Fighting coronavirus: How Manila stays ahead of the curve – for now

MANILA, Philippines – Manila Mayor Isko Moreno picked up the phone for the Skype interview from his quarters at city hall, a bare white room with a queen-sized bed, a shirt rack, paintings from supporters leaning against a wall, and a square window showing the Bonifacio Monument.

He has been sleeping in the room since placing himself under self-quarantine for 15 days from March 11.

At the time, critics scoffed, but Moreno really locked himself in, limited only to the audience of his most trusted staff. He just came from a trip to the United Kingdom, where he saw how the virus had pushed its capital London to cancel major events and shutter businesses as virus cases surged to over 300.

Two weeks later, he still slept at city hall. Now, he carried the fear that what he saw abroad could be imminent in his city.

As of Wednesday evening, March 25, Manila recorded a total of 32 people positive for the coronavirus disease (COVID-19), surging from just 13 two days before. He said they were prepared for it.

“We always wanted to be ahead of COVID-19. I don’t want it to defeat us,” Moreno told Rappler.

So far, they are managing. Of the 32 confirmed cases, 3 have died, and two have recovered. Six are being treated at their newly constructed Manila Infectious Diseases Control Center (MIDCC) at the Sta Ana Hospital, while the rest are in different private hospitals.

They expect to have 20 more rooms to accommodate more patients at the MIDCC. If the infection explodes, they are prepared to convert the entire 10-floor building of the Sta Ana hospital to cater exclusively to coronavirus patients.

They have even braced for an “armageddon scenario,” Moreno said, where the surge in cases would force the isolation of thousands. They have 5,000 rooms readied in Manila’s public schools to keep them – and they have already coordinated with the Department of Education, as required by the national government.

For social relief, he has distributed thousands of food packs with his fellow officials for the disenfranchised Manileños under the lockdown, and provided jobs for e-tricycle drivers to ferry Manila health workers to their hospitals.

How have they been able to move fast? With the virus spreading in exponential numbers, are they moving fast enough?

The story of Manila City gives a picture of the struggles of local government units in the Philippines during a generation-defining health crisis. At this time leaders are pushed to innovate and exhaust all options to prevent avoidable deaths under threat of a breakdown in public health emergency, while giving help to homebound constituents deprived of work.

The mayor's expert

While Moreno is the most visible official of Manila, it’s not all him. Moreno enjoys an advantage that many other local officials do not: his vice mayor is a doctor, Honey Lacuna.

She is the woman with the ash-colored, pixie-cut hair who always sits or stands behind Moreno in his many addresses and Facebook live videos.

“If you don’t see me sleeping, she does the same. That’s how lucky we are,” Moreno said.

Lacuna has stood as a pointperson for Moreno in coordinating with the hospital directors of Manila. Her husband, Arnold “Poks” Pangan, also a doctor, is the officer-in-charge of the Manila health department.

Rappler sat down with Lacuna in an interview on March 12, days before the cases spiked and before the national government declared a lockdown.

At that point, she already had the numbers and policies in her head: the capacity of the MIDCC (still 4 back then), the doctors and nurses they needed (21 and 50, respectively), and how soon the Sta Ana hospital can be converted exclusively for COVID-19 patients (they were coordinating with the Department of Health).

They were able to prepare earlier than many local government units. By early February when the Philippines had only 3 COVID-19 patients, the Manila city government already formed a Task Force to prepare for the spread of the coronavirus.

NEW FACILITY. Security personnel check on the isolation rooms intended for Patients Under Investigation (PUI) at the newly opened Manila Infectious Disease Control Center. Photo by Ben Nabong/Rappler

NEW FACILITY. Security personnel check on the isolation rooms intended for Patients Under Investigation (PUI) at the newly opened Manila Infectious Disease Control Center.

Photo by Ben Nabong/Rappler

In this command structure, Lacuna became the go-between, bridging the firebrand mayor and the highly technical medical professionals of Manila’s hospitals.

“These health workers are always on the field. They have to report to the mayor, but they go to me so that there wouldn’t be any misunderstanding,” Lacuna said.

Lacuna has been instrumental to Moreno’s understanding of the disease and the healthcare response needed. Moreno said that when he has ideas for the hospitals, he first consults Lacuna, still calling her “ate (big sister).”

One of Moreno’s ideas was to make improvised acetate protective face gear for medical workers in response to the shortage of the mass-produced personal protective gear. They created a production line inside city hall and gave hundreds out to frontliners.

Lacuna has also kept the Manila City Council in line as vice mayor.

When Metro Manila mayors met to agree on declaring an 8 pm to 5 am curfew, Lacuna represented Manila as Moreno remained in quarantine. The same night, she presided over the Manila City Council to pass their curfew ordinance, second only to Muntinlupa, on the declaration of the restriction.

Social media innovation

AUTOMATED. Mayor Isko Moreno's Facebook is programmed to gather medical information to be kept confidential by their emergency response team. Rappler screenshot.

AUTOMATED. Mayor Isko Moreno's Facebook is programmed to gather medical information to be kept confidential by their emergency response team. Rappler screenshot.

Moreno’s social media reach has been more valuable than ever during the coronavirus outbreak.

Every night since the lockdown was declared over Metro Manila and then Luzon, he has been going live on Facebook to give updates on how grave the problem is in the capital and how the city government is responding.

When the World Health Organization announced past midnight on March 12 that the coronavirus was already a pandemic, Moreno and Lacuna went live after at 1:23 am, to tell Manileños that they had a plan: the CODE COVID-19. The CODE stands for contain and delay.

Umasa po kayo, sa tulong ng ating Vice Mayor at ating kawaning medikal, at lahat ng kawani ng ating lungsod, ay patuloy nating gagampanan na haharapin itong nasabing pandemic na ito (You can count on us, with the help of our Vice Mayor, and our medical personnel and other city personnel, we will continue to do our job and face this pandemic),” Moreno said.

The video was shared over 2,600 times and garnered over 520,000 views.

One of the things Moreno announced was the creation of a 24/7 hotline for the city to accept any information related to the coronavirus. He called it the Manila Emergency Operations Center (MEOC).

But the MEOC did not only accept calls, they also gathered reports through Isko Moreno’s Facebook page, where Moreno’s staffers even post daily updates on the price of goods in their markets.

With the help of consultants, Moreno turned his Facebook page’s message option into a medical survey, which asks the following questions to those who initiate a Facebook conversation with his page:

DATA WORK. The breakdown of responses to Manila Mayor Isko Moreno's survey through his Facebook page. Screenshot courtesy of the Manila City Government

DATA WORK. The breakdown of responses to Manila Mayor Isko Moreno's survey through his Facebook page.

Screenshot courtesy of the Manila City Government

The entries are pooled into a database monitored by the MEOC.

If users reply yes to having difficulty breathing, having high fever, or having interacted with anyone confirmed with a confirmed case, a team is dispatched to isolate them. The survey, so far, has led to the isolation of persons under investigation.

In total, Moreno’s Facebook page has received 36,112 entries from Manileños alone as of morning of March 25. Over 30 have reported having fever, over 80 had interaction with coronavirus-positive cases, and over 550 have reported having difficulty breathing.

With the system, Manila has been trying to minimize the interaction of barangay officials with positive cases and people being probed for the virus.

Not all barangays have isolation units, and most barangay officials are not fully trained to isolate people in their barangay halls. For Moreno, the best they could do is to implement the curfew and the lockdown. If they hear one of their residents exhibit symptoms, they call city hall.

Tightrope with businesses, national government


Moreno has also hauled, even compelled, support from the private sector and the national government to keep the city afloat for the first surge in cases.

On March 18, he issued an executive order, “commandeering” hotels and motels across Manila to accommodate health workers who worked in hospitals in the capital. As of March 25, 1,482 rooms have been opened in establishments such as Dormitel, Eurotel, Victoria Court, and Sogo.

On March 25 too, Moreno got a donation from their sister city in China, Guangzhou, of 200,000 N95 masks, 100,000 surgical masks, and 2,000 infrared thermometers for Manila's frontliners.

Other big donations are added to infographics that he posts every day. Among those who have received a shoutout is the Filipino Chinese Business Association, which gave 20,000 face masks, Toyota Philippines, which gave them 3 brand new Fortuners for the service of frontliners, and Puregold, which gave them P5 million.

Moreno has also successfully gotten the favor – and neutrality, at least – of the national government. Pasig City Mayor Vico Sotto grabbed attention after calling on the national government through the media to allow them to have tricycles operate. National officials scolded him for the call. Sotto eventually relented.

Moreno, meanwhile, silently coordinated with the Department of Labor and Employment to hire electric tricycle drivers to ferry frontliners exclusively.

The Manila Mayor’s cry for help was aired when he came to the government-organized Laging Handa press briefing on Wednesday, March 25.

Kami sa Maynila, kailangan na kailangan namin ng pagkain (In Manila, we need food). We want to defeat COVID-19,” Moreno said.

As of March 25, 44,763 food boxes have been distributed by the Manila City government. The Presidential Commission For The Urban Poor, however, counts at least 104,000 urban poor families under Moreno’s watch. This does not include families fed by minimum wage earners who have been disenfranchised under the Luzon-wide quarantine.

In total, Moreno estimates that they would have to provide food for 350,000 families. He even made a hashtag for the goal: #GoFor350kFamiles.

Even though they have facilities ready for COVID-19 patients, they are also facing the crisis of having to feed the healthy yet jobless people who must stay at home.

The high number of poor families also represents the number of people that are most vulnerable if the virus outbreak spreads in their communities. These are the same communities Moreno grew up in before rising as a politician. They are the same communities to whom he promised his vision of "a new Manila."

Will Manila be able to keep it up? Moreno already has a standard answer: “May awa ang Diyos (The Lord has mercy).” – Rappler.com

Rambo Talabong

Rambo Talabong covers security, crime, and the city of Manila for Rappler. He was chosen as a Jaime V. Ongpin Fellow in 2019 for his reporting on President Rodrigo Duterte’s war on drugs.

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