Gat Andres Bonifacio Memorial Medical Center in Tondo, Manila
A health worker tends to patients inside the COVID-19 emergency response medical tents outside the Gat Andres Bonifacio Memorial Medical Center in Tondo, Manila on Monday midnight on Aug. 3, 2020.
The STAR/Miguel de Guzman

How the government plans to address concerns raised by medical frontliners

Franco Luna (Philstar.com) - August 3, 2020 - 4:57pm

MANILA, Philippines — It took just one day for President Rodrigo Duterte to call a meeting with the coronavirus task force and discuss a call by medical professionals for the administration to review its approach to addressing the COVID-19 pandemic.

“We propose the ECQ be used as a timeout to refine our pandemic control strategies addressing the following urgent conditions or problems: hospital workforce efficiency, failure of case finding and isolation, failure of contact tracing and quarantine, transportation safety, workplace safety, public compliance with self-protection, [and] social amelioration," the Philippine College of Physicians' manifesto, which gained traction like wildfire, read.

Other medical societies and groups issued similar statements as healthcare workers, worn and weary from working the frontlines of the pandemic, sounded off on what they called a "losing battle against COVID-19."

Later on Sunday night, Duterte went ahead with his health chief's recommendation to place Metro Manila and the nearby provinces of  under modified enhanced community quarantine. 

Were the healthcare sector's pleas really heard?

What did the government recommend?

At the late-night meeting of the Inter-Agency Task Force on Emerging Infectious Diseases, Health Secretary Francisco Duque bared a "seven-point response or recommendation to address the issues of the healthcare workers" to the president, which included: 

  1. Hiring additional health workers for reserve
  2. Additional benefits to healthcare workers
  3. Work and quarantine passes to minimize people going out 
  4. Localized lockdown strategy and implementation of Oplan Kalinga 
  5. Strict enforcement and the donation of 20 million cloth masks for the poor 
  6. Usage of RT-PCR as gold standard in detection
  7. Recommendation of MECQ 

Here's a point-by-point rundown of Malacañang's response, vis-a-vis what the medical professionals actually asked for. 

Enhanced community quarantine 

In their open letter, medical groups called for another round of enhanced community quarantine over Mega Manila to give frontliners a brief respite from the daily toll of the pandemic but also to give the national government time to recalibrate its faulty approach to dealing with it.

REFRESHER: Guidelines for MECQ reimposed on Metro Manila, nearby provinces

"The progressive lifting of quarantine has inadvertently fueled public misperception that the pandemic is getting better. It is not," the doctors said. 

Instead, Duterte approved health chief Francisco Duque's recommendation for a more relaxed modified ECQ.

Under MECQ, limited movement is allowed for obtaining essential services and for work, while only gatherings of up to five participants are allowed. 

Public transport also remains suspended, but biking and non-motorized transport is encouraged.

READ: What is modified, enhanced, general quarantine? Here's how to tell the difference

'Failure of case finding and isolation and workplace safety'

The Department of Health has said that Reverse Transcription Polymerase Chain Reaction or RT-PCR tests is the gold standard in testing for the new pathogen, while the Philippine Society of Microbiology and Infectious Diseases has cautioned the private sector against the use of rapid antibody test kits as these could result in false-positive tests. 

"RT-PCR is now being denied patients with symptoms. LGUs that do test continue to insist on use of inappropriate rapid antibody tests to identify cases of COVID-19, sending home patients with symptoms who test negative. This may be responsible for the surge of cases we are now experiencing, because rapid tests miss more than half of people with active, contagious illnesses," the doctors also said. 

RELATED: There are two kinds of COVID-19 tests used in the Philippines. How are they different? 

"Workplace safety is assured in few, mostly high-income settings, but there is clear failure in most settings, especially among the poor. Employees and laborers are required by LGUs and their companies to have rapid antibody tests, despite international agreement that these tests are not recommended for work clearance and just lead to missed cases and local outbreaks," the manifesto added.

Duque responded to this call squarely and head-on, telling the chief executive that among his recommendations was the usage of RT-PCR as the "gold standard in detecting cases of COVID-19."

Presidential spokesperson Harry Roque said Sunday that "the use of RT-PCT testing as gold standard has likewise been approved by President Duterte."

Hospital workforce deficiency

According to the PCP, hospitals called for the time-out, first and foremost, because they were "being overwhelmed by the alarming increase of cases in the past weeks."

"The workforce is again effectively reduced because of the need for intermittent quarantine for personnel, and isolation of many who have fallen ill. To compound this, many have resigned because of fear, fatigue, and poor working conditions. Facilities have had to close because of these problems," PCP said.

Among the health department's "proposed ways forward" on Sunday afternoon was the creation of a rapid response team of medical workers to prevent the capital's health system from being overrun.

The department also appealed to provincial health workers and returning OFWs in the medical field along with universities and medical societies to assist them in hiring personnel for the initiative.

"We will provide a roadmap and technical assistance to ensure that [local governments] put in place effective contact tracing operations," the health department said in its earlier statement, reiterating the need for the government to hire more contact tracers, particularly for industries where it has observed case clustering in such as construction and technoparks.

At the IATF-EID meeting, Duque also mentioned that the agency was looking into a risk allowance of P10,000 for private sector healthcare workers and a free life insurance that could be included in the second iteration of the Bayanihan to Heal as One Act, which would extend the duration of Duterte's sweeping special powers. 

"Kasama na rin ang pagbibigay ng libreng accommodation at transportation na siya naman po itong inumpisahan nang gawin ng Department of Health para po sa mga manggagawang pangkalusugan, at ang pagsagawa ng libre at frequent na pag-testing sa atin pong mga healthcare workers kasama na rin po ito sa ating expanded testing strategy," Duque added. 

To begin his address Sunday, Duterte said: "To our health workers, this is a war that you have been trained to fight. This is a profession that you, all of you, and who were educated and trained to face such challenges, you are frontliners in the battle because you are learned in this field."

Later on in his speech, though, he scolded the Philippine College of Physicians for "sending a message without even giving government a chance [to address the concerns]."

"There would have been no need for you into itong ganito (this kind of thing), raising your hands as if sasabihin ninyo (saying) 'revolution, revolution.'...If you think this can be solved by revolution, then by all means, start it," he challenged. 

READ: Doctors sorry if Duterte took their suggestions as 'call for a revolt'

Militarist, 'Duterte-style' lockdowns

Second Opinion, a separate group of doctors and medical workers, called for an end to what it called "Duterte-style quarantine" and instead a shift to a "medical quarantine."

"Doctors and healthcare workers must reclaim quarantine for what it should be: A public health measure aimed at saving lives by stopping the spread of disease. We must reject the distorted forms of 'community quarantine' being imposed on us, as these are devoid of scientific sense and health purpose, and serve only to oppress our people," they said.

The Coalition for People's Right to Health also called for the same, saying the current setup left the door open for human rights abuses. Cases of aggressive and overzealous enforcement piled up over the ECQ in the name of "punishing" the public for its "stubbornness" and "complacency" with quarantine regulations—the same rules that a number of government officials have, themselves, failed to follow and walked scot-free regardless.

As of this writing though, Joint Task Force COVID Shield, the government's quarantine enforcement arm is in the process of once again setting up quarantine checkpoints in areas placed under MECQ.

The task force has also deployed police supervisors in every barangay to "identify and monitor" coronavirus patients observing home quarantine, among others. 

READ: 'Medical quarantine, not ECQ': Health professionals call for change in 'militaristic' lockdowns | Task force to mobilize cops to 'identify, monitor' residents on home quarantine

During the live-streamed IATF meeting, Duque said that Oplan Kalinga, a program of the interior department and the national police to "transfer" coronavirus patients from their homes to quarantine facilities, would proceed. It is not clear if the house-to-house campaigns broached by Interior Secretary Eduardo Año are still in the pipeline. 

"Pang-apat po ang pagpapaigting sa ating mga localized lockdown strategy at ng implementasyon ng Oplan Kalinga sa tulong ng LGUs at COVID-19 CODE teams. Iyon pong CODE teams ito po ‘yung Coordinated Operations to Defeat the Epidemic, which is COVID-19," he said. 

Mass transportation woes

To recall, the very first day of general community quarantine—which was implemented to kickstart the nation's economy—saw droves of commuters unable to find rides to their workplaces, all documented in long lines at rail line stations and bus stops, owing to the pronounced lack of transportation options sans traditional jeepneys and UV Expresses. 

The government blamed these crowds on the people's lack of discipline.

Transportation chief Arthur Tugade asserted the department "never promised or said that transportation will be extensive and will meet the requirements of all on the first day." 

READ: Familiar transportation woes as Metro Manila lurches to 'new normal'

President Duterte acknowledged this himself at his penultimate State of the Nation Address, saying: "I know that many of you are worried not only about health and safety but also about our ability to move around and ride public transportation...I assure you that your government will [squarely address] these problems and challenges to overcome them."

He did not specify how, though. At Sunday night's meeting, it was Secretary Duque who brought up the topic, backing the construction of bike lanes as well. "Ang transportation issues ay nangangailangan ng immediate response at kailangan maglaan ng safe transportation options partikular na dito ang agarang pagpapatupad ng bike lanes," he said. 

While the Department of Transportation insists pushing through with its planned infrastructure projects, saying "if not now, then when?" civil society groups like the Move as One transportation coalition highlight that transportation is a public health issue and call for a service contracting scheme, which is echoed by the doctors. 

"This problem cannot be addressed by long-term infrastructure. We need prompt and rapid solutions with long-term impact such as the immediate implementation of service contracting, pop-up bicycle lanes, and pedestrian lanes. Workers need more transportation options to prevent congestion in public streets. We need these now, not next year, because people need to get to work but have no safe transport options," the doctors' manifesto read. 

LIST: Modes of transportation allowed, prohibited in areas under MECQ

Social amelioration

The doctors' groups also wrote: "We ask the [social welfare, agriculture, labor, interior] departments and local governments and other relevant government agencies to provide the necessary support for those whose livelihood will be affected by this proposed timeout for the health sector."

The Department of Social Welfare and Development's still-delayed social amelioration program was not mentioned at Sunday's address. 

Duterte, however, admitted at his address that there were indeed lapses on the part of the national government as pointed out by the healthcare professionals, though he was quick to pin the blame on corrupt officials in local governments. 

"I want the graft and corruption stopped. We have so many missteps because of corruption...I want to taste your humiliation while I am here [and] I will demand your resignation. We'll see who gets what," the chief executive swore, saying he wants corrupt officials dismissed immediately.

As of the DSWD's latest update, only P58.5 billion of the P100 billion allotted for the program has been disbursed past its self-imposed July 31 deadline, already an extension itself, for its second tranche of aid for families affected by the pandemic. 

The department's first and second tranche distributions were initially slated to be accomplished by April and May 2020, respectively.

"Problem is wala na tayong pera. I cannot give food anymore and money to people," Duterte said. 

The Philippines is still under the longest quarantine in the world and has, according to former task force adviser Dr. Tony Leachon, one of the fastest “acceleration” of cases in Southeast Asia where it still leads the region in the number of active cases.

Health authorities on Sunday logged another record-high single-day increase in coronavirus cases, this time with a troubling 5,032 new cases of the coronavirus, bringing the national caseload to 103,185, all on the fourth consecutive day and the 138th day since the first implementation of enhanced community quarantine. 

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