Covid-19 and Greater Manila’s health system: The next frontline?


By Jerik Cruz

How close are Greater Manila’s health-care systems from being overwhelmed by Covid-19? Since early March, the Duterte administration has imposed an enhanced community quarantine (ECQ) over Luzon to “flatten the curve” of contagion.

Among the criteria for decisions on how to modify the ECQ in the upcoming months should be the extent to which already-saturated health systems in Covid-19 hot spots can absorb more severe coronavirus cases. However, though the focus of public attention on NCR has been warranted, even starker gaps are emerging in Metro Manila’s peripheries—now another time-bomb in the country’s battle against Covid-19.

Significant infections even with ECQ

IN the past weeks, projections by experts have indicated that the rise in coronavirus patients in the Philippines is still poised to reach its peak between May and June 2020, up to two months after the extended ECQ. Estimates generated by Ricardo Dizon, a PhD graduate from the Ateneo de Manila University, give us a sense of the expected wave of patients for NCR. Even with radically reduced mobility (0.5 percent of regular volume), more than 4,500 new episodes of Covid-19 could require hospitalization at the curve’s apex in early May (Figure 1)—while more than 750 new patients could be in need of intensive care units (ICUs).

Though Dizon’s estimates do not include figures for Rizal, Laguna, Cavite and Bulacan, these areas already boast the highest concentration of Covid-19 cases outside of NCR, and the country’s greatest provincial population densities. Because of this, they can be expected to follow a similar, if lower-magnitude, trend.

Greater Manila’s capacity for severe cases extremely limited

Will the health systems of Greater Manila be able to weather this surge in infections? Unfortunately, available data (Figure 2) gives cause for alarm on the metro-region’s ability to accommodate critical coronavirus cases.

While Level 2 and 3 hospitals (which can host ICUs) located in Greater Manila span an authorized bed capacity of 26,511 (NCR), and 6,300 beds (provinces), most hospitals’ actual capacity is limited by their typical operations at 70 percent to 80 percent of their full capacity. Moreover, since the beginning of April at least 44 such hospitals in the Greater Manila vicinity have been closed to Covid-19 admissions.

Even more alarming are hospitals’ low intensive-care capacities. Though NCR and Greater Manila provinces may have had a maximum of 1,930 and 415 ICU beds, respectively, the DOH has already indicated that only 613 ventilators were left available for coronavirus patients nationwide as of mid-April—already below the 750 critical cases projected earlier for NCR.

These gaps are starkest for the Greater Manila provinces, which are caught with the highest provincial infection rates outside of NCR, yet with even weaker health systems. Though the availability of ICU beds for their multimillion person populations are dismal across all four provinces, the most extreme shortages are in Rizal (max. 35 beds) and Bulacan (max. 85 beds). With eight hospitals in these four provinces already reporting full bed capacity, Metro Manila’s outskirts could be the next time-bomb in the country’s fight against coronavirus: hyper-urbanized, at NCR’s doorstep, yet lacking the systems needed to confront the pandemic.

Bracing for the surge

The coronavirus pandemic has ushered in a perfect storm of potential coordination failures. The vulnerabilities of our peri-urban health systems do not only intensify dangers for their residents; they lay the groundwork for the pandemic’s resurgence in Metro Manila.

To mitigate these risks, the following measures are urgently needed:

Facilities, ICUs and medical equipment: Like the Philippine Arena in Bulacan, facilities must to be rapidly retrofitted for pandemic-response purposes for handling/isolating milder Covid-19 cases. Compared to NCR, there may need to be even more conversions in Greater Manila provinces due to the increased distances involved.

Even more crucial should be an aggressive expansion of hospitals’ intensive care capacities, including through the provision of  “Covid Cabanas” and other temporary ICU facilities. Similarly, the country’s supply of mechanical ventilators, including through low-cost, locally produced alternatives needs to be quickly expanded.

Random testing across Greater Manila with localized mass-testing: Despite recent increases in local testing capacity, mass-testing the entire Greater Manila population of 25.8 million persons is unlikely in the short term. In the interim, undertaking random-testing across the Greater Manila region may be a more viable strategy to identify population clusters where coronavirus infections are spreading, which can then be targeted for localized mass-testing.

Jerik Cruz is a lecturer at the Department of Economics at the Ateneo de Manila University and an incoming PhD student at the Massachusetts Institute of Technology. This article is an abridged version of an AdMU Econ-Acerd policy brief.

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