The Philippines is struggling with a Covid-19 rise that has accelerated at a pace not seen since the beginning of the pandemic. But fewer people are seriously ill than in previous waves, an encouraging sign for countries preparing for a similar rise in cases.
The government said last week that there was a "very high" probability that the Omicron variant had led to the latest outbreak, which began after the Christmas and New Year holiday period, although sequencing results have also shown that the Delta variant is still spreading in the country .
What is clear is that infections look different. The hospitals are not yet overwhelmed. Patients show up at health facilities with other diseases and then learn that they have coronavirus. People recover faster.
The outbreak in the Philippines adds to a growing body of evidence worldwide that the Omicron variant may not be as deadly as feared, especially among those vaccinated. Still, experts call for caution.
Already, the increase has caused a run on drugs, and the rapid transmission of the virus could create new opportunities for more dangerous mutations to spread. Hospitals could be crushed in a country with one of the lowest vaccination rates in Asia, a region still preparing for its first wave of Omicron infections.
"This is really different, another increase compared to Delta," said Dr. Rontgene Solante, Head of the Infectious Diseases Unit for Adults and Tropical Medicine at the government-run San Lazaro Hospital in Manila. "Here you have a high number of cases, but the hospitalization rate is still manageable."
The trend, if it continues, offers a glimmer of hope for the Philippines, one of the Asian countries hardest hit by the pandemic. It closed schools for 20 months and introduced one of the world's longest shutdowns, exacerbating widespread poverty. More than 52,900 people in the country have died from Covid-19.
Last Wednesday, Dr. Maria Rosario Vergeire, deputy health minister, at a news briefing that the government would adjust its policies to control Covid, provided evidence that Omicron is a more transmissible but milder strain of the virus.
From last Thursday, the contact tracking effort was rolled back. Testing will focus on diagnosing people at risk, such as seniors and those with comorbidity. People with symptoms will be encouraged to isolate themselves immediately. The government said it has shortened the isolation period for vaccinated people infected with Covid to seven days, down from 10 days.
The rules are relaxed even though the virus is still circulating at a tremendous rate. The latest data on Monday showed that the test positivity has exceeded 46 percent. This means that almost every second of those tested turns out to be positive for Covid-19. Cases double every three to four days, according to government data.
The number of active Covid-19 cases in the Philippines hit 290,938 on Monday, a record high, up from 10,095 a month ago. Health experts say the true figure is far higher because the government does not count antigen-fast tests in its inventory. What gives them hope is that many patients seem to be recovering quickly.
Two days after returning from a holiday with his family to the town of Olongapo, Cai de Leon came down with a cough and fever. Her blood pressure began to rise. On January 3, she checked herself into the hospital after her oxygen level dropped to 94. She had Covid.
Ms. de Leon, who lives in Manila, had been vaccinated with China's Sinovac and a Moderna booster shot. At the hospital, she was given Molnupiravir, an antiviral treatment, and was discharged after four days in the hospital.
"I'm still in isolation and I still have a terrible cough, but I'm already out of the woods," said Mrs. de Leon, 37. "If I did not have those vaccines, I would fear for my life."
Although Mrs de Leon, like many patients, was treated quickly, the hospitals are on edge. Thousands of healthcare professionals get sick. Nurses and doctors who test positive must be quarantined for at least five days, which overloads an already stretched healthcare system. The government said this week that 8 percent of the country's health workers have had to be quarantined or hospitalized because of the virus.
The number of hospitalized children has increased between 30 percent and 40 percent compared to September 2021, when the Delta variant ravaged the country. In Manila, parents are struggling to get fever and cough medicine before pharmacies run out. Last Monday, the government announced plans to start vaccinating children under 11 years of age.
The Philippines has one of the lowest vaccination rates in Asia, as only about 50 percent of the population has been fully vaccinated. Health experts warn that when many people become infected, there is a greater chance that the virus will mutate, potentially becoming more dangerous. Admissions could accelerate, especially in provinces with lower vaccination rates.
Dr. Jose Rene De Grano, president of the Private Hospitals Association, said there were preliminary reports of an increasing number of cases at hospitals outside Metro Manila, including North Luzon, South Luzon, Visayas and Mindanao. "Although the symptoms are milder, it should not make us complacent," said Dr. De Grano.
"Even though we think this infection is milder, especially in vaccinated people, we still need to do our best to slow it down so that it does not mutate as quickly," said Dr. Edsel Salvana, an adviser to the Philippine government on Covid-19. "Then it's going to be a different story again."
Despite the outbreak, the number of people with serious illness has not increased in the Philippines. In the Metro Manila region, where more than 96 percent of the eligible population is fully vaccinated, the government said the number of serious Covid cases has dropped to about 20 percent of the total cases. The number of mild and asymptomatic cases is now about 60 percent.
Doctors in Manila report that one of the biggest differences between the new infections and those in previous Covid waves is the clear lungs that they detect in x-rays and CT scans. During the earlier Delta climb, patients showed up with what doctors called "burnt-out lungs." Many required fans to breathe.
Philippine General Hospital spokesman Jonas del Rosario said only a few Covid-19 patients being brought to the hospital's emergency room these days have respiratory problems. "Now we can hardly see patients having to be intubated or taken on oxygen," he said at a press briefing earlier this month.
Dr. Salvana, who also specializes in infectious diseases, said he saw a recent patient in his late 80s who was infected with Covid. He had weak lungs and a history of pneumonia, but when his doctors performed a CT scan, they found that his lungs were clear.
"We wanted to: 'What?' The radiologist said, 'This can not be right,' "said Dr. Salvana.
On January 3, Rogeselle Monton, who has HIV, came up with a case of Covid-19. He developed a sore throat, cough and cold, and was hospitalized on January 7 after discovering blood in his stools. He was later diagnosed with pneumonia.
Sir. Monton, 30, had received two shots of AstraZeneca and a booster dose of the Pfizer vaccine in December. "Maybe if I hadn't been boosted, my condition could have been worse," he said.
After determining that Mr Monton's oxygen levels were stable, doctors gave him the green light to go home last week.