A simple proposal by FRANCISCO SALCEDO CRUZ, MD, MPH, initially posted on May 4, 2020 and revised/reposted on June 21, 2020
The Philippine COVID-19 outbreaks CRISIS should not be a war against the SARS COV2 virus. This 1950 science based medical education theory SOLELY attributing infection or illness to a pathogen like a virus or bacteria WAS REPLACED in the 1980s by the problem-based learning then in 2010, WAS TOTALLY DEBUNKED by Education of Health Professionals for the 21st Century (The Lancet).
The cornerstone of the Philippine COVID-19 WAR should simply be CHANGING BEHAVIOR (Knowledge, Attitude, Practices, Skills – KAPS) among individuals, families and communities INSTEAD like social distancing, regular handwashing, personal hygiene, wearing face masks, knowing early COVID-19 manifestations and its prevention, stay at home when sick, early recognition, correct lab confirmation and prompt treatment.
An appropriate TECHNOLOGY in the next 18 months or more may provide HERD IMMUNITY like a safe, effective and AFFORDABLE vaccine but until then, we need to learn living and INNOVATING under the NEW NORM.
A piece of advise. Let us not EMBRACE yet the ANTI-COVID19 vaccine until we examine the complete and truthful results of the 3-phase trials posted in a reputable public health journal and peer-reviewed by INDEPENDENT, WELL RESPECTED SCIENTISTS.
Let us not forget the Philippine Dengvaxia tragedy. In fact, some DPAs of the multi-national pharmaceuticals and its front organization (Pharmaceuticals and Healthcare Association of the Philippines) already “infiltrated” the halls of IATF, DOH, Philhealth and FDA.
FORTRESS PHILIPPINES AGAINST PANDEMICS
A medium term strategic, multisectoral health and development plan OUTLINE (July 1, 2020 – June 30, 2022) to effectively prevent and control COVID-19 pandemic and other impending/future global health emergencies.
END GAME STATEMENT (IMPACT indicator or over-all health and development GOAL):
By the end of June 2022, Filipino families and communities, including the national and local governments, academic institutions, health facilities, professional groups, private corporations, NGOs, POs, civil society and other stakeholders, are EMPOWERED to use APPROPRIATE, AFFORDABLE AND AVAILABLE TECHNOLOGY in combating local COVID-19 infections with VERIFIABLE reduction of deaths, cases and infection rate to A MERE TEN PERCENT (10%) of February – May 2020 levels.
(1) Improve health literacy and networking of families and communities starting with but not limited to COVID-19 prevention and control through community-based health promotion in barangays, schools, workplaces, worship areas and PDOS of OFWs. Health information dissemination by tri-media and social media should be synchronized and supplemental to the health education projects.
(2) Establish, maintain and expand FORTRESS LGUs starting with geo-political units having ZERO or low COVID-19 incidence or infection rate in 2020, in several subnational levels like regions or adjacent regions (Mindanao, North Luzon, Bicol region and Visayas) in 2021 and ATTAINING FORTRESS PHILIPPINES by June 2022.
The Taiwanese success story can be a blueprint on this initiative.
(3) Declare NCR, regions 3, 4A, 7, 11 and certain cities and urban areas of provinces as RED ALERT STOP COVID-19 OUTBREAKS with the IATF having FULL CONTROL over concerned regional offices and LGUs in terms of (a) movement of people, services and goods, (b) quarantine/lockdowns and other projects reducing community transmissions, (c) PCR and/or rapid antibody tests of COVID-19 sick patients, their families, close contacts (probable and suspect cases), ALL health staff (public and private) of hospitals, laboratories, clinics, RHUs, BHS and other frontliners in barangays with COVID-19 cases (BHWs), (d) COVID-19 community based disease SURVEILLANCE, outbreak investigations and contact tracing, (e) quarantine and isolation center management, (f) coordination and support services I.e. logistics and M&E to improve case management of hospitalized patients, (g) strategic health communication, (h) linkages with bilateral and multilateral international organizations including resource mobilization and special studies and (i) peace & order and civil defense concerns.
The success stories in South Korea, Hongkong and other Asean neighbors may be adapted and improved in our highly urbanized places.
(4) STOP IMPORTED COVID-19 TRANSMISSIONS FROM OTHER COUNTRIES.
In close collaboration among DFA-OUSMWA DOJ-BID, OP-PAGCOR, DOTR-PCG, DOH-BoQ, DTI-PEZA, DND-AFP-OCD, DILG-PNP and other government agencies, NO FOREIGNER (tourists, businessmen, migrant workers, diplomats) with previous or suspected COVID-19 infections should enter without the IAFT-DOH-PGH clearance subject to the principle of reciprocity.
Subject to availability of funds, laboratories and quarantine centers, returning OFWs (sick or SUSPECTED cases) from high risk countries should be repatriated at the earliest possible time. Other returning Filipinos (balikbayan, healthy OFWs, tourists abroad) should get a DOH-BoQ clearance before RE-ENTRY.
(5) Reduce COVID-19 case fatality rate, major morbidities and hospital days spent by half from March to May 2020 levels through early diagnosis and prompt treatment protocols reviewed and updated by medical experts and available medicines and life-saving equipment
In selected COVID-19 related deaths to be determined by infectious DISEASE experts, pathologists, public health and epidemiology consultants, CONDUCT AUTOPSIES AND HISTOPATHOLOGICAL EXAMS with prior consent from the families TO DETERMINE ACTUAL, IMMEDIATE AND UNDERLYING CAUSES OF DEATH among other pertinent information to improve case diagnosis and management.
(6) Monitor and prevent the recurrence of COVID-19 outbreaks (2nd and 3rd waves) especially among health professionals, front liners and high risk susceptibles living in urban slums
(7) Establish and institutionalize a population-based national emergency response to a major bio-chemical warfare/disaster under DND-AFP-OCD-NDCC.
The Johns Hopkins matrix of health safety and risk management framework in October 2019 may be useful in this endeavor.
Major strategies/ health outputs
(1) Capability building
1.a institutional orientation of the health sector on COVID-19 prevention and control
1.b development and roll out of health education modules
1.c mass testing of high risk groups and sample population based surveys for COVID-19 infection rates
1.d UHC of all hospitalized and OPD cases including lab confirmation
1.e quality QUARANTINE and isolation/treatment services with available medical specialists, medicines, logistics and equipment
1.f HMIS and FHSIS
(2) Public health vaccination using a safe, effective, affordable and easy to implement ANTI-COVID19 vaccine prioritizing health care workers, frontliners, senior citizens and susceptibles in high risk communities with 80% vaccination coverage
Also, consider the study of Dr. Robert Gallo on OPVs can protect against COVID-19.
(3) Community based DISEASE SURVEILLANCE, outbreak investigations, contact tracing and other epidemiological studies
(4) Social mobilization and health promotion
(5) Integrated FORTRESS Philippines health communication strategy
(6) Research and development including process documentation
(7) Project planning and budgeting including Monitoring and Evaluation
The Philippine COVID-19 WAR is NOT about combating an invisible virus (SARS COV2) but rather CHANGING BEHAVIOR to a new set of HEALTHY K-A-P-S together with APPROPRIATE TECHNOLOGY and innovation.
In fact, this COVID-19 pandemic may just be a wake up call, sort of a dress rehearsal for a MORE SERIOUS PUBLIC HEALTH CHALLENGE.#