MANILA, Philippines – In recent weeks, the Philippines has seen infections and hospitalizations drop to levels not seen since the early months of the pandemic, bringing hope to millions that a return to normality is in sight, just in time for the holiday season.

While vaccines have become available to all individuals aged 12 and above in the Philippines, health experts warn against complacency, which could erase months of sacrifice.

Unfortunately, as long as the virus is still around, there is no such thing as a risk-free activity. The threat of Omicron, the newest variant of concern, is also present, and scientists are still racing to learn more about its transmissibility, severity, and impact on vaccines.

So, after nearly two years of living under a pandemic, what can and can’t be done to keep safe from COVID-19?

Experts say that instead of striving for a “zero-risk” approach, people may better adjust to this stage of the pandemic by adopting a “risk-based” approach.

The World Health Organization defines it like this: “regularly assessing the risks, and adapting practices that mitigate risks.” Think properly wearing face masks, being conscious of ventilation in public spaces, avoiding crowds, getting vaccinated, and testing yourself in case you show symptoms of COVID-19.

We asked health experts to tell us what they would and wouldn’t do when it comes to common holiday activities, like Christmas shopping and gatherings, and how they might celebrate this time of year safely.

Dr. Anna Ong-Lim is the division chief of the Infectious and Tropical Disease, Department of Pediatrics, at the University of the Philippines College of Medicine. She is also a member of the Department of Health’s Technical Advisory Group and the Healthcare Professionals Alliance Against COVID-19 (HPAAC), the country’s largest group of health workers.

Dr. Antonio Dans is a clinical epidemiologist, internist, and professor at the University of the Philippine College of Medicine. He is also an academician at the National Academy of Science and Technology and is one of the lead convenors of HPAAC. 

Dr. Aileen Espina is a public health and family medicine specialist, and one of the lead convenors of HPAAC. Espina was also former chief of the Eastern Visayas Regional Medical Center. 

Dr. Benjamin Co is an infectious disease and clinical pharmacology specialist, and is chief of the section of Infectious Diseases, Division of Pediatrics, at the University of Santo Tomas Hospital. He is also chair of the research and ethics committee at the Asian Hospital and Medical Center and chair of the pharmacy and therapeutics committee at the Cardinal Santos Medical Center. 

Dr. Pauline Convocar is the immediate president of the Philippine College of Emergency Medicine and a member of HPAAC. 

Christmas shopping

Would you shop inside a mall? 

Ong-Lim: I think, rather than specifying venues, the important considerations are ventilation and crowding. A crowded market, even if outdoors, might also pose significant risk; on the other hand, a well-ventilated mall on a weekday with less people would be relatively safe.  

Dans: Depends how good the ventilation is. 

Espina: No.

Co: Yes. 

Convocar: I would, but cautiously, and will choose the least crowded operating hours, which maybe as early as opening and will be deliberate. I will not probably linger and will probably have a shopping list.

Would you shop in an outdoor market?

Dans: Yes, if not crowded. 

Espina: Yes.

Co: Yes.

Convocar: Yes. I may prefer an outdoor market.

Holiday parties, gatherings

Would you host or attend a party with friends or multigenerational family members?

Dans: Depends how good the ventilation is.

Espina: No.

Co: No. 

Convocar: Will consider, but cautiously and with provisions.

Would you travel by air or bus/van or ferry for the holiday? 

Ong-Lim: I would prefer NOT to take public transport of any kind, just to minimize risk.

Dans: Depends how good the ventilation is. 

Espina: I travel mostly for work; but for rest and recreation, we usually travel using our own private vehicle.

Co: No. 

Convocar: Yes. Part of my job as well, anyway.

How would you hold a small party in a safe way, if ever? 

Ong-Lim: Considerations for gatherings will include venue (outdoors), dining arrangements (plated meals, seated together with own bubbles), and attendees (should be vaccinated).

Dans: Assuring good ventilation + follow “APAT dapat” (4 must) [reminders]:

• A – Air quality (Outdoor activities are much safer than those indoor.) 
• P – Physical distancing (A one-meter distance reduces the risk of transmission by up to 80%.)
• A – Always wear personal protective equipment (like face masks)
• T – Time of activity 

Espina: It would be limited to our household bubble; all of us are already vaccinated.

Co: Make sure it is outdoors as much as possible, and when I say small, it should be proportional to the dwelling space. 

Convocar: Only within my bubble and only after a quarantine period and strategic negative antigen test before interacting with the family members of extreme ages.

Celebrating with kids

What safe activities would you recommended for kids who can’t get vaccinated yet? 

Ong-Lim: They can participate in outdoor activities, held in areas that aren’t crowded. Maybe the idea of drive-in movies can be explored again.

Dans: Activities in open space. 

Espina: Limit exposure to the general public; identify open spaces where children can play; come up with creative activities at home like arts and crafts, movie nights, board games; playing dress up, etc; if it cannot be prevented for unvaccinated children to go out and interact with other people, teach proper wearing of mask, hand hygiene, etc. 

Co: Take them out with other adults who are fully vaccinated but in open spaces. Thoughtfully prepare for the event – beach, park, etc – plan a picnic. I would not advice a staycation because they will mingle with adults and I am sure they will want to gallivant around the hotel. Many of the hotels are still mixed use. 

Convocar: Within family bubbles. In-house games or outdoor, well-ventilated, controlled spaces.

Religious activities

Would you physically attend Simbang Gabi?

Ong-Lim: Yes, if the attendees are vaccinated, all masked, well-ventilated venue, capacities are controlled.

Dans: Depends how good the ventilation is. 

Espina: No.

Co: Yes.

Convocar: No.

Going out

Would you take your family to see lights and Christmas trees in a park?

Ong-Lim: Yes, since outdoors, provided that the venue isn’t crowded.

Dans: Yes, if not crowded.

Espina: Yes, but only from a distance and not in the middle of the crowd; will try to observe physical distancing as much as possible.

Co: Yes.

Convocar: No.

Would you have a meal in a restaurant indoors? 

Ong-Lim: No.

Dans: Depends how good the ventilation is. 

Espina: No.

Co: Depends. If they have a private room – yes. 

Convocar: No.

Would you have a meal in an outdoor section of a restaurant?

Ong-Lim: Yes.

Dans: Yes, if not crowded. 

Espina: Al fresco dining for us.

Co: Yes. 

Convocar: May consider it, but more likely just do delivery.

Would you allow any family member to go out caroling?

Ong-Lim: No.

Dans: Yes, if they assure good ventilation and follow APAT dapat.

Espina: No.

Co: No.

Convocar: No.

Would you go to a movie? 

Ong-Lim: No.

Dans: No, unless the ventilation is improved.

Espina: No.

Co: No. 

Convocar: No.

Would you eat snacks while at the cinemas?

Ong-Lim: No.

Dans: Not applicable. 

Espina: No.

Co: No. 

Convocar: No.

Would you exercise in a gym? 

Ong-Lim: No.

Dans: If the ventilation is good. 

Espina: No.

Co: No. 

Convocar: No.

Advice

What’s your advice to Filipinos who are unsure of how to celebrate the upcoming holiday season?

Ong-Lim: Use APAT Dapat as a guide. Best if possible to comply with all of the parameters, and for all attendees to be vaccinated.

Dans: Assure good ventilation and follow APAT Dapat.

Espina: Go back to the real meaning of the season which is love and family. 

Co: Err on the side of caution. If it doesn’t feel right, don’t even attempt to do it for “Christmas’ sake.”  After all, every day can be Christmas if we believe in the spirit of the season. Make it meaningful by staying safe.  

Convocar: Celebrate peacefully and silently, avoid crowds/congestion. Only [go for] essential activities. [Make a] conscious effort to follow the health protocols. [Practice] mindfulness of how to behave in “shared spaces.”

What science about the pandemic shaped your decisions and risk tolerance? 

Ong-Lim: It is critical to understand how the virus is transmitted, so we can tailor-fit our defenses.

Dans: The science on airborne transmission.

Espina: My decisions are based upon the disease triangle. (The disease triangle shows the interactions between three factors: the environment, the host, and pathogen or virus.) 

Co: That taking risks for the sake of fun isn’t really worth it. Vaccination helped and so did the minimum health standards. We should embrace that.

Convocar: The fear of the uncertainty of the behavior of the Omicron variant, balanced with the hope brought by the protection of the vaccination.

– Rappler.com