Guiding Principles of COVID-19 Response As approved in the 25th - PowerPoint PPT Presentation

Guiding Principles of COVID-19 Response As approved in the 25th IATF Department of Health, Philippines 1

Strategic Directions GUIDING PRINCIPLES for “new normal” National Action Plan STRATEGIES 1. Whole-of-government, whole-of-system, whole-of society approach shall be espoused in the fight against COVID-19; DETECT 1. Science shall inform decision-making at the institutional and individual level; ISOLATE 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 TREAT dignity and the safety and needs of the individual shall prevail. 2

Strategic Direction for “new normal” National Government -enabled Local Government Unit -led People-centered COVID-19 Response Department of Health, Philippines 3

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 an integrated and coordinated manner 4

Revisiting roles in NG-enabled, LGU-led approach to patient-centered COVID-19 response National government National government Local government policy and strategy implementation and coordination Interagency Task National Task Force Local government Lead Force through NGAs through Task Groups units Strategies Enforcement of strategies Guidelines Roll out plans Implementation Main accountabilities Standards Resource mobilization Service delivery Impact monitoring Operations monitoring 5

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 With Exposure No 1. With travel history from a place with local transmission Exposure 2. Close contact with a probable or confirmed case Suspect (to be tested/awaiting results) With Probable (inconclusive results/test can’t be done) Non-COVID symptoms Confirmed (tested positive) No symptoms Non-COVID PUM 7

COVID-19 Must Know: Case Identification (RT-PCR) Prioritization List With Exposure - Subgroup A: Patients or healthcare No workers with severe/critical symptoms, With travel Close contact Exposure relevant history of travel/contact history from a with a probable - Subgroup B: Patients or healthcare place with local or confirmed transmission workers with mild symptoms, relevant case history of travel/contact, and considered vulnerable - Subgroup C: Patients or healthcare With Med workers with mild symptoms, relevant High Priority High Priority symptoms Priority history of travel/contact (once with 8000 capacity) No Not - Subgroup D: Patients or healthcare Low Priority Low Priority symptoms Priority workers with no symptoms but relevant history of travel/contact (once > 8000 capacity) 8

COVID-19 Must Know: Case Identification (RT-PCR and RATK) RT-PCR* Rapid Antibody Test Kit Diagnosis Symptomatic Individuals (Due to limited Should NOT be used for diagnosis. Prone to ● ● capacity and because viral load of false positive results because because symptomatic patients are high enough to immunity may result from infection from a render results accurate) non-COVID virus Subject to repeat testing if patient tests Can be used for subgroup D (least priority for ● ● negative and results worsen (less priority RT-PCR test) compared to those who have not been tested) Discharge No need May be discharged upon clearance by ● ● attending physician, positive test to follow. Determination of No need Can be used to determine full recovery if ● ● full recovery asymptomatic patient tests positive for IgG (regardless of IgM result) *All RT-PCR tests regardless of result should undergo 14-day isolation upon testing 9

COVID-19 Must Know: Isolation & Quarantine With Exposure No 1. With travel history from a place with local transmission Exposure 2. Close contact with a probable or confirmed case Isolation: Needs medical attention/symptom management and With Usual care symptoms monitoring by a medical personnel Quarantine: Needs monitoring to (1) take action as needed for No N/A possible onset of symptoms, and (2) ensure restricted movement by a symptoms 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: Case Management Principles 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: Facility Based I/Q 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 PUM, Suspect, For PUM/Suspect/Probable LIGTAS COVID-19 Probable, Individual rooms with individual toilets and showers ● CENTER (LGU) Confirmed Especially for suspect and probable cases ○ MEGA LIGTAS COVID- Suspect, Probable, In cases where this arrangement is not feasible ● 19 CENTER (NG) Confirmed Beds (3) feet or one (1) meter apart on all sides ○ Toilet/shower facilities disinfected after use ○ COVID-19 LEVEL 1/ Recovering For Confirmed: STEP-DOWN HOSPITAL confirmed Cohorting ● 12

COVID-19 Must-Know: Patient Pathway 13

COVID-19 Must Know: Contact Tracing Community No Cases Sporadic Cases Clustered Cases Transmission Implementation Preparation for Rigorous Contact Rigorous Contact Continued Contact of Contact Contact Tracing Tracing Tracing Tracing Tracing ● Assigning of ● Conduct active ● Conduct active ● Prioritize contact contact tracing case finding and case finding and tracing in newly/ teams listing of close listing of close lesser affected areas ● Preparing contacts contacts ● Prioritize tracing of necessary ● Trace, profile, ● Trace, profile, high risk close resources assess all close assess all close contacts (high-risk (transportation, contacts contacts exposure contacts, medical and office ● Test high risk ● Test high risk health workers) supplies, close contacts close contacts ● Synergize with other communication measures such as lines, etc.) physical distancing

Current vs Future Information Flow for Contact Tracing Ladderized Webbed 15

COVID-19 Must-Know: Recovery Suspect/Probable/Confirmed Clinically-resolved For reintegration to Recovering Fully Recovered symptoms the community Can be discharged without Completed 14-day Secured a certification Can be referred to a lower IgG (sent to a TTMF, step- facility/home based from the CHO/MHO/ level facility upon down facility, or home) isolation and, tested positive Quarantine Medical clearance by the attending upon clearance by the for validated IgG Officer facilitated by physician. attending physician. 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 Only protocol-based testing (following prioritization) will be covered by PhilHealth. COVID-19 Testing Testing center Technical support Test kits If testing was not paid for by DOH and the test kit used CAPEX was not donated: PPE Php 8,150.00/test HRH 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 CIUs Technical support Php 22,449.00/isolation cycle (min 14 days, unless Management CAPEX otherwise indicated*) PPE HRH

COVID-19 Must-Know: Financing EXPENDITURE FACILITY NG/LGU PHILHealth PACKAGE AMOUNT Hospital-based COVID-19 Level Technical support If with mild pneumonia in elderly or with co-morbidities: management 1/field hospital CAPEX Php 43,997.00 PPE COVID-19 referral If with moderate pneumonia: hospital Php 143,267.00 If with severe pneumonia: Php 335,519.00 If with critical pneumonia: Php 786,384.00