guiding principles of covid-19 response pdf... · expenditure facility ng/lgu philhealth package...

Department of Health, Philippines

Guiding Principlesof COVID-19 Response

As approved in the 25th IATF

1

Strategic Directions

GUIDING PRINCIPLES for “new normal”

1. Whole-of-government, whole-of-system, whole-of society approach shall be espoused in the fight against COVID-19;

1. Science shall inform decision-making at the institutional and individual level;

1. Recognizing limited resources, response shall be guided by fair and transparent priority setting;

1. In the event of any conflict of rules or guidelines, human dignity and the safety and needs of the individual shall prevail.

National Action PlanSTRATEGIES

DETECT

ISOLATE

TREAT

2


National Government -enabled

Local Government Unit -led

People-centered COVID-19 Response

3

Strategic Direction for “new normal”

Revisiting roles in NG-enabled, LGU-led approach to people-centered COVID-19 response

● National Government○ Assess landscape, develop national plans, policies & strategies,

set safety and efficacy standards, enable building capacity,measure/monitor progress, evaluate effectiveness

● Local Government Unit○ Stewards of local health systems, primary responders to the

public health emergency, implement calibrated and people-centered response including primary to tertiary care in anintegrated and coordinated manner

4

National governmentpolicy and strategy

National governmentimplementation and

coordination

Local government

Lead Interagency Task Force through NGAs

National Task Force through Task Groups

Local government units

Main accountabilities

StrategiesGuidelinesStandards

Impact monitoring

Enforcement of strategiesRoll out plans

Resource mobilizationOperations monitoring

ImplementationService delivery

5

Revisiting roles in NG-enabled, LGU-led approach to patient-centered COVID-19 response

Guidelines for the COVID-19 Response in LGUs

As of April 21, 2020

*Science is evolving for the novel coronavirus*

COVID-19 Must Know: Case Classification

No Exposure

With Exposure1. With travel history from a place with local transmission2. Close contact with a probable or confirmed case

With symptoms

Non-COVID

Suspect (to be tested/awaiting results)

Probable (inconclusive results/test can’t be done)

Confirmed (tested positive)

No symptoms

Non-COVID PUM

7

No Exposure

With Exposure

With travel history from a

place with local transmission

Close contact

with a probable or confirmed

case

With symptoms

Med Priority

High Priority High Priority

No symptoms

Not Priority

Low Priority Low Priority

Prioritization List- Subgroup A: Patients or healthcare

workers with severe/critical symptoms, relevant history of travel/contact

- Subgroup B: Patients or healthcare workers with mild symptoms, relevant history of travel/contact, and considered vulnerable

- Subgroup C: Patients or healthcare workers with mild symptoms, relevant history of travel/contact (once with 8000 capacity)

- Subgroup D: Patients or healthcare workers with no symptoms but relevant history of travel/contact (once > 8000 capacity) 8

COVID-19 Must Know: Case Identification (RT-PCR)

COVID-19 Must Know: Case Identification(RT-PCR and RATK)

9

RT-PCR* Rapid Antibody Test Kit

Diagnosis ● Symptomatic Individuals (Due to limited capacity and because viral load of symptomatic patients are high enough to render results accurate)

● Subject to repeat testing if patient tests negative and results worsen (less priority compared to those who have not been tested)

● Should NOT be used for diagnosis. Prone to false positive results because because immunity may result from infection from a non-COVID virus

● Can be used for subgroup D (least priority for RT-PCR test)

Discharge ● No need ● May be discharged upon clearance by attending physician, positive test to follow.

Determination of full recovery

● No need ● Can be used to determine full recovery if asymptomatic patient tests positive for IgG (regardless of IgM result)

*All RT-PCR tests regardless of result should undergo 14-day isolation upon testing

No Exposure

With Exposure1. With travel history from a place with local transmission2. Close contact with a probable or confirmed case

With symptoms

Usual care Isolation: Needs medical attention/symptom management and monitoring by a medical personnel

No symptoms

N/AQuarantine: Needs monitoring to (1) take action as needed for possible onset of symptoms, and (2) ensure restricted movement by a

non-medical personnel of the BHERT

(a) Isolation separates sick people with a contagious disease from people who are not sick. (b) Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.10

COVID-19 Must Know: Isolation & Quarantine

● First line of defense: individuals & households○ Routine disinfection, hand hygiene, cough etiquette, social distancing

● Second line of defense: primary care providers (BHERTs, BHWs, GPs)○ Whenever possible, minimize face-to-face contact (through TELEMEDICINE)

between the patient and the healthcare provider

● Third line of defense: facilities (TTMF, step-down care, hospitals)

● Referral network ties everything together○ Organized by provinces and cities; linked to regional hospitals & SNLs○ Maintain two pathways: COVID and non-COVID

11

COVID-19 Must Know: Case Management Principles

Facility-based quarantine and isolation shall be the first option● General term: Temporary Treatment and Monitoring Facilities (DOH DM2020-0123)● Home-based quarantine and isolation can be done if with capacity for own bed and toilet

Types of Temporary Treatment and Monitoring Facilities

Facility type Case type Accommodation arrangement

LIGTAS COVID-19 CENTER (LGU)

PUM, Suspect, Probable, Confirmed

For PUM/Suspect/Probable● Individual rooms with individual toilets and showers

○ Especially for suspect and probable cases

● In cases where this arrangement is not feasible○ Beds (3) feet or one (1) meter apart on all sides○ Toilet/shower facilities disinfected after use

For Confirmed:● Cohorting

MEGA LIGTAS COVID-19 CENTER (NG)

Suspect, Probable, Confirmed

COVID-19 LEVEL 1/ STEP-DOWN HOSPITAL

Recovering confirmed

12

COVID-19 Must Know: Facility Based I/Q

13

COVID-19 Must-Know:Patient Pathway

No Cases Sporadic Cases Clustered CasesCommunity Transmission

Implementation of Contact Tracing

Preparation for Contact Tracing● Assigning of

contact tracing teams

● Preparing necessary resources (transportation, medical and office supplies, communication lines, etc.)

Rigorous Contact Tracing● Conduct active

case finding and listing of close contacts

● Trace, profile, assess all close contacts

● Test high risk close contacts

Rigorous Contact Tracing● Conduct active

case finding and listing of close contacts

● Trace, profile, assess all close contacts

● Test high risk close contacts

Continued Contact Tracing● Prioritize contact

tracing in newly/ lesser affected areas

● Prioritize tracing of high risk close contacts (high-risk exposure contacts, health workers)

● Synergize with other measures such as physical distancing

COVID-19 Must Know: Contact Tracing

15

Current vs Future Information Flow for Contact Tracing

Ladderized Webbed

COVID-19 Must-Know: Recovery

Suspect/Probable/Confirmed

RecoveringClinically-resolved

symptomsFully Recovered

For reintegration to the community

Can be referred to a lower level facility upon

clearance by the attending physician.

Can be discharged without IgG (sent to a TTMF, step-

down facility, or home) upon clearance by the

attending physician.

Completed 14-day facility/home based

isolation and, tested positive for validated IgG

Secured a certification from the CHO/MHO/ Quarantine Medical Officer facilitated by

the BHERT

● Current policy: no need to test negative for RT-PCR prior to discharge● RT-PCR is not the standard to determine recovery from the virus.

16

COVID-19 Must-Know: Financing

EXPENDITURE FACILITY NG/LGU PHILHealth PACKAGE AMOUNT

COVID-19 Testing Testing center Technical supportTest kitsCAPEX

PPEHRH

Only protocol-based testing (following prioritization) will be covered by PhilHealth.

If testing was not paid for by DOH and the test kit used was not donated: Php 8,150.00/test

If testing was not paid for by DOH but the test kit used was donated:Php 5,450.00/test

If testing was paid for by DOH and the test kit used was donated:Php 2,710.00/test

Community-based Management

CIUs Technical supportCAPEX

PPEHRH

Php 22,449.00/isolation cycle (min 14 days, unless otherwise indicated*)

COVID-19 Must-Know: Financing

EXPENDITURE FACILITY NG/LGU PHILHealth PACKAGE AMOUNT

Hospital-based management

COVID-19 Level 1/field hospital

Technical supportCAPEX

PPE

If with mild pneumonia in elderly or with co-morbidities:Php 43,997.00

COVID-19 referral hospital

If with moderate pneumonia:Php 143,267.00

If with severe pneumonia:Php 335,519.00

If with critical pneumonia:Php 786,384.00

COVID-19 Must Know: Handling of Remains

19


Tagging of cadaver

For referral facility/hospital deaths Attending physician/ duly authorized personnel to tag cadaver

For deaths outside of referral facility/hospital

Local Health Office to tag cadaver

Designation of funeral service providers/ crematorium

All LGUs to designate through MOA

Charging of expenses for funeral services(in order or priority)

1. Surviving spouse2. Nearest kin3. LGU of residence of deceased or next of kin4. LGU where patient expired

*if indigent or kin is classified as vulnerable, disadvantaged, or in crisis situation, LGU shall shoulder expenses and DSWD to defray excess costs

Transport for burial

If with living spouse/next of kin Spouse/next of kin to coordinate with funeral service provider to transport from hospital to burial site/crematorium

If unclaimed LGU to secure transportation, retrieval, and transfer to funeral service provider

COVID-19 Must Know: Handling of Remains

20


Disposal(shall be done within 12 hours of death)

For ClaimedUpon the discretion of the spouse or next of kin whether the remains are buried or cremated. No public viewing of the deceased shall be allowed.

For Unclaimed

Method of disposal by priority:1. Cremation2. Double-sealed casket burial3. Double bag burial4. Freezer (for temporary storage)

For those with Islamic Faith

Procedure:1. Hygiene preparations of body (e.g. cleaning of body, trimming,

shaving, embalming) shall not be allowed2. Wrap in tightly sealed cloth with double bag for burial

Access Level Data that may be shared Scope Purpose

Public - Trends- Aggregates National For health education

and promotion

Implementers (facilities, LGUs)

- Individual-level data (internal) Within jurisdiction For local operations

planning

National - Individual-level data(internal) National For national planning

Re: concerns on contact tracing, 1. Patient reporting of all fields is mandatory to implementers and national agencies2. Non-patient identifier information may be used such as location, movement, places

visited. 3. Patient identifiers are name, address, and birthday. The main patient identifier shall be the

PhilHealth Identification number and the name.4. Releasing patient identifiers to public for contact tracing is option of last resort and should

be with clearance from the DOH-CHD on extenuating circumstance21

COVID-19 Must Know: Ensuring Data Privacy


Provide an operational frameworkfor Local Government Units (LGUs)to execute their public health functions in accordance with the four (4) point strategies of the DOH to fight COVID-19 and in relation to the implementation of ECQ.

PREVENT1DETECT2ISOLATE3TREAT4

Four Point StrategiesOBJECTIVE


The overall objective of the ECQ from a public health perspective is to reduce human-to-human transmission of the COVID-19 virus such that case numbers decrease over time.Given that a vaccine or a cure for the virus has not yet been discovered, the main challenge is to ensure that transmission rates are consistently decreased through NON-PHARMACEUTICAL INTERVENTIONS.

GENERAL GUIDELINES


1. PREVENTa. Increase resilience

i. Promote healthy lifestyleii. Take care of vulnerable population

b. Stop transmissioni. Wear maskii. Practice handwashingiii. Risk-based travel restriction from areas

with transmissionc. Reduce contact rate

i. Physical distancing is enforced in all LGUs to make sure that infected people do not spread the virus to uninfected people

GENERAL GUIDELINES

The four major strategies are targeted to address the overall objective of ECQ:


2. DETECT and 3. ISOLATEa. Contact tracing allows LGUs without

sustained community transmission to maximize containment of the virus without massive disruption to essential economic activity;

b. Enhancing testing capacity enables LGUs to accurately identify infected people, allowing them to conduct contact tracing, physical distancing, and triaging;

c. Enhancing isolation capacity enables LGUs to isolate those with symptoms to ensure no to minimal exposure to other non- COVID-exposed individuals

GENERAL GUIDELINES



4. TREATa. Enhancing Medical Management capacity

allows LGUs to manage cases appropriately, reducing infectivity and mortality.

GENERAL GUIDELINES



LGU Epidemic Response Frameworkby the SubTWG on Data Analytics - EpiMetrics

SPECIFIC GUIDELINES

Epidemic Phase Recognition Initiation Acceleration Deceleration Preparation

Risk Level Low Moderate High High Low

Indicator > 30 day CDT and < 30% Critical care

Utilization Rate (CUR)

7-30 day CDT or 30-70% CUR

< 7 day CDT or> 70% CUR

7-30 day CDT and 30-70% CUR

> 30 day CDT and < 30% CUR

following Deceleration

phase


Critical care Utilization Rate

<30% 30-70% >70%

Case Doubling

Time

>30 daysRecognition

Initiation AccelerationPreparation

7-30 days InitiationInitiation

AccelerationDeceleration

<7 days Acceleration Acceleration Acceleration


Each LGU (Province or City (HUC, ICC) level) shall be able to:* Universal Health Care network classification

a. Determine the risk level and recommended action■ Cases doubling time■ Critical care utilization rate■ Risk classification determines aggressiveness of response

a. Determine needs for health system capacity and preparedness■ Interventions to be delivered for the local health system

a. Monitor short-term performance and long-term planning indicators

ECQ Decision Tool Components

Component Category Indicator/s

Epidemiological classification

Cases 1) Absolute number2) Trends

Health system capacity

(vs projected need, vs max capacity)

Testing capacity 1) Tests per day

Infrastructure and equipment

1) Isolation beds, ICU beds2) Ventilators: Availability, utilization, % of max capacity

Community quarantine and isolation facilities

1) Availability2) utilization, % of max capacity

Human Resources 1) Availability, 2) distribution

Level of preparedness of LGU to implement lockdown

Socio-economic 1) Local government funding requirements 2) Available funds for COVID response

Level of Security 1) Personnel ; 2) Quarantine Control Points/ popn 3) Number of violations/ incidents


SPECIFIC GUIDELINES

Provincial/Municipal/City COVID-19 Tactical Groups (P/M/CTG COVID-19)

All Tactical Groups must be chaired by the Local Chief Executive and shall have at the minimum:


● LGU risk classification● Number of suspect/probable/confirmed cases, and

growth rate of cases over time● Incidence rate● Case fatality rate

Should the data become available, the ff. will also be included:● Case clusters● Number of tests conducted

Epidemiological Indicators

MONITORING AND EVALUATION

Dashboard with the ff. Information will be developed:


● Name, location, contact numbers, occupancy status of COVID-19-designated referral hospitals

● Community isolation units, emergency transport services, and telemedicine apps

● Total number and occupancy rate for the ff○ ICU beds with and without negative pressure○ Isolation rooms○ Ward beds for COVID patients○ Mechanical ventilators

Health System Indicators




Total number on hand and projected need for PPE equipment

● Face shields● Gowns● Goggles● Gloves● Shoe covers● N95 and surgical masks● Head covers

Supply Chain Indicators




Total number of HRH dedicated for COVID-19 patients● Medical doctors● Nurses● Respiratory therapists● Mechvent operators● Clinical laboratory scientists

HRH Indicators



“New Normal”#BagongBuhay


What’s Inside

Key Components 3

Principles 2

Settings 4

Premise 1


1. ECQ prolongs the peak and stalls the increase of COVID-19 cases in our country.

2. ECQ buys time for the health system to prepare and respond appropriately to the COVID-19 health situation.

3. Estimated infection rate (R0) decreases from 2 (1 person infects 2 other people) to 1.5 with the implementation of the ECQ. Lifting the ECQ may mean more infected people.

4. Lifting the ECQ is inevitable but must be done gradually as not to strain our health system.

Premise of the “New Normal”


Key Components of the “New Normal”

1. Reduce Vulnerability: Healthy lifestyle2. Reduce Transmission: Handwashing

and proper hygiene, cough etiquette, regular disinfection, and use of appropriate personal protective equipment.


Key Components of the “New Normal”

3. Reduce Contact: Physical distancing, reducing personnel, reducing face-to-face contact and limiting travel to essential activities

4. Reduce Duration of Infection: Early identification, referral, and management mechanisms

5. Governance and Accountability: Organizational policies and investments


Setting: HomeObj 1: Reduce Vulnerability

Obj 2: Reduce Transmission

Obj 3: Reduce Contact

Obj 4: Reduce Duration of Transmission

Obj 5: Governance and Accountability

• Healthy diet• Hydrate• Exercise• Talk to friends and

peers

• Hand hygiene• Disinfection• Extra caution for old

and with comorbids• Proper ventilation

• Stay at home• Practice physical

distancing

• Manage mild symptoms at home

• Call BHERT for severe symptoms

• Head of household to set up house rules (handwashing, cleaning and disinfection, etc)


Setting: Offices/WorkplaceObj 1: Reduce Vulnerability




Obj 5: Governance & Accountability

For employees:• Healthy diet• Hydrate• Exercise• Talk to friends

and peers

For employees:• Practice hand hygiene and

cough etiquette• Ensure use of face mask and

PPEs (when necessary)• Encourage use of personal

office items and avoid sharing

For employees:• Work from Home

(WFH) arrangement• Practice physical

distancing

For employees:• Subject to physical

examination• Manage mild

symptoms at home• Call BHERT for severe

symptoms

For employers:• Adopt WFH policy• Adopt policy for

healthy lifestyle at work

• Provide necessary PPEs and health commodities

• Providing temporary housing if possible

• Ensuring effectiveness of medical team

For employers:• Disinfect rooms and facilities• Make hygiene facilities

available• Maintaining proper ventilation• PPEs (when necessary)

For employers:• Offer WFH

arrangements• Avoid mass

gatherings

For employers:• Employees with

symptoms should stay at home

• Isolate and Refer employee exhibiting symptom


Setting: SchoolObj 1:

Reduce Vulnerability





For teachers, students & other staff:• Healthy diet• Hydrate• Exercise• Talk to friends

and peers

For teachers, students & other staff:• Avoid borrowing items• Hand hygiene• Face mask• Stay at home if experiencing

symptoms

For teachers, students & other staff:• Study from Home

(SFH) arrangement

• Practice physical distancing

For teachers, students, and other staff:• Physical examination• Manage mild

symptoms at home• Call BHERT for

severe symptoms

For employers:• Adopt SFH policy• Adopt policy for

healthy lifestyle in school

• Implement sick leave policies

• Consider lifting perfect attendance awards

• Cross-train staff• Providing

temporary housing if possible


For school administrators:• Teach preventive measures• Include handwashing in schedules• Make hygiene facilities available• Maintain proper ventilation• Disinfection• Maintain clean environment• PPEs (when necessary)

For school administrators:• Offer SFH

arrangements• Provide learning

opportunities with less contact

• No mass gatherings

For school administrators:• Individuals with

symptoms should stay at home

• Refer individuals exhibiting symptom


Setting: Places of WorshipObj 1: Reduce Vulnerability

Obj 2: Reduce Transmission Obj 3: Reduce Contact



For all:• Healthy diet• Hydrate

For religious followers, volunteers and staff:• Do not share religious items and food• Avoid physical contact and wiping of

relics

For religious followers, volunteers, and staff:• Attend services

online• Maintain 1 meter

distance

For religious organizations and followers:• For severe

symptoms, contact BHERT

• Offer alternatives for high-risk populations

For employers:• Adopt policies

encouraging preventive measures

• Create patient referral plans

• Ensure medical personnel availabilityFor religious leaders and organizations:

• Communicate risk of attending• Encourage use of face mask• Make hygiene facilities available• Maintain proper ventilation• Disinfection• PPEs (when necessary)• Modify practices (communion, hugging,

offertory, etc)

For religious leaders and organizations:• Encourage

online mass attendance

• Minimize physical interactions


Setting: TransportationObj 1: Reduce Vulnerability




For all:• Healthy diet• Hydrate• Exercise

For commuters:• Use sanitizer• Use face mask• Avoid touching face• Use tissue• Report overcrowding

For commuters:• Do not travel if

unwell• Practice physical

distancing

For commuters and staff:

• Manage mild symptoms at home

• Call BHERT for severe symptoms

For employers:• Adopt WFH

policies (when possible)

• Set up flexible work hours

• Implement flexible leave policies

• Provide PPEs

For drivers/transport operators:• Disinfect• Maintain good ventilation• Provide hygiene products and

equipment• Use face mask• Use payment boxes

For transport operators:• Use floor/seat

markings• Limit passengers• Manage

passenger entry/exit


Setting: Food and DiningObj 1: Reduce Vulnerability





For customers:• Opt for meals with

variety: Go, Grow & Glow!

• Less sugar, salt and fatty orders

• Water > Sweetened beverages

For customers:● Use sanitizer● Physical distancing: when

ordering food or dining-in● Do not remove your mask

when ordering. Make yourself audible.

● Sanitize table● Avoid touching public

spaces

For customers:● Plan orders to minimize

exposure● Mind the cue inside● Opt for take-out or

deliveries if possible● If dining-in, finish meal

immediately● Avoid sharing meals,

dips, and eating utensils● CLAYGO

● Temperature checks

● Check employees for symptoms

● Staff who are sick should stay home

● Assist employees and customers on getting medical help if needed

For employers:● Work from home

policy● Flexible work

hours and schedules

● Limit number of employees in a shift

● Provide home arrangements

● Provide PPE to staff at workFor management:

● Provide healthy options

For Management:● Availability of

handwashing stations and sanitizers

● Physical distancing ● Disinfection ● Discontinue salad bars,

buffets and the like● PPE for crew

For Management:● Take-outs or deliveries● Limit people inside the

establishment● Physical distancing for

people dining in


Setting: Grocery/Market/Food RetailObj 1: Reduce Vulnerability





For management:• Provide healthy

options

For customers:• Use sanitizer• Use face mask and avoid

touching face• Practice cough etiquette• Avoid touching items• Disinfect bought items• Wash reusable bags

For customers:• Plan your shopping list • Maintain physical

distancing (Follow marks on the floor)

• Postpone shopping if establishment is crowded

● Temperature checks and assessment of symptoms

● Restriction on symptomatic customers and employees

● Provide instructions on where to get medical attention

For employers:• Adopt WFH policies

(when possible)• Set up flexible work

hours• Implement flexible

leave policies• Provide PPEs• Providing

temporary housing if possible


For management:• Ensure availability of

handwashing stations• Disinfection of store• Discontinue self-service of

ready-to-eat foods• Air PSAs• Use of PPEs for employees

For management:• Regulate the number

of people• Minimize quantities of

foods put on display • Provide large visible

signages


Setting: Hotels, Inns, and ResortsObj 1:

Reduce Vulnerability





For all:• Healthy diet• Hydrate• Exercise• Talk to friends

and peers

For guests:• Apply sanitizer• Wear mask• Avoid touching fixtures• Practice hand hygiene

For guests:• Limit outside

travel• Practice

physical distancing

• Avoid crowds

For all:• Physical exam

before entering• be truthful about

history of travel/exposure

• Do not allow symptomatic guests

• Provide referral instructions for staff/guests with symptoms

For employers:• Adopt WFH policies

(when possible)• Set up flexible work

hours• Implement flexible

leave policies• Provide staff training• Provide PPEs• Providing temporary

housing if possible• Ensuring

effectiveness of medical team

For the management:• Provide hygiene products and

equipment• Wash linens, blankets, etc.• Disinfect• Put up signages• Train housekeepers

For the management:• Regulate guests• Remind guests

on physical distancing

• Remind guest to stay in room


Setting: Parks and Recreational PlacesObj 1: Reduce Vulnerability




For management:● Provide

healthy meal options for both guests and employees

For guests:● Use alcohol or sanitizer● Wear mask in public/communal

places● Avoid touching public spaces and

objects● Practice cough etiquette● Wash hands

For guests:● Practice physical

distancing● Avoid crowds● Build signages

or provide a map of amenities for easy access

For management:● Temperature

checks and assessment of symptoms

● Restriction on symptomatic customers and employees

● Provide instructions on where to get medical attention

For management:● Work from home

policy (if possible)● Flexible work

hours and schedules

● Limit number of employees in a shift

● Provide home arrangements

● Provide PPE to staff at work

For management:● Availability of alcohol and/or

handwashing stations in strategic locations

● Regular disinfection of facilities, receiving areas and counters frequented by guests

● PPE for all staff and personnel● Signages and reminders of

preventive measures

For the management:

● Regulate guests● Remind guests

on physical distancing


Thank you!

guiding principles of covid-19 response pdf... · expenditure facility ng/lgu philhealth package...

Documents