research proposal about covid 19 in the philippines

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

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

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

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

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

Trial registration number NCT04386083 .

• adult neurology
• epidemiology

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

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

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Strengths and limitations of this study

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

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

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

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

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

Introduction

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

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

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

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

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

Scope, limitations and delimitations

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

Methodology

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

Study design

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

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Schematic diagram of the study flow.

Study sites and duration

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

Location of 37 study sites of the Philippine CORONA study.

Patient selection and cohort description

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

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

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

Sample size calculation

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

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

Data collection

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

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

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Data to be collected in this study

Main outcomes considered

The following patient outcomes will be considered for this study:

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

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

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

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

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

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

Data analysis plan

Statistical analysis will be performed using Stata V.7.2.2.16.

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

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

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

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

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

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

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

Study organisational structure

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

Organisational structure of oversight of the Philippine CORONA Study.

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

Ethics and dissemination

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

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

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

Protocol registration and technical review approval

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

Acknowledgments

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

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VMMA and RDGJ are joint senior authors.

AIE and MCCS are joint first authors.

Twitter @neuroaidz, @JamoraRoland

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

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

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

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

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

Competing interests None declared.

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

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Published: 30 March 2022

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

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

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

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

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Introduction.

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

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

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

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

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

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

The Philippine science advice ecosystem

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

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

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

DRRM as a framework for government science advice in the Philippines

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

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

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

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

IATF-EID and OCTA Research as an independent science advisor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prospects for independent government science advice in the Philippines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Acknowledgements

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

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

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Psychological impact of COVID-19 pandemic in the Philippines

Affiliations.

• 1 Department of Physiology, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines; Philippine One Health University Network. Electronic address: [email protected].
• 2 Department of Pediatrics, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines. Electronic address: [email protected].
• 3 Department of Psychiatry and Behavioral Medicine, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines.
• 4 School of Statistics, University of the Philippines Diliman, Philippines.
• 5 South East Asia One Health University Network. Electronic address: [email protected].
• 6 Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge 119228, Singapore. Electronic address: [email protected].
• PMID: 32861839
• PMCID: PMC7444468
• DOI: 10.1016/j.jad.2020.08.043

Background: The 2019 coronavirus disease (COVID-19) pandemic poses a threat to societies' mental health. This study examined the prevalence of psychiatric symptoms and identified the factors contributing to psychological impact in the Philippines.

Methods: A total of 1879 completed online surveys were gathered from March 28-April 12, 2020. Collected data included socio-demographics, health status, contact history, COVID-19 knowledge and concerns, precautionary measures, information needs, the Depression, Anxiety and Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) ratings.

Results: The IES-R mean score was 19.57 (SD=13.12) while the DASS-21 mean score was 25.94 (SD=20.59). In total, 16.3% of respondents rated the psychological impact of the outbreak as moderate-to-severe; 16.9% reported moderate-to-severe depressive symptoms; 28.8% had moderate-to-severe anxiety levels; and 13.4% had moderate-to-severe stress levels. Female gender; youth age; single status; students; specific symptoms; recent imposed quarantine; prolonged home-stay; and reports of poor health status, unnecessary worry, concerns for family members, and discrimination were significantly associated with greater psychological impact of the pandemic and higher levels of stress, anxiety and depression (p<0.05). Adequate health information, having grown-up children, perception of good health status and confidence in doctors' abilities were significantly associated with lesser psychological impact of the pandemic and lower levels of stress, anxiety and depression (p<0.05).

Limitations: An English online survey was used.

Conclusion: During the early phase of the pandemic in the Philippines, one-fourth of respondents reported moderate-to-severe anxiety and one-sixth reported moderate-to-severe depression and psychological impact. The factors identified can be used to devise effective psychological support strategies.

Keywords: Anxiety; COVID-19; Depression; Philippines; Psychological impact; Stress.

Copyright © 2020 Elsevier Ltd. All rights reserved.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

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ORIGINAL RESEARCH article

Impact of the covid-19 pandemic on physical and mental health in lower and upper middle-income asian countries: a comparison between the philippines and china.

• 1 College of Medicine, University of the Philippines Manila, Manila, Philippines
• 2 Faculty of Education, Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei, China
• 3 Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
• 4 Southeast Asia One Health University Network, Chiang Mai, Thailand
• 5 Department of Psychological Medicine, National University Health System, Singapore, Singapore
• 6 Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore

Objective: The differences between the physical and mental health of people living in a lower-middle-income country (LMIC) and upper-middle-income country (UMIC) during the COVID-19 pandemic was unknown. This study aimed to compare the levels of psychological impact and mental health between people from the Philippines (LMIC) and China (UMIC) and correlate mental health parameters with variables relating to physical symptoms and knowledge about COVID-19.

Methods: The survey collected information on demographic data, physical symptoms, contact history, and knowledge about COVID-19. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21).

Findings: The study population included 849 participants from 71 cities in the Philippines and 861 participants from 159 cities in China. Filipino (LMIC) respondents reported significantly higher levels of depression, anxiety, and stress than Chinese (UMIC) during the COVID-19 ( p < 0.01) while only Chinese respondents' IES-R scores were above the cut-off for PTSD symptoms. Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection ( p < 0.05), recent use of but with lower confidence on medical services ( p < 0.01), recent direct and indirect contact with COVID ( p < 0.01), concerns about family members contracting COVID-19 ( p < 0.001), dissatisfaction with health information ( p < 0.001). In contrast, Chinese respondents requested more health information about COVID-19. For the Philippines, student status, low confidence in doctors, dissatisfaction with health information, long daily duration spent on health information, worries about family members contracting COVID-19, ostracization, and unnecessary worries about COVID-19 were associated with adverse mental health. Physical symptoms and poor self-rated health were associated with adverse mental health in both countries ( p < 0.05).

Conclusion: The findings of this study suggest the need for widely available COVID-19 testing in MIC to alleviate the adverse mental health in people who present with symptoms. A health education and literacy campaign is required in the Philippines to enhance the satisfaction of health information.

Introduction

The World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) to be a Public Health Emergency of International Concern on January 30 ( 1 ) and a pandemic on March 11, 2020 ( 2 ). COVID-19 predominantly presents with respiratory symptoms (cough, sneezing, and sore throat), along with fever, fatigue and myalgia. It is thought to spread through droplets, contaminated surfaces, and asymptomatic individuals ( 3 ). By the end of April, over 3 million people have been infected globally ( 4 ).

The first country to identify the novel virus as the cause of the pandemic was China. The authorities responded with unprecedented restrictions on movement. The response included stopping public transport before Chinese New Year, an annual event that sees workers' mass emigration to their hometowns, and a lockdown of whole cities and regions ( 1 ). Two new hospitals specifically designed for COVID-19 patients were rapidly built in Wuhan. Such measures help slow the transmission of COVID-19 in China. As of May 2, there are 83,959 confirmed cases and 4,637 deaths from the virus in China ( 4 ). The Philippines was also affected early by the current crisis. The first case was suspected on January 22, and the country reported the first death from COVID-19 outside of mainland China ( 5 ). Similar to China, the Philippines implemented lockdowns in Manila. Other measures included the closure of schools and allowing arrests for non-compliance with measures ( 6 ). At the beginning of May, the Philippines recorded 8,772 cases and 579 deaths ( 4 ).

China was one of the more severely affected countries in Asia in the early stage of pandemic ( 7 ) while the Philippines is still experiencing an upward trend in the COVID-19 cases ( 6 ). The gross national income (GNI) per capita of the Philippines and China are USD 3,830 and 9,460, respectively, were classified with lower (LMIC) and upper-middle-income countries (UMIC) by the Worldbank ( 8 ). During the COVID-19 pandemic, five high-income countries (HIC), including the United States, Italy, the United Kingdom, Spain, and France, account for 70% of global deaths ( 9 ). The HIC faced the following challenges: (1) the lack of personal protection equipment (PPE) for healthcare workers; (2) the delay in response strategy; (3) an overstretched healthcare system with the shortage of hospital beds, and (4) a large number of death cases from nursing homes ( 10 ). The COVID-19 crisis threatens to hit lower and middle-income countries due to lockdown excessively and economic recession ( 11 ). A systematic review on mental health in LMIC in Asia and Africa found that LMIC: (1) do not have enough mental health professionals; (2) the negative economic impact led to an exacerbation of mental issues; (3) there was a scarcity of COVID-19 related mental health research in Asian LMIC ( 12 ). This systematic review could not compare participants from different middle-income countries because each study used different questionnaires. During the previous Severe Acute Respiratory Syndrome (SARS) epidemic, the promotion of protective personal health practices to reduce transmission of the SARS virus was found to reduce the anxiety levels in the community ( 13 ).

Before COVID-19, previous studies found that stress might be a modifiable risk factor for depression in LMICs ( 14 ) and UMICs ( 15 – 17 ). Another study involving thirty countries found that unmodifiable risk factors for depression included female gender, and depression became more common in 2004 to 2014 compared to previous periods ( 18 ). Further, there were cultural differences in terms of patient-doctor relationship and attitudes toward healthcare systems before the COVID-19 pandemic. In China, <20% of the general public and medical professionals view the doctor and patient relationship as harmonious ( 19 ). In contrast, Filipino seemed to have more trust and be compliant to doctors' recommendations ( 20 ). Patient satisfaction was more important than hospital quality improvement to maintain patient loyalty to the Chinese healthcare system ( 21 ). For Filipinos, improvement in the quality of healthcare service was found to improve patients' satisfaction ( 22 ).

Based on the above studies, we have the following research questions: (1) whether COVID-19 pandemic could be an important stressor and risk factor for depression for the people living in LMIC and UMIC ( 23 ), (2) Are physical symptoms that resemble COVID-19 infection and other concerns be risk factors for adverse mental health? (3) Are knowledge of COVID-19 and health information protective factors for mental health? (4) Would there be any cultural differences in attitudes toward doctors and healthcare systems during the pandemic between China and the Philippines? We hypothesized that UMIC (China) would have better physical and mental health than LMIC (the Philippines). The aims of this study were (a) to compare the physical and mental health between citizens from an LMIC (the Philippines) and UMIC (China); (b) to correlate psychological impact, depression, anxiety, and stress scores with variables relating to physical symptoms, knowledge, and concerns about COVID-19 in people living in the Philippines (LMIC) and China (UMIC).

Study Design and Study Population

We conducted a cross-cultural and quantitative study to compare Filipinos' physical and mental health with Chinese during the COVID-19 pandemic. The study was conducted from February 28 to March 1 in China and March 28 to April 7, 2020 in the Philippines, when the number of COVID-19 daily reported cases increased in both countries. The Chinese participants were recruited from 159 cities and 27 provinces. The Filipino participants, on the other hand, were recruited from 71 cities and 40 provinces representing the Luzon, Visayas, and Mindanao archipelago. A respondent-driven recruitment strategy was utilized in both countries. The recruitment started with a set of initial respondents who were associated with the Huaibei Normal University of China and the University of the Philippines Manila; who referred other participants by email and social network; these in turn refer other participants across different cities in China and the Philippines.

As both Chinese and Filipino governments recommended that the public minimize face-to-face interaction and isolate themselves during the study period, new respondents were electronically invited by existing study respondents. The respondents completed the questionnaires through an online survey platform (“SurveyStar,” Changsha Ranxing Science and Technology in China and Survey Monkey Online Survey in the Philippines). The Institutional Review Board of the University of Philippines Manila Research Ethics Board (UPMREB 2020-198-01) and Huaibei Normal University (China) approved the research proposal (HBU-IRB-2020-002). All respondents provided informed or implied consent. The collected data were anonymous and treated as confidential.

This study used the National University of Singapore COVID-19 questionnaire, and its psychometric properties had been established in the initial phase of the COVID-19 epidemic ( 24 ). The National University of Singapore COVID-19 questionnaire consisted of questions that covered several areas: (1) demographic data; (2) physical symptoms related to COVID-19 in the past 14 days; (3) contact history with COVID-19 in the past 14 days; and (4) knowledge and concerns about COVID-19.

Demographic data about age, gender, education, household size, marital status, parental status, and residential city in the past 14 days were collected. Physical symptoms related to COVID-19 included breathing difficulty, chills, coryza, cough, dizziness, fever, headache, myalgia, sore throat, nausea, vomiting, and diarrhea. Respondents also rated their physical health status and stated their history of chronic medical illness. In the past 14 days, health service utilization variables included consultation with a doctor in the clinic, being quarantined by the health authority, recent testing for COVID-19 and medical insurance coverage. Knowledge and concerns related to COVID-19 included knowledge about the routes of transmission, level of confidence in diagnosis, source, and level of satisfaction of health information about COVID-19, the likelihood of contracting and surviving COVID-19 and the number of hours spent on viewing information about COVID-19 per day.

The psychological impact of COVID-19 was measured using the Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered questionnaire that has been well-validated in the European and Asian population for determining the extent of psychological impact after exposure to a traumatic event (i.e., the COVID-19 pandemic) within one week of exposure ( 25 , 26 ). This 22-item questionnaire, composed of three subscales, aims to measure the mean avoidance, intrusion, and hyperarousal ( 27 ). The total IES-R score is divided into 0–23 (normal), 24–32 (mild psychological impact), 33–36 (moderate psychological impact) and >37 (severe psychological impact) ( 28 ). The total IES-R score > 24 suggests the presence of post-traumatic stress disorder (PTSD) symptoms ( 29 ).

The respondents' mental health status was measured using the Depression, Anxiety, and Stress Scale (DASS-21) and the calculation of scores was based on a previous Asian study ( 30 ). DASS has been demonstrated to be a reliable and valid measure in assessing mental health in Filipinos ( 31 – 33 ) and Chinese ( 34 , 35 ). IES-R and DASS-21 were previously used in research related to the COVID-19 epidemic ( 26 , 36 – 38 ).

Statistical Analysis

Descriptive statistics were calculated for demographic characteristics, physical symptom, and health service utilization variables, contact history variables, knowledge and concern variables, precautionary measure variables, and additional health information variables. To analyze the differences in the levels of psychological impact, levels of depression, anxiety and stress, the independent sample t -test was used to compare the mean score between the Filipino (LMIC) and Chinese (UMIC) respondents. The chi-squared test was used to analyze the differences in categorical variables between the two samples. We used linear regressions to calculate the univariate associations between independent and dependent variables, including the IES-S score and DASS stress, anxiety, and depression subscale scores for the Filipino and Chinese respondents separately with adjustment for age, marital status, and education levels. All tests were two-tailed, with a significance level of p < 0.05. Statistical analysis was performed on SPSS Statistic 21.0.

Demographic Characteristics and Their Association With Psychological Impact and Adverse Mental Health Status

We received 849 responses from the Philippines and 861 responses from China for 1,710 individual respondents from both countries. The majority of Filipino respondents were women (71.0%), age between 22 and 30 years (26.6%), having a household size of 3–5 people (53.4%), high educational attainment (91.4% with a bachelor or higher degree), and married (68.9%). Similarly, the majority of Chinese respondents were women (75%), having a household size of 3–5 people (80.4%) and high educational attainment (91.4% with a bachelor or higher degree). There was a significantly higher proportion of Chinese respondents who had children younger than 16 years ( p < 0.001) and student status ( p < 0.001; See Table 1 ).

Table 1 . Comparison of demographic characteristics between Filipino (LMIC) and Chinese (UMIC) respondents ( N = 1,710).

For Filipino respondents, the male gender and having a child were protective factors significantly associated with the lower score of IES-R ( p < 0.05) and depression ( p < 0.001), respectively. Single status was significantly associated with depression ( p < 0.05), and student status was associated with higher IES-R, stress and depression scores ( p < 0.01) (see Table 2 ). For Chinese respondents, the male gender was significantly associated with a lower score of IES-R but higher DASS depression scores ( p < 0.01). Notwithstanding, there were other differences between Filipino and China respondents. Chinese respondents who stayed in a household with 3–5 people ( p < 0.05) and more than 6 people ( p < 0.05) were significantly associated with a higher score of IES-R as compared to respondents who stayed alone.

Table 2 . Comparison of the association between demographic variables and the psychological impact as well as adverse mental health status between Filipino (LMIC) and Chinese (UMIC) respondents ( n = 1,710).

Comparison Between the Filipino (LMIC) and Chinese (UMIC) Respondents and Their Mental Health Status

Figure 1 compares the mean scores of DASS-stress, anxiety, and depression subscales and IES-R scores between the Filipino and Chinese respondents. For the DASS-stress subscale, Filipino respondents reported significantly higher stress ( p < 0.001), anxiety ( p < 0.01), and depression ( p < 0.01) than Chinese (UMIC). For IES-R, Filipino (LMIC) had significantly lower scores than Chinese ( p < 0.001). The mean IES-R scores of Chinese were higher than 24 points, indicating the presence of PTSD symptoms in Chinese respondents only.

Figure 1 . Comparison of the mean scores of DASS-stress, anxiety and depression subscales, and IES-R scores between Filipino and Chinese respondents.

Physical Symptoms, Health Status, and Its Association With Psychological Impact and Adverse Mental Health Status

There were significant differences between Filipino (LMIC) and Chinese (UMIC) respondents regarding physical symptoms resembling COVID-19 and health status. There was a significantly higher proportion of Filipino respondents who reported headache ( p < 0.001), myalgia ( p < 0.001), cough ( p < 0.001), breathing difficulty ( p < 0.001), dizziness ( p < 0.05), coryza ( p < 0.001), sore throat ( p < 0.001), nausea and vomiting ( p < 0.001), recent consultation with a doctor ( p < 0.01), recent hospitalization ( p < 0.001), chronic illness ( p < 0.001), direct ( p < 0.001), and indirect ( p < 0.001) contact with a confirmed diagnosis of COVID-19 as compared to Chinese (see Supplementary Table 1 ). Significantly more Chinese respondents were under quarantine ( p < 0.001).

Linear regression showed that headache, myalgia, cough, dizziness, coryza as well as poor self-rated physical health were significantly associated with higher IES-R scores, DASS-21 stress, anxiety, and depression subscale scores in both countries after adjustment for confounding factors ( p < 0.05; see Table 3 ). Furthermore, breathing difficulty, sore throat, and gastrointestinal symptoms were significantly associated with higher DASS-21 stress, anxiety and depression subscale scores in both countries ( p < 0.05). Chills were significantly associated with higher DASS-21 stress and depression scores ( p < 0.01) in both countries. Recent quarantine was associated with higher DASS-21 subscale scores in Chinese respondents only ( p < 0.05).

Table 3 . Association between physical health status and contact history and the perceived impact of COVID-19 outbreak as well as adverse mental health status during the epidemic after adjustment for age, gender, and marital status ( n = 1,710).

Perception, Knowledge, and Concerns About COVID-19 and Its Association With Psychological Impact and Adverse Mental Health Status

Filipino (LMIC) and Chinese (UMIC) respondents held significantly different perceptions in terms of knowledge and concerns related to COVID-19 (see Supplementary Table 2 ). For the routes of transmission, there were significantly more Filipino respondents who agreed that droplets transmitted the COVID-19 ( p < 0.001) and contact via contaminated objects ( p < 0.001), but significantly more Chinese agreed with the airborne transmission ( p < 0.001). For the detection and risk of contracting COVID-19, there were significantly more Filipino who were not confident about their doctor's ability to diagnose COVID-19 ( p < 0.001). There were significantly more Filipino respondents who were worried about their family members contracting COVID-19 ( p < 0.001). For health information, there were significantly more Filipino who were unsatisfied with the amount of health information ( p < 0.001) and spent more than three hours per day on the news related to COVID-19 ( p < 0.001). There were significantly more Chinese respondents who felt ostracized by other countries ( p < 0.001).

Linear regression analysis after adjustment of confounding factors showed that the Filipino and Chinese respondents showed different findings (see Table 4 ). Chinese respondents who reported a very low perceived likelihood of contracting COVID-19 were significantly associated with lower DASS depression scores ( p < 0.05). There were similarities between the two countries. Filipino and Chinese respondents who perceived a very high likelihood of survival were significantly associated with lower DASS-21 depression scores ( p < 0.05). Regarding the level of confidence in the doctor's ability to diagnose COVID-19, both Filipino and Chinese respondents who were very confident in their doctors were significantly associated with lower DASS-21 depression scores ( p < 0.01). Filipino and Chinese respondents who were satisfied with health information were significantly associated with lower DASS-21 anxiety and depression scores ( p < 0.01). Chinese and Filipino respondents who were worried about their family members contracting COVID-19 were associated with higher IES-R and DASS-21 subscale scores ( p < 0.05). In contrast, only Filipino respondents who spent <1 h per day monitoring COVID-19 information was significantly associated with lower IES-R and DASS-21 stress and anxiety scores ( p < 0.05). Filipino respondents who felt ostracized were associated with higher IES-R and stress scores ( p < 0.05).

Table 4 . Comparison of association of knowledge and concerns related to COVID-19 with mental health status after adjustment for age, gender, and marital status ( N = 1,710).

Health Information About COVID-19 and Its Association With Psychological Impact and Adverse Mental Health Status

Filipino (LMIC) and Chinese (UMIC) respondents held significantly different views on the information required about COVID-19. There were significantly more Chinese respondents who needed information on the symptoms related to COVID-19, prevention methods, management and treatment methods, regular information updates, more personalized information, the effectiveness of drugs and vaccines, number of infected by geographical locations, travel advice and transmission methods as compared to Filipino ( p < 0.01; See Supplementary Table 3 ). In contrast, there were significantly more Filipino respondents who needed information on other countries' strategies and responses than Chinese ( p < 0.001).

Information on management methods and transmission methods were significantly associated with higher IES-R scores in Chinese respondents ( p < 0.05; see Table 5 ). Travel advice, local transmission data, and other countries' responses were significantly associated with lower DASS-21 stress and depression scores in Chinese respondents only ( p < 0.05). There was only one significant association observed in Filipino respondents; information on transmission methods was significantly associated with lower DASS-21 depression scores ( p < 0.05).

Table 5 . Comparison of the association between information needs about COVID-19 and the psychological impact as well as adverse mental health status between Filipino (LMIC) and Chinese (UMIC) participants after adjustment for age, gender, and marital status ( N = 1,710).

To our best knowledge, this is the first study that compared the physical and mental health as well as knowledge, attitude and belief about COVID-19 between citizens from an LMIC (The Philippines) and UMIC (China). Filipino respondents reported significantly higher levels of depression, anxiety and stress than Chinese during the COVID-19, but only the mean IES-R scores of Chinese respondents were above the cut-off scores for PTSD symptoms. Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection, recent use of medical services with lower confidence, recent direct, and indirect contact with COVID, concerns about family members contracting COVID-19 and dissatisfaction with health information. In contrast, Chinese respondents requested more health information about COVID-19 and were more likely to stay at home for more than 20–24 h per day. For the Filipino, student status, low confidence in doctors, unsatisfaction of health information, long hours spent on health information, worries about family members contracting COVID-19, ostracization, unnecessary worries about COVID-19 were associated with adverse mental health.

The most important implication of the present study is to understand the challenges faced by a sample of people from an LMIC (The Philippines) compared to a sample of people from a UMIC (China) in Asia. As physical symptoms resembling COVID-19 infection (e.g., headache, myalgia, dizziness, and coryza) were associated with adverse mental health in both countries, this association could be due to lack of confidence in healthcare system and lack of testing for coronavirus. Previous research demonstrated that adverse mental health such as depression could affect the immune system and lead to physical symptoms such as malaise and other somatic symptoms ( 39 , 40 ). Based on our findings, the strategic approach to safeguard physical and mental health for middle-income countries would be cost-effective and widely available testing for people present with COVID-19 symptoms, providing a high quality of health information about COVID-19 by health authorities.

Students were afraid that confinement and learning online would hinder their progress in their studies ( 41 ). This may explain why students from the Philippines reported higher levels of IES-R and depression scores. Schools and colleges should evaluate the blended implementation of online and face-to-face learning to optimize educational outcomes when local spread is under control. As a significantly higher proportion of Filipino respondents lack confidence in their doctors, health authorities should ensure adequate training and develop hospital facilities to isolate COVID-19 cases and prevent COVID-19 spread among healthcare workers and patients ( 42 ). Besides, our study found that Filipino respondents were dissatisfied with health information. In contrast, Chinese respondents demanded more health information related to COVID-19. The difference could be due to stronger public health campaign launched by the Chinese government including national health education campaigns, a health QR (Quick Response) code system and community engagement that effectively curtailed the spread of COVID-19 ( 43 ). The high expectation for health information could be explained by high education attainment of participants as about 91.4 and 87.6% of participants from China and the Philippines have a university education.

Furthermore, the governments must employ communication experts to craft information, education, and messaging materials that are target-appropriate to each level of understanding in the community. That the Chinese Government rapidly deployed medical personnel and treated COVID-19 patients at rapidly-built hospitals ( 44 ) is in itself a confidence-building measure. Nevertheless, recent quarantine was associated with higher DASS-21 subscale scores in Chinese respondents only. It could be due to stricter control and monitoring of movements imposed by the Chinese government during the lockdown ( 45 ). Chinese respondents who stayed with more than three family members were associated with higher IES-R scores. The high IES-R scores could be due to worries of the spread of COVID-19 to family members and overcrowded home environment during the lockdown. The Philippines also converted sports arena into quarantine/isolation areas for COVID-19 patients with mild symptoms. These prompt actions helped restore public confidence in the healthcare system ( 46 ). A recent study reported that cultural factors, demand pressure for information, the ease of information dissemination via social networks, marketing incentives, and the poor legal regulation of online contents are the main reasons for misinformation dissemination during the COVID-19 pandemic ( 47 ). Bastani and Bahrami ( 47 ) recommended the engagement of health professionals and authorities on social media during the pandemic and the improvement of public health literacy to counteract misinformation.

Chinese respondents were more likely to feel ostracized and Filipino respondents associated ostracization with adverse mental health. Recently, the editor-in-chief of The Lancet , Richard Horton, expressed concern of discrimination of a country or particular ethnic group, saying that while it is important to understand the origin and inter-species transmission of the coronavirus, it was both unhelpful and unscientific to point to a country as the origin of the Covid-19 pandemic, as such accusation could be highly stigmatizing and discriminatory ( 48 ). The global co-operation involves an exchange of expertise, adopting effective prevention strategies, sharing resources, and technologies among UMIC and LIMC to form a united front on tackling the COVID-19 pandemic remains a work in progress.

Strengths and Limitations

The main strength of this study lay in the fact that we performed in-depth analysis and studied the relationship between physical and mental outcomes and other variables related to COVID-19 in the Philippines and China. However, there are several limitations to be considered when interpreting the results. Although the Philippines is a LMIC and China is a UMIC, the findings cannot be generalized to other LIMCs and UMICs. Another limitation was the potential risk of sampling bias. This bias could be due to the online administration of questionnaires, and the majority of respondents from both countries were respondents with good educational attainment and internet access. We could not reach out to potential respondents without internet access (e.g., those who stayed in the countryside or remote areas). Further, our findings may not be generalizable to other middle-income countries.

During the COVID-19 pandemic, Filipinos (LMIC) respondents reported significantly higher levels of depression, anxiety and stress than Chinese (UMIC). Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection, recent use of medical services with lower confidence, recent direct and indirect contact with COVID, concerns about family members contracting COVID-19 and dissatisfaction with health information than Chinese. For the current COVID-19 and future pandemic, Middle income countries need to adopt the strategic approach to safeguard physical and mental health by establishing cost-effective and widely available testing for people who present with COVID-19 symptoms; provision of high quality and accurate health information about COVID-19 by health authorities. Our findings urge middle income countries to prevent ostracization of a particular ethnic group, learn from each other, and unite to address the challenge of the COVID-19 pandemic and safeguard physical and mental health.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

Ethical review and approval was required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. The Institutional Review Board of the University of Philippines Manila Research Ethics Board (UPMREB 2020- 198-01) and Huaibei Normal University (China) approved the research proposal (HBU-IRB-2020-002).

Author Contributions

Concept and design: CW, MT, CT, RP, VK, and RH. Acquisition, analysis, and interpretation of data: CW, MT, CT, RP, LX, CHa, XW, YT, and VK. Drafting of the manuscript: CW, MT, CT, RH, and JA. Critical revision of the manuscript: MT, CT, CHo, and JA. Statistical analysis: CW, PR, RP, LX, XW, and YT. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2020.568929/full#supplementary-material

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Keywords: anxiety, China, COVID-19, depression, middle-income, knowledge, precaution, Philippines

Citation: Tee M, Wang C, Tee C, Pan R, Reyes PW, Wan X, Anlacan J, Tan Y, Xu L, Harijanto C, Kuruchittham V, Ho C and Ho R (2021) Impact of the COVID-19 Pandemic on Physical and Mental Health in Lower and Upper Middle-Income Asian Countries: A Comparison Between the Philippines and China. Front. Psychiatry 11:568929. doi: 10.3389/fpsyt.2020.568929

Received: 02 June 2020; Accepted: 22 December 2020; Published: 09 February 2021.

Reviewed by:

Copyright © 2021 Tee, Wang, Tee, Pan, Reyes, Wan, Anlacan, Tan, Xu, Harijanto, Kuruchittham, Ho and Ho. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Cuiyan Wang, wcy@chnu.edu.cn

† These authors share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Modeling COVID-19 cases using NB-INGARCH and ARIMA models: : A case study in Iligan City, Philippines

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Fighting COVID-19 in the Philippines

8 ways usaid reachhealth supports pandemic response.

As COVID-19 swept the world in 2020, the Philippines became Southeast Asia’s most affected country.

RTI International has been supporting the COVID-19 response in the Philippines through ReachHealth , a five-year United States Agency for International Development (USAID) project that strengthens and improves access to family planning and maternal and child health services.

Building on 14 years of RTI experience working with local governments in the Philippines to improve health outcomes, the USAID ReachHealth Project supports the COVID-19 response in 15 priority local government units across the country. Working closely with the Department of Health (DOH), the Department of Interior and Local Governance, UN agencies, the private sector, and civil society organizations, we strengthen the government’s emergency and ongoing response at all levels.

Our support has included operationalizing nationwide COVID-19 policies, rolling out vaccines, helping facilities access national COVID-19 financing and testing kits, strengthening the capacities of health workers on infection prevention and control and case management, improving contact tracing, and supporting risk communication and community engagement efforts. Most recently, ReachHealth has helped the country prepare for the roll out of child vaccines and the safe reopening of in-person schools.

Since ReachHealth began supporting the Philippines' pandemic response, we have trained over 20,000 people and reached nearly 37 million people with messages on preventing gender-based violence and COVID-19’s spread.

Here are eight of the important ways we have and continue to respond to COVID-19 in the Philippines:

1. Strengthening community health and support systems

Barangay Health Emergency Response Teams, or BHERTs, usually connect community members to health facilities — but during times of emergency their work becomes more important than ever. These neighborhood-based teams formed the frontline of efforts to delay COVID-19’s spread and locally contain the pandemic by communicating risk, facilitating contact tracing and vaccination, and connecting communities with broader local health systems. ReachHealth works to ensure BHERTs in hotspot communities are active, effective, and trained on critical elements of the COVID-19 community response, including essential behaviors to prevent the virus’ spread, infection prevention and control, vaccination and testing protocols, contact tracing, and quarantine and isolation. ReachHealth has helped train over 7,800 people on contact tracing and rapid response so far.

2. Increasing vaccine coverage

In 2021, ReachHealth collaborated with the DOH and local actors to plan for vaccine rollouts. We developed public messaging for local governments to spread the word, updated FAQs for community health responders like BHERTs, and supported health facility planning and preparation. Once vaccines were available, ReachHealth also helped speed up the roll out by deploying 28 mobile vaccine teams across the country to ensure even the most remote communities got access. ReachHealth has established or supported over 200 vaccination sites in the Philippines. More than 2.8 million Filipinos have been fully vaccinated with ReachHealth’s support.

Grace Jose receives a COVID vaccine at a vaccination site in Caloocan City. Photo by Christian Rieza/USAID ReachHealth

3. Strengthening health and testing facilities

Throughout the pandemic, the science on COVID-19 and how to address it has evolved. To help health facilities keep up, ReachHealth provided training to over 5,000 people on case management and over 3,000 people on infection prevention and control. We also partnered with local governments to establish 10 additional mobile testing units and four community testing centers in vulnerable areas. As COVID-19 testing increased, so did the demand for accredited labs that could process tests quickly. By providing support , ReachHealth helped increase the number of accredited labs across the country and reduced testing times to just a few hours in eight labs in Mindanao and Luzon. 

Vilma Cabral gets tested for COVID-19 at a USAID-supported community-based testing center in the Philippines. Photo by Rosana Ombao for USAID

4. Supporting a data-driven response

The DOH collaborated with the World Health Organization to launch a mobile application, COVID KAYA , that supports frontline responders with contact tracing and case monitoring. The introduction of any new, centralized data system across regions with varying needs and infrastructure can be challenging and uneven. Our team provided technical assistance to help local governments roll out the application, and directly trained officials, health workers, and personnel from health epidemiology units on its use.

5. Addressing gender-based violence

In the Philippines, 1 in 20 women and girls aged 15-49 have experienced sexual violence. COVID-19 lockdowns and quarantines brought extended periods of restricted movement and home confinement for millions of people — an unprecedented situation that worsened violence against women and children at home. ReachHealth supported the continued functioning of gender-based violence (GBV) services, such as a 24-hour helpline, while a messaging campaign, Hindi kailangang magtiis! (You don’t need to suffer in silence!), sought to prevent GBV and to let people know about available services. Since October 2020, this campaign has reached over 9 million Filipinos on Facebook alone.

6. Distributing essential equipment and supplies

Frontline health workers needed personal protective equipment (PPE) to care for their patients safely. In partnership with the Armed Forces of the Philippines, ReachHealth supported the distribution of PPE donated by the US Defense Threat Reduction Agency to 109 hospitals, rural health units, and quarantine facilities in vulnerable areas across the country. We also partnered with Proctor & Gamble to distribute more than 700,000 face masks. ReachHealth is now providing PPE and communication materials to local schools to aid in the safe reopening of in-person classes.

Boxes of personal protective equipment destined for health facilities during the COVID-19 pandemic in Cebu City, Philippines. Photo by Robyn Lacson/USAID ReachHealth

7. Prioritizing water, sanitation, and hygiene

Although water, sanitation, and hygiene (WASH) was not a focus area for ReachHealth, our team recognized that good sanitation and hygiene are critical to slowing the spread of COVID-19. We developed a tool to assess and prioritize sites for handwashing stations and installed these facilities in more than 200 quarantine centers, shelters, and public spaces. We also incorporated WASH messaging into our trainings and messaging campaigns and partnered with the DOH and Procter & Gamble to procure and distribute 70,000 hygiene kits to adults and young people. We have reached over 2.5 million Filipinos with WASH support so far, and our team continues to collaborate with local WASH organizations to bolster their ongoing work.

U.S. Ambassador Sung Kim uses one of the 16 handwashing stations installed in facilities and communities around the city. Photo by Rosana Ombao/USAID ReachHealth

8. Keeping our focus on family planning

Family planning (FP) continues to be an essential health service, especially in times of social and economic uncertainty. While our team stepped up to contribute their expertise to the COVID-19 response, they remain committed to expanding access to quality FP services across the Philippines. In March 2020, 25% of surveyed health centers reported a disruption in FP services and 81% saw a decline in people seeking FP care. From creating online resources to helping service providers improve their teleconsultation abilities, our team rapidly adapted approaches to accommodate the new normal and ensure all Filipinos could continue to access FP care. More than 2,000 teleconsultations on family planning have occurred since.

A team of "Nurses on Wheels" delivers family planning supplies to neighborhood health stations in Cainta. Photo by Mon Joshua Vergara/Cainta Municipal Health Office

• U.S. Agency for International Development (USAID)
• Global Health
• Global Health Security
• COVID-19 Research + Response
• Health Systems Strengthening
• Primary Health Care in Low- and Middle-Income Countries
• Interventions and Prevention Programs

ReachHealth: Strengthening Access to Critical Services for Filipino Families

Assessing the availability of essential family planning services during covid-19 in the philippines, from hotspots to bright spots: fighting covid-19 in the barangays of the philippines, hope on wheels: delivering vaccines to remote communities, stopping the spread: making covid testing accessible for filipinos.

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Pandemic Politics in the Philippines: An Introduction from the Special Issue Editors

• 1 Introduction

The Coronavirus Disease 2019 ( COVID -19) pandemic continues to impact people’s health and livelihood systems around the globe. As governments roll out mass vaccination programs in their respective jurisdictions, it is uncertain whether herd immunity can be achieved at the soonest time, given the mutations and emergence of new COVID -19 variants and vaccine hesitancy on the part of citizens. Meanwhile, political leaders have straddled the thin line between imposing mobility restrictions to save lives and reopening the economy to save jobs. This raised fundamental concerns about the political responses at both domestic and international levels toward the crisis.

It is important to examine and compare the political dynamics of the pandemic in various contexts. The articles in this special issue unpack the role of politics in confronting an existential health crisis such as the COVID -19 pandemic. Specifically, it delineates three core dimensions of the state necessary to address such a crisis: authority, capacity, and legitimacy (Gisselquist and Vaccaro 2021).

• 2 An Outbreak of Autocratic Governance

The strong predisposition towards autocratic governance was spreading across the globe even before the outbreak of COVID -19 in late 2019 (Cooper and Aitchison 2020). However, the pandemic exacerbated this tendency. In many countries, it provided an opportunity for authoritarian leaders to expand their powers. As the pandemic raged, these elected chief executives demanded and received even more authority from the legislature to manage the health crisis.

Various forms of democratic backsliding worldwide have intensified more than a decade ago. This trend involves the erosion of democratic governance features within any regime (Waldner and Lust 2018). It occurs through an incremental process where elected populist leaders draw measures to weaken the countervailing power exercised by institutional checks such as the political opposition, independent media, and civil society that are important in a vibrant democracy (Diamond 2021).

The military takeovers and electoral violence prevalent during the Cold War have waned in the contemporary period. Instead of fomenting regime change, current forms of democratic backsliding tend to produce political systems that are ambivalently democratic or hybrid. According to Bermeo (2016), executive aggrandizement has become the more common type of backsliding. This happens when elected executives dilute the constitutional checks on executive power through concerted actions that erode the power of independent groups to offer alternate options and challenge executive choices.

• 3 Democratic Backsliding in the Philippines

The Philippines presents an interesting case of democratic backsliding that accelerated with the election of a populist leader, Rodrigo Duterte, as president in 2016. Populism is considered a thin-centered ideology that portrays society as divided into two homogeneous and contending camps: the pure people versus the corrupt elite (Mudde and Kaltwasser 2018). Populism is a recurring feature of Philippine politics (Magno 2021). However, under Duterte’s populist presidency, executive aggrandizement was pushed to the hilt. Pappas (2019) argued that when populism cannot settle on the point of political equilibrium, it often swings at either end of the spectrum, at times toward mending liberalism and at other times veering towards autocracy. Under Duterte’s rule, the autocratic version of populism became dominant, facilitating democratic backsliding in the Philippines.

Democratic backsliding has affected pandemic governance in the Philippines. The rise of autocratic populism weakened democratic institutions and systems of checks and balances within the state and society. The concentration of power in the executive, coupled with the lack of willingness to consult with stakeholders and the limited capacity to integrate various proposals, prevented the government from mounting a coherent policy response to the crisis. Democratic backsliding has contributed to poor pandemic governance, especially in responding to health and economic problems and addressing the second-order issues of ensuring accountability in public expenditure management under emergency conditions. However, the outbreak of COVID -19 initially threatened Duterte’s populist legacy (Teehankee 2021).

4 The Arrival of COVID -19

The COVID -19 pandemic is acknowledged to have begun on November 17, 2019, with the first recorded case of the disease in the city of Wuhan in Hubei Province, China. In the following weeks, cases of people infected with the virus piled up. However, the government kept a tight lid on health data and even reprimanded the local doctors who warned of the new disease. The Chinese government informed the World Health Organization ( WHO ) of the existence of the virus only on December 31, 2019. Such a lack of transparency prevented health authorities globally from taking preventive action and containing the transmission of the COVID -19 virus across cities, nations, and borders (Steingrüber et al. 2020).

The Inter-Agency Task Force Against Emerging Infectious Diseases ( IATF ) was convened in January 2020 to deal with the COVID -19 problem in the Philippines. The policy architecture to address the crisis took shape in response to previous contagious diseases. Executive Order No. 168 that created the IATF was originally issued in 2014 to confront emerging infectious diseases ( EID  s). These include Avian Influenza, Ebola, Severe Acute Respiratory Syndrome ( SARS ), and the Middle East Respiratory Syndrome Coronavirus ( MERS-COV ), which can easily spread due to heightened mobility of travelers and products brought by globalization. The IATF was designed to facilitate cross-sectoral collaboration and efficiently manage the effects of any potential epidemic or pandemic.

The functions of the IATF included establishing a system to identify, screen, and assist those suspected or confirmed to be infected with EID  s. It is expected to prevent or minimize the entry of suspected patients into the country through rigid screening and identification of EID carriers and institutionalizing a surveillance system in all ports of entry. The IATF is tasked with preventing the local spread of EID through contact tracing and quarantine procedures. It also strives to lessen casualties by strengthening clinical management, healthcare facilities, and public safety measures.

To combat COVID -19, the reconstituted IATF proposed temporary restrictions on travel to and from Hubei Province, China, and the institution of quarantine protocols for returning Filipinos from the area under Resolution No. 1, dated January 28, 2020. The first COVID -19 infections in the Philippines were detected in a tourist couple from Hubei Province who entered the country through Hongkong. They were admitted to the San Lazaro Hospital, a national infectious disease referral hospital in Manila. While the first patient recovered, her companion’s condition deteriorated and was confirmed as the first COVID -19 death outside China on February 1, 2020 (Edrada et al. 2020).

• 5 Series of Lockdown Policies

On March 8, 2020, President Duterte signed Proclamation No. 922, declaring a state of a public health emergency. At that time, there were only 20 confirmed COVID -19 cases. Classes were suspended in Metro Manila. A few days later, on March 12, Duterte placed the National Capital Region under lockdown. Travels going in and out of Metro Manila were banned. Another executive edict was released on March 16, 2020. Under Proclamation No. 929, the entire country was placed under a state of calamity. This measure enabled local government units ( LGU  s) to tap their local calamity funds for COVID -19-related expenditures. It also extended the strict lockdown policies in Metro Manila to the entire island of Luzon. The most stringent restrictions were applied under this lockdown category, officially known as enhanced community quarantine ( ECQ ).

Under ECQ protocols, the movement of people was severely restricted. Mass public transportation services were suspended, while land, air, and sea travel were restricted. The restrictions included transport network vehicle services. All establishments were closed, except those that provide necessities like supermarkets, convenience stores, hospitals, medical clinics, pharmacies, banks, food preparation and delivery services, and water-refilling stations. Government offices, business process outsourcing companies, and export-oriented industries were allowed to operate with skeletal staff. Work in the private sector went on under work-from-home arrangements (Gregorio 2020).

While the IATF crafted policy recommendations for the President, the National Task Force Against COVID -19, headed by the Secretary of the Department of National Defense, handled the operational command. An Incident Command System also functioned as an on-scene disaster response mechanism to manage hazards and other consequences associated with COVID -19.

The IATF may call upon any department, bureau, office, agency, or instrumentality of the government, including Government-Owned-or-Controlled Corporations ( GOCC  s), government financial institutions ( GFI  s), LGU  s, non-government organizations ( NGO  s), and the private sector for assistance. On the other hand, the Joint Task Force COVID -19 Shield was established to enforce quarantine protocols and manage border checkpoints. It was composed of elements of the Philippine National Police ( PNP ), Armed Forces of the Philippines ( AFP ), Philippine Coast Guard ( PCG ), Bureau of Fire Protection, and barangay officers.

The Duterte administration sought the support of Congress to legitimize emergency powers for the president to deal with the COVID -19 crisis. Republic Act No. 11469, otherwise known as the Bayanihan to Heal as One Act, was enacted on March 25, 2020. It contained policy measures to curb the spread of the virus, strengthen the healthcare system, and provide the affected sectors with social assistance. The law authorized the president to exercise temporary budgetary measures and effectively allowed the executive branch to discontinue government programs to generate savings and realign, reallocate, and reprogram funds to implement COVID -19 measures.

The legislation provided the president with special powers to launch aid programs and punish people disobeying the emergency regulations. In this regard, people faced prison sentences for breaking lockdown regulations. More than 76,000 people were arrested between March and July 2020. Among those apprehended were homeless people and street vendors. Indeed, the capacity to observe quarantine regulations varied across income classes (Holmes and Hutchcroft 2020). The law punished those violating restrictions with up to two months imprisonment or fines up to PHP 1 million ( USD 20,000). These sanctions also applied to individuals or groups found to be creating or spreading false information regarding the COVID -19 pandemic.

• 6 Lockdown and Economic Downturn

The response of the Filipino government to the pandemic showed the negative effects of the trade-off between health and the economy. The administration of harsh lockdown measures prevented the spike in COVID -19 cases that would overwhelm the capacity of the health care system but came at the expense of plunging the country into a deep economic recession. At the onset of the pandemic, the Philippines registered a gross domestic product ( GDP ) growth rate of −0.7 percent during the first quarter of 2020. The impact of stringent restrictions was dramatically felt when the economy contracted by 16.9 percent in the next quarter. The economy continued to falter in the following quarters, with GDP growth rates of −11.4 percent in the third quarter and −8.3 percent in the fourth quarter of 2020 (See Figure 1).

GDP growth rate (2019–2020)

Citation: Philippine Political Science Journal 43, 2 (2022) ; 10.1163/2165025x-12340047

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The economy slightly improved but was still down by 4.2 percent in the first quarter of 2021. The negative growth for five successive quarters represents the most prolonged recession faced by the country since the 1985 debt crisis. The Philippines posted the worst growth record among peers in the Southeast Asian region in the first quarter of 2021, including Thailand (−2.6 percent), Indonesia (−0.7 percent), Malaysia (−0.5 percent), and Vietnam (4.5 percent). The contraction was pushed by the decline in private domestic demand due to inflation, income losses, and protracted lockdown measures (World Bank 2021, 10).

In 2020, the number of persons in the labor force was estimated at 43.9 million. This number represents the economically active population, either employed or unemployed, accounting for a 59.5 percent labor force participation rate ( LFPR ) of the 73.7 million 15 years old and over. This annual LFPR is the lowest since adopting the new definition of unemployed in April 2005, reflecting the effect of the various community quarantine controls, business closures, and physical distancing measures put in place in the Philippines in response to the pandemic.

The unemployment rate surged to 17.6 percent at the height of the lockdown restrictions in April 2020. It dropped to 10 percent in July 2020. It slid down further to 7.1 percent in March 2021, which is the lowest reported rate covering the period of the COVID -19 pandemic since April 2020 (See Table 1).

Unemployment rate (April 2020–March 2021)

The economic fallout from the prolonged lockdown measures was also reflected in the involuntary hunger experienced by Filipino families due to the loss of employment and livelihood opportunities. In a September 2020 survey, the Social Weather Stations ( SWS ) reported a hunger rate of 30.7 percent (7.6 million families). The average hunger rate for 2020 was 21.1 percent, exceeding the previous record of 19.9 percent in 2011 and 2012 and double the average of 9.3 percent for 2019. The survey showed that Metro Manila has the highest incidence of Hunger at 23.3 percent (780,000 families), followed by Mindanao at 16.0 percent (909,000 families), Balance of Luzon at 14.4 percent (1.6 million families), and the Visayas at 14.3 percent (674,000 families).

• 7 Vaccination Woes

On March 1, 2021, the Philippines became the last country in Southeast Asia to roll out a national vaccination program against COVID -19. The absence of a law providing for an indemnity fund had delayed the shipment of the vaccines. Congress had to rush the approval of a bill creating a PHP 500 million National Vaccine Indemnity Fund to cover compensation for the potentially adverse effects stemming from the doses’ emergency use. President Duterte signed R.A. No. 11525, otherwise known as the COVID -19 Vaccination Program Act, on February 26, 2021.

The indemnity law granted COVID -19 vaccine manufacturers immunity from lawsuits for claims from people experiencing any adverse effects from the COVID -19 vaccines. It was confirmed that pharmaceutical companies, which asked for an indemnification clause from the government, were fearful that what happened to Sanofi in the anti-dengue vaccine case might be repeated in the COVID -19 situation (Valderama 2021).

• 8 Prelude to Pandemic Politics

The process of democratic backsliding characterized by executive aggrandizement was reflected in a series of actions that undermined the independence of state and societal institutions. The executive encroached on the powers of the co-equal branches of government and stymied the exercise of media freedom. A supermajority coalition of parties supportive of the new president was established in the House of Representatives of the Philippine Congress following the 2016 national elections. The PDP -Laban led the coalition, the party of the new executive, together with the Nacionalista Party, National People’s Coalition, National Unity Party, Lakas- CMD , and various party-list organizations. Ironically, the bulk of the elected representatives from the Liberal Party, the former administration party, opted to join the majority instead of the minority bloc. There was a similar realignment in the upper chamber, with the parties identified with the new administration forming a majority bloc to support the president’s legislative agenda. However, unlike the lower house, a substantial minority bloc was formed in the Senate.

The judiciary did not escape executive aggrandizement. A quo warranto proceeding was initiated in the Supreme Court against Chief Justice Maria Lourdes Sereno. It is a legal procedure for removing a public official on the ground that the individual has no legal right to the office. Prior to her removal, Sereno voiced the need to observe the rule of law in the war on drugs and to respect legal procedure in dealing with judges accused of involvement in the drug trade. In May 2018, the Supreme Court ruled that Sereno’s appointment was invalid by a vote of 8–6 (Deinla et al. 2018).

Aside from whipping the legislature and judiciary into line, the executive also challenged the independence of constitutional bodies. Due to its criticism of the drug war, the Commission on Human Rights ( CHR ) was threatened with abolition. At one time, a proposal was made during the Congressional hearings for the 2018 national budget to render the CHR inutile by allocating an annual budget of only 1,000 pesos to the beleaguered agency. The president also pushed but failed for the impeachment of former Ombudsman Conchita Carpio Morales after her agency said it was investigating the Duterte family’s wealth (Esmaquel II 2021).

Another constitutional body that earned the ire of the chief executive was the Commission on Audit ( COA ) after the agency flagged the deficiencies of the Department of Health ( DOH ) in the administration of PHP 67.3 billion COVID -19 emergency funds. These included purchases deemed to be disadvantageous to the government, as well as defects in the sworn statements in contracts, non-posting of procurement information on government websites, and non-provision of technical specifications in contracts. However, the president dismissed the 2020 COA report as inadequate and merely indicated missing paperwork rather than corruption (Cator et al. 2021). The COA is the supreme audit institution in the country. Under the Constitution, it is mandated to prepare an annual report covering the financial condition and operation of the government, its subdivisions, agencies, and instrumentalities, including government-owned or controlled corporations and non-governmental entities subject to its audit.

Non-state actors like the media play a key role in democratic oversight as suppliers of information fostering reasoned debate in society. This critical function of media was severely tested as lawsuits were filed against independent media practitioners. Congress also denied the franchise renewal of a leading media firm. Media harassment and coordinated bashing from electronic trolls generated a chilling effect that drove media practitioners to exercise self-regulation.

• 9 Erosion of Institutional Checks and Balances

As democratic backsliding proceeded apace, executive aggrandizement led to the erosion of legislative and judicial independence and weakened the institutional checks exercised by constitutional bodies. The power of appointment was also used to expand the political control of the chief executive. It becomes a matter of public concern whether loyalty or competence are the driving factors for personnel recruitment in key positions in the bureaucracy. Congressional oversight in confirmation of appointees becomes perfunctory with strong executive influence over the legislature. Under presidential systems, the waning clout of traditional actors such as party organizations over personnel selection has given a wide latitude for the chief executive to choose loyalists in the context of accomplishing the administration’s policy and political goals in the bureaucracy (Lewis 2011). It is acknowledged in Philippine development planning documents that the integrity of the civil service has been diminished by an appointment process based on political accommodation rather than merit, which partly stems from the president’s broad powers of appointment and discretion ( NEDA 2011, p. 21).

The appointment of retired generals in key cabinet posts, and other high executive positions, was not new. However, the high ratio of such appointments was evident under the Duterte administration. More than 60 former military officers held ranking positions in the government as of early 2021 (Parrocha 2021). When the pandemic struck the Philippines in 2020, President Duterte tapped former military officials, who were already in the cabinet, to lead the COVID -19 response.

In battling COVID -19, the Philippines imposed one of the longest lockdowns in the world. Entire provinces and cities were put into lockdown under various quarantine classifications. The government relied heavily on the police and the military to maintain order. All health protocols, including mobility restrictions, wearing masks, and social distancing, were followed through punitive action (Hapal 2021). It was only in September 2021 that a more contained, granular lockdown approach was adopted. Various sectors have criticized the militarized approach to the pandemic for not paying enough attention to the health and economic dimensions of the problem.

The poor pandemic performance of the government drove health front-liners to call for a medical time-out at the end of July 2020. During a press conference, Jose Santiago, president of the Philippine Medical Association, said that the medical time-out should be used to refine pandemic control strategies by addressing hospital workforce efficiency, failure of contact tracing and quarantine, transportation safety, workplace safety, public compliance with self-protection, and social amelioration (Hallare 2020).

Since the pandemic, the community of health professionals forwarded many bright ideas on managing the health crisis. For instance, the Healthcare Professionals Against COVID -19, a coalition of over 170 medical groups, proposed the recalibration of the DOH One Hospital Command into a One COVID -19 referral network to integrate other health facilities aside from hospitals, such as barangay health centers, clinics, laboratories, and even pharmacies. This would expand care provision in communities and prevent hospitals from being overwhelmed by patients. An added move to answer the challenge of getting medical attention, especially where social distancing measures are in place, was to improve telemedicine services. The medical group also pushed for strengthening the role of science and experts in making decisions, specifically by tapping the Health Technology and Assessment Council created by the Universal Health Care Act (Tomacruz 2020).

The insidious effects of democratic backsliding on introducing an appropriate pandemic response were felt under conditions where key stakeholders were not consulted, and alternative viewpoints were abandoned as politically motivated. Repeated calls by the Senate for the Department of Health ( DOH ) Secretary to step down due to poor performance in handling the COVID -19 crisis were left unanswered ( CNN Philippines Staff 2021).

• 10 Corruption in Pandemic Times

The eruption of the COVID -19 pandemic brought to the fore severe corruption vulnerabilities in many countries. However, even before the pandemic, it is estimated that an average of 10–25 percent of a public contract’s value may be lost to corruption ( UNODC 2013). Globally, over USD 7.8 trillion were allocated annually for public health ( WHO 2019). With more public funds being made available to fight the pandemic, better safeguards are needed to prevent corruption.

The potential for corruption in pandemic times was high, especially when pressures for swift government action may lead to shortcuts that damage the integrity of institutional processes. The main risk areas include withholding accurate health data, irregularities in public procurement, the purchase of sub-standard equipment, and misappropriation of health budgets (Steingrüber 2020).

The corruption risks in the health sector surfaced in a big way with the eruption of allegations regarding the misuse of funds by the Philippine Health Insurance Corporation (PhilHealth) at the height of the COVID -19 crisis in 2020. The PhilHealth case brought to the fore the weak exercise of institutional control mechanisms in the state-run agency. The resigned anti-fraud officer and head executive assistant of PhilHealth became whistle-blowers in revealing information that led to investigations by the legislature on the malpractices in the government corporation. These came on the heels of COA observations regarding the questionable transactions in PhilHealth. These indicate the importance of legislative and audit oversight agencies as accountability institutions within a system of checks and balances.

It was reported that COA had a hard time auditing PhilHealth due to the difficulty of obtaining documents from its central office. Corruption is perpetrated when there is a deviation from legal and institutional norms. The system of checks and balances to combat corruption can be improved by adopting an integrated approach. This requires promoting a comprehensive strategy that includes the facilitation of basic democratic standards, participation of a strong civil society engaged in transparency and accountability work, and the consistent application of the rule of law.

It is disconcerting that a spate of allegations had been raised about the misuse of public funds amid the uphill battle of the Philippines to control the COVID -19 crisis. The Senate investigated the questionable disbursement of PhilHealth funds drawn from the PHP 30-billion Interim Reimbursement Mechanism ( IRM ). The IRM was an emergency support program for hospitals taking care of COVID -19 patients. The COVID -19 crisis affected people’s health and public finance in a very injurious way. As the crisis deepened, it began to unravel that the use of the IRM was just one of the many alleged corrupt practices that happened in pandemic times.

• 11 The Articles Ahead

Despite imposing one of the world’s strictest lockdowns, the Duterte administration struggled with the health crisis. In his final year in government, the populist Duterte confronted the deadly surge of the Delta strain of the COVID -19 pandemic (Teehankee 2022). Nevertheless, Duterte’s populism proved resilient, supported by high approval ratings. The irony of Duterte’s populist resilience despite his inadequate pandemic response highlights his skill of political deployment in a weak state.

This special issue compiles four articles that examine the various facets of pandemic politics in the Philippines, including state authority, capacity, and legitimacy. For the lead article, Paul D. Hutchcroft and Weena Geera investigate central-local dynamics in the Philippines during the pandemic, showing that the national government has not maintained the “central steering” needed to combat COVID -19. Instead, President Rodrigo Duterte strong-armed local politicians. This authority may mask the government’s “weak steering” and make the president look in charge, but it didn’t generate the national-subnational cooperation needed for a successful pandemic response. It intensifies Duterte’s 2016–19 methods, but without the local autonomy rhetoric. Through assessing the government’s pandemic response, the authors argue that strong-arming is no replacement for efficient central steering in this or future crises.

Rosalie Arcala Hall assesses President Rodrigo Duterte’s use of emergency powers to lock down Metro Manila and Cebu City. In 2020, deployed soldiers ran quarantine checkpoints at borders and city wards and enforced curfew and liquor bans. The increased visibility of uniformed troops in urban areas and subsequent arrests of quarantine offenders were heavily criticized. The militaristic lockdown failed to stop the virus’ spread and introduced new civil-military dynamics locally. The deployment broadened the military’s civilian reach. Its law enforcement actions with the police threatened civil-military balance and democracy. President Duterte relied on the state’s coercive infrastructure to respond to the outbreak, allowing him to dominate local governments and stifle dissent.

The continued popularity of President Duterte despite his government’s dismal handling of the pandemic continues to be a puzzle among analysts, pundits, and observers of Philippine politics. Ronald Pernia attempts to account for the uptick in political trust in the Philippines. His article theorizes that subjective health and political attitude (democratic or non-democratic) explain political trust in the Philippines. It hypothesizes that healthy authoritarians are more inclined to prefer political institutions because they appreciate order and stability. Strongmen trigger such political beliefs. The 2019 World Values Survey supports this claim. The operationalization of Pernia’s study nuances citizen perceptions of political trust in nascent democracies. Overall, the major results provide credibility to the cultural foundations of political trust and explain why Philippine political institutions remain trusted despite the bungled pandemic response and Filipinos’ support for Duterte.

Lastly, the article by Mathea Melissa Lim and Jesse Hession Grayman focuses on the Philippines’ response to the humanitarian crisis that is the COVID -19 pandemic. They examine the use of face masks and face shields to reduce viral transmission. In the Philippines, where individuals were compelled to wear face masks and face shields for individual and public protection during the pandemic, such objects have become part of everyday life for both healthcare staff and the general population. Their article contends that these artifacts have become symbols of extraordinary meaning that shape social relationships, everyday politics, and ways of life during a global pandemic. Following Karl Marx’s idea of “commodity fetishism,” the article traces the concealment, transformation, and mystification of face masks and face shields as humanitarian objects for COVID -19 in the Filipino context and the implications of this fetishization on the Philippines’ most vulnerable populations.

• Acknowledgements

The editors would like to acknowledge the funding support from the Konrad Adenauer Stiftung Philippines Office for this special issue.

• Notes on the Editors

Francisco A. Magno is a Professor of Political Science and Development Studies at De La Salle University where he occupied such positions as Director of the Institute of Governance, Director of the Social Development Research Center, and Chair of the Political Science Department. He has conducted teaching and research in various universities, including Osaka University, Waseda University, Hiroshima University, Florida State University, University of Hawaii, and University of the Philippines. Elected as President of the Philippine Political Science Association from 2015 to 2017, he was selected to head the Commission on Higher Education Technical Panel on Political Science from 2020-2024. In the year 2000, he became the first Political Scientist to receive an Outstanding Young Scientist Award from the National Academy of Science and Technology of the Philippines. He finished his PhD in Political Science from the University of Hawaii at Manoa under an East-West Center Fellowship.

Julio C. Teehankee is a Professor of Political Science and International Studies at De La Salle University, where he served as Chair of the Political Science Department, Chair of the International Studies Department, and Dean of the College of Liberal Arts. He served as President of the Philippine Political Science Association from 2017 to 2019 and the Asian Political and International Studies Association from 2009 to 2011. Since 2019, he has served as the Philippine representative to the Council of the International Political Science Association. He has held several visiting appointments, including Kyoto University, Australian National University, City University of Hong Kong, Osaka University, University of Tokyo, Waseda University, and Southern Illinois University at Carbondale. In 2022, he was invited as a Senior Visiting Fellow at the Saw Swee Hock Southeast Asia Centre, the London School of Economics and Political Science.

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Ramos , Christia Marie . 2020 . “ Senators seek Duque’s ‘immediate resignation’ over ‘failure’ in handling COVID -19 crisis ,” Inquirer.net , April 16 ; https://newsinfo.inquirer.net/1259630/senators-seek-duques-immediate-resignation .

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Youth social innovation during the COVID-19 pandemic in the Philippines: a quantitative and qualitative descriptive analyses from a crowdsourcing open call and online hackathon

Allan ulitin.

1 Institute of Health Policy and Development Studies - National Institutes of Health, University of the Philippines Manila, Manila, Philippines

Jana Deborah Mier-Alpaño

2 University of the Philippines Manila, Manila, Philippines

Meredith Labarda

3 Department of Medicine, University of the Philippines Manila - School of Health Sciences, Palo, Leyte, Philippines

4 Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines

Abigail Ruth Mier

Joseph d tucker.

5 IGHID, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Weiming Tang

6 University of North Carolina Project-China, Guangzhou, China

Mallika Auplish

7 World Health Organization-Regional Office for the Western Pacific, Manila, Philippines

Po-lin Chan

Associated data.

All data relevant to the study are included in the article.

Introduction

Young people have played a pivotal role as part of the COVID-19 response, including developing health messages and social innovations. Social innovation in health engages multiple stakeholders in linking social change and health improvement. The study examined the feasibility of youth ideas and innovations to address the impacts of the COVID-19 pandemic using quantitative and qualitative descriptive analyses.

In partnership with the WHO, academic institutions, youth organisations and civil society groups, we conducted a crowdsourcing open call among Filipino youth (15–30 years old) using a structured Special Programme for Research and Training in Tropical Diseases/Social Innovation in Health Initiative process. The open call had three categories: youth voices to cocreate the post-COVID-19 world (entries were texts, images, videos and music), youth-led COVID-19 social innovations , and youth-led social innovations not related to COVID-19 . Each submission was evaluated by three independent judges. Finalists were selected in each of the categories alongside four grand winners. All finalists were invited to attend a 1 day online civic hackathon.

We received a total of 113 entries ( youth voices to cocreate the post-COVID world =76; youth-led COVID-19 social innovations =17; youth-led social innovations not related to COVID-19 =20). Twelve entries focused on youth mental health during the pandemic. The online hackathon provided the participants mentorship for further development of their ideas. Finalists were able to produce draft health communication campaigns and improved social innovations.

Many Filipino youth created exceptional entries in response to the open call. This suggests the feasibility of including youth voices in strategic planning processes. A global youth social innovation call is recommended.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• The current COVID-19 response limits the extent to which youth have been engaged to address health challenges during the pandemic especially in low-income and middle-income countries (LMICs) including the Philippines.
• The COVID-19 pandemic has had a profound impact on youth, especially on their health in which this shared experience also highlighted the ways where they can be active agents of change to address these health needs and challenges through social innovation.

WHAT THIS STUDY ADDS

• The Social Innovation in Health Initiative Philippines, in partnership with Social Entrepreneurship to Spur Health, Asian Medical Students Association Philippines and other youth organisations and the World Health Organization-Western Pacific Regional Office conducted a crowdsourcing open call and online civic hackathon to gather Filipino youth’s ideas about the future postpandemic and to come up with innovative solutions to identified health needs during the pandemic.
• Filipino youth’s ideas about the future provided insights into the present experience of the youth during the pandemic and presented imagined life postpandemic highlighting advancements in technology and issues relating to work, family, education, social interactions and environment. The youth open call received commendable ongoing and proposed social innovation entries that address a wide range of emerging health problems during the COVID-19 pandemic, with several tackling mental health.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE AND/OR POLICY

• Bringing in youth voices to inform programmes and policies is imperative. Crowdsourcing open calls and online civic hackathons to solicit youth input could be useful tools to respond to health emergency needs in LMIC settings.
• Exceptional innovation entries open space for implementation research to assess their quality and impact on improving specific health and development outcomes.

COVID-19 responses have been mostly expert driven by central authorities, limiting the extent to which youth have been engaged. The pandemic has had a profound impact on youth health, especially mental health. 1 2 The shared experience of the pandemic has also highlighted ways that youth can be active agents of change through social innovation. 3–5 Social innovation can be defined as a solution—a process, product, practice or market mechanism—developed by a range of actors in response to health challenges within a geographic context. 6 One way to identify social innovations is through crowdsourcing open calls.

Crowdsourcing open calls are novel approach to identify and solicit community-based solutions. Through crowdsourcing, actors work together to come up with solutions to identified health needs. 7 Crowdsourcing has been widely used in public health and medical research, 8 such as in identifying approaches to manage infectious diseases. 9 10 In addition, crowdsourcing may help recognise innovative solutions that are actionable, quick, and low cost for health and economic challenges brought by the pandemic. 11 12 Crowdsourcing may be done through a hackathon, an event that convenes actors with varied expertise during a brief period to solve a problem. 7 For the purpose of our activity, we adapted an online civic hackathon to be an opportunity for the youth to develop civic and innovative solutions for problems in their communities. 13

Online hackathons are emerging approach within the space of health innovations to help generate solutions in response to COVID-19. These activities promote inclusive participation, cross-regional collaboration and rapid multisectoral partnership and may be less expensive. 13 Since the onset of the pandemic, online hackathons have helped to organise community responses to COVID-19 and identify compelling innovations. 14 15

While youth who are directly and indirectly affected by the pandemic are particularly well suited to cocreate COVID-19 solutions, current published literature has paid little attention to youth voices and perspectives to address the health priorities brought by the pandemic. 16 This holds true among low-income and middle-income countries (LMICs) including the Philippines, where responses to the pandemic were organised primarily by central authorities. 17

At present, there is limited available literature exploring the needs of Filipino youth in various aspects of their lives during the pandemic, as well as participatory events such as hackathons that are organised particularly for them. Moreover, existing open call and hackathon initiatives paid far too little attention to youth-initiated non-digital solutions and health innovations that adapted a systems approach (ie, impact of economy, future of work and technology on health). 18 This led us to conduct an open call and online civic hackathon to solicit: (A) youth ideas about how they foresee the future after the COVID-19 pandemic, (B) youth-led social innovation projects to address health needs brought by the COVID-19 pandemic in local communities and (C) social innovation projects implemented during the time of pandemic to address non-COVID-19 related health needs.

We used the WHO/TDR (Special Programme for Research and Training in Tropical Diseases)/Social Innovation in Health Initiative (SIHI)/Social Entrepreneurship to Spur Health (SESH) practical guide on crowdsourcing in health research 7 that provides the steps on organising a crowdsourcing contest. In the Philippine context where many young people are present both in school and out-of-school communities, we involved key government agencies including the Department of Education, Commission on Higher Education, Sangguniang Kabataan ( Sangguniang Kabataan is a council meant to represent the youth in each barangay or village in the Philippines), community-based arts youth groups, indigenous peoples’ groups and faith-based organisations in consultation and cocreation process, and promotional activities to ensure that our open call reaches across youth groups of different socioeconomic status. We used social media and email to promote and collect entries, drawing on a snowball referral method.

Our open call aimed to ideate solutions among the youth. It also sought to stimulate youth’s thinking about the future, the problems that may arise and ideating solutions based on these, thereby skilling youth in futures literacy and enabling thinking and response mechanisms to resolve projected issues.

The SIHI Philippines Hub, in partnership with Social Entrepreneurship to Spur Health, Asian Medical Students Association Philippines and other youth organisations, with the support of the World Health Organization-Western Pacific Regional Office conducted an open call for the Filipino youth. The purpose of the open call was to generate youth ideas about the future and collect youth-led social innovations related to the COVID-19 pandemic.

Filipino youth (ages 15–30) were invited to submit entries to any of the following categories: (A) youth voices to cocreate the post-COVID-19 world (youth ideas): future-oriented ideas on the problems or concerns that would emerge in youth lives out of the pandemic (eg, in work, education, family and health); entries could be texts, images, videos and music; (B) youth-led COVID-19 social innovations: youth-led social innovations implemented to address problems or challenges brought by COVID-19 in a given community; entries could be innovations that address either direct or indirect COVID-19 health problems; and (c) youth-led social innovations not related to COVID-19 : non-COVID-19 related youth-led innovations that address other health problems or challenges not related to COVID-19. The open call was promoted starting 14 October 2020 and accepted submissions from 4 November to 18 December 2020.

Steering committee

To facilitate the implementation of the open call, we organised a steering committee composed of representatives from multiple sectors and fields including medicine, public health, health service delivery, youth development, social and behavioural science, social entrepreneurship, social development, and futures thinking and literacy. They were involved in the conceptualisation and design of the open call through consultations and cocreation process. Regular consultation meetings were conducted to monitor progress of the open call.

Promotion of the open call

We used digital platforms such as Facebook and Twitter to promote the open call. Promotional materials were also posted on SIHI’s official website. Facebook was mainly used as it is the most popular social media platform in the Philippines. We used paid promotion to enhance youth engagement across the country. We also reached out to different youth organisations and advocate groups to promote the open call through their social media accounts and networks. Most publicity materials were posted on Thursday and Friday nights to maximise youth engagement based on increased online activity during those periods. Steering committee members and partner organisations also shared the publicity materials on their social media accounts. The Facebook’s insights tool tallied a total of 332 931 post reach, which represent the number of people who saw our posted materials, 19 13 331 total engagements (reactions, comments and shares) and 30 189 post clicks (photo views, website link clicks, profile name clicks, ‘see more’ clicks).

Selection of entries

Each entry was evaluated by three independent judges. The entries were distributed for evaluation to a total of 27 judges, a collective of health professionals, academics, social innovation champions, youth leaders and other key partners in health and social innovations. For the youth ideas category, entries were assessed to ensure these included a clear description to reimagine a collective future postpandemic and an innovative idea about the future expressed in a compelling way. All youth-led innovation entries were evaluated based on the degree of innovativeness, feasibility, inclusiveness, effectiveness and potential to inform policies and programmes. Grand winners of two innovation categories received seed money for implementation activities of their novel solutions.

Online youth civic hackathon

Part of the incentives for the open call finalists was participation in a 1 day online civic hackathon. Due to COVID-19 restrictions preventing face-to-face events, the hackathon was conducted online. It had the following specific objectives: (A) highlight the Filipino youth situation, perspectives,and experiences during the pandemic; (B) provide mentorship for research, ideation and further development of the finalists’ innovative ideas; and (C) provide a platform for networking among the participants. It was designed to consist of three major segments: capacity building of participants through plenary talks by local experts, mentoring sessions by volunteer mentors and pitching of final outputs.

Data analysis

The general profile of the respondents who filled out the participant’s information form were presented as summary statistics on gender, age, employment, education and geographical location. The emerging themes of the open call entries across three categories were also summarised. Two authors (AU and JDM-A) separately examined all the submissions. They independently identify the themes of the entries by determining the concerns or issues addressed by the submitted ideas and innovations. Individual findings were presented and consulted to the rest of the team for consensus. Statistical analysis of quantitative data and textual analysis of qualitative data were performed using Excel (Office 365, Microsoft).

Patient and public involvement

No patient involved.

The open call received a total of 113 entries from a total of 71 individual participants and 22 groups. Among the 45 participants who provided their personal information along with their submitted entries, 24 identified themselves as men, 21 identified as women. Most of these participants belonged to the age bracket 18–23 years (21), were students (28) and were from the Luzon island group (27). The general profile of the participants is summarised in table 1 . An overview of the received entries is presented in table 2 .

Sociodemographic characteristics of youth open call participants (n=45)

Overview of entries to the open call

After the evaluation process, a total of 15 entries with the highest mean scores in their respective categories were selected as finalists. Distribution of mean scores is presented in figure 1 . Six finalists were selected for the category youth voices to cocreate the post-COVID-19 world: text entries. Three finalists each were selected for the categories youth voices to cocreate the post-COVID-19 world: non-text entries, youth-led COVID-19 social innovations and youth-led social innovations not related to COVID-19 . One grand winner was then chosen for each category. Top-ranked entries to the open call are presented in table 3 .

Histogram showing a distribution of mean scores of entries to the Philippine youth open call (n=113).

Top-ranked entries to the open call

Youth voices to cocreate the post-COVID-19 world

There were eight emerging themes from the 76 entries on ideas about the future postpandemic as summarised in table 2 . Framing the entries through the lens of strategic planning, some of them provided insights into the present experience and plight of the youth during the pandemic. These entries either described the current situation, called for necessary actions, shared reflections from the pandemic experience or presented the status of the welfare of the youth. Other entries depicted the imagined life postpandemic highlighting advancements in technology and issues related to work, family, education, social interactions and environment.

Youth-led social innovations

There were nine emerging themes from the 37 innovation entries of which the majority addressed physical health and mental health. Innovation entries were further categorised into either implemented or proposed innovations as summarised in table 2 .

Out of 31 invited finalists, 28 joined the hackathon, of which 16 were male and 12 were female. Mean age of the participants was 23 years old. Ten participants were from Luzon, 8 were from Visayas and 10 were from Mindanao.

Participants were given a presentation on design thinking and provided mentorship by volunteer mentors to improve their innovation entries and produce health communication campaigns.

Participants from youth voices to cocreate the post-COVID-19 world category were able to come up with draft health communication campaigns. Two groups identified mental health of adolescents and young adults amidst the pandemic as their health priority. One group focused on physical health and well-being of senior high school and college students, highlighting changes in lifestyle from attending online classes. Outputs were presented during plenary session. Feedback of mentors revolved around the following themes: evidence-based approach for the campaign; inclusiveness, uniqueness and innovativeness; incorporating solutions in the campaign; and strategies to expand reach of the campaign.

Participants from youth-led social innovations categories received advice from mentors for the improvement of their ongoing or proposed innovations. Mentors’ feedbacks addressed the following key areas: general context of the innovations; technical specifications of innovation products; sustainability and marketability of innovations; and expansion of networks and building partnerships to scale-up innovations.

The youth open call and online civic hackathon that we organised demonstrated that these activities can be effective approaches to stimulate strategic planning for policymakers by engaging the youth. These methods are also helpful tools to solicit novel solutions to community health needs in the time of COVID-19. Our experience is consistent with other crowdsourcing and hackathon research. 11 20 This extends the literature by presenting how open calls and hackathons could be useful in responding to emergency health needs, focusing on youth voices and soliciting crowd input from an LMIC setting. Our experience on gathering ideas and solutions provides practical insight for future implementation.

From the pool of submitted entries and the creation of health communication campaigns during the online civic hackathon, mental health was identified as an important health concern among the youth participants. Three entries in youth ideas category, seven youth-led innovation entries and two health communication campaigns during the hackathon tackled mental health. The mental health challenges that were highlighted include isolation or lack of social interaction during the lockdown and increased cases of anxiety, depression, self-harm and suicide during the pandemic. Understandably, these challenges were followed by proposed solutions and innovations in some entries. Some examples of these include provision of spaces for constructive interaction among youth, venues or media for expression, enabling good coping skills through education, and guidance to deal with stress and anxiety. Limited literature is available about these interventions during the pandemic especially in LMIC settings. 21 Furthermore, this observation affirms the findings of recent studies that identify COVID-19 pandemic as having significant impact on youth mental health. 1 2 15 22–24 This also signifies that mental health is a concern that needs more serious attention of both research and policy sectors especially during COVID-19 pandemic.

One of the winning youth-led innovation entries, This Book is so Boring , is a creative social innovation developed by a local adolescent nurse. It is a printed personal journal that seeks to address mental health issues. The journal was initially focused on serving a local city population of one province, but its reach has expanded to surrounding cities and municipalities. In the first 10 months of implementation, a total of 700 hundred printed copies of the journal were distributed all over the province. The journal could be a useful resource for other sectors including educational institutions to promote mental health among the youth. This simple solution could be adapted for different settings and used in many resource-constrained contexts. This responds to the substantial gap in mental health interventions for youth 21 and allows for services to reach members of the population with limited digital resources.

Youth and non-experts submitted several high-ranked entries to our open call. This is consistent with the hypothesis that crowds can generate wisdom to improve health outcomes. 25 Our open call has received commendable entries, with a mix of proposed and ongoing social innovations. These innovations address a wide range of health needs and challenges including those related and not related to COVID-19. The COVID-19 related innovations mainly focus on monitoring and prevention of cases. The non-COVID-19 related innovations target improving physical health and well-being of the target community members. Our open call, however, was not able to measure the health impacts of implemented social innovations and assess the key factors that may affect the feasibility of the proposed social innovations.

We recorded unique entries envisioning the future after the pandemic. These include screenplay that told a story about life with advanced technologies and literary works (eg, poems, stories and essays) that featured the future of life in various aspects. These entries suggest creative means of making the public more future-informed for strategic planning. The ideas of the youth about their present predicament and their envisioned life in the future create an overarching background on why they produced specific innovations. This process of ideation followed a futures thinking approach that allows one to identify emerging issues, and from these issues to ‘negotiate uncertainties, articulate scenarios and develop a common vision of a desired future through wide participation’. To achieve the envisioned future, innovations will then be introduced. These steps would be essential for informed policies and strategies. 26

Due to practical constraints, our open call and online youth civic hackathon had several limitations. First, our open call only accepted entries that were submitted online due to COVID-19 restrictions. Second, as the platform for the online hackathon required steady internet connectivity, some participants from resource-limited areas were not able to attend the entire duration of the hackathon due to poor bandwidth. This was partially mitigated by paying for internet coverage, a parallel mobile phone text chat and extensive note taking. Acknowledging the fatigue that online events can cause, we organised the hackathon to be only a 1-day event. We understand that experiences from other open calls suggest that in-person activities can extend and enhance engagement. 27 Lastly, we have limited resources to track our received innovations particularly in terms of feasibility of implementation or roll-out. It is also beyond our scope to monitor the outcomes of the mentoring and seed money investments for the selected innovations.

Our data have applications for programmes and policies. We propose our findings to be incorporated into our ministry of health’s programme on healthy schools and communities under their health promotion agenda.

Our youth open call and online youth civic hackathon have several implications both for research and practice. First, these events have allowed the youth to generate and cocreate ideas and solutions to emerging health problems during the COVID-19 pandemic. These identified solutions might contribute to the holistic approach to the COVID-19 pandemic response especially in LMIC setting where youth voices are missing in strategic planning processes. Moreover, exceptional innovation entries open opportunities for implementation research to assess quality and impact on improving specific health and development outcomes. Finally, this experience suggests the need for a global youth open call to amplify youth voices in response to the pandemic.

We described the processes of an open call and online civic hackathon for Filipino youth that solicited ideas and solutions to emerging challenges brought by the COVID-19 pandemic. Promising entries offer novel solutions that may contribute to the national and regional COVID-19 response in LMIC settings. Youth ideas and innovations highlight the need for more research to understand further the youth perspectives on COVID-19 pandemic challenges and assess the impact and feasibility of the proposed solutions as we move forward to the post-COVID-19 world.

Acknowledgments

The crowdsourcing open call and online hackathon were made possible by generous funding from the World Health Organization Western Pacific Regional Office. The authors would like to thank Sucelle Czarina Deacosta and Ma. Pamela Tagle for their expertise and roles in making the online hackathon possible. The authors would like to thank the finalists and participants of the crowdsourcing open call and online hackathon who submitted their entries to share their ideas and innovations to adress the impact of the COVID-19 pandemic.

Twitter: @janadeborahmd, @JosephTucker

Deceased: NJ since deceased.

Contributors: All authors took part in the conceptualisation of this work. AU collected the data. AU, JDM-A, JDT, ML and ARM analysed the results and drafted the manuscript. All authors reviewed and approved the manuscript for submission. AU, as guarantor, accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

Funding: The Social Innovation in Health Initiative (SIHI) is funded by TDR, the Special Programme for Research and Training in Tropical Diseases cosponsored by UNICEF, UNDP, the World Bank and WHO. TDR receives additional funding from the Swedish International Development Cooperation Agency (Sida) to support SIHI.

Disclaimer: The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions or policies of PAHO or TDR. In any reproduction of this article there should not be any suggestion that PAHO or TDR endorse any specific organisation services or products.

Competing interests: None declared.

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

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.

China gave the world Covid-19; PH spreading 'Philippinization' in politics?

PRACTICALLY everyone in the world knows now that the Philippines is the biggest thorn in China's extravagant claim of sovereignty over all of the South China Sea, including our exclusive economic zone, or the West Philippine Sea.

What is baffling is the news which is borne out by the archives of The Manila Times that our country appears also to have bequeathed a disease to the world, just as China lacerated and tormented the world with the Covid-19 pandemic.

The latter feat requires urgent national attention and correction, because it could disfigure our newfound place in the geopolitics of the Indo-Pacific region.

Covid-19 pandemic

The facts about the Covid-19 pandemic are well-known.

According to Wikipedia, "The Covid-19 pandemic (also known as the coronavirus pandemic), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began with an outbreak of Covid-19 in Wuhan, China, in December 2019. It spread to other areas of Asia, and then worldwide in early 2020. The World Health Organization (WHO) declared the outbreak of a public health emergency of international concern (PHEIC) on Jan. 30, 2020 and assessed that the outbreak had become a pandemic on March 11."

Covid-19 vaccines were developed rapidly and deployed to the general public beginning in December 2020, made available through government and international programs. Common mitigation measures during the public health emergency included travel restrictions, lockdowns, business restrictions and closures, workplace hazard controls, mask mandates, quarantines, testing systems and contact tracing of the infected.

The pandemic caused severe social and economic disruption around the world, including the largest global recession since the Great Depression. Widespread supply shortages, including food shortages, were caused by supply chain disruptions and panic buying. Reduced human activity led to an unprecedented temporary decrease in pollution. Educational institutions and public areas were partially or fully closed in many jurisdictions, and many events were canceled or postponed in 2020 and 2021. Telework became much more common for white-collar workers as the pandemic evolved. Misinformation circulated through social media and mass media, and political tensions intensified. The pandemic raised issues of racial and geographic discrimination, health equity and the balance between public health imperatives and individual rights.

The WHO ended the public emergency for Covid-19 on May 5, 2023. The disease has continued to circulate, but as of 2024, experts were uncertain as to whether it was still a pandemic. Pandemics and their ends are not well-defined, and whether or not one has ended differs according to the definition used.

As of July 25, 2024, Covid-19 has caused 7,053,524 confirmed deaths. The Covid-19 pandemic ranks as the fifth-deadliest pandemic or epidemic in history.

A Third World political disease

Now, what is this talk about the Philippines spreading a disease called "Philippinization"?

The source of this information is incredibly Juan Gatbonton, the late much-awarded Filipino writer and editor, who is so widely recognized and admired internationally and nationally, that I cannot seriously believe that he associated the nation's name with a disease.

From 2014 to 2019, during his latter years, Johnny (as his friends and family fondly called him) published commentaries and essays on politics and culture in The Manila Times. Some of the pieces were so incisive and timely, they drew wide attention and provoked discussion.

One of these articles was a commentary titled, "Philippinization, a disease in Third World politics," which was published by The Times on Oct. 18, 2014. The piece is so relevant to our public life today, I want to quote it at length and let it speak for itself. He wrote:

"Our parties have become negative models of political disintegration.

Our dysfunctional political system has achieved a distinction of sorts. Political scientists are apparently beginning to recognize a phenomenon among political parties that they identify as 'Philippinization.'"

A political party infected with "Philippinization" is both extremely fractionalized and weakly institutionalized. These two traits — weak organic linkages and the inability to develop stable norms and practices — have become so pronounced in Philippine parties that they have come to typify a new species of political "disease" fit for academic study.

In a pioneering paper, a German academic, Andreas Ufen, looked into the condition of political parties in post-authoritarian Indonesia — and found them to be "weakly rooted and at the brink of 'Philippinization.'"

Being afflicted with Philippinization is apparently no small matter. The consolidation of democratic practices is most difficult to carry out in political systems of this sort. Such systems are also the most vulnerable to political collapse and state failure.

Institutionalization is the conventional goal of political organizations; but party systems are breaking up almost everywhere. The communications revolution is making it remarkably easy for charismatic politicians to reach out directly to the volatile mass electorate over the heads of the party functionaries.

As we might expect, the most successful of these new-type politicians are film-TV stars, champion athletes and other media celebrities — all personalities practiced at projecting their affinity with everyday people.

One such personality, Jakarta's governor — fondly known as "Joko" Widodo — has just become Indonesia's first president drawn from outside the political-military-bureaucratic elite. Joko lives and functions in the style of the Indonesian Everyman. Since he is without any experience in national politics, his partisans anxiously await his first test at governance — deciding on Indonesia's increasingly burdensome energy subsidies.

While the political role of ideology is declining in the new states, it is regaining its passion in Western politics.

Meanwhile, Third World parties are degenerating into competing factions held together only by personalist ties of reciprocity, loyalty — and the pork barrel.

Many of them have lost the ideological edge that had given them their sense of purpose. Even our communist parties, once models of party discipline, have broken up into quarrelsome — and sometimes murderous — factions.

Factionalism also has a moral cost. Parties — in the opinion of the British conservative Edmund Burke (1729-1797) — are formed to promote a view of the national interest on some shared principle. But factions are by nature self-interested; they concern themselves with nothing more than "the mean and interested struggle for place and emolument."

In Indonesia, critics accuse the multiparty coalitions contesting seats in Parliament of being more interested in sharing the spoils of office than in building competing parties, and of operating as "Kartel Politik," or political cartels.

In some new countries, the struggle for power among these contending factions has become so intense it has induced disillusion and despair among electorates — paralysis in governments — and even state collapse.

Most recently, 15 years of parliamentary deadlock between the Bangkok royalist and business elite, and the populist billionaire Thaksin Shinawatra's "Thais Love Thais" party has set off yet another episode of authoritarian rule in our close neighbor, Thailand.

Democracy's need for parties

"Populism is the new political mode; and it has attracted even the Catholic Church of the first Latin-American pontiff. Pope Francis is trying to invigorate Rome's populist 'preferential option for the poor' in its effort to compete with pentecostal and charismatic breakaway faiths in the Third World.

"In India and the Philippines, the corruption and ineffectuality of established parties have revived interest in the concept of 'partyless democracy' that Gandhi and Quezon espoused in the 1930s.

"Direct democracy may have sufficed for classical Athens. But once the electorate exceeds the capacity of the marketplace, representative government cannot be anything but party government. Our political problems are in fact rooted in our lack of groupings able to think — and act — coherently in the national interest.

"Our politicians — beyond their obligation to deliver 'pork barrel' benefits to their ward-leaders and constituencies — are individually responsible only to themselves. They can pursue their self-interest without inhibition."

Rebuilding our party system

"Rebuilding our party system, then, must become our central political task. We will need to reestablish norms and practices as conventions within which our parties can compete.

"Since a party structure is shaped by its funding source, we must face up to the centrality of our party-financing regime. A measure of public financing for mainstream parties must become a central reform — as soon as the Philippine State becomes strong enough to enforce it.

"Because our 'parties' are financed by their leaders, they revolve around individual ambitions. As a result, our politics — like our economy — is run by 'an anarchy of families.'

"The lack of an accepted financing system also makes our parties vulnerable to corrupt practices and the intervention of special interests.

"We must put our political system on a stable footing; and the Supreme Court has set us on the right path by outlawing every variety of the pork barrel.

"We must also do something about the multitude of 'parties' that have formed from the slipshod drafting of the 1987 Charter. We've stumbled into a Constitution that mixes features of both the two-party and multiparty systems.

"We've lost almost every semblance of the relative stability that had resulted from the alternation in power of the Nacionalistas and Liberals in post-Independence politics.

"Our transition to a 'free and open party system' has so far resulted only in a series of 'minority' presidents — because the 1987 Charter does not even prescribe the usual 'run-off elections' to decide on a final winner.

"In my view, we cannot escape doing a great deal of serious and thoughtful 'constitutional engineering.'"

Johnny Gatbonton's observations on the state of our political parties provokes plenty of thought and study from the administration and the opposition alike. They both need to look at themselves in the mirror and attend to the elemental work of organizing their parties for the challenge of the May 2025 midterm elections.

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COVID-19 drives high mortality rate in Australia

By Agence France-Presse Published Jul 30, 2024 8:40 am

COVID-19 is still driving Australia's above-average mortality rate, research showed on Monday, July 29, with experts predicting the disease's impact will continue to be felt for years to come.

The Australian Actuaries Institute found that five percent more people died than would be expected in 2023, amounting to 8,400 excess deaths. 

Experts measured the number of people who had died as a direct or indirect result of Covid and found the excess mortality rate was still higher than pre-pandemic levels.

About 4,600 deaths were directly attributed to COVID-19, the ninth leading cause of death last year.

Non-COVID-19 excess deaths, meanwhile, were "particularly apparent" in Australians over 75 years old—with previous infections and interruptions in healthcare related to Covid increasing risks related to heart disease, stroke, diabetes and dementia.

Delays in routine or emergency care and undiagnosed COVID-19 were cited as possible reasons for the higher-than-usual death rate.

Still, the excess mortality rate was lower in 2023 than it was in 2022, according to experts. 

"It's encouraging that each successive COVID-19 wave has, so far, resulted in fewer deaths than the previous one," Actuary Institute spokeswoman Karen Cutter said. 

"However, we think that COVID-19 is likely to cause some excess mortality for several years to come, either as a direct cause of death or a contributing factor to other causes such as heart disease." 

She added the "new normal" level of mortality was likely higher than it would be had the pandemic not occurred. 

The report also found Australia's excess mortality was lower than the global average—with Ecuador, Mexico and Russia showing the highest rates of unexplained deaths. 

New Zealand had the lowest excess mortality rate of the 40 countries for which data was available.  (AFP)

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(RE-ADVERTISEMENT): Implementation of Research (Behavioural Insights) for Evidence-Based Parenting in the Philippines

The World Health Organization (WHO) Philippines is looking for a contractor for the implementation of research (behavioural insights) for evidence-based parenting in the Philippines under a Technical Services Agreement (TSA). 

The deadline for submission of proposals is on 17 July 2024.

Read Request for Proposal