Preparing for the Worse: Lessons from the Philippine Frontlines

[pl_row]
[pl_col col=12]
[pl_text]

As the Philippines became the first regional nation that took such drastic measures against the virus, millions of people woke up confused and uncertain about such guidelines. There was also a battle between which could be more rational by now that President Rodrigo Duterte described as “the fight of our lives” while taking into account the impact it can lead to low-income families.

Since the surge of COVID-19 pandemic in the Philippines, hospital congestion has been creating problems due to the influx of suspected and confirmed COVID-19 patients. Even before the start of this health crisis, many hospitals are already busy with other cases.

As soon as strict home quarantine came in effect, Southeast Asia prepared tighter measures against a surge in coronavirus cases. 

More patients flood in the hospitals while hundreds of health workers are quarantined. The scarcity of protective equipment forced hospitals to deny admission to more COVID-19 related cases. Due to the unavailability of facilities and equipment, four major NCR hospitals have announced that they can no longer accommodate patients suspected or confirmed with the coronavirus disease. Aside from these reasons, their ability to deliver the utmost care for some patients needn’t be compromised.

In response, the Department of Health (DOH) categorized individuals who possibly contracted the virus into two: Person Under Investigation (PUI) and Person Under Monitoring (PUM). COVID-19 being highly contagious, proper triage was made by the local health units together with a quarantine plan to be strictly implemented.

PUM’s are individuals who have a travel history and exposure to a positive patient. They should strictly undergo a 14 days self-quarantine at home or a designated Barangay isolation unit. Meanwhile, PUI’s are individuals who have the same exposure as PUM with a manifestation of COVID-19 symptoms, whether mild or severe, and with co-morbidity. However, PUI’s will only be tested if the individual exhibits severe symptoms.

As for the guideline of triage, the DOH released this infographic accessible online to properly direct suspected and confirmed COVID-19 cases.

Hospital representatives, both private and government, have created an alliance in a unified approach to commit their financial, workforce, and technical assistance to three COVID-19 referral centers. Thes
three are:

  • Lung Center of the Philippines
  • Rodriguez Hospital in Tala, Caloocan
  • University of the Philippines-Philippine General Hospital (UP-PGH)

Due to limited resources, these three Metro Manila hospitals are designated as COVID-19 referral centers but limited to mild PUIs (patients under investigation) who are at high risk of deterioration (above 60 years of age and with co-morbidities) and moderate to critical PUIs.

The appeal was endorsed by the Philippine College of Physicians and the Philippine College of Surgeons, stating the purpose of designating these specific hospitals for easier progress monitoring of patients and efficient logistic allocation of resources.

Among many other essential reasons for doing this is to avoid exposure of in and out-patients with non-COVID-19 health concerns. This designation could also make health professionals be focused on cases other than COVID-19 patients with equally severe conditions. It was also taken into account emergency cases like heart attacks and strokes. Surgeons could also attend and monitor surgery cases.

DOH government hospital also expressed their willingness to accept non-COVID-19 patients that the three mentioned hospitals might not be able to handle during this crisis.

As of this writing, the Philippine government is still in the process of dispatching Chinese medical expert team to facilitate technical advice and share medical treatment experience.

‘Test, test, test.’

The Director-General of the World Health Organization (WHO) in one of his speeches regarding COVID-19 reiterates that testing, isolation and contact tracing are the backbones of COVID-19 response.

Among these mentioned steps, the Philippines has to up its competitiveness in testing.  WHO being a significant organization at this time of health crisis, composed of the world’s best and most experienced doctors, scientists, and experts on international public health, has urged countries to test suspected cases as we cannot fight a fire blindfolded.

Without the essential parts of testing, the country cannot document all new cases, including deaths. Many persons under investigation (PUIs) die without benefit of testing, so they’re not recorded as COVID-19 deaths. Additionally, the Philippine Health Insurance Corporation (PhilHealth) will shoulder the costs of testing for COVID-19 in hospitals. 

#MassTestingNow

A call for mass testing from netizens with the hashtag #MassTestingNow was an all-around social media post. After a thorough study, the DOH revised its testing policy and included health-care workers who exhibit even mild flu-like symptoms to be considered as red flags. The Philippine Medical Association reported that 17 doctors have already succumbed to COVID-19.

If they are tested negative, they can go back to work as the workforce was already depleted. The country is targeting April 14 as the start of extensive testing of persons suspected of coronavirus infection. 

 Step-By-Step, Day-By-Day

Even with a massive number of 150,000 test kit donations coming from the Jack Ma and Alibaba Foundation, there would still be a bottleneck at the part of laboratory testing. 

Given the complexity of conducting Polymerase Chain Reaction (PCR), the Department of Health-Research Institute for Tropical Medicine (DOH–RITM) has reiterated that interested molecular diagnostics laboratories must first undergo and comply evaluation and proficiency tests of technologists.

Essential Biosafety principles that the laboratory have to establish:

  • Biosafety Level 2 facility 
  • laboratory technologists trained on biosafety and PCR procedures
  • Regularly calibrated equipment and instruments
  • Well-established protocol on the quality assurance of test results

At the time of this writing, eight accredited laboratories were in full testing phase, increasing testing capacity to more than 1,000 per day and reducing the turnaround time from seven to ten days into two to three days from the time samples are received. 

The Department of Health we’re also determined to fast track the accreditation of other subnational laboratories for massive testing of PUI’s and PUM’s. 

Threat In Health-Care Workers Safety

As these front liners are risking their lives daily for everyone to live, some narrow-minded citizens are discriminating against them. Some were prohibited from going home to their respective boarding houses as they may be contaminated. Not to mention an incident where a nurse was severely beaten and had bleach thrown his face on the streets while on his way home from duty. 

With regards to clinical exposure, WHO Director-general mentioned that even if we do everything else right if we don’t prioritize the protection of health care workers by providing complete protective equipment, they may harbor the virus and get sick. It may subsequently paralyze the hospital workforce, and the list goes on. A harmful domino effect is likely to happen.

Helpful measures that can primarily work

Dr. Rafael R. Castillo, a columnist from Inquirer.net, suggested ways on how we can minimize health-care exhaustion:

  • Primary Care Physicians and other volunteer doctors can do the preliminary evaluation on mild to moderate patients. Follow-up would be delegated to Barangay health workers, and the use of phones would suffice to minimize physical contact.
  • President Duterte’s emergency powers could convince Telcos to waive fees on mobile phones within this crisis.
  • Dictated prescriptions and phone consultations with volunteer physicians and pharmacies should be allowed.
  • Manufacturing industries should focus on producing test kits, personal protective equipment for front-liners, and basic respirators. 

Best Practices

While the country harnesses its available resources, an effective triage system is of big help now involving the smallest unit of health facility to accredited reference centers. 

Depending on the patient’s clinical presentation and exposure, Barangay level up to Level 2 and 3 hospitals are doing their best to facilitate patient evaluation before the whole health care system could reach exhaustion.

As I mentioned, three national reference hospitals and DOH approved hospitals in provincial levels are designated to allocate certain areas of their hospitals. Without these initiatives, it would be hard to appropriate resources and logistics.

These experiences learned first-hand from Wuhan gave the country a lesson in response to this crisis. Implementing rules and guidelines one step ahead among other Southeast Asian countries makes the Philippines catch up with the virus that seemed to be always a few steps ahead.

Provincial Situation

  • Province of Cavite – Gov. Remulla announced that they would soon launch their testing program as soon as they can find a suitable facility and meet the standards of DOH-RITM. 
  • Province of Tarlac- Gov. Susan Yap asked for volunteers with medical background and experience to facilitate municipal quarantine sites.
  • Bicol Region- The Department of Health’s Center for Health Development (DOH-CHD) started handing over ambulances to local government units (LGUs) and hospitals as the coronavirus threat escalates.
  • Bangsamoro Government- The Ministry of Health (MOH) is working on the possibility of setting up COVID-19 dedicated hospital.
  • Cagayan de Oro City- (DILG)-10 urges local government units to identify government facilities that may be temporarily converted into isolation and quarantine facilities. 
  • Province of Negros Occidental – Dr. Julius Drilon, chief of Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) in Bacolod City, Negros Occidental province, said that he is frustrated over the government’s response to provincial needs and they cannot survive with donations alone.
  • Province of Pangasinan- Region I Medical Center (RIMC) based in Dagupan City has also been surviving on support and donations from people, business companies and nongovernment organizations while awaiting medical supply from the DOH. 
  • Province of Benguet- Health workers in La Trinidad town and nearby Baguio City have been making their protective face shields out of recycled acetate sheets as supplies remain low.

[/pl_text]
[/pl_col]
[/pl_row]

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.