DOH raises COVID-19 alert level to CODE RED: What does it mean?

The Department of Health (DOH) confirmed that the previously-reported 5th case of Coronavirus Disease 2019 (COVID-19) is the first case of local transmission in the country after verification with the Bureau of Immigration showed that the patient had no recent travel history.

DOH also reported that the patient’s wife tested positive for COVID-19 after contact tracing activities were prompted. This brings the total number of COVID-19 cases in thecountry to six (6).

The 6th confirmed case is a 59-year-old female who presented with cough and was admitted at the Research Institute of Tropical Medicine (RITM) on March 5. The patient is currently in stable condition.

“The DOH is currently exhausting all its efforts to identify others who may have come in contact with the confirmed cases to ensure that this localized transmission does not progress to community spread,” Health Secretary Francisco T. Duque III said.

In light of the confirmation of localized transmission in the country and in anticipation of possible sustained community transmission, DOH has raised the COVID-19 Alert System to Code Red sublevel 1. DOH is quick to clarify that this is a preemptive call to ensure that national and local governments and public and private health care providers can prepare for possible increase in suspected and confirmed cases.

With Code Red, the DOH has recommended to the Office of the President for the declaration of a State of Public Health Emergency which will facilitate mobilization of resources, ease processes, including procurement of critical logistics and supplies, and intensifying reporting.

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.

“This declaration is a signal to all concerned agencies, Local Government Units and health care providers to be ready to implement planned response measures. We are continuously reminding everyone to practice personal protective measures such as hand hygiene, social distancing, and proper cough etiquette. Avoid unnecessary travel and postpone mass gatherings, as well. It is our individual responsibility to protect ourselves and the people around us. Only through collective action in our communities will we be able to limit the spread of the virus,” the Health Chief reminded.

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.

Appeal to Responsible Sharing of Information

The DOH would like to remind all health care providers, institutions, and stakeholders to exercise utmost prudence in sharing sensitive information about suspected or confirmed cases.

“Our objectives for sharing information are two-pronged: ensure the public’s health and safety by facilitating contact tracing and ensure that the individual’s right to privacy is not impinged. Hence, we appeal to all to coordinate closely with the Department of Health when disseminating information to the public and within their respective institutions.

Let us make sure the information sharing process will yield the utmost benefit, and avoid unnecessary stress and stigma to individuals and institutions,” Duque said.

The DOH commits to be more circumspect in reporting confirmed cases, to balance interests of public health and privacy. To this end only pertinent information necessary to facilitate contact tracing will be provided to the public, i.e. activity, location and time, if available.

Improving Diagnostic Capacity

The current gold standard for diagnosing COVID-19 is through laboratory-based Polymerase Chain Reaction (PCR) testing. RITM, with the assistance of WHO, is currently capacitating five Subnational Laboratories for PCR testing: San Lazaro Hospital and Lung Center of the Philippines in Manila, Baguio General Hospital and Medical Center in Northern Luzon, Vicente Sotto Memorial Medical Center in the Visayas region, and Southern Philippines Medical Center in Mindanao. In addition, efforts are underway for the University of the Philippines – National Institutes of Health to be similarly capacitated.

DOH has received several proposals of rapid testing kits, including one that has been developed locally. To date, these kits have yet to be listed or validated under the WHO Emergency Use List. Such validation is necessary to ensure accuracy of test results.

“DOH is determined to expand our testing capacity for COVID-19 to immediately ascertain that cases are identified and dealt with. We are studying these proposals to ensure that they are accurate and safe for the public’s use.” Duque said.

“Enhanced testing capacity is a prerequisite to prevention and containment, hence DOH is placing expansion of testing centers as its topmost priority,” he added.

Updates on Contact Tracing

On the 3 new confirmed cases, the Epidemiology Bureau, in coordination with the Centers for Health Development and City Health Offices, is currently establishing travel history and identification of individuals who might have had contact with the positive cases. Identified contacts are being interviewed and assessed for signs of respiratory illness.

“We will be prioritizing testing of those symptomatic individuals found to have had close contact with the confirmed cases. We urge those who may have interacted with the confirmed cases within the past 14 days to immediately call the DOH Hotline (02)8-651-7800 loc 1149-1150 for appropriate referral to a health facility,” Duque said.

DOH reiterates that based on current data, 81% of cases have mild disease, about 14% appear to progress to severe disease, and 5% are critical.

“For persons with known history of exposure or travel and with mild symptoms including cough, fever, cold, and sore throat, DOH is advising you to undergo home quarantine and contact your respective city/municipal health office for proper assessment, monitoring, and management,” Duque said.

“We have recommended the declaration of a State of Public Health Emergency despite the fact that we have only two cases constituting localized transmission. Trust that the Department of Health is proceeding with utmost vigilance and is working vigorously to protect Filipinos against COVID-19,” the Health Chief concluded.//

DOH Press Release (DOH CONFIRMS LOCAL TRANSMISSION OF COVID-19 IN PH; REPORTS 6TH CASE)