Major gaps in COVID-19 prevention and symptom awareness as Metro Manila’s lockdown eases

The Philippines was deeply affected by the COVID-19 pandemic. As of May 25th, over 14,000 Filipinos were infected with COVID-19. The government responded with an extended lockdown across Metro Manila for over two months, affecting the incomes and livelihoods of millions of households. The dual challenges of infection risk and income loss are especially critical in urban areas, where population density is high and lockdown enforcement is strict.

To support the City Health Office of Parañaque, a diverse city of 700,000 that’s part of Metro Manila, IDinsight conducted a rapid phone survey to understand:

1. Are people aware of and practising COVID prevention methods, including complying with quarantine measures? Are they aware of COVID symptoms and how to respond if/when they emerge?
2. How are the pandemic and lockdown measures affecting household incomes and basic needs? Have people received cash or in-kind relief?
3. How are the pandemic and lockdown affecting health-seeking behaviours and access to non-COVID related health services? Are people still seeking and able to access the care that they need?

We aimed to interview low-income residents of Paranaque through phone surveys. Lacking a comprehensive list of these residents, we used a novel approach relying on Facebook ads to create respondent lists and offered ~1 USD mobile airtime compensation. As such, our results are generalizable to those who opted into our survey — in other words, those who have access to Facebook, own a mobile phone, were incentivized by the airtime and were willing to complete the survey. Although our sample was self-selected, we find that it resembles the broader population on key demographic variables, including gender, age, household size, and area of residence (barangay), likely due to the high Facebook penetration in the Philippines. Our final sample consists of 598 respondents: 55 per cent women, 29 per cent aged 46+, and between 1–15 per cent residing in each of Paranaque city’s sixteen barangays.

What did we learn?

Less than half knew that “difficulty breathing” is a symptom. Less than half of respondents knew that COVID-19 could manifest as difficulty breathing, which is a severe symptom that necessitates immediate professional care. It is much less known than ‘flu-like symptoms’, such as fever and cough, and was slightly less known by older respondents. In addition, when asked what they would do if they or someone in the family experienced difficulty breathing, 13 per cent of respondents would not seek professional care.

“Staying at home” is the most known protection method, with other methods lagging behind.

“Staying at home” was cited by the vast majority (72 per cent) of respondents as a way to prevent the spread of COVID-19, but fewer than one in ten knew COVID-19 could be prevented by disinfecting common surfaces, using cough etiquette, or avoiding touching the face. This is an area of concern because over-reliance on “staying at home” as the primary safety measure could lead to complacency while at home, where indoor transmissions are most common. This is especially a concern as quarantine restrictions start easing because some household members will likely leave the home and risk exposure, potentially exposing vulnerable family members who haven’t left home upon their return.

The majority of those who needed medical treatment reported forgoing non-COVID health services.

Nearly a third of respondents’ families have conditions and chronic diseases that need medical support (beyond COVID symptoms or cases). There is a moderate prevalence of co-morbidities of COVID-19, including high blood pressure, diabetes, respiratory conditions, and cancer. Among those who needed to seek help or treatment since quarantine began, 66 per cent (~8 per cent of all families in our sample) did not receive sufficient help or treatment. The main barriers were transportation inconvenience (24 per cent) and limited availability of medical professionals (15 per cent).

The majority of respondents have lost incomes, but less than a quarter have received cash relief.

When asked to compare their situation pre-quarantine to the survey period, 72 per cent of primary income earners said they lost their salaries or closed their businesses. Consequently, food scarcity has also increased; families who do not have enough food to eat every day quadrupled from 10 to 43 per cent. Meanwhile, cash relief to ameliorate the loss of income has not reached most citizens who need it. More than three-quarters of respondents have not received cash from government sources at the time of the survey. Despite already being in week 7–8 of the quarantine, about 1 in 5 of them were still waiting to get any form of cash assistance.

What’s next?

Based on these findings from the rapid phone survey, we shared policy recommendations for the City Health Office and City Council of Parañaque City on evidence-driven social and behavioural change communication campaigns and socio-economic responses. Specifically, we emphasized the need to prioritize communicating hygienic protection measures, especially as quarantine restrictions start easing; provide guidance around when families should seek medical care for severe COVID symptoms, and non-COVID concerns; and strengthen economic support to families that have lost income, particularly with efficient disbursements of cash relief. We look forward to continuing to engage with our government counterparts and development partners to help them use these findings to inform policy decisions during this critical time.

For more detail on our findings and recommendations, you can read our policy brief here.

If you are interested in conducting rapid surveys on Covid-19 response or other topics in Southeast Asia, please contact Meg Battle at meg.battle@idinsight.org