Eighty-year-old Nardo Samson, a retired policeman, lay dying in the back of a makeshift ambulance. It was nearly Easter. A surge in coronavirus cases triggered yet another lockdown in the capital Manila, where a confusing patchwork of quarantines to contain the virus persists.
His family's race to save him is part of a larger tableau of the pandemic in the Philippines. Relatives desperate to save a critically ill loved one are left to fend for themselves as recriminations rise against the government's handling of the public health crisis, which has resulted in over one million cases of COVID-19.
Trying to save 'Daddy Lolo'
Samson's grandson Jan Daniel Belmonte told NPR his grandfather's health took a worrying turn after Samson's entire household in Valenzuela City in northern Metro Manila was diagnosed with the coronavirus in late March. The source of the infection, says Belmonte, was likely Samson's son-in-law, also a policeman, whose entire precinct of 18 officers had been infected. In Manila, a positive test means automatic quarantine in an isolation facility outside the home.
Accordingly, Samson, his 78-year-old wife, their daughter and son-in-law, along with their three young children, were all moved to a quarantine center in a local high school. But it was so full the family was put up in a courtyard that had been outfitted with beds and dividers to afford privacy.
In stifling summertime Manila, the whole family struggled with their own COVID symptoms to varying degrees, but their grandfather couldn't breathe, says Belmonte. "And basically the [family was] just there lying down and trying not to expend energy, just trying to deal with the worsening symptoms that they were experiencing," he recounts.
With his oxygen saturation levels plummeting to 40 (95 and above is considered normal) his grandfather was moved to a filled-to-capacity emergency infirmary, where he was put in an air-conditioned van for overflow patients. "And this van just [had] the oxygen tank that [was] being used to support his breathing," Belmonte explains, "but he was deteriorating."
Samson's daughter, who was at her father's side in the rudimentary ambulance, provided the family with hourly updates that Belmonte says doubled as therapy. There were prayer sessions and lachrymose video calls with grandpa. "People were really crying and expecting the worst," says Belmonte, who is 27. "I haven't had that kind of experience with my extended family."
On Good Friday, Belmonte's mother asked him to inquire about transferring his failing grandfather to the Makati Medical Center in Manila's commercial district. Belmonte's wife, Marielle Belmonte, 28, is a doctor at the well-equipped hospital, but it was full.
Racing against time, Belmonte jumped on social media and feverishly contacted friends about leads for a vacancy at another facility. Consulting Google Maps, aunts, uncles and cousins called at least 100 hospitals in their hunt for a bed for their grievously ill grandfather.
There were none. Only waiting lists.
"Most of the waitlists were at around 50 people on the queue," Belmonte says. The "worst," he says, was a hospital an hour and half away, where "there were 250 people in line."
The indefatigable team of eight callers continually redialled the hospitals, hoping a slot would open up.
Belmonte remembers it as "the most helpless that I felt in my entire life."
Finally, a glimmer of hope on Easter Sunday. A small private hospital an hour from the infirmary would admit the grandfather, but it took the ambulance two hours to pick him up.
"By the time he got to the hospital, he immediately went into a coma," says Belmonte. Nardo Samson died on April 6 and was cremated with the family unable to say a proper goodbye. Strict pandemic burial protocols in the Philippines prevented a service of any kind, and no one family member was allowed to condole the man who had been known affectionately as "Daddy Lolo," "lolo" meaning grandfather in Filipino.
In finding a bed, the family had succeeded where many families had failed, but Belmonte says events conspired against them. "My mother and aunts were furious" about the ambulance delay, he says.
The hospital had "called us to say they were ready to take my grandpa in. Then suddenly, the ambulance is not there?" he says in disgust.
A national shortage of hospital beds
Many families are suffering through the same kind of ordeal. Nearly every bed in the emergency departments of major Manila hospitals is occupied, according to the Philippine College of Emergency Medicine, a physician's society. Its president, Dr. Pauline Convocar, said last week that in their 13 medical facilities in Manila, 300 people were waiting in tents.
"There are still patients queuing in our emergency departments as we speak," Convocar says. "People were lining up in the tents, and unfortunately people are dying in the tents while waiting for the hospital bed."
The Philippine Health Department's data show that 63% of the 2,956 ICU beds in Manila dedicated to COVID patients are occupied, and 44% of the 19,034 isolation beds for such patients are being used. Officials have called such high ICU occupancy alarming.
For Belmonte, the data suggests a gross underestimation of the reality on the ground. He says the statistics "prove" that the government has "no real understanding" of what's happening. "It's just a bunch of old men giving each other pats on the back saying that they're doing their job," he says.
Dr. Convocar says with entire households testing positive for the coronavirus, she's now counseling families on the need to pick who among them will get the scarce hospital bed if one is needed.
Where the Philippines went wrong
Had the Philippines been able to vaccinate its most vulnerable citizens, the story of Belmonte's grandfather might have had a different ending.
Belmonte's grandfather did not have the benefit of a vaccine. According to the Reuters COVID-19 Tracker, the Philippines has administered 2,129,185 doses of COVID-19 vaccine so far. That translates into 1.9% of the country's estimated 110 million people having at least one dose of the vaccine.
Philippine Foreign Affairs Secretary Teddy Locsin, Jr., told NPR that his government failed to secure the Pfizer vaccine just months into the pandemic because it had fumbled the finalization of a contract with the drugmaker.
Locsin said he told U.S. Secretary of State Antony Blinken in a telephone conversation: " 'We keep dropping the ball. I think we should stop saying that basketball is our national pastime. We don't seem to be very good at this,' and he laughed."
One in four people in wealthy countries have received at least one vaccine dose, according to the World Health Organization, while the ratio in low-income nations is about 1 in 500 people. WHO Director General Tedros Adhanom Ghebreysus has called it "a shocking imbalance."
Rich countries have secured vaccines in quantities that far exceed their populations, contributing to the imbalance.
Public health experts often say such "hoarding" is indefensible when most of the world is struggling to get even small allotments of vaccine. But the Philippines' top diplomat stakes out a more forgiving position rarely heard from low- and middle-income country officials.
"Please don't blame yourselves for over-ordering," Locsin says. "When somebody brought that up in a [government] meeting, I said, 'Hey, you know, the countries that over-ordered did it because they wanted to protect their people. The countries like us that hemmed and hawed — well, now we're there." And by "there," he means the grim place the Philippines now finds itself as a result of its painfully slow vaccine rollout.
But Locsin says thankfully there's currently an overabundance of vaccines in rich countries — and his expectation is that they will share.
"When they have secured their populations ... it's available now for us," he says. It should not be a gift, Locsin adds, but rather the Philippines ought to buy the vaccines. "Why do I pay taxes? What are we saving the money for?"
Vaccines are coming — but are people willing to take them?
The Philippines clocked more than 115,000 new infections the past two weeks, but the average number of cases reported each day is now falling from a high of 9,600 to 6,700.
The hope is that the vaccine will soon be able to make a dent in the terrible toll — although getting the doses is just one step. Convincing reluctant citizens is another.
Six out of 10 Filipinos are unwilling to be vaccinated mostly out of safety concerns with the COVID-19 vaccines, according to a Pulse Asia survey released in March, which conducted face-to-face interviews with 2,400 Filipinos age 18 and up.
The survey also found that the vaccine developed by Pfizer was the most preferred by those willing to get vaccinated against COVID-19. Only 22% of the respondents favored the vaccine developed by Chinese drugmaker Sinovac, which has been the Philippines' primary vaccine to date.
A small tranche from Pfizer is due in May. Locsin says the COVID-19 catastrophe in India has upended plans to ship millions of doses to countries like the Philippines. He says Moderna and Russia's Sputnik V are on order but not expected before June or July.
Locsin himself has not been vaccinated yet, and won't likely get a shot until the Moderna doses — the vaccine ordered for the Foreign Affairs Department — arrive in the Philippines.
As for the Chinese vaccine, Sinopharm, it has not yet been approved by the Philippine FDA but local regulators allow it to be administered under "compassionate use." On Monday, President Rodrigo Duterte, 76, received his first dose, streamed live on Facebook. Duterte's aides said he took the vaccine to encourage reluctant Filipinos to get vaccinated. He later apologized for using an unapproved vaccine. Chastened by criticism from medical experts that it was risky to use serum that had not been fully assessed by regulators, Duterte said, "We are sorry. You are right." He said China should replace it with the Sinovac vaccine instead.
Coping with COVID's aftereffects
Dr. Convocar insists that the country must stop "romanticizing" Filipino "resilience" as a means to overcome a pandemic that has devastated the economy, shuttered schools and killed more than 18,000 people in the Philippines.
"We have to also look at accountability, competence. We can't just forever pin our hopes on resiliency. There's really a breaking point there somehow," she says.
Even with all the resilience in the Philippine population as it copes with the pandemic, the reality is that coping is very tough and very expensive.
By sad coincidence, Jan Daniel Belmonte's grandmother Estelita Samson found a bed just days after her husband Nardo Samson died from the lack of one. Upon learning he had contracted COVID-19, Samson had immediately contacted the Fatima University Medical Center to be put on a waiting list in the event he needed a hospital bed. The staff finally called with a vacancy, two days after he died, and his wife was given the bed. But Belmonte says she may have to sell her house to pay for the cost of the care in the ICU. Even though senior discounts and insurance reduced her $37,000 hospital bill, it was still a sizable sum: $15,500.
In addition to that, the family was sent scurrying to buy medical supplies. The hospital had run out of hemoprofusion cartridges used in dialysis to purify the blood of some critically ill COVID patients, removing cytokines that cause storms of inflammation, affecting the organs. The four cartridges alone cost more than $6,600, Belmonte reported. He helped defray his grandmother's exorbitant bills, raising $4,000 online.
The family calamity was both tragedy and epiphany for Belmonte. He says what struck him most was his good fortune in contrast to many other Filipinos facing dire straits in this pandemic. He says he could only feel gratitude for his quality education and access to the internet, tools to help his family.
"We still have a better scenario compared to all the other people who were less privileged than us," he says. He notes that many less fortunate Filipinos live in cramped, dense quarters where the coronavirus flourishes. With slim to no chance of finding a hospital bed for their sick relatives, Belmonte envisioned how their ordeal would be far worse than his own family's. "I was imagining ... people would be staying and dying at home. And it really exposed the huge inequality in access to health care."
Belmonte says there's no excuse that a year into a deadly pandemic the system is so unprepared. And that families across the Philippines, a society that confers lavish attention on wakes and funeral masses and burials, are completely deprived of those rituals today.