Republic of the PhilippinesDepartment of Health

OFFICE OF THE SECRETARY

MAY 04 2020ADMINISTRATIVE ORDERNo. 2020-__ 0016

SUBJECT: inimum_Heal tem_CapaciPreparedness and Response Strategies

I. RATIONALE

Coronavirus Disease 2019 (COVID-19) wasfirst identified last December 2019 as a clusterof pneumonia cases of unknown etiology. On 30 January 2020, the World HealthOrganization declared the COVID-19 outbreak as a Public Health Emergency of InternationalConcern and eventually as a Global Pandemic by 11 March 2020.

The Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID) National ActionPlan with strategies “Detect, Isolate, and Treat” and the development of minimum publichealth standards shall form the backbone of response to the COVID-19 outbreak.This issuance shall outline the minimum health system capacity standards for each level ofthe health system.

IL OBJECTIVE

This Order aims to define the minimum health system capacity standards for COVID-19preparedness and response strategies as guidance for sectoral and local planning.

ii, SCOPE AND COVERAGEThis Order shall apply to all entities involved in COVID-19 response both from public andprivate sectors, including all national government agencies (NGAs), government offices,private offices and workplaces, local government units (LGUs), development partners,academic and researchinstitutions, civil society organizations,, and all others concerned.

2 GENERAL GUIDELINESA. Effective whole-of-government and whole-of-society action against the COVID-19

threat requires a national government-enabled, local government-led, andpeople-centered response, aligned with the principles of universal health care.

ational government agencies, local government units, and DOH Centers for Health

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Development, and the private sector shall work together to rapidly expand healthsystem capacity and provide mechanismsfor sharing of resources, as necessary.(All province and city-wide health care provider networks, as provided by RA 11223or the Universal Health Care Act, shall endeavorto establish patient navigation andcoordination systems, harmonized information and communication technology,

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medical transport system and network mechanisms for efficient operations andperformance management.

. The IATF-EID shall provide the risk classification of provinces, HUCs and ICCs inaccordance with scientific analysis of latest, most reliable evidence. Risk stratifiedand evidence-based actions shall serve as the backbone of the country’s strategicresponse to COVID-19 and shall guide decision-making bothat the national and localgovernment levels to ensure timely and effective preparedness and responsestrategies.

. All actors shall endeavor to achieve the minimum health system capacity targets toensure that all persons classified as suspect, probable and confirmed COVID-19 casesand close contacts are detected, isolated, and treated.

. The IATF-EID shall ensure monitoring and compliance of families, offices, agencies,and institutions on the minimum health system capacity standards andthe risk basedpublic health standards for COVID-19 Mitigation

IMPLEMENTING GUIDELINES

. The national government, led by the Department of Health, shall endeavor to ensurethe following minimum national health system capacity standards for COVID-19preparedness and response are met:

a. Develop national government-enabled, local government-led, andpeople-centered sectoral policies for prevention, detection, isolation, andtreatment of COVID-19

b. Increase national testing capacity to at least 30,000 tests per day by May30, 2020 through the development of laboratories and ensuring access totesting laboratories and related commodities to enable health workers toaccurately detect, isolate, and treat new and resurging cases

c. Increase supply of personal protective equipment to at least 5 million amonth, and stimulate self-sustainability with local production inaccordance with FDA. standards with due regard to ease-of-doing business.

d. Increase access to critical care capacity across the country throughinfrastructure and equipment investments for healthcare provider networksto have adequate surge response capability to provide efficient andresponsive health services.

-] All regions, led by DOH Centers for Health Development and DOH RegionalHospitals, shall endeavor to ensure the following minimum regional health systemcapacity standards for COVID-19 are met:

1. For infrastructure and equipment:

a. At least 1 Biosafety Laboratory 2 (BSL2) with Real Time PolymeraseChain Reaction (RT-PCR) testing capacity per region consistent with the

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requirements indicated in AO 2020-0014, with dedicated laboratory and,

support staff who are trained in molecular laboratory diagnosis andbiosafety and biosecurity

Atleast one (1) dedicated referral hospital/facility/floor/wing staffed by adedicated medical support team, with the purpose of serving as theregion’s primary referral center for severe or critical COVID-19 casesconsistent with DM 2020-0142;

At least one (1) Intensive Care Unit (ICU) bed and mechanical ventilatorfor every 25,000 population, or corresponding to the peak day critical carecapacity in updated projections from a DOH-recognized epidemiologicprojection model for COVID-19; and

At least 30% ofall current public and private hospital beds must have thecapacity to accommodate and service COVID-19 patients, orcorresponding to the peak daycritical care capacity in updated projectionsfrom a DOH-recognized epidemiologic projection model for COVID-19.

2. For commodities and supplies:

a.

b.

Atleast 30 days buffer supply ofPPE forall health facilities are availableAt least 30 days supply of testing kits, swabs, reagents, and othercommodities for testing in laboratories

3. For organizational plans and processes:

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a. Regional Incident Command and Inter-agency Task Force structure,including processes for escalation and resolution of region-level issues;

Regional plan on referral and safe transportation of samples across heaithfacilities for COVID-19 testing;

Regional risk and/or crisis communication plan and strategies forcommunity engagement including frequently asked questions

Monitoring and validation processes that all levels of the health system areimplementing simultaneous and complete reporting of all suspect,probable and confirmed cases to concerned CESU/MESU, PESU, RESUand EB within 24 hours from a case that was seen, consulted or admitted;

Monitoring and validation processes that minimum health standards aremetacross all local government units

Regional coordination mechanism or call center to facilitate navigation,care coordination, and patient transport mechanisms especially forsevere/critical COWVID-19 cases (worsening condition), consistent withDM 2020-0178 across different health facilities in the regional network

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C. All provinces/HUCs/AICCs, led by the Provincial/HUC/ICC Government, incoordination with their component cities and municipalities, shall endeavour to ensurethe following minimum provincial health system capacity standards for COVID-19preparedness and response are met:

1. For health human resource:

a. At least one (1) dedicated epidemiology and surveillance officer for every100,000 population in a city or municipality

b. At least one (1) trained contact tracing personnel for every 800 population

c. At Icast onc active BHERTfor every 1,000 individuals corresponding tothe staffing required to ensure BHERT mandates are met (Annex A)

d. At least 10 staff per province are trained on proper collection, packagingand transportation of samples for COVID-19 testing

e. Roster of trained and experienced health care workers to manage suspects,probable and confirmed cases in the different health facilities working inrotation and with ongoing training and provided with updated guidelines

2. For infrastructure and equipment:

a. At least one (1) established temporary treatment and monitoring facility asdefined by DM 2020-0123, where there is one (1) isolation bed for every2,500 population, or corresponding to the peak day critical care capacity inupdated’ projections from a DOH-recognized epidemiologic projectionmodel for COVID-19;

b. At least one (1) ambulance or medical transport mechanism available forthe patients within the catchmentarea;

c. At least one (1) vehicle to transport specimens to COVID-19 testinglaboratories; and

d. At least one (1) designated funeral home for COVID-19 related deaths,with operations consistent with DOH guidelines on disposal of remains.

3. For supplies and commodities:

a. At least 30 days buffer supply of PPE for all health facilities are available

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b. At least 30 days supply of testing swabs, reagents, and other commoditiesfor testing in laboratories

For organizational plans and processes:

a. Engagement of all public and private health facilities as a network toproviding medical care for COVID-19 and essential non-COVID-19 cases;

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b. Defined primary care-oriented pathways for Non-COVID-19 andCOVID-19 cases in an established referral network catering to the wholespectrum of care (from primary to tertiary care) including onlineconsultation platforms and triage stations for each health facility;

c. Use of information technologyto facilitate timely reporting of case, closecontacts, laboratory, and health system capacity data and contact tracingefforts;

d. LGU-wide communication coordination system with centralized transportmechanisms especially for patient referral including ambulances or othervehicles and public postingofall relevant contact information;

e. Support mechanism including transport and temporary isolation to receive,assist transport, and monitor each repatriate and stranded student, worker,or, as applicable, resident entering their catchment;

f. Support systems including PPE, transport, human resource, per diem andtravel allowances, and to ensure essential services such as immunizations,maternal and child care, primary care consults, and other services specifiedby DC 2020-0167, are continuously provided;

g. Accurate and timely reporting of confirmed, probable and suspectCOVID-19 cases and their close contacts, testing and test results, as perRA 11332, or the Mandatory Reporting of Notifiable Diseases and HealthEvents of Public Health Concern; and

h. Systematic healthcare waste management for the network including properwaste handling as indicated in the Health Care Waste Management Manualand a sewage treatment plant for hazardous solid waste through in-housetreatmentor third party hauler.

i. Ensure adequate access for supply chains especially for medicines, PPEs,testing supplies, and other health commodities

j. Ensure training and updating of all health care workers in latest contacttracing, testing and case management protocols developed by the DOH

k. Establish local risk and/or crisis communication plan and strategies forcommunity engagement

All health facilities at all levels shall implement the minimum health requirements forhealth settings (Annex B)

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1. Risk Based Actions for COVID-19 Response (Annex C)2. AO on Risk-Based Public Health Standards for COVID-19 Mitigation (AO

2020-0015) (Annex D)

VI. REPEALING CLAUSE

Other related issuances not consistent with the provisions of this Order are herebyrevised, modified, or rescinded accordingly. Nothing in this Order shall be construedas a limitation or modification of existing laws, rules and regulations.

VII. SEPARABILITY CLAUSE

Should any provision of this Order or any part thereof be declared invalid, the otherprovisions, insofar as they are separable from the invalid ones, shall remain in fullforce and effect.

VII. EFFECTIVITY

This Order shall take effect immediately.

FRA UQUE TI, MD, MScSecretary of Health

CERTIFIED TRUE COPY

MAY 05 2029CORAZOK s. p

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Annex A. Local Contact Tracing Team Structure and Functions

LOCAL CONTACT TRACING TEAM STRUCTURESTEERING COMMITTEE

Lead: City/Municipal Health OfficerCo-lead City/Municipal PNP

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e Ensure completeness and correctness of contacttracing data to be submitted to PESU, RESU and EB

e Facilitate coordination between C/MESUs andBHERTs

BHERTs On Patient Navigation® Conduct home visits for proper assessment and

referral of patientse Report cases back to LGU

On Contact Tracinge Conduct home visits to trace close contacts

Provide health education to close contactsCollect close contact profilesClassify close contacts and assessrisk level ofexposure

@ Monitor close contacts under home quarantine

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Republic of the PhilippinesDepartment of Health

OFFICE OF THE SECRETARY

APR 27 2020

ADMINISTRATIVE ORDERNo. 2020 -_0015

SUBJECT: Guidelines on the Risk-Based Public Health Standards forCOVID-19 Mitigation

I. RATIONALE

Coronavirus Disease 2019 (COVID-19) wasfirst identified last December 2019 as a clusterof pneumonia cases of unknown etiology. On 30 January 2020, the World HealthOrganization declared the COVID-19 outbreak as a Public Health Emergency of InternationalConcern and eventually as a Global Pandemic by 11 March.2020.

In the absence of specific treatment or a vaccine, non-pharmaceutical interventions (NPI)form the backbone of the response to the COVID-19 outbreak. Non-pharmaceuticalinterventions ar¢ public health strategies meant to mitigate and suppress transmission ofinfectious diseases. While the Enhanced Community Quarantine (ECQ) has beeninstrumental in slowing the rapid spread ofthe disease, local evidence suggests that the gainsfrom the ECQ will be reversed in the absence of complementary interventions that willminimize case resurgence.

The Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID) Resolution No.28 mandates that minimum public health standards must be specified by the Department ofHealth (DOH) and ‘adhered to by all sectors. These standards shall serve as a guide ininstitutionalizing key NPIs to combat COVID-19.

Il. OBJECTIVE

This Order aims to provide guidance for sectoral planning on the implementation of NPIs asminimum public health standards to mitigate the threat of COVID-19. It shall serve as a basisin the decision-making process and development of more specific sectoral policies forCOVID-19 response.

Iii, SCOPE AND COVERAGE

This Order shall apply to all entities involved in COVID-19 response both from public andprivate sectors, inchiding all national government agencies (NGAs), government offices,private offices and workplaces, local government units (LGUs), development.partners,academic and research institutions, civil society organizations,, and all others concerned.IV. DEFINITION OF TERMSA. Administrative Controls - refer to procedural interventions or. modifications’ inpolicies, standards, and processes, that ‘are meant to reduce the frequency and severityAy”Building 1,San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila © Trunk Line 651-7800 local 1108, 141, 1112, 1113 yv_ Direct Line: 714-9502; 711-9503 Fax: 743-1829 © URL: htip:/www.doh.gov.ph; e-mail: fduguete:doligov.ph- -

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of exposure to infectious diseases (c.g. hygiene and disinfection protocols, workshifting, etc.)Comorbidity at risk of COVID-19 exacerbation - presence of one or moreadditional conditions co-occurring with (that is, concomitant or concurrent with) aprimary condition that increases an individual's risk for mortality if afflicted byCOVID-19. This includes immunocompromised individuals (such as but not limitedto those with cancer, HIV/AIDS ‘and other autoimmune disorders) and individualswith chronic conditions (such as but not limited to hypertension, diabetes mellitus,and chronic kidney disease).Engineering Controls - refer to physical interventions or modifications in spaces orenvironments, that is meant to prevent the transmission of infectious discases (e.g. uscof physical barriers, exhaust ventilation, etc.)Medical-grade Protective Apparel - refers to the specialized personal protectiveequipment worn by healthcare workers and other frontlincrs involved in the diseaseoutbreak response, for the purpose of protection against infectious materials. Theseinclude. surgical face. masks, N95. respirators, face shield or goggles, ‘coveralls,isolation gowns, surgical gloves, protective oversleeves, head cap, and shoe cover,among others.Modification Potential - refers to the degree to which mitigation strategies and otherpublic health measures can reduce the risk of COVID-19 transmission in differentsettings.Most-at-risk Population (MARP) for COVID-19 - refers to population groups whohave a higher risk of developing severe COVID- 19 infection’such as individuals aged60 and above, pregnant, and thosé with underlying conditions or comorbidity at riskof COVID-19 exacerbation.

. Non-pharmaccutical Interventions (NPI) - refers to public health measures that donot involve vaccines, medications or other pharmaceutical interventions, thatindividuals and communities can carry out in order to reduce transmission rates,contactrates, and the duration of infectiousness of individuals‘in the ‘population.Protective Personal Equipment- tefers to protective garments or equipment worn byindividuals to increase personal safety from infectious agentsVulnerable groups - refers to socially disadvantaged groups. that are most susceptibleto suffer directly from disasters and health events. These include senior citizens,immunocompromised individuals, women, children, persons deprived with liberty(PDL), persons’ with disabilities (PWDs), and members of indigenous peoples (IPs),internally displaced persons (IDPs), indigenous.cultural communities (ICCs), amongothers.

GENERAL GUIDELINES

. The DOH shail set-minimum public health standards to guide the development ofsector-specific and localized guidelines on mitigation measures for its COVID-19response across all settings - such as but not limited to home, public places, officesand workplaces, high-density communities, food and other service establishments,schools, hotels. and other accommodations, churches and. places of worship, prisonsand other places of detention, public transportation (air, Jand, and water transport),and health facilities.

AvK BL. The adoption and implementation of the standards shall be guided by the following

principles:

1, Shared accountabilitya) Health is a key development objective that is the shared accountability of

the government, communities, houscholds, and individuals.b) A whole-of-system, whole-of-government, wholé-of-society approach is

essential to develop cohesive solutions to current and future challenges topublic health and national security.

c) All efforts shall espouse the government's strategic directions of nationalgovernment-cnabled, local government-led, and people-centered responseto the COVID-19 health event.

2. Evidence-based decision-makinga) Evidence shall guide policy development and decision-making at all

levels of government.b) As science ‘continues to evolve, all actors shall :periodically assess and

recalibrate policies, plans, programs and guidelines.

3. Socioeconomic equity & rights-based approacha) Recognizing that vulnerabilities:are socially determined, it is important to

be cognizant of the equity considerations and implications of blanketpolicies, plans, and programs that are being conceptualized for scaled-upimplementation. Vulnerable groups should therefore be identified andprovided additional social safety net protections.

/

b) Policy design shall always choose the least restrictive alternative thatachievesits goals,

c) In the event of any conflict of rules or guidelines, the interpretation shallensure the protection of human rights. As such, the safety, needs, andwell-being ofthe individual shall prevail.

x C 2. All policies, investments, and actions shall ensure that COVID-19 mitigationobjectives are achieved using the following strategies:1, Objective 1: Increase physical and mental resilience

a. Ensure access to basic. needs of individuals, :including food, water,sheltér and sanitation.

b. Support adequate nutrition and dicts based on risk.Encourage appropriate physical activity for those with access to openspaces as long as physical distancing is practiced.Discourage smoking and drinking of alcoholic beverages.Protect the mental health and gencral welfare of individuals.Promote basic respiratory hygiene and coughetiquette.Protect essential workforce through provision of food, PPE and othercommodities, lodging, and shuttle services as necessary.Provide financial and healthcare support for workforce who contractedCOVID-19 through transmission at work.

i. Limit exposure of MARP groups, such as through limitation in entry orprioritization in service or provision of support.

j. Provide appropriate social safety net support to vulnerable groups forthe duration of the COVID-19 health event.

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2. Objective 2: Reduce transmissiona. Encourage frequent hand washing with soap and water, and discourage

the touching of the eyes, nosc, and mouth, such as through appropriateinformation and education campaigns.Encourage symptomatic individuals to stay at home unless there is apressing need to go to a health facility for medical consultation, ifvirtual consultation is not possible.Ensure access to basic hygiene facilities such as toilets, handwashingareas, water, soap, alcohol/ sanitizer.Clean and disinfect the environment regularly, every two hours forhigh touch areas’such as toilets, door knobs, switches, and at least onceevery day for workstations and other surfaces.Ensure rational use of personal protective equipment (PPEs) that issuitable to the setting, and the intended user. Medical-grade protectiveapparel shall be reserved for health care workers and other frontliners,and symptoinatic individualsat all times.

3. Objective 3: Reduce contacta.

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implement strict physical distancing at all times, specially at publicareas, workstations, eating areas, queues, and other high traffic areas.Reduce movement within and across areas and scttings.Restrict unnecessary mass gatherings.Limit non-essential travel and activities.Install architectural or engineering interventions, as may be deemedappropriate.Implement temporary closure or suspension of service in high riskareas or establishments, as necessary.

4. Objective 4: Reduce duration of infectiona. Identify symptomatic individuals and immediately isolate, such as

through the use of temperature scanning, symptom self-monitoring,and voluntary disclosure.Coordinate symptomatic individuals through appropriate health systementry points suchas primary care facilities or teleconsulting platforms.Trace:and quarantine close contacts of confirmed individuals consistentwith Department of Health guidelines.

IMPLEMENTING GUIDELINES

A. Risk Severity Grading. All actors (NGAs in coordination with Civil ServiceCommission, LGUs and/or Private Sector) shall base their COVID-19 mitigationresponse from the IATF-EID’s risk severity grading (¢.g., Low, Moderate, and HighSeverity)

B. Risk-based Public Health Standards Across Settings. At the mininu:m, all actorsshall implement the prescribed interventions in various settings (Annex A) dependingon their Risk Severity Grading. For each prescribed intervention, concrete examplesof corresponding hazard controls (¢.g. engineering control, administrative control,and PPEs.) are provided.

Depending ontherisk severity grading:1. Interventions that are listed as ‘MUST DO?’ shall be mandatory. See Annex B.2. Interventions thai are listed as ‘CAN DO’ shall be optional, and may be

tailored further as guided by the Modification Potential Matrix on Annex C.1.

NGAs shall build on the identified interventions in devcloping scctor-specific policiesand plans, and may propose adjustments for additional interventions inconsistent withthose indicated in this Order.

C. Prioritizing Additional Mitigation Strategies based on Modification Potential.All actors may implement additional mitigation interventions for different settings .The Modification Potential Matrix provided for in Annex C.1, rated settings based onthe likelihood that it can be modified to lessen contact. All actors are encouraged toprioritize settings that scored high, followed by medium, then low.

VII. ROLES AND RESPONSIBILITIES

A. DOH shall:1, Provide technical assistance in facilitating inter-agency or sector-specific

planning;2. Continue to update the set minimum public health standards based -on most

recent evidence available and issue succeeding updates through DOHDepartment Circulars;

3. Develop -standards, systems, and guidelines on operationalizing .post-ECQinterventions;

4.. Engage -stakeholders and promote awareness on NPls.and its importance,including relevant and accurate information about appropriate protocols; and

5. Consolidate reports and recommendations from NGAs and LGUs. forendorsement.to the IATF-EID. and other agencies concerned

B. Other National Government Agencies shall:1. Develop and submit their ‘sector-specific plans and guidelines on. the

operationalization ofthe risk-based public health standards to theDOH, whichshall be consolidated and endorsed by the Secretary ofHealth to theIATF; and

2. Submit to the DOH sector-specific monitoring tools to track compliance.

C. Local Government Units shall:1. Ensure implementation of risk-based public‘health standards for COVID-19

mitigation;2. Set up mechanisms to monitor ‘compliance and submit reports according to

providedtools;3. Coordinate with DOH and other NGAs in carrying out these guidelines;4, Develop counterpart local ordinances, to ensure compliance with national

directives at the local level;:and5. Ensure immediate and widest -dissemination of these guidelines to all

units/sectors within their jurisdiction

D. ‘Industries and the Private Sector shall:1. Comply with the risk-based public health standards set by DOH,

sector-specific policies and plans by other NGAs, and other relevant rules and—

regulations x.

Vv,oo s pt- . -

VIL.

IX.

REPEALING CLAUSE

Other related issuances not consistent with the provisions of this Order are herebyrevised, modified, or rescinded accordingly. Nothing in this Order shall be construedas a limitation or modification of existing laws, rules and regulations.

SEPARABILITY CLAUSE

Should any provision of this Order or any part thereof be declared invalid, the otherprovisions, insofar as they are separable from ‘the invalid ones, shall remain in fullforce and effect.

EFFECTIVITY

This Order shall take effect immediately.

E 11, MD, MScSecretary of Health

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