Intensifying the Fight Versus COVID-19 While Transitioning to a New Normal:

A COVID-19 Health Policy Working Group Follow-up Recommendations for our National
and Local Leaders

Further to the 4-point policy recommendation put forward last 6 April 2020: implement
massive testing; sufficient health workforce with full protection; establish community and
household-based risk mapping and assessment; and Capable LGUs, and cognizant that many
of said proposals have been or are currently being implemented, we note with appreciation
the positive response from government.

While much has been done, so much more needs to take place in this fight against COVID-19.
Hence, we again urge our national and local leaders to consider these follow on
recommendations:

1. Better and Expanded Capacity for Mass Testing and Detection:

In order to have more people tested, especially as government contemplates easing
some of the restrictions after 30 April 2020, there is a need to further strengthen our capacity
to test using the best available and scientifically evaluated testing kits, guided by clear
protocols.
• Towards this end, technical and biosafety certification of laboratories capable
of performing RT-PCR tests may be shared by the Research Institute for
Tropical Medicine with the University of the Philippines Manila - National
Institutes of Health as the latter has a similar capability to do laboratory
evaluation and certification;
• To provide better guidance to the public on the effectiveness of available rapid
antibody test kits, an evaluation of the specificity and sensitivity of the said
test must be conducted by government and other recognized research
institutions. The results of such evaluation may then be used in deciding
whether to procure and utilize said test kits for widescale public or private use.
Along this line, randomized testing of communities with high incidence of
COVID-19 using rapid and confirmatory testing may be done to support the
value of rapid test for general use and establishing levels of immunity;
• Both public-private testing facilities must be fully operational, working at three
8-hour shifts daily to cater to the demand in NCR and in the anticipated next
outbreak regions of Central Luzon, CALABARZON, Metro Cebu and Metro
Davao, with the full cost of testing shouldered by PHILHEALTH based on
existing guidelines, and in accordance with the Universal Health Care Law;
• There must be a clear policy to deploy and reposition PCR-based testing
laboratory capacities to areas with high COVID-19 incidence at the earliest
possible time, and ensure their accessibility to LGUs;
• To ensure availability of needed local testing supplies, such as reagents and
consumable laboratory supplies, government must mobilize and tap
production capacities of Philippine-based Biotechnology and local
pharmaceutical companies;
• To provide an alternative mode of detecting COVID-19 cases in anticipation of
a scenario where there will be a global shortage of testing supplies, a research
 study must be commissioned, using global review of literature and available
clinical data on COVID-19 from hospital records by a team of infectious disease
and laboratory science experts, to develop appropriate technology-based
interim or composite clinical and laboratory indicators for COVID-19. The
output could be a COVID-19 algorithm using a composite list of signs and
symptoms, laboratory results and diagnostic tools (like chest x ray, finger
oximeters) for clinicians to arrive at a presumptive diagnosis of COVID-19 while
waiting for the results of the PCR test and validation of the Rapid Testing Kits.
Such algorithm can be integrated into the treatment protocols for COVID-19
to be used in all hospitals and clinics in the Philippines;

2. Protection of Health Workers On and Off-site.

With a high percentage of our health care workers (HCWs) afflicted with COVID-19
compared to other countries in the Western Pacific Region, government has to do much more
than provide HCWs adequate compensation, proper training and Personal Protective
Equipment (PPEs), and ensuring they are not discriminated against. The Department of Trade
and Industry, whose mandate is the production of PPEs through a public private partnership
agreement must give a timetable and clear deliverables when hospitals can have a guarantee
of supply of PPEs in every region.

Government must further ensure that preventive and protective mechanisms are in
place to minimize exposure of Health Care Workers to the SARS CoV-2 virus whether at work
or at home, such as hiring more personnel so that work shifts are more conducive to
occupational safety and health, providing on-site or near work accommodations and immune-
booster like anti-oxidants (melatonin), minerals (zinc), pro-biotics, pre-biotins and vitamins,
thereby ensuring that a three 8-hour shift in PCR laboratory centers and ICUs in hospitals will
be a more common norm rather than frontline HCWs working in 12 hour shifts.

3. Well-established Workplace Preventive and Protective Measures in a Modified

Quarantine Scenario in Addition to a COVID-19 Responsive Health Care System
As we move towards a possible lifting or modification of the Enhanced Community
Quarantine for certain vital industries, it becomes important that we do not lose the gains
from the ECQ nor expose us to another wave of COVID-19 infection. It is imperative that we
have a ready health care system both at the primary and tertiary levels that can appropriately
respond to mild and severe cases of COVID-19 as well as other disease burdens.

Among the measures that may be considered by vital industries (large private
industries, medium and small scale enterprises and informal sector like transport drivers,
market vendors, construction workers, etc.) moving to reopen are the following: conduct of
a COVID risk self-assessment by companies, and establishment of DOH-recommended
occupational safety and health guidelines and protocols in the context of the COVID-19
pandemic, for instance, the use of COVID-19 Rapid Testing Kits, with PCR validation or use of
x-ray and oximeters, as appropriate for each industry ; color coding of risks to workers based
on exposure (nature of work and work environment); epidemiological sentinel surveillance
sites for industry through COVID-19 case reporting that will provide an indication of what
type of workers will be most-at-risk; making arrangements for the transport of workers that
complies with social distancing; and providing workers accommodations. The DOLE-Bureau
of Working Conditions should now develop a self-assessment tool or checklist that can be
used by companies.

4. COVID-19 READY LGUs

Local Government Units are also in the forefront of the fight versus COVID-19, and
they must be equipped to take on that role. As such it is important that real-time data on
COVID-19 that can aid LGU decision making must be provided both at the National and
Regional Levels, and cascaded down to them right on schedule, without bureaucratic delay.

LGUs must likewise be assisted by the national government in the setting up of

accredited local community quarantine and isolation facilities, taking into consideration the
guidelines provided by the Philippine Society of Public Health Physicians. The official
guidelines must be issued by the IATF at the soonest possible time for all LGUs to follow. For
LGUs which operate Community Isolation Units that are to be set-up in State Universities and
Colleges (SUCs), the Commission on Higher Education has already issued appropriate
guidelines for this purpose. LGUs are also encouraged to set up community based wellness
programs like nutrition, community kitchens, family food gardens, exercise promotion,
behaviour change communication, mental health services and a health referral system.

Densely-populated areas are to be considered potential hotspots. As such, outside

Metro Manila, the areas of Central Luzon, CALABARZON, Metro Cebu and Metro Davao must
ensure that their localities are COVID-19 ready, and their local preparedness plans in place.
Provincial governments must closely monitor the status of preparedness at the city, municipal
and barangay level, and provide or facilitate the technical assistance needed to ensure that
localities are on a war footing. Government must pay close attention to vulnerable sectors
where compliance will be difficult and risk of transmission is higher. To aid in planning, it will
be good to tap and incentivize SUCs and various Regional Health Research and Development
Consortia to conduct sentinel surveillance to generate local data for health system
improvement.

Moving ahead, aware that the extended enhanced community quarantine period might be
modified, these proposals, along with our original recommendation may be taken to account
prior to the lifting or modifying the enhanced community quarantine: better and improved
detection capability through scientifically approved and evaluated testing kits and other
COVID-19 indicators that may be developed; sufficient health workforce with full protection
on and off-site; workplace preventive and protective measures in place along with a ready
health care system both at the primary and tertiary levels that can appropriately respond to
mild and severe cases of COVID-19 as well as other disease burdens; and COVID-19-ready
LGUs, with access to data needed for decision-making, and having adequate community and
facility-based case management to include quarantine and isolation, with well-established
hospital referral systems.
Recognizing that at some point, the government needs to re-calibrate the quarantine—from
enhanced to general—measures towards a new normal, we again encourage that only those
who are immune, have considerably low risks, and engaged in priority and essential industries
and services should be allowed outside established quarantine zones or color-coded zones
based on incidence of COVID-19 cases, provided that preventive and protective measures,
including sentinel surveillance systems, have been put in place.#

DR. JAIME GALVEZ-TAN DR. ESPERANZA CABRAL

DR. MANUEL DAYRIT DR. EDDIE DOROTAN

DR. VICENTE Y. BELIZARIO, JR. DR. DENNIS BATANGAN

SEN. RISA HONTIVEROS