Dramatic increases in knowledge, attitudes and practices of COVID-19 observed among low-income households in the Philippines: A repeated cross-sectional study in 2020

Introduction

COVID-19 has spread wider and persisted for longer than most people expected, but the end of the pandemic is still far from sight. Virtually no country has been left untouched by COVID-19, with most having experienced multiple waves of iinfections and the unintended consequences of imposing a series of measures to control its spread [1]. In the Philippines, when community transmission of the virus was detected towards the end of February 2020 [2], the government rapidly imposed sweeping enhanced community quarantine (ECQ) measures, including strict stay-at-home orders, curfews, the suspension of public transport and any operation of economic activity that was deemed “non-essential” [3].

For many regions in the Philippines, especially those considered “high-risk”, these measures were in place for months, but the consequences of limiting economic activity led to the loosening of lockdown restrictions in May 2020 [4]. However, an accelerated spread of the virus soon followed, with a daily average of over 2000 incident cases of COVID-19 from July to September 2020, more than double the figures in June 2020 [2]. Hospitals, especially in the national capital region, came close to full capacity [5,6]. To ease the burdens on the health care system, ECQ measures were reimposed in August 2020, with modifications to allow some industries to operate at reduced capacities [4]. With a return to stay-at-home orders and restrictions on economic activity, life was significantly disrupted for most of the population in the Philippines, with magnified effects for those without fixed incomes or savings to sustain living costs [7].