Apocalypse Now? Philippines in the Age of Worldwide Sickness

What's the deal with social distancing?
Photo courtesy of Kaguya-sama: Love is War

Globalization began long before the Age of Discovery and Exploration in the 15th century, but while many herald the triumphs of global cooperation, our increased interconnection also paved the way for better transmission of ills. Does pandemic ring a bell? It was believed the term began to be used only as early as the 17th century, and it was defined as an outbreak of a disease which occurs in a wide geographic area with an exceptionally high proportion of the population contracting it.

The Philippines is no stranger to illnesses. Certainly, the coronavirus pandemic (COVID-19, SARS-COV-2) would not be the first Filipinos had encountered, and hopefully not the last. We would likely survive not only with adherence to science, but also to history, because as far as human experience is concerned, we managed to survive all those epidemics and pandemics to this day.

Kolera

One of the more persistent epidemics in the Philippines was cholera, a waterborne disease which Filipinos managed to come up with a lot of theories on bad air (miasma) and the like. It even led to extreme measures. An 11-month quarantine from March 1902 to February 1903 was one thing. We already felt how brutal one or two months under lockdown was. But cholera also helped incite a massacre of around 100 foreigners in 1820 because the native population believed imported cases exacerbated the spread of the disease. What lifted us from the cholera, however, was neither the quarantine nor the purge foreign arrivals on their own. It was Sanidad, or the cleanliness campaign which instituted clean water and sanitation for all. Filtration and distribution of water improved. Until then, only the Balara Filters along Marikina River served the capital with potable water. Arrivals were quarantined and were provided baths. In the words of Victor Heiser, director of La Junta de Sanidad, Manila was cleaning up the Pacific.

The "Spanish" flu ravaged the world at the wake of World War I.
While influenza may have not originated from Spain per se, the name stuck.
Photo courtesy of Time Magazine

Trangkaso
Another disease that plagued the world was influenza or flu, a short-distance airborne virus. Recent memory might remind Filipinos of the swine flu (AH1N1) in 2009, but long before this, the flu had been a resurgent virus in our setting. While the Philippines was still reeling with the fading cholera epidemic (lasting until 1923), the flu arrived in the Philippines in 1918, just before the First World War ended. Again, the miasma theory floated among the population, but it was not much about the air itself than the droplets which go along with it. Also similar to cholera, the flu did not come in two waves, but three. Each wave lasted around three to four months, coinciding with periods when the public relaxed from observing restrictions. The later waves proved more deadly than the first as the disease moved from major ports of entry like Manila, Iloilo, and Cebu to the neighboring provinces. Up to 40 percent of some 10 million Filipinos were believed to have contracted the virus. This was not enough for herd immunity, which posits a 70 percent infection rate. More than quarantine and similar heavy-handed tactics, however, what saved the country was a radical behavioral shift. Cleanliness was emphasized, distancing prioritized, and health-seeking behavior was reinforced. People wearing masks were a common sight, more so among Asians. Perspectives on health had changed quite dynamically, and it still does today.

Apocalypse Now or Futures Thinking?

A vaccine for these diseases did not necessarily prevent new epidemics, and as these illnesses evolved, there came many variables and genetic features we know nothing much about. For instance, the flu reemerged in the Philippines in 1959, and again in 2009. However, it did help humanity learn and adapt. In fact, the lessons from our history with illnesses were still largely visible to this day. Even our body remembers well. Vaccines are essentially trainers for our immunity system to respond better. Meanwhile, the coronavirus threat is likely to transcend the memory of future generations as one of the largest and deadliest. In retrospect, they would study and evaluate how overreaction, underreaction, and other responses fared, just as we did with past ills we thought was apocalyptic. It is our hope that there would actually be future generations who would come. Stay healthy, be historic.

References can be seen here.