COVID-19 pneumonia: what has CT taught us?”
The Lancet Infectious Diseases, 24 February 2020, accessed 5 April 2020, https://www.thelancet.com/
journals/laninf/article/PIIS1473-3099(20)30134-1/fulltext.
29 “RCR position on the role of CT patients suspected with COVID-19 infection,” The Royal College of Ra-
diologists, accessed 5 April 2020, https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/
rcr-position-role-ct-patients-suspected-covid-19.
30 “ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Sus-
pected COVID-19 Infection,” American College of Radiology, 19 March 2020, accessed 5 April 2020, https://
www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radi-
ography-and-CT-for-Suspected-COVID19-Infection.
31 Ibid.
CT imaging of a patient with
COVID-19 in the early and
then rapid progression stage.
Notice in the second scan the
ground-glass patterned areas,
which represent lesions. These
findings were found in China
on practically 50% of patients
within the first two days of
progression. Source: Military
Medical Research. https://
mmrjournal.biomedcentral.
com/articles/10.1186/s40779-
020-0233-6.
3 COVID-19 CARE GUIDELINES
Personal protective equipment (PPE) for healthcare workers
Medical facilities have stringent requirements for the use of personal protective equip-
ment (PPE) among healthcare workers who are directly dealing with patients and
persons under investigation (PUI) for COVID-19. A protective layer of clothing is the
primary protective barrier against transmission of infectious material, and it is a must
for healthcare workers who are on the frontlines for treating COVID-19 patients. PPE
is defined as “specialized clothing or equipment worn by an employee for protection
against infectious materials.”1
Aside from frontliners, community members such as pharmacists and tellers who
may be exposed may also wear face masks to reduce the risk of infection.2 In Met-
ro Manila and urban areas, supplies have been scarce, so people with no access to
masks may make improvised coverings for their face, practice proper hand-washing
and disinfecting at all times, and avoid contact with people through social distancing.
According to the CDC, there are basically three components of the PPE3:
1 “Personal protective equipment,” US OSHA.gov, accessed 5 April 2020, https://www.osha.gov/SLTC/

personalprotectiveequipment/.
2 “Guidance for the selection and use of personal protective equipment (PPE) in healthcare settings,”
US Centers for Disease Control and Protection, accessed 5 April 2020. https://www.cdc.gov/hai/pdfs/
ppe/ppeslides6-29-04.pdf.
3 Josh Farkas, “Personal protective equipment,” The Emcrit Internet Book of Critical Care, 2 March
2020, accessed 5 April 2020, https://emcrit.org/ibcc/covid19/#anti-bacterial_therapy.
28
The proper use of PPE is extremely important to prevent incidences of transmission.

First and foremost is preventing emissions from the respiratory tract (either through
coughs or sneezes) from entering the body through its orifices (mouth, nose, eyes).
This should be remembered when putting on and removing the PPE. Soiled PPE is
particularly critical and difficult4 because improper disposal of PPE with traces of
droplets and minute particles may also lead to contact and transmission.
Applying and removing PPE should also be done before contact with the patient.
The healthcare worker should pay attention to the space between gloves and gowns
that can serve as a point of entry of the pathogen. The gown should be tucked into
the gloves (leaving no gap in-between). Later, the long cuffs of gowns can be used
in the removal of the gown and gloves as a single unit.5
Below are the steps in the proper use of PPE based on US CDC Guidelines for health-
care workers caring for patients with coronavirus disease (COVID-19)6:
1. Put on PPE before patient contact in a sanitized room.
2. Before putting on the PPE, perform hand hygiene using an alcohol-based sanitizer.
3. Before putting on the PPE, check to ensure that all items are free from damage.
4. Wear the gown first. This should be a clean and disposable material. The gown
should fully cover the torso, have a comfortable fit, and have long sleeves. The opening
in the back can be secured by the strings’ ties at the neck and waist part.
5. Next in the sequence is the mask or respirator. In treating COVID-19, the N-95 mask
has been identified as effective because of its sub-micron filter. It protects the nose
and mouth by fully covering these areas to prevent fluid penetration and particles that
N95
are less than 5 microns in diameter. The N-95 has a flexible nosepiece and can be
secured to the head with elastic ties for a snug fit.
6. Goggles are also prescribed to shield the eyes. The goggles can provide a barrier of
protection against minute particles that can enter the eye ducts and cause infection.
Prescription glasses should not be used as a substitute for goggles.
7. Last to be donned are the gloves. The gloves should fit the hand well and be made
of appropriate materials like vinyl or latex. The gloves can be worn over the gown
cuffs to secure them. It can also provide additional protection for the wearer’s skin.
N95 8. At all times, the healthcare worker should keep the gloved hands away from the face.
He or she should also avoid adjusting the mask or the goggles in a contaminated zone.
4 Farkas, Ibid; “Personal protective equipment.”

5 Farkas, Ibid.
6 “Guidance for the selection and use of personal protective equipment (PPE).”
9. Once the gloves are torn they should be removed immediately and replaced with
a new pair, but not before performing hand hygiene first. Workers should also limit
touching surfaces and items.
10. Removing the PEP should also be done in a clean and sanitized room. Untie the gown
first then peel from the body carefully. The gown can be rolled up and then removed
along with the gloves, careful not to touch the contaminated parts.
11. The gown and gloves should be thrown immediately in the proper bin.
12. The goggles can then be removed, and thrown also in the proper bin.
13. Last to be removed is the mask, but this should be done in an area outside the
anteroom, after the door has been closed.
N95
14. Lastly once all PPE is removed, practice hand hygiene immediately using soap and
water and an alcohol-based sanitizer.
Basic protective measures against COVID-19 for the general public

The World Health Organization (WHO) reminds the public to be properly informed about
the latest information on the COVID-19 outbreak. Information should be gathered from
reliable sources such as the WHO and CDC websites. The public should also be wary
about feeds appearing on social media sites or accepting such posts as factual unless
the info is from verified sources.
Recovery rates from COVID-19 are considerably high among those already infected,
but people should still take extra care of their health and their daily activities to avoid
infection, especially during a quarantine or lockdown. The WHO has released to the
general public the following basic guidelines against COVID-197:
Frequent hand-washing: People should practice frequent and thorough hand washing
using soap and water. Throughout the day, it is also important to sanitize the hand using
an alcohol-based hand gel. This practice can help kill viruses found on one’s hands.
Maintain social distancing: A minimum distance of 3 feet (1 meter) between each per-
son should be observed. The same distance should be considered when a person is in the
same area as a person who is coughing or sneezing. When someone coughs or sneezes,
they spray small liquid droplets from their nose or mouth, which may contain the virus.
If one is too close, he or she can breathe in the droplets, including the COVID-19 virus if
the person coughing has the disease.8
Avoid touching the eyes, nose and mouth: The eyes, nose, and mouth can be entry
points of respiratory tract emissions that may include COVID-19 virus pathogens. As such,
people should avoid touching these parts of the face using their hands, which are most
susceptible to pick up viruses from contaminated surfaces.
7 “Coronavirus disease (COVID-19) advice for the public,” World Health Organization, accessed 5 April
2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.
8 “Coronavirus disease (COVID-19) advice.”
Practice respiratory hygiene: Good respiratory hygiene must be observed everywhere,

especially in enclosed spaces. This means covering the mouth and nose with a bent el-
bow or tissue when one coughs or sneezes. Used tissue should be disposed of immedi-
ately in a lined garbage bin.
Seek medical care early when experiencing symptoms: People experiencing symp-
toms such as cough, flu, or difficulty in breathing are advised to seek medical attention,
depending on the severity of their symptoms. Those with mild symptoms should stay at
home and go on a self-quarantine until they recover. For others who have prior travel
history or exposure to potential COVID-19 patients, they should seek medical attention
and notify the authorities immediately.
Stay informed and follow advice given by the authorities: People should also stay up
to date with the latest developments about COVID-19. Aside from healthcare providers,
local government units and public health authorities will be tasked to keep citizens updated
about the latest developments. These agencies will be using social media and traditional
print, TV, or radio to release information, so these should be prioritized instead of getting
instant online feeds coming from dubious sources.
How to self-quarantine
People who have been exposed to COVID-19 are now mandated to isolate themselves
to prevent possible infection of their family, friends, relatives, and neighbors. The
self-quarantine period is advised for at least two weeks, which is the presumed in-
cubation period of the virus.
The US Centers for Disease Control and Prevention has issued the following “House
Rules” on self-quarantine, published by the New York Times9:
1. If suffering from mild cough or colds, the patient should avoid going to the hospital
because he or she might get infected by potentially positive patients.
2. The patient should stay home unless he or she must see a doctor. He or she should
stay in a designated room for his or her exclusive use and if possible with his or her
own bathroom.
3. If the patient needs to come out of the isolation room, he or she should wear a mask.
If going out to see a doctor, the patient should wear a mask, and gloves if available.
x 4. The patient should not share food, drinking glasses, eating utensils, towels, or
bedding with anyone.
5. Contact with the patient should be discouraged at all times, especially the elderly.
x 6. The patient should not accept visitors. If it is unavoidable to make contact with
others in the household inside closed quarters, a distance of one to two meters away
from others must always be maintained.
7. Proper hygiene should be practiced at all times. The patient should cover his or her
mouth and nose with a tissue if he or she coughs or sneezes. Used tissue should be
properly discarded after use in a lined trash bin.
9 Roni Caryn Rabin, “How to quarantine yourself,” The New York Times,” 6 March 2020, accessed 5
April 2020, https://www.nytimes.com/2020/03/06/health/self-quarantine-coronavirus.html.
8. Hand-washing should be frequently done with soap and water for at least 20 seconds.
9. The patient should avoid touching his or her eyes, nose and mouth. He or she should
also avoid touching surfaces, and even pets.
10. The patient should inform his caregivers to call a doctor immediately in case of
severe symptoms. The medical staff should be informed about the risk of infection
with COVID-19.
Supportive care for patients on self-quarantine

Family or loved ones of people who are in self-quarantine following exposure to the
coronavirus are likewise advised to follow protocol and get factual knowledge on the
proper care of their patient. They should also make sure that they are safe and pro-
tected from potential virus transmission since they are usually in the same household
with the patient on self-quarantine.
Below are the US CDC guidelines for the supportive care of people on self-quaran-
tine, also published by the New York Times:10
1. Choose an isolation room with its own toilet for the patient on self-quarantine. Do
not allow anyone to enter the room of the patient under self-quarantine.
2. If the toilet is to be shared, the isolation room should be located close to the shared
toilet.
3. The patient should be in full protective gear when he or she moves out of the iso-
lation area.
4. Wait an hour after patient returns to the isolated room. Then disinfect the whole
area of the shared toilet.
5. Wear a protective suit that covers the eyes, face, and gloves. Use long sleeves so
that the virus cannot enter through exposed skin. Ensure that the eyes are covered
well and protected from droplets that can enter via eye ducts and cause infection.
6. Caregivers should ensure the provision of supplies to the patient in quarantine.
Supplies and food should be left outside the door for the patient to collect.
7. The patient should use disposable paper plates, cups and utensils. These items
should be discarded after use in a double garbage bag.
8. Disinfect the door and the whole hallway, both floors and walls, with Lysol or 70%
alcohol.
9. Insulate the door by wrapping the door jambs with plastic wrap.
10. The caregiver should also practice proper hand hygiene. Always wash hands with
soap and water for at least 20 seconds. Use a sanitizer if there’s no access to soap
and water.
11. Call a doctor immediately if the patient develops symptoms or if they worsen. Make
sure to tell the medical staff that the patient is at risk of infection with COVID-19.
12. Stay in the loop by consulting newsletters, daily updates, and reliable information
guides on the virus.
Risk assessment
The elderly sector has been identified as more susceptible to the COVID-19 virus, but
this does not exempt the rest of the population from being carriers of the pathogen
10 Rabin, Ibid; “How to quarantine yourself.”

or from being infected through transmission from asymptomatic carriers. The WHO
rates the risk assessment of COVID-19 as “very high” on a regional and global level,11
so control of the pandemic is now prioritized across different countries through the
imposition of community-wide and nationwide quarantine or lockdowns.
The risk of COVID-19 is now also being assessed based on specific factors, such
as the severity of the patient’s condition, how it is transmitted between people, the
characteristics of the virus, and the success rate of medical measures utilized to con-
trol the impact of the virus. There is no approved vaccine or prescription medicine
against the virus to date, so healthcare providers can only resort to therapeutic care
or experimental medications to alleviate or combat the disease’s symptoms.
With the COVID-19 virus exhibiting an exponential rate of increase as the outbreak
expands, the risk of exposure is likewise expected to go up as the virus takes its course
in an area. The documented cases in the Philippines show transmission between family
members or those within a common community, then spreading further to other areas
when an asymptomatic patient unwittingly introduces the pathogen into a locality.
At elevated risk of exposure are:
• Residents and transients where there is ongoing community spread of the virus,
with the level of risk dependent on the location12
• Healthcare workers caring for patients with COVID-19
• Close contacts with persons symptomatic of COVID-19
Figure 1. A graph 140 Coronavirus disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU)
No.of hospitalizations, ICU admissions, and deaths
indicating the number admissions, and deaths, by age group — United States, February 12 - March 16, 2020
of hospitalizations, ICU
admissions, and fatalities 120
classified by age groups Hospitalizations
from 12 February to 16 March
100
2020 in the United States ICU admissions
as registered by its Centers
for Disease Control and Deaths
80
Prevention. Source: “Severe
outcomes among patients
with coronavirus disease 60
2019 (COVID-19) — United
States,” https://www.cdc.
gov/mmwr/volumes/69/wr/ 40
mm6912e2.htm.
20
0
0-19 20-44 45-54 55-64 65-74 75-84 ≥85
Age group (yrs)
Hospitalization status missing or unknown for 1,514 cases.
11 “Coronavirus disease 2019 (COVID-19) situation report – 46,” World Health Organization, accessed
5 April 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-si-
trep-46-COVID-19.pdf?sfvrsn=96b04adf_2.
12 “Coronavirus disease 2019 (COVID-19) situation summary,” US Centers for Disease Control and
Prevention, 15 March 2020, accessed 5 April 2020, https://www.cdc.gov/coronavirus/2019-ncov/
cases-updates/summary.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavi-
rus%2F2019-ncov%2Fsummary.html.
• ravelers returning from locations abroad where community spread is ongoing, with

T
the level of risk dependent on where they traveled.
At risk of severe illness are:

• Older adults, with risk increasing by age13
• People who have serious chronic medical conditions like:
• Heart disease
• Diabetes
• Lung disease
• High blood pressure
Doing your part by helping flatten the epidemic curve

The term “flattening the curve” has become a byword recently, with experts pointing
to this strategy as the most effective in dealing with the COVID-19 virus. It refers to
slowing down the natural course of the disease that is spread from an infected person
to another. This can be achieved by isolating cases as well as suspected patients, and
preventing further spread of the virus through community quarantine, social distanc-
ing, and urban lockdowns to break the chains of disease transmission. By doing so,
governments and healthcare providers can be in a position to provide better treatment
for infected patients with adequate medical facilities being equipped to handle cases.14
The flattening-the-curve model illustrates how community protective measures
can reduce the daily number of cases and delay the peak of the outbreak, leading
to improved healthcare system capacity. Without the protective measures, the R, or
reproductive rate of the disease will be exponentially higher, and the outbreak may
become uncontrollable once hospitals become inundated with a deluge of patients.
President Rodrigo Duterte’s decision to place the island of Luzon on enhanced
community quarantine may have dismayed many civil liberty-loving citizens, but on
the side of public health experts, such move was a legitimate response to arrest the
spread of the virus. Without such quarantines, the country could be looking at the
possibility of a faster and more widespread transmission, as experienced by China,
Italy, Spain, the United States, and other nations.
Under the quarantine, citizens are mandated to stay at home, while all modes of pub-
lic transport are suspended. However, provision for food and essential health services
will be regulated, while the presence of uniformed personnel to enforce quarantine
procedures will be heightened.15
The quarantine follows similar initiatives taken by other countries in their objective
of lessening the spread and impact of the COVID-19 virus. Governments now work
closely with local and regional units, agencies, private partners, as well as public health
partners, to respond to the massive public health threat of COVID-19.
13 “Coronavirus disease 2019 (COVID-19): If you are at higher risk,” US Centers for Disease Control and
Prevention, 15 March 2020, accessed 5 April 2020, https://www.cdc.gov/coronavirus/2019-ncov/specif-
ic-groups/high-risk-complications.html.
14 Siobhan Roberts, “Flattening the Coronavirus Curve,” The New York Times, 11 March 2020, accessed
5 April 2020, https://www.nytimes.com/2020/03/11/science/coronavirus-curve-mitigation-infection.html.
15 Virgil Lopez, “Duterte orders Luzon-wide ‘enhanced community quarantine,’” GMA Network, 16 March
2020, accessed 5 April 2020, https://www.gmanetwork.com/news/news/nation/729875/duterte-or-
ders-lockdown-of-entire-luzon-due-to-covid-19-threat/story/.
Mainland China Italy Iran Spain South Korea Germany
Figure 2 Epidemic 4000

curves of China
(red), Italy (pink), Iran
(purple), Spain (blue), 3500
Germany (magenta),
and South Korea
(green) based on 3000
COVID-19 Cases per Day
reported number of
COVID-19 cases per
day from February 2500
to March 2020, as of
19 March 2020. after
the graphics of The 2000
New York Times,“
Which Country Has
Flattened the Curve 1500
for the Coronavirus?”
https://www.nytimes.
com/ interactive/ 1000
2020/03/19/
world/ coronavirus-
flatten-the-curve- 500
countries.html.
February 2020 March 2020
Taiwan Hong Kong Singapore Philippines

Figure 3 Epidemic 20
curves per
reported cases per
day from February
to 19 March 2020
15
COVID-19 Cases per Day
of the following
countries:
Philippines (red),
Singapore (green),
Taiwan (dark blue),
and Hong Kong 10
(light blue). Graphs
modeled after the
graphics of The
New York Times,
“Which Country
Has Flattened 5
the Curve for the
Coronavirus?”
0
February 2020 March 2020
Figure 4 Two epidemic

3500
curves for Metro Manila Epidemic curve presumed actual cases including
from 10 February to 30 asymptomatic infections
June 2020, assuming that 3000
Number of active cases

standard deviations
the enhanced community
quarantine is not as 2500 reported cases
effective. The higher standard deviations
red curve estimates the 2000
presumed actual cases
(including asymptomatic
1500
cases), while the smaller
blue curve uses the
actual case numbers 1000
as reported by the
Department of Health. 500
This graph is based on
Dr. Jomar Rabajante’s 0
epidemiological 10-Feb-20 01-Mar-20 21-Mar-20 10-Apr-20 30-Apr-20 20-May-20 09-Jun-20 29-Jun-20
projections dated 15
March 2020.
Evolution of health state (compart_SIR)

Figure 5 Epidemic curves
charting the increase or S Number of Susceptible
1.000e+6 individuals
decrease of individuals
who are Susceptible I N
umber of Infected
(green), Infected (red)
Number of individuals
8.000e+5 individuals
and Recovered (blue)
in the Philippines as R Number of Recovered
modeled by Dr. Darwin individuals
Bandoy of the College 6.000e+5
of Veterinary Medicine
at UP Los Baños and
the School of Veterinary 4.000e+5
Medicine at University Peak of epidemic on 30 June 2020 with 244,628 new cases
of California at Davis.
Vibal graphic after Dr. 2.000e+5
Bandoy’s epidemiological
model posted in
https://github.com/ 0.000e+0
darwinbandoy/COVID19_ 0 Day 30: 50 Day 60: 100 150 200
150 new cases 150 new cases Time (days)
PH/blob/master/
covid19ph_03152020_
github_final.pdf. A TALE OF 2 PROJECTIONS
Figure 4 (top) is a graph depicting two epidemic curves modeled by Dr. Jomar Rabajante, who predicted
that “based on my optimistic forecast, if the interventions such as the enhanced community quarantine aren’t
that effective, the peak might happen mid-April, with around 2,500 active cases in Metro Manila” (red curve).
In a second graph (not shown), Dr. Rabajante predicted that the epidemic would subside by the end of June
when a total of 11,000 cases would have been reported in Metro Manila. Figure 5 (above) Nationwide in
scope, and with more daunting figures. Dr. Darwin Bandoy’s analysis points to a peak by the end of June,
with a total of 245,000 cases. He believes that the epidemic will subside not earlier than October this year.
Source: “[ANALYSIS] Why Filipinos need to stay at home until June (or even longer),” Rappler, https://www.rappler.com/
thought-leaders/255096-analysis-why-filipinos-need-stay-home-until-june-2020-or-longer.
Adam Kucharski, an infectious disease expert and author of the book The Rules of
Contagion, stated that containment is widely regarded as the solution to controlling
the virus globally, since it worked remarkably well for the earlier outbreak of SARS
in 2003. Control should focus on isolating the cases and their potential contacts while
avoiding disruption to the wider population. This method breaks the chains of trans-
mission and ensures that no further transmission occurs.16
Kucharski declared in a TED Talks interview: “I think for this infection (COVID-19),
because some cases are missed and undetected, you really got to be capturing a large
chunk of people at risk. If you refuse to do that, you potentially get an outbreak.”
Two Philippine studies pointed out the grim projections for the alarming spread of
COVID-19 cases in the Philippines,17 with the disease expected by experts to further
peak in the next few months. Both confirmed the number of cases reaching a 4- to
6-digit range. A study (figure 4) by Dr. Jomar Rabajante of the Institute of Mathematical
Sciences and Physics at the University of the Philippines Los Baños, predicted that
in Metro Manila, the epidemic will peak around mid-April, with about 2,500 cases in
a single day (Graph 1). His calculations predicted that the epidemic would subside by
the end of June, with a total 11,000 cases in Metro Manila.
The second study (figure 5) by Dr. Darwin Bandoy of the College of Veterinary Med-
icine at UP Los Baños and the School of Veterinary Medicine at University of California
at Davis, is nationwide in scope, and with more daunting figures. His analysis points
to a peak by the end of June, with a total 245,000 cases in a day. The study posits that
the epidemic would subside not earlier than October this year.
Such mathematical modeling predictions are indeed pivotal in influencing govern-
ment policies. A study (figure 6) led by mathematical epidemiology expert Neil Fer-
guson for the Imperial College of London influenced the pandemic response policies
of both the UK and US governments by analyzing “the likely impact of multiple health
measures on slowing and suppressing the spread of coronavirus.”18
The study predicted the sheer number of fatalities (510,000 Britons and 2.2 mil-
lion Americans) that would occur if nothing urgent was done by both governments
in controlling the epidemic curve.19 Reflecting on the Chinese experience, the report
stated that “Through the hospitalisation of all cases (not just those requiring hospital
care), China in effect initiated a form of case isolation, reducing onward transmission
from cases in the household and in other settings. At the same time, by implementing
population-wide social distancing, the opportunity for onward transmission in all lo-
cations was rapidly reduced. Several studies have estimated that these interventions
16 Adam Kucharski, “How can we control the coronavirus pandemic?” TED.com, accessed 18 March
2020, https://www.ted.com/talks/adam_kucharski_how_can_we_control_the_coronavirus_pan-
demic#t-202680.
17 JC Punongbayan, “Why Filipinos need to stay at home until June (or even longer,” Rappler.com, 19
March 2020, accessed 5 April 2020, https://www.rappler.com/thought-leaders/255096-analysis-why-
filipinos-need-stay-home-until-june-2020-or-longer.
18 Sabine L. van Elsland and Ryan O’Hare, “COVID-19: Imperial researchers model likely impact of pub-
lic health measures,” Imperial College of London, 17 March 2020, accessed 5 April 2020, https://www.
imperial.ac.uk/news/196234/covid19-imperial-researchers-model-likely-impact/.
19 Neil Ferguson et al., “Impact on non-pharmaceutical interventions (NPIs) to reduce COVID-19 mor-
tality and healthcare demand,” Imperial College COVID-19 Response Team, 16 March 2020, accessed 5
April 2020, https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Im-
perial-College-COVID19-NPI-modelling-16-03-2020.pdf.
Figure 6 Differently shaped

epidemic curves that depict
the predicted impact that
government countermeasures
could have on critical care
bed use in Britain. Note
the the different estimated
peaks in the UK, which is
predicted to occur any time
between late May through
July. After figure 2 of Neil
Ferguson et al., “Impact
on non-pharmaceutical
interventions (NPIs) to
reduce COVID-19 mortality
and healthcare demand,”
Imperial College COVID-19
Response Team,https://
www.imperial.ac.uk/media/
imperial-college/medicine/
sph/ide/gida-fellowships/
Imperial-College-COVID19-
NPI-modelling-16-03-2020.
pdf. reduced R [reproduction rate] to below 1. In recent days, these measures have begun
to be relaxed. Close monitoring of the situation in China in the coming weeks will
therefore help to inform strategies in other countries.”20
These three studies, which coincide with similar studies done abroad, point to the
urgent need of Filipinos to help flatten its epidemic curve by slowing down infection
rates through implementing population-wide social distancing, enforcing the rules of
the lockdown, and practicing good personal hygiene.
By following government guidelines with regard to social distancing and strategies for
flattening the curve, you can help break the spread of infection. You and all your friends
and loved ones can help stem this infectious tide with your personal actions and sacrifice.
Preparing for living through an eventual Wuhan-style lockdown

The social distancing programs of the government may eventually prove not to be
enough to curb the rate of infection in your locality. From the example of Wuhan, the
following may be ordered by the authorities: cutting all transport into and out of your
locality; shutting down of all public and private institutions such as schools, offices,
and factories; the prohibition of operation of private vehicles and even public trans-
portation in city streets; the imposition of entry and exit restrictions in neighborhoods
and apartment complexes; obligatory isolation of people with fever or symptoms for
monitoring by health authorities; and the deployment of police or military to ensure
lockdown compliance.
Some signs of an impending total lockdown are the following: the successive dou-
bling of reported infections in a day; infections that range in the thousands per day;
or increasing fatality rates. In the event that your local government would take more
20 Neil Ferguson et al., “Impact on non-pharmaceutical interventions (NPIs) to reduce COVID-19 mor-
tality and healthcare demand,” 14.
stringent and even draconian measures, here are protocols derived from the lessons of
the Wuhan lockdown that took effect on 23 January 2020. Movements of your house-
hold will be monitored with only one person from each household allowed to exit or
enter your residence every two or three days but only for essential purposes such as
the purchase of medicine or food or consultation with a doctor. A temperature check
will be performed upon exit or entry of your residence.21
Protocols for safe travel in possibly contaminated areas:
1. Before leaving, create a containment zone immediately by your exit door.
2. Leave fresh clothes, alcohol, or sanitizer in the containment zone.
3. Before leaving, wear a face mask and eye goggles or visor.
4. Take along a hand sanitizer or a spray bottle of 75% alcohol.
5. If the errand requires a high touch area such as a grocery, wear gloves.
6. Once outside, take care not to touch high-touch surfaces such as elevator buttons,
handrails, bus rails, or wall surfaces.
7. Sanitize immediately after coming into contact with surfaces.
8. Remember not to touch the face, especially the eyes, nose, or mouth.
9. When you get back home, disinfect your eye protection gear, clothes and throw
them directly into the wash or into a sealed garbage bag.
10. Dispose of mask and gloves into a sealed garbage bag.
11. Wash hands with soap and water.
12. Change into fresh clothes or shower immediately.
13. Disinfect paper or plastic bags, groceries, and any packages from outside.
14. Disinfect car keys, door handle and lock, and any mobile phones.
15. Disinfect paper money or coins.
21 This community information was compiled from personal blog posts and tips posted by Wuhan resi-
dents in WeChat or other social messaging apps.
4 COVID-19 AND GLOBAL
SOCIOECONOMIC AND
HEALTH ISSUES
A S THE WORLDWIDE CASES of COVID-19 infections increase rapidly each day,
more and more countries have imposed stringent measures to stem its spread.
This pandemic is unprecedented in global history. Although China and South
Korea have seemingly controled the further spread of the ailment in their own coun-
tries, in many areas of the world infections still multiply exponentially, overwhelming
healthcare workers as death rates ratchet up with nary a vaccine or prescribtion
medicines in sight. Experts point to grim scenarios or successive waves of epidemics
lasting for up to several months. Only one thing is certain: this new endemic disease
poses daunting challenges for global health, society, and economy.
Effects of the pandemic: an economic overview

An article published by Forbes enumerates the four basic ways the pandemic can affect
the global economy. First, it will cause continuous disruptions in the supply chains,1 a
formidable problem but not the worst.2 The second harm results in lost work by those
who are sick or taking care of the sick as a direct effect of the epidemic. In its early
stages, this health problem may be perceived as having a lesser impact.3 Third is the
indirect effect of quarantines, travel bans, and business closures, which to date has
made the most immediate impact. Once a significant number of people lose their job
and businesses get scarred by losses, the economy will experience demand shocks.
Since several governments are now strictly limiting close human interaction, the global
1 A supply chain is a network between a company and its suppliers to produce and distribute a specific
product to the final buyer. See Will Kenton, “Supply chain,” Investopedia, last modified 10 February 2020,
accessed 5 April 2020, https://www.investopedia.com/terms/s/supplychain.asp.
2 Bill Conerly, “Economic forecast March 20, 2019 for COVID-19, coronavirus impact,” Forbes, 20 March
2020, accessed 5 April 2020, https://www.forbes.com/sites/billconerly/2020/03/20/economic-fore-
cast-update-march-20-2020-for-covid-19-coronavirus-impacts/#438ec32b2f07.
3 Ibid.
40
41 COVID-19 and Global Socioeconomic and Health Issues
demand for products and services, especially air transportation, food service, and other
service-oriented industries has precipitously declined.4
Figure 1. A graph reflecting

the impact of the COVID-19
The impact of coronavirus on stock markets since the start of the outbreak
pandemic on global stock
markets. Graph modeled after
5%
the graphics of BBC News
“Coronavirus: A visual guide 0%
to the economic impact,”
https://www.bbc.com/news/ -5%
business-51706225.
-10%
-15%
-20%
-25%
Nikkei: -28.7%
-30% Dow Jones: -31.1.%
FTSE 100: -34.1.%
-35%
-40%
January February March
Equity markets take a nosedive amid COVID-19 fears

Barometers of business expectations, global stock markets around the world have slid
downward and experienced extreme volatility as business and industry have halted
their operations to heed government restrictions. The biggest equity markets such as
the Financial Times Stock Exchange (FTSE),5 Dow Jones,6 and Nikkei7 have experi-
enced steep declines since the start of the outbreak, with the FTSE and Dow Jones
experiencing the lowest slump since 1987.8 Asian equity markets also experienced
a steep fall as well as in Australia.9 This global freefall of stock prices signaled the
impending prospects of a worldwide recession.
4 Ibid.
5 FTSE or the FTSE 100 is the index of the 100 biggest companies listed in the London Stock Exchange,
“What is the FTSE?” Hargreaves Lansdown, accessed 5 April 2020, https://www.hl.co.uk/help/funds-
shares-and-other-investments/shares/introduction/what-is-the-ftse.
6 The Dow Jones is an index that tracks the thirty large and financially sound companies listed in the
New York Stock Exchange. See Gordon Scoot, “Dow Jones Industrial Average (DJIA) Definition,” In-
vestopedia, last updated 18 March 2020, accessed 5 April 2020, https://www.investopedia.com/terms/d/
djia.asp.
7 Nikkei is Japan’s leading index which tracks the country’s top 225 companies that trades on the Tokyo
Stock Exchange, James Chen, “Nikkei,” Investopedia, 7 May 2019, accessed 5 April 2020, https://www.
investopedia.com/terms/n/nikkei.asp.
8 Lora Jones, David Brown, and Daniele Palumbo, “Coronavirus: A visual guide to the economic impact,”
BBC News, 20 March 2020, accessed 5 April 2020, https://www.bbc.com/news/business-51706225.
9 “US stock futures sink as Washington struggles over rescue plan: live updates,” The New York Times,
last modified 23 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/22/business/
stock-market-today-live.html?action=click&module=moreIn&pgtype=Article&region=Footer&action=-
42 THE COVID-19HANDBOOK1253G.AranetaAvenue, QuezonCity, 1104Philippines • https://www.vibalgroup.com/covid-19/
To counter this, many central banks in the world have resorted to monetary stimulus
programs, slashing their interest rates to spur cheaper borrowing and infuse liquidity
into their national economies.
On 23 March, the US Federal Reserve launched an aggressive plan to protect the
American economy. It bought as many government-backed debts as it sought to keep
US financial markets afloat. This was followed by a program that would give compa-
nies adequate sources of funds. Meanwhile, the US Senate approved the biggest-ever
stabilization package worth more than two trillion US dollars that will aid healthcare,
businesses, and families.10 In the UK, the Bank of England has slashed its interest
rate to 0.25 percent, the lowest level in its history as a response to the effect of the
pandemic.11 Notwithstanding these drastic measures, many economists still warn of
an impending global recession or economic downturn.12
The national responses reflected the growing disparity between richer and devel-
oping nations, with wealthy ones such as Denmark, Germany and the United Kingdom,
Figure 2. A graph Airlines most at risk from EU travel ban

indicating the impact of
the COVID-19 pandemic on
Total number of seats on scheduled flights
airline companies. Graph between EU and non-EU countries
modeled after the graphics
of BBC News “Coronavirus: Air France 815,000
A visual guide to the
economic impact,” https:// Luftansa 573,000
www.bbc.com/news/ Emirates 544,000
business-51706225.
KLM 507,000
Wizz Air 468,000
Qatar Airways 372,000
Ryanair 369,000
Turkish Airlines 354,000
Delta Airlines 338,000
Aeroflot 322,000
Note: EU restrictions envisage some skeleton

services may continue to operate
click&module=MoreInSection&pgtype=Article&region=Footer&contentCollection=The%20Coronavi-
rus%20Outbreak.
10 “Stocks fall despite Fed unleashing new spending power: live update,” The New York Times, 23
March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/23/business/stock-market-to-
day.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-markets&variant=-
show&region=MID_MAIN_CONTENT&context=storyline_updates_business#link-14bf2de3.
11 “Coronavirus: UK interest rates cut to lowest level ever,” BBC News, 19 March 2020, accessed 5 April
2020, https://www.bbc.com/news/business-51962982.
12 JC Punongbayan, “Why Filipinos need to stay home until June 2020 (or longer),” Rappler, 21 March
2020, accessed 5 April 2020, https://www.rappler.com/thought-leaders/255096-analysis-why-filipi-
nos-need-stay-home-until-june-2020-or-longer.
discarding their austerity programs in favor of generous infusions of their stimulus

programs that are directed at big and small industries as well as individuals.13
Travel industries are the most affected

As of present, many countries have implemented travel bans, particularly in the worst-
hit pandemic zones. As a result, more and more airlines have cancelled flights and have
cut their workforce to keep afloat. In UAE, Emirates said that they have ceased to fly
for the short term and will cut their workers’ salaries in half. Meanwhile, in Hong Kong,
Cathay Pacific has slashed its passenger capacity by ninety-six percent. On March
29, the Chinese government slashed almost all inbound and outbound air travel. Air
Canada, on the other hand, was forced to lay-off over 5,000 employees temporarily.
In Europe, the biggest airline Deutsche Lufthansa AG will decrease its passenger
capacity by ninety-five percent and will halt the operations of its 700 aircraft.14 The
European Union, meanwhile, has banned travelers from non-member states for 30
days. The move is expected to affect an estimated 48,000 flights with 10.2 million
Figure 3. A graph presents Chinese industrial production fell by 13.5% in

the huge decline in Chinese the first two months of the year
industrial production caused
by the COVID-19 pandemic. 10%
Graph modeled after the
graphics of BBC News
“Coronavirus: A visual guide 5%
https://www.bbc.com/news/
business-51706225.
0%
-5%
-10%
-15%
Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan-Feb
13 Peter S. Goodman, “Europe’s leaders ditch austerity and fight pandemics with cash,” The New York
Times, 26 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/26/business/eu-
rope-economy-coronavirus.html.
14 “Global airlines slash flights as travel restrictions multiply,” Aljazeera, 23 March 2020, accessed 5
April 2020, https://www.aljazeera.com/ajimpact/global-airlines-slash-flights-travel-restrictions-multi-
ply-200323020930099.html; “Cathay cuts nearly all flights, Air Canada lays off thousands,” Aljazeera, 20
March 2020, accessed 5 April 2020, https://www.aljazeera.com/ajimpact/cathay-cuts-flights-air-can-
ada-lays-thousands-200320062959371.html?utm_source=website&utm_medium=article_page&utm_
campaign=read_more_links.
seats.15 Replicated in every continent, such temporary scenarios could persist for an
extended period, leading many airlines and its related industries to bankruptcy.
Production in China decreased

China, where COVID-19 was first reported, became the sixth worst-affected country
in the world after the United States, Spain, Italy, Germany, and France. When the dis-
ease became an outbreak, it ordered the strictest lockdown of many cities, confining
people to their homes and only allowing them to buy food or medicine. It also utilized
the army and the police, as well as other draconian measures to monitor its citizens,
thus shutting down businesses and services in the process.
Unfortunately, China is also the second largest economy as well as the world’s big-
gest manufacturer of many vital products. Many multinational companies rely on China
when it comes to raw materials or parts.16 Therefore, when Chinese factories were
ordered to shut down, the global supply chains have been disrupted. This situation has
eased in the early part of March, when China loosened its policies and allowed workers
to return to work after eight weeks of a virtual shutdown. However, the country might
Figure 4. A graph shows Oil is at its lowest price since June 2001
how the price of oil has
plummetted to its lowest level US dollars per barrel
since 2001, brought about
by the COVID-19 pandemic. $150
“Coronavirus: A visual guide $125
business-51706225. $100
$75
$50
$25
$26.22
$0
2002 2005 2008 2011 2014 2017 2020
15 “Coronavirus: A visual guide to the economic impact.”

16 Bill Conerly, “COVID-19 coronavirus and complex supply chains,” Forbes, 15 February 2020, accessed
5 April 2020, https://www.forbes.com/sites/billconerly/2020/02/15/covid-19-coronavirus-and-com-
plex-supply-chains/#178f9524538f.
find it difficult to restart as global demand plunges as other countries still reel from
their own ordeal with COVID-19.17
Figure 5. A graph illustrates The value of gold is now plumeting

how the value of gold has
declined this year amidst $1,700
the COVID-19 pandemic.
graphics of BBC News $1,650
“Coronavirus: A visual guide
business-51706225. $1,600
$1,550
$1,500
$1,476
$1,450
$1,400
January February March
Prices of oil and gold plummeted

Due to restrictions on movement and travel, the demand for oil hit its lowest price since
2001. The price of petroleum has been reduced this year due to the conflict between
Russia and OPEC, an oligopolistic group of oil producers. Falling demand caused by
the pandemic contributed further to the drop in price of crude oil. And as COVID-19
continues to spread to other countries, the price of oil is forecast to decrease even
further.18
Even the price of gold, which is a barometer as a “less risky” investment and re-
garded as a “safe haven” in times of economic crisis, has also been affected. As the
threat of a global recession looms, even the price of gold has slid.19
The global economy will take years to recover

The Organization for Economic and Cooperation and Development (OECD) offered a
grim assessment that many advanced countries may take years to recover from the
health and economic crisis, with no certainty on when businesses can undertake
normal operations. According to Angel Gurría, the director-general of OECD, a serious
17 Keith Bradsher, “Halting China’s economy was hard. restarting it is harder,” The New York Times,
last modified 16 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/12/business/
china-coronavirus-economy.html.
18 “Coronavirus: A visual guide to the economic impact.”
19 Ibid.
Figure 6. A graph presents Economic growth (GDP) expected to slow down in 2020
the grim forecast for
the economic growth in Growth in 2019 Forecasted growth in 2020
countries in 2020, expected
to be slowed down by China
the COVID-19 pandemic.
World
“Coronavirus: A visual guide
to the economic impact,” US
business-51706225. UK
France
Euro area
Japan
Germany
Italy
0% 1% 2% 3% 4% 5% 6%
pandemic could halve the global growth rate20 to 1.5 percent, which is the lowest since
the 9/11 terror attack or the 2008 recession.21
The Philippine scenario

In the Philippines, Pres. Rodrigo Duterte declared an enhanced community quarantine
for the whole Luzon area from 16 March to 13 April and placed the entire country un-
der a state of calamity as the nation combated the contagion. Experts predicted that
the worst was yet to come and forecast the outbreak peak by April or June. While the
stringent measures have been followed by many, there are still a greater number of
Filipinos who are not able to abide the quarantine due to their needs. Furthermore,
many businesses, particularly the small-scale ones, are already seriously affected
barely a week after the declaration of a quarantine.
As a response, the Bangko Sentral ng Pilipinas (BSP) has cut interest rates, sus-
pended bank penalties, and allowed increased lending. BSP Governor Benjamin Dio-
kno added that there was no need for “unconventional tools to address the COVID-19
pandemic,” and the programs it implemented would suffice.22
This was in response to the position paper titled “A Philippine Social Protection and
Economic Recovery Plan,” which called for a “liquidity bazooka.” It was authored by UP
20 If the economy is growing, it can generate more jobs. The growth rate is measured through the
gross domestic product (GDP) or the value of services or goods it produced for a year, “Coronavirus: A
visual guide to the pandemic.”
21 Szu Ping Chan, “Global economy will suffer from years to come, says OECD,” BBC News, 23 March
2020, accessed 5 April 2020, https://www.bbc.com/news/business-52000219.
22 Prinz Magtulis, “BSP rejects ‘unconventional measures’ vs outbreak,” Philippine Star, 22 March
2020, accessed 5 April 2020, https://www.philstar.com/business/2020/03/22/2002770/bsp-re-
jects-unconventional-measures-vs-outbreak.
economists led by Professor Emeritus Emmanuel de Dios. According to this study, the
measures undertaken by the central bank are not enough due to the sudden demand
suppression, which knocked down the vulnerable sector, especially those who belong
to the informal economy.23 Furthermore, the paper also proposed that the government
should offer a social insurance package that would minimize the economic impact
brought by the outbreak on people, especially on the poorest of the poor, who do not
have safety nets they can tap in times of financial crisis.
By allocating at least 100 to 300 billion pesos for social protection and economic re-
covery programs, the government would be able to protect its most vulnerable citizens,
avert an economic recession, and cushion the effects of COVID-19.24 Among the social
protection measures it suggested was securing supply chains for food and non-food
items, such as medicine and personal hygiene products, and ensuring unhampered
operations of essential services, such as groceries, supermarkets, pharmacies, hospi-
tals, and clinics. Another was the immediate distribution of cash and non-cash support
to poor households. For the economic recovery program, the paper recommended that
small and medium-scale enterprises should be given tax relief and workers should
continue to receive salaries even if they have temporarily ceased to work.25
The Philippines set up

checkpoints around Luzon
as part of the enhanced
community quarantine. People
coming in and going out from
each area are required to
present quarantine passes
and IDs to verify if they can
be allowed entry. Frontliners
also check their tempereature
to ensure that they do not
present COVID-19 symtoms.
Source: Shutterstock.
Government response to COVID-19 in the Philippines

The Department of Health in the Philippines confirmed local transmission of the COV-
ID-19 disease on 7 March 2020. Only a week later, they issued a warning on sustained
community transmission26 with contact tracing for new cases becoming more im-
23 Emmanuel de Dios, et. al., “A Philippine Social Protection and Economic Recovery Plan,” UP School
of Economics, 22 March 2020, accessed 5 April 2020, https://www.econ.upd.edu.ph/dp/index.php/dp/
article/view/1525.
24 Ibid.
25 Ibid.
26 “DOH: Philippines now has sustained COVID-19 community transmission,” GMA Network, 17 March
The local government of

Antipolo uses a hihg-powered
mechanical spray to disinfect
public spaces and residential
areas to reduce transmission
of COVID-19. Source:
Shutterstock.
possible to detect. Pres. Duterte announced a partial lockdown of Metro Manila on 15

March 2020 which escalated to the National Capital Region (NCR) and the municipality
of Cainta in Rizal being placed under “community quarantine” until 14 April. With the
growing number of COVID-19 cases in Luzon, Pres. Duterte then announced on 16
March that the entire Luzon island was to be placed under a partial lockdown, which
was euphemistically called an “enhanced community quarantine.” However, some
Philippine scientists, however, predicted the outbreak could last until June this year.27
Suppression of the viral disease has proven to be more difficult for the country due
to a shortage of personal protective equipment (PPEs) and, respirators, poorly executed
social distancing guidelines in various communities, as well as the slow testing process.
On 21 March 2020, the Department of Health announced the news of 120,500 COVID-19
test kits donated by different countries in order to boost the country’s testing capacity.28
On April 4, the FDA announced the approval of the homegrown PCR-based test kit of
UP for public distribution, which only costs P 1,300 each, as well as the approval of
30 rapid test kits, which are blood-based strips that detect antibodies in the blood of
a person who has been previously exposed to the COVID-19 virus.29 As of 3 April, the
country has tested 16,368 people only, with certified laboratories processing 900 to
1,200 tests in a day. The DOH signaled that it will increase the labs’ testing capacity
to more than 3,000 a day by April 14 and 10,000 a day by month end.
COVID-19 and its impact on society

Worldwide media has broadcast scenes around the world that seem straight out of
an apocalyptic movie: deserted highways, barricaded roads, uniformed personnel in
2020, accessed 5 April 2020, https://www.gmanetwork.com/news/news/nation/730026/doh-philip-

pines-now-has-sustained-covid-19-community-transmission/story/.
27 Punongbayan, “Why Filipinos need to stay at home.”
28 Kristina Sabillo, “DOH says to speed up COVID-19 testing with more labs, 120,000 test kits,” ABS-
CBN News, 21 March 2020, accessed 5 April 2020, https://news.abs-cbn.com/news/03/21/20/doh-
says-to-speed-up-covid-19-testing-with-more-labs-120000-test-kits.
29 “Game-changing Philippine-made COVID-19 test kits finally get FDA approval,” ANCX, 4 April 2020,
accessed 4 April 2020, https://news.abs-cbn.com/ancx/culture/spotlight/04/04/20/game-changing-
philippine-made-covid-19-test-kits-finally-get-fda-approval.
hazmat suits milling around a makeshift tent housing the sick, and military staff sin-
gling out people and vehicles at checkpoints. Words like work-from-home, quaran-
tine, code red, lockdown, N95 mask, social distancing, and coronavirus have become
bywords of a population that is now forced to endure traumatic developments in their
country and across the entire world. This seemingly new normal and alternate reality
is demonstrated by people being compelled to maintain a safe distance of a meter or
more while interacting with others. The afflicted claimed by the disease are given
unceremonious send-offs to the afterlife with funerals banned and families barred
from visiting their loved ones. Healthcare workers begin to crumble both physically
and emotionally under the strain of having to cope with the deluge of the sick and the
fear of contracting the viral disease themselves.
Social events and gatherings have been postponed along with travel plans, busi-
ness conferences, community events, and entrepreneurial activities. Close physical
interaction with families and friends has been put on hold. Schools, offices, and es-
tablishments have been ordered to close temporarily. Entire streets, neighborhoods,
villages, cities, ports, and islands have been cordoned off. All these countermeasures
in the guise of fighting an unseen enemy have made a gargantuan impact.
Risks to mental health

Apart from dealing with the ever looming COVID-19 contagion, individuals and com-
munities have been cut off from the other and may also become more susceptible to
loneliness and alienation. The fear and anxiety caused by the coronavirus disease can
incite strong emotions and stress in adults and children. Each individual has different
reactions to stressful situations and ways of coping with it.30
On the other hand, the community quarantine can also give people an opportunity
to be closer to their families and their community. Helping ourselves and others cope
with anxiety and stress is a vital factor in making a community stronger. According to
30 “Stress and Coping,” US Centers for Disease Control and Prevention, accessed 25 March 2020,
https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html?CDC_AA_
refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fcoping.html.
The alarming number of
COVID-19 cases around the
world can stress people
and communities. Experts
around the world have
noticed that the coronavirus
disease has produced strong
emotions and stress in both
adults and children. Source:
Shutterstock.
the Centers for Disease Control and Prevention (CDC), people can make the outbreak
less stressful by: (1) taking breaks from watching, reading, or listening to news stories
because constantly being bombarded by the pandemic could be upsetting; (2) taking
care of the body by exercising, eating healthy food, getting enough sleep, and avoiding
alcohol and drugs; (3) doing activities that you enjoy; and (4) connecting virtually with
people you trust and care for.31
Social distancing and proper hygiene are best practices to prevent the disease from
entering our body. However, we should make extra efforts to maintain our mental
well-being in order to continue to cope with unbearable hardship and sacrifices.
Long-standing societal problems

The COVID-19 pandemic has also unearthed prevailing societal problems, especially the
issues related to poverty and inequity. In the Philippines, the community quarantine has
amplified the clamor to help daily-wage earners, blue-collar workers and laborers, the
homeless, and poverty-stricken neighborhoods. For disadvantaged ones, the outbreak
is not just a battle against the disease. It is about their survival from day to day in the
absence of any means for them to continue making a living.
Social distancing is now being While most are stuck at their homes, some have chosen to make use of the situation
implemented in supermarkets, to give back and help. Many Filipinos are used to lending a hand to the needy. Some
drugstores, and other public have raised funds to help the impoverished and the frontliners. Some also volunteered
spaces. Source: Shutterstock.
their skills to contribute to information campaigns on COVID-19.32 Retired medical
practitioners also returned to hospitals, stepping up to fight COVID-19 and supplement
hospital manpower.33
One of the major global problems is the ongoing armed conflicts around the world. As
more nations followed lockdown and community quarantine, the government deployed
the military to monitor access points of city and provincial boundaries. To focus on
the COVID-19 outbreak, Pres. Duterte also declared a ceasefire, ordering government
forces to stop operations against armed communist rebels, effective from 19 March
to 15 April 2020.34 Worldwide, the United Nations also urged an immediate ceasefire
in conflicts around the world to tackle the new coronavirus pandemic. In a statement,
UN Secretary-General Antonio Guterres said that the world faces “a common ene-
my—COVID-19” which doesn’t care “about nationality or ethnicity, faction or faith.”35
A helping hand from businesses and other governments

In times of tragedy, humankind’s innate propensity to help, unite, and render selfless
acts do emerge. China has been rolling out aid to various parts of the world continu-
ously, also sharing strategies on how they were able to rein in the spread of infection.
31 Ibid.
32 Tristan Zinampan, “Volunteer your skills during the lockdown through these initiatives,” Rappler, 18
March 2020, https://www.rappler.com/move-ph/254945-volunteer-skills-donation-drive-coronavirus.
33 Kathless Doheny, “COVID-19 and Kindness,” WebMD, 20 March 2020, accessed 5 April 2020, https://
www.webmd.com/lung/news/20200320/covid-19-kindness-caremongering-is-trending.
34 Elmor Santos, “Duterte declares unilateral ceasefire with CPP-NPA to focus on COVID-19 fight,” CNN
Philippines, 18 March 2020, accessed 5 April 2020, https://www.cnnphilippines.com/news/2020/3/18/
duterte-cpp-npa-ceasefire-covid-19.html.
35 The Associated Press. “UN Chief Urges Immediate Global Cease-Fire to Fight COVID-19,” The New
York Times, 23 March 2020, https://www.nytimes.com/aponline/2020/03/23/world/ap-un-virus-out-
break-un-cease-fire.html?searchResultPosition=1.
In the Philippines, at least two recent shipments have been made, including 100,000
testing kits which the county is in dire need of.
Canada for its part vowed to spend millions to help the world’s poor amidst the pan-
demic36, while the United Nations has been working non-stop to ensure humanitarian
aid for poor countries.37 Donation drives continue to come in left and right, with dif-
ferent organizations seeking ways to send help to the hard-hit areas of the pandemic.
In the Philippines, while local government units come up with their own “creative”
ways to roll out relief operations for locked down cities, the nation’s largest corpora-
tions have also funded relief initatives.
“Project Ugnayan” is a joint venture of the country’s biggestt conglomerates, among
them the Aboitiz Group, ABS-CBN/Lopez Group, Alliance Global/Megaworld, AY Foun-
dation and RCBC, Ayala Corporation, Caritas Manila, Century Pacific, Concepcion In-
dustrial Corp, DMCI, ICTSI, Jollibee, Leonio Group, Metrobank/GT Capital, Nutri-Asia,
Oishi/Liwayway Marketing Group PDRF, PLDT/Metro Pacific Investments Corporation,
Robinsons/Gokongwei Group, Puregold, San Miguel Corporation, SM/BDO, and Suyen
Corp.38
Over 51.5 billion in funds will be used to distribute grocery vouchers worth 51,000
to urban poor residents in Mega Manila. The noble venture is in partnership with
the Philippine Disaster Resilience Foundation (PDRF), and will aim to benefit over a
million households in the metro. The vouchers can be used to purchase food items
from groceries and supermarkets. The project has been initiated in four pilot areas,
in collaboration with Caritas Manila’s Project Damayan and ABS CBN’s Pantawid ng
Pag-ibig program.
Aside from relief distribution, the big businesses are also showing their humani-
tarian side by extending pay for employees who are presently on forced leave due to
the enhanced community quarantine. SM Supermalls has assured their employees of
regular compensation despite going on vacation or sickleave, while their frontliners
get premium pay for serving customers during the lockdown. The mall chain also
volunteered to waive rental fees for tenants who have been affected by the closure
order during the Luzon-wide quarantine.39
Other notable efforts from the private sector:40
• The Jollibee Group under billionaire Tony Tan Caktiong donated food products worth
5100 million for health workers and other frontliners.
36 Mike Blanchfield, “Canada to spend millions to help world’s poor amid COVID-19 pandemic: min-
ister,” GlobalNews.CA, 25 March 2020, accessed 5 April 2020, https://globalnews.ca/news/6728980/
coronavirus-humanitarian-aid-canada/.
37 “UN aid teams work round the clock amid COVID-19 pandemic to ensure humanitarian support
to millions, United Nations News, 20 March 2020, accessed 5 April 2020, https://news.un.org/en/sto-
ry/2020/03/1059862.
38 Yvette Fernandez, “Big business donates P1.5 billion to help feed urban poor: Project Ugnayan,” Es-
quire, accessed 5 April 2020, https://www.esquiremag.ph/money/industry/-project-ugnayan-big-busi-
ness-donates-p1-5-billion-to-help-feed-urban-poor-a2325-20200322.
39 “SM assures employees of pay, frontline staff get premium,” ABS-CBN News, 20 March 2020,
accessed 5 April 2020, https://news.abs-cbn.com/business/03/20/20/sm-assures-employees-of-pay-
frontline-staff-get-premium.
40 “More businesses pitch in with donations, test kits for COVID-19 response,” CNN Philippines, 17
March 2020, accessed 5 April 2020, https://cnnphilippines.com/business/2020/3/17/sm-donation-to-
ritm-pgh.html.
• denna Group under presidential ally Dennis Uy turned over 1,000 COVID-19 test
U
kits to the Department of Health (DOH)
• Vista Land under Manny Villar donated 200,000 face masks and a daily supply of
bottled water to nine public hospitals in NCR
• Alibaba founder and Chinese billionaire Jack Ma pledged a donation of 500,000
face masks and 100,000 test kits to the Philippines
• Aboitiz Group turned over 5,700 N-95 masks to DOH for health and security workers,
apart from medical supplies such as surgical gloves, thermometers, folding beds,
laboratory goggles, and tents.
• Metrobank and GT Capital Holdings Group of the Ty family pledged 5200 million to
respond to the health crisis, mainly for the production of more coronavirus test kits
by the University of the Philippines National Institutes of Health
• The Gokongwei Brothers Foundation led by the heirs of the late taipan John Gokong-
wei, Jr. pledged a 5100-million fund to mitigate the impact of COVID-19, which will
be spent on additional protective gear of health workers and rapid test kits produced
by scientists from UP.
• Businessman Manny Pangilinan through Metro Pacific Hospitals deployed frontline
workers to needed areas and have been importing additional protective gear for their
use. Some 4,000 liters of alcohol have also been donated for government hospitals.
• The Araneta Group donated UP-made COVID-19 test kits to the Quezon City Gov-
ernment through the J. Amado Araneta Foundation.
• San Miguel Corporation produced ethyl alcohol in its liquor plant, which is under
regulatory approval for public use. The diversified conglomerate said it has started
to distribute rubbing alcohol for free to hospitals and local government units. SMC
has also revived the production of the Nutribun, or vitamin-packed bread popular
originally distributed for feeding programs in the 1970s, to donate to Caritas Manila
for distribution to communities.
• Tycoon Andrew Tan and the Alliance Global Group also pledged 1 million liters of
70 percent ethyl alcohol to the Department of Health, the police, military, and local
government units.
• Ayala-owned GCash launched an online donation drive for hospitals and frontline
health workers. Using the e-wallet app, users can choose to donate money which
will be evenly divided to its partners: the Philippine Disaster Resilience Foundation,
the Philippine Red Cross, World Vision, UP Medical Foundation, PGH Foundation,
Inc., ABS-CBN Lingkod Kapamilya Foundation, and Ayala Foundation.
• Cosmetic surgery firm Belo Medical Group led by its CEO Vicki Belo donated its
remaining stocks of PPE in its clinics for the use of hospitals and health centers in
need and will continue to donate once additional supplies arrive.
Government responses in different parts of the world

At a media briefing held on 11 March 2020, the WHO Director-General proclaimed the
COVID-19 outbreak as a global “pandemic”— the first caused by a coronavirus41. A call
for collective action was deemed necessary by the organization, prompting govern-
41 “WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020,”
World Health Organization, 11 March 2020, accessed 5 April 2020, https://www.who.int/dg/speeches/
detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
Frontliners, such as these

Iranian ambulance staff,
have been hailed all over the
world for their courage and
heroism in treating patients
with COVID-19. Source:
Shutterstock.
ments and international agencies around the world to do their part in implementing
emergency response mechanisms. With the alarming rise of case numbers around
the world, social distancing is being strictly implemented, mass testing is encouraged;
schools, offices, and establishments are being closed down—every country is forced
to choose their particular set of strategies to address the global health crisis.
A month before the proclamation of a global pandemic, the United States discovered
its first ever case in Chicago. Currently, the US has surpassed China as having the
most number of confirmed cases of over 312,146 confirmed cases and 2,24 fatalities.42
Tragically, a study of the Trump administration’s Department of Health and Human
Services in 2019, however, had previously warned of the incapability of the US to
fully protect itself from a large-scale epidemic much like that started by the novel
coronavirus43.
A faulty test kit distributed by the U.S. Centers for Disease Control and Prevention
has further slowed down efforts to control the outbreak in the American continent.44
Following Pres. Donald Trump’s acknowledgement of the spread of the COVID-19
disease as a matter of national concern and the US government’s declaration of a pub-
lic health emergency, orders for stay-at-home lockdowns, travel restrictions, school
closures, cancellation of events and large gatherings are being executed throughout
different states. Several of the hardest hit states have been New York, Michigan,
Washington, New Jersey, and Louisiana.45
42 “Coronavirus COVID-19 Global Cases,” Johns Hopkins University and Medicine, 5 April 2020, ac-
cessed 5 April 2020, https://coronavirus.jhu.edu/map.html.
43 David Sanger et al., “Before Virus Outbreak, a Cascade of Warnings Went Unheeded,” The New
York Times, 19 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/19/us/politics/
trump-coronavirus-outbreak.html.
44 John Cohen, “The United States badly bungled coronavirus testing—but things may soon improve,”
Science, 28 February 2020, accessed 5 April 2020 https://www.sciencemag.org/news/2020/02/united-
states-badly-bungled-coronavirus-testing-things-may-soon-improve.
45 “Coronavirus COVID-19 Global Cases.”
On 13 March 2020, the WHO proclaimed Europe as the epicenter of the pandemic
with the most reported cases and deaths outside China. The European Union then
announced “a 30-day restriction on non-essential travel” in 26 of its nations.46 With
Europe closing off its borders, other member countries followed with nationwide
lockdowns including Italy, Spain, Germany, France, Belgium, and more. Much like other
nations, European nations have shut down schools, prohibited gatherings involving
more than 100 people, and advised self-isolation at home. On the other hand, the Brit-
ish government ordered 1.4 million of its people who have serious health problems to
self-quarantine for 12 weeks.
On 17 March 2020, Dr. Poonam Khetrapal Singh, the Regional Director of WHO
Southeast Asia region, urged more aggressive action in preventing further spread of
the deadly disease across the region47—with the individual case numbers of several
Southeast Asian nations surpassing the 3,000-mark during that time. As a response,
most SEA countries have imposed travel bans and restricted foreign or local travel
including Vietnam, Thailand, Singapore, Malaysia, and the Philippines. In the South
Asian region, India ordered a three-week sudden lockdown on 24 March 2020, even
though it had recorded only 469 active cases of COVID-19 out of a population of over
1.3 billion, a huge sacrifice for a nation representing a fifth of humanity.48
From horizontal to vertical interdiction—a probable solution

Nations across the globe have closed their borders. Southeast Asia is currently facing
a growth in COVID-19 case numbers. Europe has been declared the epicentre of the
pandemic and the United States is already experiencing a public health crisis surpass-
ing the magnitude of China and Spain combined. Yet, some countries have achieved
some success in flattening the curve of new infections. From the unprecedented
Wuhan outbreak that grew to thousands of active cases and deaths in the last two
months, mainland China has recently reported no new locally transmitted infections
after implementing strict social distancing measures.
On the other hand, the Republic of South Korea has seen a significant drop in their
case numbers even without China’s “draconian” measures such as large-scale lock-
downs, which have also been implemented in Europe and the US49. Instead of impeding
everyday economic activities, South Korea has instead put up massive mass-testing
programs, completing by 16 March 2020 more than 270,000 tests50. Isolating and con-
46 Matina Stevis-Gridneff and Richard Perez-Peña, “Europe Barricades Borders to Slow Coronavirus,”
The New York Times, 17 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/17/
world/europe/EU-closes-borders-virus.html.
47 “WHO calls for urgent, aggressive actions to combat COVID-19, as cases soar in South-East Asia
Region,” World Health Organization, 17 March 2020, accessed 5 April 2020, https://www.who.int/south-
eastasia/news/detail/17-03-2020-who-calls-for-urgent-aggressive-actions-to-combat-covid-19-as-
cases-soar-in-south-east-asia-region.
48 Alex Ward, “India’s coronavirus lockdown and its looming crisis, explained,” Vox, 24 March 2020,
accessed 5 April 2020, https://www.vox.com/2020/3/24/21190868/coronavirus-india-modi-lock-
down-kashmir.
49 Max Fisher and Choe, Sang-hun. “How South Korea Flattened the Curve,” The New York
Times, 23 March 2020, accessed 5 April 2020, https://www.nytimes.com/2020/03/23/world/
asia/coronavirus-south-korea-flatten-curve.html.
50 Dennis Normille, “Coronavirus cases have dropped sharply in South Korea. What’s the secret to its
success?,” Science, 17 March 2020, accessed 5 April 2020, https://www.sciencemag.org/news/2020/03/
coronavirus-cases-have-dropped-sharply-south-korea-whats-secret-its-success.
tact tracing of all known and previously undocumented cases were strictly followed.
Although mass testing, self-isolation, and extensive lockdowns have been proven ef-
fective, how can viral transmission be halted without causing an economic collapse,
especially for nations who are undefunded and unprepared for a disaster such as this?
Dr. David L. Katz of Yale University suggests a “vertical interdiction strategy” as
opposed to a horizontal approach to the problem by implementing quick isolation for
two weeks in communities experiencing an outbreak while letting other unaffected
communities’ function.
The lockdown in the Philippines is also vertical in that only Luzon has been closed
down, with other local government units in Visayas and Mindanao presented with an
option to follow suit if they saw it fit. The concept of a 14-day total shutdown instead of
gradually restricted actions also seem to be a sensible approach to this epidemic. But
in doing so, Dr. Katz reminds us of three important goals—saving lives, maintaining a
functionable health care system, and “making sure that in the process of achieving the
first two goals we don’t destroy our economy, and as a result of that, even more lives.”51
It has been a number of weeks since countries all over the world have initiated
lockdowns and shut down “non-essential” businesses. However, depending on where
one resides, this may either be a temporary inconvenience or a major life-changing
event. In some countries like Belgium, Denmark, and the Netherlands, workers will
have 90 percent of lost wages covered.52 In most developing countries, locals are not
provided the same safety nets. The Philippine government is being heavily criticized
for this reason. The 14-day lockdown of Luzon has been labeled “anti-poor,” with daily
Empty shelves and sections

in a supermarket (such as
this one in Madrid, Spain)
has become a common
occurrence around the world,
brought about by the panic
and fear of lockdowns caused
by the COVID-19 pandemic.
51 Thomas Friedman, “A plan to get America back to work,” The New York Times, 22 March 2020, ac-
cessed 5 April 2020, https://www.nytimes.com/2020/03/22/opinion/coronavirus-economy.html.
52 Matt Apuzzo and Monika Pronczuk, “Covid-19’s economic pain is universal. but relief? Depends on
where you live,” The New York Times, 23 March 2020, https://www.nytimes.com/2020/03/23/world/eu-
rope/coronavirus-economic-relief-wages.html?action=click&module=Top%20Stories&pgtype=Home-
page.
wage workers out of work and unable to rely on the national government for support.
Although everyone is faced with the same dilemma, it is a sad reality that not everyone
is equipped to survive the crisis without suffering tremendous losses.
Lessons from Wuhan

After two months of battling the coronavirus, the people of the city of Wuhan in China
finally took off their face masks and appreciated their newly recovered freedom. The
ground zero of the coronavirus outbreak first declared zero new cases on 19 March
2020.53 Wuhan, though, remains on lockdown to keep the virus from returning to the
healing city. Now that the rest of the world is currently the new battlefield of the
contagion, it is vital to look back and understand how Wuhan dealt with the viral foe.
Harsh but effective approach

Many have criticized the way the Chinese government contained the disease in Wuhan.
To halt further transmission outside of Wuhan, the Chinese government mandated its
lockdown on 23 January 2020 together with other major cities.54
Initially, the residents were still allowed to go out of their houses; but as days went
by, the lockdown tightened. In some areas, going out to buy necessities was limited to
one family member every two days. The residents were also restricted from leaving the
city. Public transportation was put to a halt, giving no exception even for personal and
medical emergencies. Private vehicles without special permission were also barred
The Chinese government
promptly instituted quarantine from the roads. For the entire duration of the lockdown, travel was banned. Establish-
of patients with COVID-19 ments were also shut except for those selling food and medicines. Drugstores were
symptoms in Wuhan, as a part strictly monitored by authorities. Later on, the lockdown became more aggressive.
of its lockdown measures.
Health officials even went door-to-door to monitor and force anyone ill into isolation.55
It was the first time that a quarantine of this scale had been implemented in the
modern world. Some had taken the policy with a grain of salt. Skeptics expressed that
such measures were unnecessary, and that the government should have focused on
mass testing, strict implementation of social distancing, and identifying those who
needed to be isolated. However, it is also noteworthy that during the early onset of
the outbreak, there were no reliable and rapid testing kits to screen the masses. They
only depended on laboratory genetic sequencing analysis, which was a tedious and
costly process. The only way to manage the spread of the disease and save more lives
was to limit the movement of its carriers.
The National Medical Products Administration of China took immediate action to
hasten the production of detection kits. The first test kit in China was introduced on
23 January, the same day that Hubei was put under lockdown. Two weeks later, bio-
53 “Update: China’s Wuhan reports zero increase in novel coronavirus infections,” Xinhua, 19 March
2020, http://www.xinhuanet.com/english/2020-03/19/c_138894272.htm, accessed 5 April 2020.
54 “China coronavirus: Lockdown measures rise across Hubei province,” BBC, 23 January 2020, ac-
cessed 5 April 2020, https://www.bbc.com/news/amp/world-asia-china-51217455.
55 Pien Huang and Huo Jingnan, “Life In lockdown: from shock to panic to ... acceptance,” NPR, 18 March
2020, accessed 5 April 2020, https://www.npr.org/sections/goatsandsoda/2020/03/18/815585991/
life-in-lockdown-from-shock-to-panic-to-acceptance; Emma Graham-Harrison and Lily Kuo, “China’s
coronavirus lockdown strategy: brutal but effective,” The Guardian, 19 March 2020, accessed 5 April
2020, https://amp.theguardian.com/world/2020/mar/19/chinas-coronavirus-lockdown-strategy-bru-
tal-but-effective.
tech companies in China manufactured a sufficient supply to accommodate the testing

needs of the hardest-hit areas, especially Wuhan.56
Modern problem, modern solutions

As the number of COVID-19 cases ballooned in Wuhan, the demand for hospital beds
to isolate thousands of patients also posed a major problem in the outbreak epicenter.
This pushed officials to put up a makeshift hospital to house infected individuals.
Thousands worked day and night to complete the coronavirus hospital in ten days.
The Chinese state media reported that the design features of makeshift hospitals built
during the SARS outbreak in 2003 were used. The new hospital was designed in such
a way that patients were categorized based on the severity of the infection and the
risk they posed.57
Technology also played an important role in combating the virus. The outbreak has
tested China’s technology industry and how well people can utilize these advancements
during catastrophic events such as public health crises. In hospitals, nurses roamed
to check on patients and to deliver medicines. To reduce the risk among medical staff,
hospitals replaced nurses with robots to deliver medicines to patients.58
Another hardware that provided multiple applications were drones. Heavy-duty
drones were deployed in the cities to disinfect public spaces. There were also drones
mounted with thermal cameras to detect suspected COVID-19 patients. Some drones
equipped with facial recognition were also flown to fight crime and to monitor move-
ment of the citizens. These efforts also tested the ethical boundaries of using such
aerial surveillance technologies. Such collective initiatives seem to have paid off for
Wuhan and were even being held as models to be replicated by other nations.
Lessons from Italy

The Italian healthcare system has been regarded as one of the best among developed
countries in the Western world. Its efficient structure largely depends on the shared
authority between the central government and the 20 Italian regional governments,
which oversee health services, provisions, and source appropriation.59 In previous
years, academic journals have commended this constitutionally tacit relationship for
ostensibly improving and maintaining the health status of Italians. However, everything
changed in the span of three weeks from late February to early March 2020. Italy’s
healthcare system was suddenly crippled by an unseen enemy: COVID-19.60
56 Xifeng Wu et al., “6 lessons from China’s Zhejiang Province and Hangzhou on how countries can
prevent and rebound from an epidemic like COVID-19,” World Economic Forum, 12 March 2020, accessed
5 April 2020, https://www.weforum.org/agenda/2020/03/coronavirus-covid-19-hangzhou-zhejiang-gov-
From top: Temperature ernment-response/.
scanning of flight passengers 57 “Oscar Holland and Alexandra Lin,” How to design a hospital that’s built in days, by someone who’s
in airports, deployment done it before,” CNN, 8 February 2020, accessed 5 April 2020, https://edition.cnn.com/2020/02/07/
of robots in hospitals, asia/wuhan-coronavirus-hospital-design-intl-hnk/index.html; “Wuhan to follow Beijing’s SARS treat-
and utilization of heavy- ment model in new coronavirus control,” Xinhua, 24 January 2020, accessed 5 April 2020, accessed 5
duty drones to disinfect April 2020, http://en.people.cn/n3/2020/0124/c90000-9651671.html.
public spaces in the city— 58 Sarah O’Meara, “Coronavirus: Hospital ward staffed entirely by robots opens in China,” New Sci-
these were some of the entist, 9 March 2020, accessed 5 April 2020, https://www.newscientist.com/article/2236777-coronavi-
technologies used during the rus-hospital-ward-staffed-entirely-by-robots-opens-in-china/.
outbreak in Wuhan. Source: 59 George France, Francesco Taroni, and Andrea Donatini, “The Italian health-care system,” Health
Shutterstock. Economics, 14 September 2005, accessed 25 March 2020, https://doi.org/10.1002/hec.1035.
60 Jason Horowitz, “Italy’s health care system groans under coronavirus— a warning to the world,” The
ITALY’S RED ZONES

Map of Italy highlighting the
"red zones," or the worst
affected regions of the
country. Graphic modeled
after the graphics of Daily Treviso
LOMBARDY
Mail “Australian au pair Venice
Milan Padua
who was caught in Italy’s
coronavirus ‘red zone’ reveals Turin Asti Piacenza
how her trip of a lifetime Parma Regglo Emilia
Alessandria
turned into a nightmare Modena
Genoa
- before she fled over the Aimini
border to Switzerland,”
Florence Urbino Pesaro
https://www.dailymail.co.uk/
news/article-8094627/amp/
Australian-woman-caught-
Italys-coronavirus-red-zone-
reveals-escaped.html.
Rome
Bari
Naples
Cagliari
Palermo
Why did a country like Italy with a fully prepared and world-class healthcare system
Gatania
end up as such? What early measures did the Italian government take to fight the
contagion many countries had already warned about? What mistakes did its officials
commit for this health crisis to turn for the worse?
Italy: COVID-19 epicenter

The symptoms of COVID-19 can be easily attributed to ordinary severe flu. On 18 Feb-
ruary 2020, a 38-year-old unsuspecting man went to a local hospital in Codogno in
the northern Lombardy region of Italy. As he was only manifesting flu symptoms, the
hospital released him hours later. But when the same man was rushed back into the
intensive care unit and tested positive for the virus on the same day, people started to
ask questions: How did the patient contract the virus without a travel history to China?61
That same week, two more Italians who recently traveled to China were also diag-
nosed with the virus.62 In the succeeding weeks, the number of cases in Italy multiplied
New York Times, 12 March 2020, accessed 5 April 2020, https://nyti.ms/3cQroLw.

61 Jason Horowitz, Emma Bubola, and Elisabetta Povoledo, “Italy, pandemic’s new epicenter, has les-
sons for the world,” The New York Times, 21 March 2020, accessed 5 April 2020, https://nyti.ms/3bcT-
DCz.
62 Graziano Onder, Giovanni Rezza, and Silvio Brusaferro, “Case-fatality rate and characteristics of
patients dying in relation to COVID-19 in Italy,” JAMA, 23 March 2020, accessed 5 April 2020, https://doi.
org/10.1001/jama.2020.4683.
a thousand-fold. A month later, the country had already surpassed China’s total death
toll by more than half, becoming the new epicenter of the COVID-19 pandemic. As of
5 April 2020, Italy reported 124,632 confirmed cases, with the death toll reaching
15,362, surpassing that of China.63
Italy’s draconian strategies and pitfalls

According to media and health experts, partly to blame for Italy’s woeful handling of
the outbreak was the horizontal interdiction belatedly implemented by the central
government in the affected regions. This strategy relied on draconian policies blindly
imposed on an entire population, with complete disregard for other factors such as
the population segments that are most vulnerable to illnesses. Rather than swiftly
executing this to abate the rapid spread of COVID-19 across the country, the Italian
central government chose to feed the people a false sense of normalcy and urged them
to carry on with their daily lives. But when the cases surged into the local hospitals
in northern Italy, the draconian measures already came too late. “Infodemic” or mixed
messages from central government officials also had flummoxed the Italians on what
was really happening in the country. This then forced local officials like the regional
president of Lombardy, Attilio Fontana, to make tough decisions on his own.
The northern area of the Lombardy region was the first to be forced into lockdown.
Along with the confirmed community transmission, this area also recorded almost half
of the nationwide count of positive cases and two-thirds of the official death count.64
Later on, the remaining towns in southern Lombardy, including its main city Milan,
were placed under lockdown. On 10 March 2020, Italian Prime Minister Giuseppe
Conte addressed the public and expanded the regional quarantine into a nationwide
lockdown. He pledged that aside from the $28 billion allotted for relief package, the
government would also provide economic assistance amounting $8.5 billion to prevent
the country from sliding into recession.65
The overlooked factors

Although Italy was indeed the first Western country to enforce such extreme measures
in handling the domestic outbreak, initially there was little positive evidence that they
could prove effective.66 At the outset, the country was hobbled by its inability to con-
duct viral testing for its huge population. As of 23 March 2020, it had only conducted
around 230,000 tests. This is way behind in comparison with the estimated 340,000
tests conducted by the South Korean government in mass-testing centers and drive-
through clinics.67. Also, the transmission trend revealed that COVID-19 tended to target
immunocompromised and elderly people. Based on statistics, the relative risk of virus
63 “Coronavirus COVID-19 Global Cases,” John Hopkins University, 5 April 2020.
64 Ferdinando Giugliano, “The lessons from Italy’s COVID-19 mistakes,” Bloomberg, 23 March 2020,
accessed 5 April 2020, https://www.bloomberg.com/opinion/articles/2020-03-23/italy-s-covide-19-tri-
al-and-error-and-lessons-for-france-and-u-k.
65 Silvia Amaro, “Italy vows to implement ‘a massive shock therapy’ against the coronavirus,” CNBC,
9 March 2020, accessed 5 April 2020, https://www.cnbc.com/2020/03/09/italy-wants-more-public-
spending-to-fight-coronavirus-amid-lockdown.html.
66 David L. Katz, “Is our fight against the coronavirus worse than the disease?” The New York Times,
20 March 2020, accessed 5 April 2020, https://nyti.ms/2J1v53h.
67 Max Fisher and Choe Sang-Hun, “How South Korea flattened the curve,” The New York Times, 23
March 2020, accessed 5 April 2020, https://nyti.ms/3aeD35C.
Italy’s healthcare facilities

have been overwhelmed
with the deluge of COVID-19
patients seeking treatment,
forcing authorities to put
up makeshift field hospitals
just as this one in Florence.
contractions among older age groups is critically high. Italy has an aging population,
and the mean of its demographic age is around 45 years old. Like other family cul-
tures, Italians of many generations tend to live under one roof, making the possibility
of viral transmission within households even higher even with the implementation of
the public containment policies. This then implied that the elderly may not be even
safe in their own homes. As of 23 March 2020, the median age of COVID-19 deaths
in Italy has been set around 80 years old, and patients over 90 years old have a very
high fatality rate of 22.7%.
However, it may be said that Italy, as of writing, is not anymore at the peak of the
outbreak. But even though local hospitals are still struggling to house patients with
critical symptoms and seventy-fou healthcare professionals have fallen victim to COV-
ID-19 as of 3 April, they are all holding up and getting by. Italian hospitals and regional
presidents have now already created improvised ICUs and distributed medical supplies
and staff they have to more vulnerable areas.68
And even though the death count in the country continues to climb, the number of
new infections has recently dropped to only 4,053 last 1 April 2020, compared to the
recorded 6,557 cases in 22 March 2020.69 If these rates of infections continue to drop,
there is indeed hope for Italy, and the rest of the world can expect an alleviation in the
battle against this global scourge if it manages the challenges right.
68 Katherine Harmon Courage, “The stark differences in countries’ coronavirus death rates, ex-
plained,” Vox.com, 1 April 2020, accessed 5 April 20202, https://www.vox.com/2020/4/1/21203198/
coronavirus-deaths-us-italy-china-south-korea; and Denise Chow and Emmanuelle Saliba, “Italy has a
world-class health system; the coronavirus has pushed it to the breaking point,” NBC News, 18 March
2020, accessed 5 April 2020, https://www.nbcnews.com/health-news/italy-has-world-class-health-
system-coronavirus-has-pushed-it-n1162786.
69 Frances D’Emilio, “Italy records smaller increase in virus cases for 2nd day,” The Associated Press,
24 March 2020, accessed 25 March 2020, https://apnews.com/a69c921eb603e6a85fd5c2c490d66a9.
5 ANSWERS TO COMMON
COVID-19 QUESTIONS
A SIDE FROM COVID-19 ITSELF, Filipinos are faced with the challenge of distin-
guishing verified information regarding COVID-19 from the plethora of fraudu-
lent ones that are posted in social media or various websites. Those who have
limited medical knowledge are especially at risk of following false COVID-19 prevention
tips. For instance, on 10 March 2020, the International Business Times reported that at
least 44 Iranians died due to alcohol poisoning. They fell prey to the rapidly spreading
rumor of alcohol being effective in curing coronavirus. There were 36 deaths report-
ed in Khuzestan, followed by seven in the northern region of Alborz, and then one in
Kermanshah. Meanwhile, 200 Iranians were hospitalized in Ahvaz.1
There are also posts circulating on social media claiming that COVID-19 is a biological
weapon that aims to reduce the world’s population. Such posts incite prejudice and
fearmongering. Increasingly, people need to educate themselves about the crediblity
of online sources, as there are some websites manned by trolls2 that resemble official
ones. This chapter provides scientifically based answers to commonly asked questions
regarding COVID-19.
What is COVID-19?
Initially called 2019-nCoV Acute Respiratory Disease, COVID-19 is an infectious dis-
ease manifesting flu-like symptoms, such as dry cough, fever, fatigue, and shortness
of breath. In some cases, infected people may develop pneumonia and multiple organ
failure, which can lead to death. This disease is caused by SARS-CoV-2, a new type
of coronavirus only recently known to infect humans.3
1 Tisha Ocampo, “Iran: 44, dead of alcohol poisoning due to COVID-19 protection fake rumor,” Interna-
tional Business Times, 10 March 2020, accessed 5 April 2020, https://www.ibtimes.com/iran-44-dead-
alcohol-poisoning-due-covid-19-protection-fake-rumor-2937427.
2 Trolls are online writers who harass other online users and post deceitful and/or inflammatory
statements.
3 “Q&A on coronaviruses (COVID-19),” World Health Organization, 9 March 2020, accessed 5 April 2020,
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses.
61
62 THE COVID-19 HANDBOOK 1253 G. Araneta Avenue, Quezon City, 1104 Philippines • https://www.vibalgroup.com/covid-19/
How worried should I be about getting sick?

COVID-19 is a highly contagious disease. Everyone who is active socially is susceptible
to contracting the COVID-19 virus. Chances of infection are even higher once commu-
nities have an outbreak. The infection leads to a generally mild illness for children and
young adults unless they have conditions that weaken the immune system. But still,
one out of five infected people will need hospital care. Not all infected people also
experience symptoms. These carriers are called asymptomatic and carry about, placing
the people around them at risk of infection. Currently, asymptomatic carriers are not
being tested on a wide scale, thus the epidemic moves stealthily through the populace.
This information may indeed cause worry. But worry can be transformed to hope
with the right information and consistent hygiene and social distancing practices. The
Philippine government’s mandated quarantine measures are helpful in preventing the
further spread of the disease. Follow social distancing guidelines, practice personal
and social hygiene protocols, and disinfect your work and home environment.4
How is COVID-19 transmitted?

According to the World Health Organization, COVID-19 is transmitted by infected people
who shed the virus through respiratory droplets carried by their cough or exhalation
up to a distance of two meters (six feet). If possible, people should avoid interacting
with others. If you need to do so, place yourself at a two-meter distance from others.
If you come into contact with high-touch surfaces, wash yout hands thoroughly with
soap.5 Refrain from touching your face, since your hands can be contaminated with
droplets of the virus found on objects and surfaces. COVID-19 may also be caught di-
rectly from inhaling the droplets of an infected individual’s cough or exhalation, which
is why social distancing is currently being practiced all over the world. The common
symptoms of COVID-19 are dry cough, fatigue, and fever. However, some cases also
report body pain, clogged nose, diarrhea, or sore throat.6
Who are at higher risk of experiencing the severe and critical symptoms
of COVID-19?
People with a weak immune system, such as older adults and those with pre-existing
medical conditions, such as high blood pressure, heart disease, lung disease, cancer,
or diabetes are prone to develop severe and critical symptoms. Smokers are also at
risk due to the actual smoking habit and their possibly reduced lung capacity.7
Should young people be worried about infection?

Yes. While older people are considered at more risk from coronavirus, the World Health
Organization (WHO) has warned young people not to view themselves as “invincible.”
4 “Coronavirus disease 2019 (COVID-2019) situation report-59,” World Health Organization, 19 March
2020, accessed 5 April 2020, https://www.who.int/docs/default-source/coronaviruse/situation-re-
ports/20200319-sitrep-59-covid-19.pdf?sfvrsn=c3dcdef9_2.
5 The US Centers for Disease Control and Prevention advise that vigorous handwashing must be done
with soap for at least 20 seconds.
6 “Coronavirus disease (COVID-19) advice for the public: Myth busters,” World Health Organization,
accessed 5 April 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/ad-
vice-for-public/myth-busters.
7 “Q&A: Similarities and differences–COVID-19 and influenza,” World Health Organization, 17 March
2020, accessed 5 April 2020, https://www.who.int/news-room/q-a-detail/q-a-similarities-and-differ-
ences-covid-19-and-influenza.
63 63THECOVID-19 CATALOG
COVID-19 HANDBOOK 1253 G. Araneta Avenue, Quezon City, 1104 Philippines • https://www.vibalgroup.com/covid-19/
Newborn children are also susceptible to the disease, while a one-year-old girl in
Oriental Mindoro also tested positive.8 While the elderly with compromised immune
systems and pre-existing illnesses are the most susceptible, young people who also
share the same conditions may also become infected and wind up seriously ill.9 In ad-
dition, young carriers can also infect older loved ones such as their family and friends.
How is COVID-19 different from the flu or SARS?

Although COVID-19, influenza or flu, and SARS have similarities, they are entirely dif-
ferent diseases. All of them attack the respiratory system with overlapping symptoms
and very similar means of transmission. The virus responsible for COVID-19 and SARS
came from the family of coronaviruses. In contrast, the influenza virus belongs to the
family of Orthomyxoviridae, another group of RNA-based pathogens.
Children are essential transmission drivers of flu, but COVID-19 is more risky among
the elderly and those with underlying conditions. Up to date, COVID-19 appears more
deadly than flu. In context, however, SARS was more deadly but much less infectious
than COVID-19. The two coronaviruses also differ in their method of respiratory trans-
mission. COVID-19 is transmitted in larger droplets compared to SARS.10
How deadly is the coronavirus?

The crude fatality rate from COVID-19 can range from as high as 12% to as low as 1%,
depending on the country. This is because the denominator for computing this death
rate is dependent on the number of reported cases of infection, which is dependent on
the prevalence of testing of the population. One of the reasons for this high variability is
because not all infections are confirmed by testing and many carriers are asymptomatic.11
How close are we to developing a coronavirus vaccine or drug?

Presently, there are more than 20 vaccines in development along various stages. Sci-
entists are working at breakneck speed around the world to obtain results of animal and
human trials later in the year. But even if scientists can finally achieve development of
a vaccine within twelve months, there is still the challenge of mass production. Real-
istically, a vaccine or drug would not be ready until at least the middle of next year.12
Should I wear a mask to protect myself or others from coronavirus?

You should wear a mask if you suspect that you are ill with COVID-19 symptoms (es-
pecially cough or fever) or are looking after someone who may have been infected
by the virus. A disposable face mask can only be used once and should be disposed
off properly. If you are not ill or looking after someone who is ill, you may not need to
wear a mask. If you are healthy, refrain from using one, so that you do not deplete the
8 “Coronavirus: Newborn becomes youngest person diagnosed with virus,” BBC News, 6 February
2020, accessed 5 April 2020, https://www.bbc.com/news/world-asia-china-51395655; ”Oriental Min-
doro’s first COVID-19 patient is a 1-year-old girl,” CNN Philippines, 27 March 2020, accessed 5 April
2020, https://www.cnnphilippines.com/regional/2020/3/27/Oriental-Mindoro-baby-coronavirus.html.
9 Rachel Schraer, “Coronavirus: What’s young people’s risk?” BBC News, 25 March 2020, accessed 5
April 2020, https://www.bbc.com/news/health-52003804.
10 “Q&A: Similarities and differences.”
11 Robert Cuffe, “Coronavirus death rate: What are the chances of dying?” BBC News, 24 March 2020 ,
accessed 5 April 2020, https://www.bbc.com/news/health-51674743.
12 James Gallagher, “Coronavirus: How close are we to a vaccine or drug?” BBC News, 20 March 2020
, accessed 5 April 2020, https://www.bbc.com/news/health-51665497.
supply of someone like a nurse or a doctor who actually needs it. The most effective
ways to protect yourself from COVID-19 is to distance yourself socially and to avoid
unnecessary contact with people. If you are forced to leave your home, frequently
wash your hands, cover your cough with the bend of the elbow or tissue, and maintain
a distance of at least 1 to 2 meters (3 to 6 feet) from people.
Can I catch COVID-19 from my pet?

There have been reported isolated cases of two dogs in Hong Kong13 and one cat in
Belgium14 that tested positive from COVID-19 infection, but the WHO has maintained
that there is presently no evidence that any pet can transmit the virus.15 As an extra
precaution, patients with COVID-19 are still advised not to touch their pets.
Can warm climate eliminate COVID-19?

Human-to-human transmission of COVID-19 can occur regardless of a country’s cli-
mate. The World Health Organization states that the best way to protect oneself is to
distance yourself and wash your hands frequently and thoroughly. And considering
that the Philippines is now under enhanced community quarantine, it is best to remain
at home if there is no essential task to be accomplished outdoors such as purchasing
food or medicine.16
Will a hot bath or shower protect me from COVID-19?

This alone will not be able to protect a person from COVID-19. In fact, the World Health
Organization warns against taking an extremely hot bath or shower, as it would lead to
burns. To reiterate, the best way to protect oneself is to distance yourself from other
people and to wash hands frequently and thoroughly. In a community quarantine, social
distancing must be observed at large as well. This means not leaving home,17 except
for urgent needs such as purchasing food or medicine.
How long does the coronavirus live on surfaces?

The coronavirus can live for as long as 17 days on surfaces. This was discovered by the
US Centers for Disease Control when it did a study of the surfaces of the contaminated
Diamond Princess cruise ship after all its passengers had disembarked. They discovered
that the coronavirus was still alive on surfaces of cabins that had been occupied by
both infected and healthy passengers on the ship.18 Another study published by the
New England Journal of Medicine found that the virus can live for up to 3 hours in the
13 Natalie O’Neill, “Second dog in Hong Kong tests positive for coronavirus,” New York Post, 19 March
2020, accessed 5 April 2020, https://nypost.com/2020/03/19/second-dog-in-hong-kong-tests-positive-
for-coronavirus/.
14 Lee Brown, “First known cat infected with coronavirus reported in Belgium,” New York Post, 27 March
2020, accessed 27 March 2020, https://nypost.com/2020/03/27/first-known-cat-infected-with-corona-
virus-reported-in-belgium/.
15 “Q&A on coronaviruses (COVID-19).”
16 “Coronavirus disease (COVID-19) advice for the public.”
17 Ibid; “Handwashing: Clean Hands Save Lives,” US Centers for Disease Control and Prevention, ac-
cessed 18 March 2020, https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html.
18 Leah Moriarty, Mateusz M. Plucinski, Barbara Marston, et al., “Public health responses to COVID-19
outbreaks on cruise ships,” US Centters for Disease Control and Prevention, 23 March 2020, accesssed
29 March 2020, Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, Febru-
ary–March 2020.
air and up to 3 days on plastic and stainless steel.19
Someone told me that gargling salt water and/or rinsing the nose with
saline can fight off COVID-19.
The former is considered as a remedy for sore throat, while the latter is a remedy for
the common cold. Both claims, however, are not backed up by any scientific evidence
as measures against COVID-19.20
Can a thermal scanner accurately detect all those infected with COVID-19?
A thermal scanner is only capable of detecting individuals with fever,21 which is one
of the symptoms of COVID-19. However, not all carriers of the disease are sympto-
matic. Some studies have indicated that asymptomatic carriers, or those who DO NOT
exhibit symptons such as fever, cough, or fatigue, may be responsible for many more
infections than is commonly believed.22 The World Health Organization states that “it
takes between [two] and [ten] days” before symptoms develop. Thus, there are also
asymptomatic carriers. These are infected individuals who do not exhibit any symp-
toms23 but are just as dangerous in spreading the disease.
What vaccine or medication should I avail so as to avoid being infected?

There still is no prescribed medication or vaccine that could protect you from COVID-19.
Medical experts, however, recommend being vaccinated against respiratory illnesses
such as the flu. The World Health Organization as well as other countries continues
to work with medical experts in the development of a cure24 or a vaccine.
Can COVID-19 be transmitted through mosquito bites?

O UGH ! There is no report confirming that COVID-19 can be acquired through a mosquito bite.
So far, what is known is that the COVID-19 virus is transmitted through large respira-
tory droplets, which are generated when an infected person coughs or sneezes, or
through the discharge from the nose or droplets of saliva.25
Does COVID-19 originate from bats?

It is widely circulated that COVID-19 started when “patient zero” ate a bat soup from
a seafood market and got infected, and he subsequently spread the infecction in
early December 2019 in Wuhan. However, the World Health Organization has not yet
19 Neeltje van Doremalen et al., “Aerosol and surface stability of SARS-CoV-2 as compared with SARS-
CoV-1,” The New England Journal of Medicine, 17 March 2020, accessed 5 April 2020, https://www.nejm.
org/doi/full/10.1056/NEJMc2004973.
20 “Handwashing: Clean hands save lives,” US Centers for Disease Control and Prevention.
21 The normal body temperature ranges from 36.5°C to 37°C.
22 Ruiyun Li, Sen Pei, Bin Chen, et al., “Substantial undocumented infection facilitates the rapid dissem-
ination of novel coronavirus (SARS-CoV2),” Science, 16 March 22020, accessed 5 April 2020, https://
science.sciencemag.org/content/early/2020/03/24/science.abb3221. This study of geospatial and tem-
poraral data of 3 billion trips in or from China estimated that prior to the 23 January 2020 lockdown of
Wuhan 86% of all infections were undocumented, allowing the disease to escape to other parts of China
and many international ports with direct connections to China.
23 “Myth busters.”
24 Ibid.
25 Ibid.
confirmed the source of the COVID-19 virus and its initial animal-to-human route of
transmission. Recent studies indicate that more than 500 coronavirus strains have been
circulating in bats in China. However, it remains unclear if eating bats can transmit
the COVID-19 virus to humans.26
Is COVID-19 an airborne disease?

In a normal setting, COVID-19 virus can only be transmitted through respiratory droplets
and close contact. However, the World Health Organization reminded health workers on
the precautionary measures to avoid exposure to COVID-19 while at duty.27 There are aer-
osol-generating procedures (AGP) performed in hospitals, such as intubation and manual
ventilation, that heighten the risk of health workers vvia aerosol transmission. Aerosols or
fine air particles can carry the virus to the air, especially in an enclosed room.28
Can banana or garlic prevent the new coronavirus disease?

The Philippine Department of Health has stated there is no scientific evidence that
backs up the claim that eating banana or garlic can help in the prevention and cure of
COVID-19. Although they nourish the body, there are no studies suggesting that banana
and/or garlic have properties that can alleviate the COVID-19 virus.29
Are antibiotics effective in preventing or treating COVID-19?

Unfortunately, antibiotics do not work against viruses. They only work on bacterial
infections, and since COVID-19 is caused by a virus, antibiotics will not be effective.
Antibiotics should not be used as a means of prevention or treatment of COVID-19.
They should only be used as directed by a physician to treat a bacterial infection.
How can my family reduce the risk of getting COVID-19?

The risk level of your home depends on the epidemiological spread of COVID-19. How-
ever, it is better to observe strict personal and environmental hygiene to protect our
homes, whether or not our community already has a reported infection. Asymptomatic
cases in the Philippines are not widely known due to limited testing of the populace.
Personal hygiene
• Cover your mouth and nose when you sneeze, clear the throat, or cough. If tissue
is not available, cough into your elbow.
• Avoid touching one’s mouth, eyes, and nose.
26 Fernando Duarte, “Who is ‘patient zero’ in the coronavirus outbreak?” BBC Future, 24 February
2020, accessed 5 April 2020, https://www.bbc.com/future/article/20200221-coronavirus-the-harm-
ful-hunt-for-covid-19s-patient-zero; “Novel Coronavirus (2019-nCoV) situation report-22,” World Health
Organization, 11 February 2020, accessed 5 April 2020, https://www.who.int/docs/default-source/coro-
naviruse/situation-reports/20200211-sitrep-22-ncov.pdf?sfvrsn=fb6d49b1_2.
27 “World Health Organization holds a briefing on the coronavirus pandemic,” CNBC Television, 16
March 2020, YouTube video, 48:35, https://www.youtube.com/watch?v=CHHCJFiDoR4.
28 “Aerosol generating procedures,” Health Protection Surveillance Centre, 20 December 2013, accessed
5 April 2020, https://www.hpsc.ie/a-z/respiratory/influenza/seasonalinfluenza/infectioncontroladvice/
File,3625,en.pdf.
29 “Myth busters”; John Eric Mendoza, “Bananas no cure for COVID-19,” The Manila Times, 16 March
2020, accessed 5 April 2020, https://www.manilatimes.net/2020/03/16/news/latest-stories/bananas-
no-cure-for-covid-19-doctor/703677/.
• Frequently wash your hands. Wash your hands for 20 seconds with soap and water.
Use tissue paper or clean cloth to dry your hands. If handwashing is not possible,
use alcohol or alcohol-based sanitizer to keep your hands clean.
• Do not leave your home except to buy essential items. Make sure to give the task
to a capable household member who is not at high risk for COVID-19 infection.
The pregnant, elderly, or someone with high blood pressure, heart disease, lung
disease, cancer, or diabetes should be kept safely at home.
• Change into new clothes and take a bath once you arrive home from the market,
pharmacy, or hospital or after you have been exposed outside.
Keep your family healthy

• Rest well. Make sure that you have enough sleep, and you feel rested. If possible,
divide household tasks among family members during the quarantine period to
provide everyone a chance to rest.
• Keep a balanced and healthy diet. Always have a variety of vitamin-rich fruits and
vegetables. Make sure to properly prepare and cook all food.
• Perform physical exercises at home.
• Drink 8 to 10 glasses of water.
• Avoid smoking and excessive consumption of alcohol.
• For pregnant women, continue with your scheduled prenatal checkups and observe
your body for unusual signs requiring immediate medical attention.
• For the elderly, try to get some sunlight, even just for 10 minutes.
• For those at risk, strictly follow the medications and lifestyle changes prescribed
by your physician. Find ways to keep a healthy lifestyle even while at home and
avoid places frequented by many people.
Keep your surroundings clean and disinfected

• Always disinfect common areas and commonly touched surfaces, such as door-
knobs, light switches, tables, mobile phones, among others.
• Use bleach diluted in water or 70% alcohol to disinfect your home.
• Use a designated trash bin for used tissues, face masks, and disposable cleaning
cloths. Seal the trash bin immediately.
What should I do if I feel sick?

Observe and take note of common COVID-19 symptoms, which include fever, tiredness,
and dry cough. Some patients report experiencing aches and pains, nasal congestion,
and less frequently a runny nose, sore throat, and diarrhea. Seek medical attention
once a person starts experiencing a combination of fever, continuous dry cough,
and breathing difficulty. Aside from hospitals, many local doctors now provide online
medical consultations to avoid crowding the hospitals. During the consultation, doc-
tors would ask essential questions, such as previous travel history and pre-existing
conditions, to determine if the patient would be advised for testing and hospitalization.
What should I do in case of an outbreak in my community?

First of all, stay calm. It also helps to be prepared prior to such events. Follow the
steps below:30
• Stay home and isolate yourself if you are sick. If you are healthy, stay in a diffent
room to keep away from people who are sick.
• Stay informed about the local COVID-19 situation. Be aware of community activities
and protocols in your area.
• Continue practicing proper hygiene and sanitation. Cover coughs and sneezes with
a tissue and wash your hands often with soap and water for at least 20 seconds. If
soap and water are not available, use a hand sanitizer that contains 70% alcohol.
Clean frequently touched surfaces and objects daily using a regular household
disinfectants or bleach diluted in water.
• Work from home or take a leave if you or someone in your office or work area gets
sick with COVID-19 symptoms.
• Stay in touch with others by phone, social media, or email. If you have a chronic
medical condition and live alone, ask family, friends, and health care providers to
check on you during an outbreak. Stay in touch with family and friends, especially
those at increased risk of developing severe illness, such as older adults and people
with severe chronic medical conditions.
What hotlines should I take note of during the quarantine period?

• Department of Health (Philippines) COVID-19 Hotline: (02) 894-26843
• For PLDT, Smart, Sun, and TnT Subscribers: 1555
• Philippine Red Cross: 1158
• Joint Task Force CV SHIELD Command Center, Philippine National Police Com-
mand Center
1. Globe: 09173125626
2. Smart: 09988940013
3. Landline: (02) 7253176
• The Lung Center of the Philippines: Facebook (COVIDAskForce)
• UP Diliman Psychosocial Services: 0916-7573157; email: psychserv.upd@up.edu.ph
• The Coalition for People’s Right to Health and Council for Health and Development:
FB Messenger or hotlines (02) 8929-8109 and (02) 8806-1306.
• The Manila Doctors Hospital Pulmonology Postgraduate Course Facebook page
30 “Preparing for an Outbreak,” US Centers for Disease Control and Prevention, 8 March 2020, accessed
5 April 2020, https://www.cdc.gov/coronavirus/2019-ncov/prepare/faq.html?CDC_AA_refVal=https://
www.cdc.gov/coronavirus/2019-ncov/community/home/faq.html.
COVID-19: A TIMELINE
NOVEMBER 2019
November 17
The original case of an infection from the novel coronavirus was said to have been that of a
55-year-old man, “Patient Zero,” in Hubei province. However, the novel virus was not recog-
nized at that time.
DECEMBER 2019
December 1
The first known patient to experience symptoms of the novel coronavirus was documented
in China.
December 8-18
Seven patients diagnosed with coronavirus were documented. This was also the first time the
virus spread was linked to the Huanan Seafood Wholesale Market in Wuhan.
December 31
The World Health Organization (WHO) China Country Office was informed about cases of pneu-
monia with unknown etiology (unknown cause) detected in Wuhan City, Hubei province of China.
JANUARY 2020
January 7
China identified a new type of coronavirus.
January 9
The WHO confirmed the mystery virus as a new strain of coronavirus.
January 10
China shared globally the genome sequencing of the novel coronavirus to be used in “devel-
oping specific diagnostic kits.”
January 20
The WHO reported 282 confirmed cases of the 2019-nCoV from four countries including China
(278 cases), Thailand (2 cases), Japan (1 case) and the Republic of Korea (1 case).
January 21
The WHO reported a total of 314 confirmed cases of 2019-nCoV globally. Six deaths were
from Wuhan.
January 23
The WHO reported a total of 581 cases worldwide, of which 571 cases were from China; other
cases were from Thailand, Japan, Hong Kong Special Administrative Region, Taipei Municipality,
China, Macau Special Administrative Region, United States of America, and the Republic of
69
Korea. All cases had travel history to Wuhan. Seventeen deaths were reported (all from Hubei
province). An immediate lockdown of Wuhan and three neighboring cities was ordered. Au-
thorities shut down the airport, bus, and train lines and banned private car transport. However,
the lockdown was later seen as too late, delaying its spread to the rest of China by three to five
days and to the rest of the world by a few weeks. A later study published by Science showed
that at 100 undetected (untested and asymptomatic) but infectious travelers had already been
on the move prior to lockdown and were likely the ones who had spread it to the rest of the
world. Even though international air connections from Wuhan were banned on this day, other
internationally connected Chinese cities such as Shanghai, Shenzhen, Beijing, Guangzhou,
Hangzhou, Xiamen, and Kumning still maintained direct links to Japan, Thailand, South Korea,
Taiwan, USA, Singapore, Malaysia, Australia, Vietnam, Philippines, Indonesia, Cambodia, Russia,
UK, Canada, Germany, UAE, India, Italy, and France.
January 24
The WHO reported a total of 846 confirmed cases of 2019-nCoV globally—China, Hong Kong
SAR, Macau SAR, Taipei, Republic of Korea, Vietnam, Republic of Singapore, Thailand, and
USA. Twenty-five deaths in China have been reported.
January 25
The WHO reported a total of 1,320 confirmed cases of 2019-nCoV globally. Forty-one deaths
in China were reported.
January 28
The Philippines temporarily stopped issuing visas to travelers from Hubei province. The Philip-
pine Bureau of Immigration also temporarily suspended the visa upon arrival (VUA) mechanism
for Chinese tourists and businessmen. The Department of Foreign Affairs (DFA) called for a
voluntary repatriation for Filipinos in Hubei who wish to come home.
January 30
The WHO confirmed 7,818 cases in the West Pacific, Southeast Asia, Americas, Europe, and
the Eastern Mediterranean regions. Six thousand people on-board an Italian cruise ship were
briefly quarantined as tests were carried out on two Chinese passengers suspected of hav-
ing coronavirus, a spokesman for the Costa Crociere cruise company said. The International
Health Regulations Emergency Committee of the WHO declared the outbreak a “public health
emergency of international concern.” The first-ever case of the 2019-nCoV was confirmed in
the Philippines—a 38-year-old Chinese woman who was confined at the San Lazaro Hospital
in Manila.
January 31
Philippine President Rodrigo Duterte imposed a travel ban on Chinese citizens coming from
Hubei province and other areas of China.
FEBRUARY 2020
February 1
Every province of China reported at least one case.
February 2
The WHO reported a total of 14, 557 confirmed cases globally. The second local case was con-
firmed: a 44-year-old Chinese man who died a day earlier. This was also the first confirmed
death from the disease outside mainland China.
February 3
The Diamond Princess cruise ship was put under quarantine for 14 days. Around 3,700 pas-
sengers and crew were on board, one of which was an 80-year-old man from Hong Kong who
71 COVID-19: A Timeline
tested positive for the virus. It was later reported by the DOH that the second local patient to
recover from the virus was a “31-year-old Filipino male who was repatriated from the Diamond
Princess cruise ship in Yokohama, Japan.”
February 5
Only a few days after the Diamond Princess cruise ship incident, the World Dream cruise ship
quarantined 3,600 passengers and crew members after having previously carried eight infected
passengers who tested positive for the virus.
February 11
The International Committee on Taxonomy of Viruses (ICTV) identified the 2019-nCoV as “se-
vere acute respiratory syndrome coronavirus 2” or SARS-CoV-2, genetically related to the
coronavirus responsible for the SARS outbreak in 2003. The WHO officially named the new
disease caused by SARS-CoV-2 as “COVID-19”.
February 11
US Pres. Donald Trump called the Democratic Party’s criticism of his response to the new
coronavirus outbreak as “their new hoax.”
MARCH 2020
March 3
A total of 80,151 cases were confirmed in mainland China. Internationally, there were 10,566
additional cases reported in 72 countries.
March 5
The first case in the Philippines with no travel history abroad was confirmed—a 62-year-old
male who frequented a Muslim prayer hall in Greenhills, San Juan, Metro Manila.
March 7
The WHO registered 100,000 cases of COVID-19 around the world and advised all countries
and communities to “implement robust containment and control activities.” It notes that it took
three months to reach this “tragic milestone.” The Philippine Department of Health (DOH)
reported the first case of local transmission in the country after verifying with the Bureau of
Immigration that the identified patient had no recent travel history.
March 11
The COVID-19 outbreak was declared as a pandemic by the WHO.
March 12
President Rodrigo Duterte announced a partial lockdown of Metro Manila (16 cities and one
municipality) starting 12 midnight on 15 March. Land, domestic air, and domestic sea travel to
and from Metro Manila were suspended until 14 April 2020. Mass transportation within Metro
Manila continued to operate following social distancing guidelines.
March 13
The WHO announced Europe as the epicenter of the pandemic—with more reported cases and
deaths than the rest of the world combined, apart from China.
March 15
The Philippine government placed the National Capital Region (NCR) and the municipality of
Cainta, Rizal under “community quarantine” or partial lockdown that will last until 14 ApriI.
March 16
President Rodrigo Duterte declared a state of calamity in the Philippines and ordered that the
entire island of Luzon be placed under an enhanced community quarantine— a modified ver-
sion of a lockdown. The DOH confirmed reports of the first recovered Filipino COVID-19 case.
March 18
The WHO reported a total of 191,127 confirmed cases and 7,807 deaths around the world. A
hopeful milestone made news around the world: Chinese officials announced that they “have
seen a new dawn” as the country records a landmark of no new local infections. However, the
news was accompanied by an ominous report of 34 new foreign-introduced cases, signaling
that China could once again be threatened by a second wave of infection from foreigners
visiting the country.
March 19
COVID-19 cases in the Philippines surpassed the two-hundred mark with the DOH confirming
217 cases—8 recoveries, and 17 deaths. China recorded a second day of no new local infections.
March 20
WHO Director General Tedros Ghebreyesus reported another “tragic milestone”: more than
200,000 infected worldwide, including 9,000 deaths. It took three months to reach 100,000
cases and only 12 days to double that. Italy’s death toll from COVID-19 rose to 3,405, overtaking
the total number of disease-related deaths in China. The state of California orders a stay-at-
home order to all 40 million residents. China recorded a third day of no local infections.
March 21
The Philippines posted its biggest single-day increase of cases since the outbreak began in
January, with 77 new cases testing positive for COVID-19. The Department of Health tallied
the country’s total at 307 cases, with 13 recoveries and 19 deaths. The country meanwhile re-
ceived a second batch of donations from China including 100,000 testing kits. China recorded
a fourth day of no local infections.
March 22
An ominous milestone was reported when John Hopkins University announced that the global
pandemic topped 300,000, with over 13,000 fatalities all over the world. The US alone reported
more than 26,000 cases of infection, placing it as the fourth hardest hit country after China,
Italy, and Spain. Italy reported the highest yet recorded fatalities of 793 in a single day, with
Spain recording over 300 deaths, making Europe the epicenter of the pandemic. WHO stated
that more cases were being reported in Europe every day than were reported in China at the
height of its epidemic. Warning signs of an impending massive outbreak in the US were signalled
by 45 states shutting down schools, bars, and restaurants, and implementing social distancing
rules. The Philippines reported 73 new cases, bringing the total to 380 with 15 recoveries
and 25 deaths. China recorded a fifth day of almost no new local infections, except for one in
Guangdong. WHO also launched Solidarity, the world’s largest megatrial of four coronavirus
medical pharmeceutical interventions, which included an antiviral compound called remdesivir;
the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs,
lopinavir and ritonavir; and that same combination plus interferon-beta.March 23
The US CDC reported that SARS-CoV-2 can live up to 17 days on surfaces of contaminated
and non-contaminated cabins inside the Diamond Princess cruise ship after its passengers had
left. The Philippines hit 462 total COVID-19 cases, with a death toll of 33. In addition, 82 new
cases and 18 recoveries were reported.
March 24
US President Donald Trump signaled that the US will reopen for business by Easter Sunday,
which will be on April 12. He stated that “Easter’s a very special day for me... Wouldn’t it be
great to have all the churches full? You’ll have packed churches all over our country … I think
it’ll be a beautiful time.” This U-turn in American public health policy came as John Hopkins
University confirmed a fast ballooning number of 46,500 COVID-19 cases, including 590 deaths
in the US. China announced that it has no new local infections. However it reported 74 imported
73 COVID-19: A Timeline
cases. The Chinese government said it is lifting travel restriction in the first COVID-19 epicenter,
Hubei province, starting on April 8.
March 25
The world recorded another tragic milestone: 400,000 cases with 18,277 fatalities. In summary
it took 67 days to reach 100,000 infections, 11 days to reach 200,000, another four more days
to reach 300,000, and just two more days to reach this grim milestone. WHO predicted that
the US could soon become the new epicenter of COVID-19 with 49,519 cases and 813 deaths.
The 2020 Tokyo Olympics is postponed to a future date. China recorded zero local infections.
Philippine DOH reported a total of 636 cases, of which 38 are fatalities.
April 2
Global confirmed COVID-19 cases topped one million as per the statistics compiled of John
Hopkins Unveristy and Medicine,
April 3
Coronavirus-related deaths in the U.S. surpassed the 7,000 mark with US-wide infections
reaching 277,000, according to data from Johns Hopkins University.
April 5
Spain reported its third consecutive day of falling death counts. New York recorded 630 deaths,
a record high. Worldwide, more than 1.2 million cases of coronavirus have been reported, accord-
ing to John Hopkins University. The US registered the most confirmed infections at 312,1245.
Globally, Italy has suffered the most fatalities with 15,362, while Spain was second-worst hit with
12,418 deaths. The Philippines recorded 3,246 cases, with 152 fatalities., or a 4.6% fatality rate.
SOURCES
Local and international news reports from GMA Network, CNBC, Business Insider, MSN, Science
Mag, Rappler, CNN Philippines, Philippine Department of Health , US, European, and Philippine
Centers for Disease Control and Prevention, and World Health Organization.
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COVID-19 GLOSSARY
Airborne disease is any malaise that is caused by pathogens that can be transmitted
through the air by both small, dry particles and as larger liquid droplets.
Alert systems is a platform that delivers an alerting message to a small or large group
of people—anywhere, anytime, on any device or service, all at once. In that way,
emergency response administrators provide maximum protection for their people
while simultaneously minimizing any damage inflicted on a community’s assets.
Animal-human route of transmission also known as direct zoonosis, wherein the
disease is directly transmitted from other animals to humans through bites and
saliva (rabies) or through intermediate infection via other animals.
Asymptomatic carrier is a person or other organism that has become infected with
a pathogen but displays no signs or symptoms.
Biological weapon also called germ weapon, is any of a number of disease-producing
agents—such as bacteria, viruses, fungi, toxins, or other biological agents—that may
be utilized as weapons against humans, animals, or plants.
Code Blue Alert a.k.a. Alert Level 2, which is raised when an imported case of
COVID-19 infection is reported inside the country. The World Health Organization’s
declaration of Public Health Emergency of International Concern triggers Alert
Level 3, still under Code Blue. Under both alert levels, authorities are expected to
activate an inter-agency task force on emerging infectious disease. Government
guidelines for disease surveillance are established, along with testing setup for
the virus. Travel restrictions, home quarantine, and isolation of patients should be
imposed.
Code Red Alert a.k.a. Alert Level 4, which is raised when a local transmission is
reported, with a corresponding response. The inter-agency should include more
government agencies to expand its response to the spread of the infection. Selective
contact tracing will be done. Vulnerable and high-risk groups will be the priority for
testing and care. Authorities should intensify its awareness to minimize the fear,
anxiety, and unrest of the public.
Code White Alert a.k.a. Alert Level 1, which is raised when an identified case of in-
fection outside the country is confirmed. The Department of Foreign Affairs (DFA)
and embassies should start coordinating the monitoring of confirmed cases abroad,
75
surveillance at the points of entry, as well as the enforcement of Health Declaration

Checklist are expected to be strengthened.
Community quarantine a.k.a. Code Red Level 2, refers to efforts that limit the move-
ment of people going in and out of a city or area, to those working and traveling
to provide essential goods only. Stringent social distancing is implemented. Mass
gatherings are prohibited and select workers are allowed to travel to and from the
city, provided that they present valid proof of employment or a reasonable motive.
Community spread refers to people having been infected with the virus in an area,
including some who are not sure how or where they became infected.
Contact tracing in public health, contact tracing is the process of identification of
persons who may have come into contact with an infected person and subsequent
collection of further information about these contacts.
Contact transmission occurs when the respiratory secretions are transferred directly
through physical contact with an infected patient, (i.e., handshaking and touching)
or indirectly by exposure to intermediate surfaces or objects.
Containment is the isolation of infected cases and their potential contacts in an area
or city; this method aims to limit opportunities for exposure, and includes repeated
follow-ups of the isolated persons under investigation (PUIs) to ensure that no
further transmission occurs
Contamination is the presence of a constituent, impurity, or some other undesirable
element that spoils, corrupts, infects, makes unfit, or makes inferior a material,
physical body, natural environment, or workplace.
Coronavirus disease-2019 (COVID-2019) is an ailment caused by the Severe Acute
Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which is the seventh known
coronavirus to infect people worldwide. It is a “novel” virus, meaning it is a new
virus that had not been previously identified in humans. Previously called 2019-nCoV
Acute Respiratory Disease, COVID-19 is a contagious disease that causes flu-like
symptoms such as dry cough, fever, and shortness of breath, with some cases
progressing to pneumonia and multiple organ failure. Similar to other coronavirus
diseases like MERS and SARS, COVID-19 is transmitted between humans through
respiratory droplets, often produced during coughing and sneezing or through in-
direct transmission via touching contaminated surfaces. The symptoms generally
show between two and 14 days, with an average of five days, after the time a person
is exposed.
Coronaviruses are a family of viruses responsible for widely known respiratory dis-
eases that have caused an outbreak in recent years: the Severe Acute Respiratory
Syndrome (SARS), the Middle East Respiratory Syndrome (MERS), and the ongoing
Coronavirus Disease 2019 (COVID-19). These viruses can infect both people and
many different species of animals, including camels, cattle, cats, and bats. They can
cause a range of respiratory illnesses in humans, which range from the common
cold and the flu to lung lesions and pneumonia, resulting in symptoms like fever,
cough, and breathing difficulties.
Critical cases (of COVID-19) is a category given to patients that suffer from res-
piratory failure, septic shock or multiple organ dysfunction, mostly in the elderly
or vulnerable population.
Disinfection is a process that deliberately reduces the number of pathogenic micro-
organisms in water, air, and surfaces, to protect public health.
77 COVID-19 GLOSSARY
Droplet transmission occurs when the virus is transferred by the respiratory se-
cretions expelled by an infected individual onto the mucosal surfaces, such as the
mouth, eyes, and nose.
Enhanced community quarantine is a method of isolation where citizens are man-
dated to stay at home, while all modes of public transport are suspended. However,
provision for food and essential health services will be regulated, while the presence
of uniformed personnel to enforce quarantine procedures will be heightened. This
is the next level above general community quarantine.
Epidemic is the sudden increase in the cases of disease beyond what is normally
expected in the population of an area. If an epidemic becomes worldwide, then it is
characterized as a pandemic.
Extreme enhanced community quarantine the next level above enhanced community
quarantine. Specific areas identified as “hot zones” will be completely closed due to
the heightened quarantine. Under the measure, all residents within the quarantine
area are mandated to stay inside their homes. Entry to the areas is totally prohibited.
Face mask a material that you wear over your face, for example to prevent yourself
from breathing contaminated air or from spreading germs, or to protect your face
when you are in a dangerous situation.
Fatality rate in epidemiology, a case fatality rate (CFR) — sometimes called case
fatality risk or case fatality ratio — is the proportion of deaths from a certain disease
compared to the total number of people diagnosed with the disease for a certain
period of time.
Flattening the curve means slowing down the natural course of the disease, which
is to spread from an infected person to another. This can be achieved by isolating
cases as well as suspected patients, and preventing further spread of the virus
through community quarantine, social distancing, and city lockdowns to discourage
disease transmission. By doing so, governments and healthcare providers can be in
a position to provide better treatment for infected patients, with medical facilities
being equipped to handle cases. The lingo is derived from the curved shape of the
plotted number of infections over a period of time. A sharply rising curve indicates
a faster spread of infection, while a gently rising curve indicates a gradual rise of
infected cases over a longer period of time.
Frontliners is a term used to describe people who work on the front lines of an op-
eration, primarily in service roles. In the case of the COVID-19 situation, it refers to
medical and military personnel who are deployed to handle the crisis.
Hand hygiene refers to the protocol of washing hands thoroughly with soap and
water for at least 20 seconds, which is to be observed throughout the day. In the
absence of soap and water, an hand sanitizer with 70% alcohol content can be used.
High-risk more likely than others to get a particular disease, condition, or injury
Hot zone an area where at least three confirmed COVID-19 cases have been con-
firmed. People in hot zones will not be allowed to leave their homes while other
people will not be allowed entry into the marked area.
Human-to-human transmission refers to the method of transmitting infection from
one person to the next and then further onward — in the way that flu or other es-
tablished human viruses work. It can occur among clusters of people who are in
close contact with each other, such as in a family, religious, social, or a work setting.
Immune system a complex network of cells and proteins that defends the body
against infection. The immune system keeps a record of every germ (microbe) it
has ever defeated so it can recognize and destroy the microbe quickly if it enters
the body again.
Incubation period refers to the time in which a patient catches the COVID-19 virus
and the appearance of first symptoms, which is estimated to be in the average five
to six days. This is explained by the clinical phenomenon in which the virus repli-
cates inside the cells. At this stage, the immune system response occurs, but the
body fails to contain the virus.
Infection is the invasion of an organism’s body tissues by disease-causing agents,
their multiplication, and the reaction of host tissues to the infectious agents and
the toxins they produce. Infectious disease, also known as transmissible disease
or communicable disease, is illness resulting from an infection.
Isolation is the separation of an ill person from others in order to prevent the spread
of an infection or contamination. If a person has a travel history to a contaminated
area or was exposed to an infected person, and has symptoms of respiratory illness,
then the person will be isolated in a private room.
Local transmission a locally acquired case, by a person who, despite having no travel
history, was infected by the disease
Lockdown an emergency measure or condition in which people are temporarily
prevented from entering or leaving a restricted area or building (such as a school)
during a threat of danger.
Mild cases (of COVID-19) are characterized by mild symptoms of a cold or cough,
making COVID-19 virtually indistinguishable from the common cold or seasonal flu.
But for mild cases, the virus is likely “self-limiting” meaning that symptoms will go
away on their own, as with the flu and common cold. This leads to a dangerous situa-
tion where asymptomatic carriers may indeed be transmitting the virus unknowingly.
Mitigation refers to measures undertaken to lessen the gravity of a health emergency.
Non-pharmaceutical interventions (NPIs) are actions, apart from getting vaccinated
and taking medicine, that people and communities can take to help slow the spread
of illnesses like pandemic influenza (flu). NPIs are also known as community miti-
gation strategies. NPIs are among the best ways of controlling pandemic flu when
vaccines are not yet available.
N95 mask is an air-purifying respiratory mask that is effective against coronavirus
because of its sub-micron filter. It protects the nose and mouth by fully covering
these areas to prevent fluid penetration and particles that are less than 5 microns
in diameter.
Outbreak is the rise of the cases of disease concentrated within a certain geographic
location.
Pandemic refers to the worldwide spread of a new disease or an epidemic that affects
many countries and many people across the globe at the same time.
Pathogen is anything that can produce disease. A pathogen may also be referred to
as an infectious agent, or in common non-medical language as a germ.
Personal protective equipment (PPE) are specialized clothing or equipment worn
by a person for protection against infectious materials.
Pre-symptomatic relating to, being, or occurring before symptoms appear
Public Health Emergency of International Concern is a World Health Organization
category that characterizes a situation that can be regarded as a public health risk
to other nations that may require immediate international action.
PUM or Persons Under Investigation is used to characterize people who are under
monitoring for being at serious risk of spreading the COVID-19 disease.
79 COVID-19 GLOSSARY
PUI or Persons Under Investigation is used to characterize people who are under
investigation for having the virus that causes COVID-19.
Quarantine refers to the restriction of activities or separation of persons from those
who are not ill, but who may be exposed to an infectious agent or disease. Undergo-
ing quarantine, mandated or voluntary, does not mean that the persons are infected.
Self-Quarantine refers to a protocol of refraining from any contact with other indi-
viduals for a period of time (such as two weeks) during the outbreak of a contagious
disease by remaining in an isolated room and limiting contact with family members.
Individuals are typically asked by health officials to self-quarantine following known
contact with an infectious person or after returning from a region where cases of
the disease are widely reported.
Severe cases (of COVID-19) suffer from shortness of breath, low blood oxygen
saturation, or other respiratory problems.
Social distancing is a protocol of observing a minimum distance of 3 feet (1 meter)
between each person, which is undertaken to prevent transmission of viral patho-
gens. On a community level, it involves avoiding congregation in places with more
than ten people.
Susceptible in epidemiology a susceptible individual is a member of a population
who is at risk of becoming infected by a disease.
Sustained community transmission an increasing number of local cases whose links
cannot be established
Symptomatic serving as a symptom or sign; in the case of COVID-19, patients with
fever, cough, and shortness of breath acquired 2-14 days after exposure
Testing is a method of identifying if a suspected person has COVID-19. It is also done
to determine if a patient is cleared from the disease.
Testing kit is used for a medical diagnosis of COVID-19. Testing kits are known by
many brands, which have been certified by the World Health Organization. In the
Philippines, a team of experts from the University of the Philippines National In-
stitutes of Health received approval from the Food and Drug Administration (FDA)
for their COVID-19 Real-time Reverse Transcription Polymerase Chain Reaction
(rRT-PCR) detection kit, commercially known as GenAmplify.
Warm zones areas within a 500-meter radius of residences of COVID-19 infected
persons. These areas are strictly under surveillance and monitoring.
Vaccine is a biological preparation that provides active acquired immunity to a par-
ticular infectious disease.
Virus is an infective agent that typically consists of a nucleic acid molecule in a
protein coat and is able to multiply only within the living cells of a host.
Zoonotic refers to the propensity of transmitting pathogens from animals to humans.

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2 COVID-19 HANDBOOK OF CARE

UPDATED 5 APRIL 2020

Caring for family,

T HE GLOBAL PANDEMIC caused by the coronavirus disease called COV-

THE COVID-19 HANDBOOK OF CARE (UPDATED 5 APRIL 2020)

Published as a public service by Vibal Group, Inc.

T HE WORLD HAS NEVER BEFORE EXPERIENCED a pandemic developing on

The case study of China

National Bureau of Statistics on 16 March 2020. It reported a set of daunting year-on-

The spread in Asia

The pandemic in Europe

A surveillance report of the

has surpassed the combined fatalities of other coronavirus-related diseases such as

Medicinal treatment and pandering to false hope

or humidity of the environment.)4 When someone infected with coronavirus coughs,

A infographic depicting the

COUGH SNEEZES SPEAKS

Maintain a safe Avoid touching your Strengthen your immune

An infographic depicting the

Gastrointestinal Vomiting or nausea

humans. Many strains of coronaviruses commonly circulate in bats, specifically those

Signs and symptoms

Screening and testing for COVID-19

Persons who have Persons who have Persons who have

Quarantine versus isolation

PRODUCT NAME MANUFACTURER DISTRIBUTOR

• CT scan should not be used to screen for or as a first-line test to diagnose

1 “Personal protective equipment,” US OSHA.gov, accessed 5 April 2020, https://www.osha.gov/SLTC/

The proper use of PPE is extremely important to prevent incidences of transmission.

1. Put on PPE before patient contact in a sanitized room.

4 Farkas, Ibid; “Personal protective equipment.”

Basic protective measures against COVID-19 for the general public

Practice respiratory hygiene: Good respiratory hygiene must be observed everywhere,

Supportive care for patients on self-quarantine

10 Rabin, Ibid; “How to quarantine yourself.”

•  ravelers returning from locations abroad where community spread is ongoing, with

At risk of severe illness are:

Doing your part by helping flatten the epidemic curve

Mainland China Italy Iran Spain South Korea Germany

Figure 2 Epidemic 4000

February 2020 March 2020

Taiwan Hong Kong Singapore Philippines

Figure 4 Two epidemic

Number of active cases

Evolution of health state (compart_SIR)

Figure 6 Differently shaped

Preparing for living through an eventual Wuhan-style lockdown

Protocols for safe travel in possibly contaminated areas:

1. Before leaving, create a containment zone immediately by your exit door.

2. Leave fresh clothes, alcohol, or sanitizer in the containment zone.

3. Before leaving, wear a face mask and eye goggles or visor.

4. Take along a hand sanitizer or a spray bottle of 75% alcohol.

7. Sanitize immediately after coming into contact with surfaces.

10. Dispose of mask and gloves into a sealed garbage bag.

11. Wash hands with soap and water.

12. Change into fresh clothes or shower immediately.

15. Disinfect paper money or coins.

Effects of the pandemic: an economic overview

Figure 1. A graph reflecting

Equity markets take a nosedive amid COVID-19 fears

Figure 2. A graph Airlines most at risk from EU travel ban

Note: EU restrictions envisage some skeleton

discarding their austerity programs in favor of generous infusions of their stimulus

• ravelers returning from locations abroad where community spread is ongoing, with