Perspective of two public health professionals

In my previous column, I cautioned that while the Bayanihan to Heal as one Act appeared to respond to the basic funding requirements to fight the COVID-19 pandemic – the disease itself and the immediate economic consequences of a lockdown – the proof of the pudding is in the eating. That is to say how fast the funding provided for is translated into actual hospital beds, ventilators, testing, PPEs, not to mention cash transfers to those left unemployed. Last Monday, one week after the law was passed, President Duterte delivered his report to the nation in a pre-recorded speech, almost eight hours after it was originally scheduled. By law, the President was required to deliver a report to Congress of the progress of the implementation of the Act – basically how the money was spent. Well, he did not provide specific answers in his televised remark and I gather that the written report submitted belatedly to Congress a day later was equally bereft of details.

It is the lack of details on how the government intends to directly fight the virus that is worrisome. I sought the views of two respected medical practitioners who had previously served as our country’s most senior public health officials on what that plan ought to be. I paraphrased what they had to say. I want to thank Dr. Manuel Dayrit and Dr. Esperanza Cabral for their valuable input.

We need to test on a massive scale. Only a little more than 2,000 unique individuals have been tested in the two months that our one and only testing center has been doing the tests. There have been reports of patients waiting for 12 days to get their results which is too late to matter. With the acquisition of more kits, RITM is now doing 1,000 tests/day and the new labs are doing about 100 tests/day to total 1,500 tests/day which is a five-fold rise in testing; but not nearly enough to track the spread of infection in the community.

One set-up can be:

Screen at the community level, over the phone, or online and pre-approve for testing.

Consolidate and take test samples at multiple, at scale, sampling sites in the municipality or city preferably near the testing laboratories

Deliver sample to laboratories for testing.

Deliver results to the city or municipal health offices for proper disposition

An example of a mega sampling site might be the St. Luke’s extension clinic in Malate.  Designed for TB testing and visa medical screening, it is equipped to handle hundreds of cases a day. This could serve as the off-site testing facility for the Philippine General Hospital in order to segregate patients prior to recommending their transfer to PGH for care. Proximity wise, it could not be any better. Less than a kilometer a way, Pedro Gil could even be cordoned off in order to prevent public contamination.

We need to figure out where to put Persons Under Investigation (PUI) and Persons Under Monitoring (PUM) while waiting for test results. We need to consolidate the care we give to COVID patients to make our scarce human resources as effective and efficient as we can. We need facilities that can accommodate these hundreds, even thousands of PUIs and PUMs and mildly ill COVID-19 patients. Other countries built temporary ones. Our government is rushing to convert the PICC Forum Halls, The World Trade Center and the Rizal Memorial Sports Complex into quarantine centers, which accommodate close to 1,000 of these patients. DPWH Secretary Mark Villar said that these facilities should be partially operational within the week. More than one group has proposed to build makeshift facilities out of decommissioned shipping containers. House the health care professionals in nearby hotels and shuttle them to the COVID facilities. It will make taking care of the patients and health care professionals easier.

We need dedicated facilities for seriously ill patients too. Having hospitals with “designated COVID wings” will not work as well as dedicated COVID hospitals. Manpower, PPEs, ventilators, and other supplies can be more efficiently used by consolidating them in these hospitals. All other hospitals will be “referring hospitals” after triage to these mega-sites. Three government COVID-19 dedicated hospitals have been designated namely PGH, Lung Center, Jose Rodriguez Medical Center (formerly Tala Leprosarium). Dr. Dayrit is working with private sector to get Quezon Institute and the Del Mundo Hospital in Banawe going as private COVID-19 hospitals.

We need to protect our frontliners.  Nineteen doctors have died fighting coronavirus. That is 20 percent of all who have died from the disease. More health professionals are gravely ill from it. Hundreds are out of commission as PUIs and PUMs themselves. Our health workers do not need DOH’s P500 a month. What they need is proper protection, ample tools with which to practice their art and science, assurance that they will be taken care of should they fall ill in the line of duty and the unbreakable promise that their families will not be abandoned should they have to make the ultimate sacrifice.

We need to deal urgently with the short-term economic consequences such as loss of income and bankruptcies. But we also need to lay the groundwork for economic recovery when the crisis is over. If there are no assurances on what the other side looks like after the health portion of the crisis is over, the civil crisis that follows may even be worse.

We also have to get competent people to run this organization and enable them completely.  Government should involve the private sector in a systematic way. That will help government give a cogent presentation on the strategy for blunting the COVID-19 threat and mitigating the socio-economic effects. Clarity around how they will be deploying the public funds will be so needed at this time. The messaging should focus on setting the expectation, controlling the story, and delivering in due time.

The coronavirus tragedy will not disappear on April 14. We need to build the infrastructure, we need to develop our human resources.  We need to be better prepared. We need to act. And we are not acting fast enough.