How the Department of Health processes potential COVID-19 cases
San Lazaro Hospital in Manila has implemented a "No face mask, No entry" policy after the Department of Health confirmed that one of the patients under investigation tested positive for the novel coronavirus.
The STAR/Edd Gumban

How the Department of Health processes potential COVID-19 cases

Franco Luna (Philstar.com) - March 8, 2020 - 1:05pm

MANILA, Philippines — On Saturday, the Philippines was placed under a state of public health emergency and Code Red sub-level 1 after the Department of Health (DOH) confirmed a sixth patient with the novel coronavirus (COVID-19).  

The declaration facilitates the mobilization of resources, the intensifying of quarantine measures and ease of processes, while a "code red" alert means that all hospital personnel are required to report for duty in their respective facilities to provide medical services. 

Under Republic Act 11332—the Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act—a public health emergency refers to an “occurrence of an imminent threat of an illness or health condition which could pose a high probability of a large number of deaths…widespread exposure to an infectious agent.”

Pending new guidelines under the declaration, here is a quick briefer on the Health Department’s processes when confirming potential cases.

According to a bulletin dated February 26 on the department’s Screening Tool, the DOH looks at three main factors before placing an individual under Patient Under Investigation status: 

  • Signs and symptoms: Does the person exhibit any respiratory symptoms linked to the novel coronavirus? Does the person have a fever over 38.0 degrees?
  • Travel history in the past fourteen days to areas with issued travel restrictions
  • History of exposure to confirmed cases or other PUIs

The briefer outlined a number of factors taken into account when assessing the history of exposure, including: 

  • Providing direct care for confirmed patients of the virus, working with healthcare workers 
  • Working together in close proximity or sharing the same classroom environment 
  • Travelling together with COVID-19 patients in any kind of conveyance 
  • Living in the same household as a COVID-19 patient within a 14-day period after the onset of symptoms in the case under investigation

"PUIs are isolated in hospitals and tested for COVID-19. If positive [they're] manage[d] accordingly until 2 negative tests are reached and then discharged with close monitoring," Health Secretary Francisco Duque III told Philstar.com in a text message. 

Once samples are taken from PUIs, the Research Institute for Tropical Medicine (RITM) runs confirmatory tests for traces of COVID-19. The Health Department says these tests can take up to 48 hours.

Travel restrictions and quarantines

As of this writing, areas issued travel restrictions by the Philippine government include mainland China, Hong Kong, and Macau, and in North Gyeongsang province, South Korea, while further travel bans in Japan, Iran, and Italy are reportedly being mulled. 

Overseas Filipino Workers, permanent residents, and students are not affected by these restrictions, though the department has already outlined their protocols for quarantining persons under investigation.

The government has so far put two batches of Filipinoes in a quarantine facility in New Clark City in Capas, Tarlac:  Those repatriated from Wuhan in China and Filipino crew repatriated from the MV Diamond Princess, a cruise ship that was hit by the virus.

A batch of repatriates from Macau has been told to go on home quarantine.  

RELATED: How the OFWs repatriated from Wuhan, China were screened and quarantined

The Health department has also suggested home quarantine and assessment, monitoring, and management with their respective city or municipal offices for those who may have been exposed to COVID-19 while traveling. 

Those under self-quarantine are asked to sustain this for at least 14 days.

The DOH said Saturday that contact tracing efforts have already started to find people who may have come into contact with new cases confirmed over the weekend.

Identified contacts, meanwhile, were already being interviewed and assessed for signs of respiratory illness.

When are confirmed COVID-19 patients discharged?

Health officials have said that their criteria for counting a patient as recovered is testing negative twice. 

What does local transmission mean?

After the first cases of the virus were confirmed, Health Secretary Duque was careful to point out that all three had travel history to Wuhan, the epicenter of the virus outbreak, and thus were classified as imported cases or cases where the patients were infected abroad.

Because local transmission has now been declared by the Health Department, the virus is now officially spreading among Filipinos on Filipino soil.

However, in the current scenario, contact tracing is still possible as authorities are still able to track a clear trail of the spread of the virus. Healthcare groups earlier told Philstar.com that local transmission would make the situation much worse because of the state of healthcare in the country. 

What is a community transmission case of coronavirus?

Community-based transmission means any person who has been diagnosed with the disease who was not in a high-risk area and were not known to have been in contact with any other confirmed cases. Because they do not fall under the department's screening tool, this indicates that the virus was transmitted to them in the community and  it is unclear where they would have contracted it.

“At this stage of localized transmission, intensified contact tracing and home quarantine of close contacts of confirmed cases, improved hospital preparedness, enhanced Severe Acute Respiratory Illness surveillance, and activation of other laboratories outside of RITM to increase capacity to diagnose are now being implemented,” the Health Department said in a statement on Saturday

“However, once there is sustained community transmission - or an increasing number of local cases whose links cannot be established - the strategy will be shifted from an intensive contact tracing to the implementation of community-level quarantine (or lockdown), and/or possibly, suspension of work or school. These will be implemented in municipal, city, or provincial scale as may be warranted. Augmentation of health staff from unaffected areas and uniformed personnel will also be facilitated.”

The Health Department has said that “as of now, there is no specific treatment for or vaccine against COVID-19. However, many of the symptoms can be treated based on the patient’s clinical conditions.”

As of this writing, some 106,000 worldwide have been afflicted with the new virus. — with report from Agence France-Presse 

If you believe you have come into possible contact with infected patients, you may be directed to the proper office of the Department of Health for advice through the following lines: (632) 8651-7800 local 5003-5004 or (632) 165-364.

You may also opt to call the Research Institute for Tropical Medicine at (02) 8807-2631/ 8807-2632/ 8807-2637. 

COVID-19 EXPLAINER NOVEL CORONAVIRUS
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