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HEALTH AND COVID-19 RESPONSE

Mandated Actions under RA11469:

A. General Policies for the population (GP) A.1. Sec. 4(a): Adopt WHO guidelines and best practices to prevent or suppress transmission and spread of COVID-19 A.2. Sec. 4(b): Testing, Isolation, and Treatment A.2.1. Prompt testing (including streamlining of accreditation of testing kits) A.2.2. Isolation and treatment of patients A.2.3. Philhealth mandate to cover healthcare expenditures of COVID-19 patients B. Human Resources for Health (HRH) B.1. Sec. 4(d): Special risk allowance for HRH (public health workers) B.2. Sec. 4(e): Philhealth mandate to cover healthcare and work-related injury expenditures of public and private health workers B.3. Sec. 4(f): Financial support to public and private health care workers and their families B.4. Sec. 4(k.6): Ancillary services B.5. Sec. 4(m): Temporary HRH to complement or supplement the health workforce C. Facilities, Equipment, and Supplies (FES) C.1. Sec. 4(h): Direct operations of privately-owned hospitals and health facilities (when public interest so requires), including passenger vessels and other establishments to (a) house health workers, (b) serve as quarantine area, (c) serve as medical relief and aid distribution

center, (d) serve as temporary medical facility, and (e) ferry health personnel and other persons

C.2. Sec. 4(j): Ensure expeditious processing and distribution of donated health products C.3. Sec. 4(k): Expeditious procurement of: (a) Sec. (k.1.): Medical supplies and equipment;

(b) Sec. (k.3.) Lease of real property related to COVID-19 response; (c) Sec. (k.4.) Establishment, construction, and operation of facilities; and (d) Sec. (k.5.) Utilities, telecommunications, and other critical services

C.4. Sec. 4(o): Liberalize incentives for manufacture or importation of needed equipment and supplies

Actions Taken based on the President’s Report dated 11 May 2020

A. General Policies for the population (GP)

A.1. Prevent and suppress transmission and spread of COVID-19

• The Department of Health (DOH), Department of the Interior and Local Government (DILG), and Department of Information and Communications Technology (DICT) are jointly implementing the second phase of the DOH Telemedicine Program, which includes home visits of barangay health emergency response teams (BHERT) to check on the health of individuals.

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• The Environmental Management Bureau (EMB) of the Department of Environment and Natural Resources (DENR) issued Memorandum Circular No. 20-2020 on protocols for the proper transportation, treatment, and disposal of healthcare wastes and other hazardous wastes.

• The Commission on Population and Development (POPCOM) conducted virtual orientation in the operationalization of the Demographic Vulnerabilities Tool (DVT) with the National Economic and Development Authority (NEDA), DOH, and DILG. The DVT helps assess LGUs’ level of vulnerabilities using certain indicators, such as household characteristics1.

• The Philippine Institute for Development Studies (PIDS) Health Study Team submitted to the Department of Finance (DOF) scenario analysis using a four-scenario model.

• The National Ethics Committee and Philippine Health Research Ethics Board prepared an e-book on Ethics Guidelines for COVID-19 Crisis-level Hospital Care, with funding support from the Department of Science and Technology (DOST).

• To decongest jails, the Bureau of Jail Management and Penology (BJMP) provided paralegal assistance to persons deprived of liberty (PDLs), which resulted in the expedited release of 4,188 PDLs from 17 March to 30 April 2020.

• As of 05 May 2020, 222 of the 469 BJMP facilities have designated isolation areas for newly-committed PDLs and those suspected of COVID-19. In addition, quarantine facilities have been set up at the New Bilibid Prisons and the Correctional Institute for Women.

• The Bureau of Pardons and Parole issued Resolution No. OT-04-15-2020 or the Interim Rules on Parole and Executive Clemency, and started processing applications for executive clemency to decongest jails and detention centers.

• The Department of Social Welfare and Development (DSWD) provides psychosocial support through its helpline.

A.2. Testing, Isolation, and Treatment

• From 01 to 07 May 2020, the Philippine Coast Guard (PCG) administered rapid antibody tests to 6,911 repatriated Overseas Filipino Workers (OFWs), bringing the total number of OFWs tested in One Stop Shops at NAIA Terminals 1 and 2, and seaports, to 14,430.

• The PCG administered rapid tests to 8,029 OFWs quarantined in hotels and 1,936 OFWs quarantined in cruise ships, as well as 180 government personnel.

• The Food and Drug Administration (FDA) approved the use of 38 PCR-based COVID-19 test kits and 37 rapid antibody test kits. The agency likewise approved 218 out of 702 applications for test kits and approved another 70 applications lodged at the Bayanihan One-Stop-Shop (BOSS).

• The StaySafe.ph contact tracing application recorded 530,000 registered users. The DICT reviews the application’s interoperability with other COVID-19 systems.

• Representatives from NCR, Cagayan Valley, CALABARZON, and CAR had been trained on the use of FASSSTER disease surveillance tool and the TanodCOVID SMS-based contact tracing application, which can be used by the public to report COVID-19-like symptoms to their LGUs. Meanwhile eight cities in NCR started to use FASSSTER and TanodCOVID.

1 POPCOM. (2020). IATF-EID ENDORSES POPCOM’S DEMOGRAPHIC VULNERABILITY TOOL TO HELP TRACK DOWN COVID-19 CASES IN EVERY BARANGAY. POPCOM Region VII [online]. 17 April 2020 [viewed on 19 May 2020]. Available at: http://rpo7.popcom.gov.ph/index.php/27-related-news/67-iatf-eid-endorses-popcom-s-demographic-vulnerability-tool-to-help-track-down-covid-19-cases-in-every-barangay

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• Philhealth released P100 million as interim financing for COVID-19 testing in Philippine Red Cross facilities.

• Philhealth released P12.32 billion to 494 accredited healthcare institutions through its Interim Reimbursement Mechanism (IRM) to boost their response to the coronavirus pandemic (as of 06 May 2020)2.

• Philhealth paid 3.6 million claims amounting to P35.35 billion, with check payments from January to 6 May 20203.

B. Human Resources for Health (HRH) B.1. Special risk allowance for HRH - B.2. Philhealth mandate to cover healthcare and work-related injury expenditures of public and

private health workers -

B.3. Financial support to public and private health care workers and their families - B.4. Ancillary services - B.5. Temporary HRH to complement the health workforce

• Two doctors and 17 nurses were hired by the Bureau of Corrections (BuCor) to assist in efforts to control COVID-19 spread in correctional facilities.

• DOH approved 3,042 slots for emergency hiring in 56 health facilities. B.6. Others (HRH-related but do not directly fall under B.1. to B.5.)

• The Department of Transportation (DOTr) continues to assist HRH with free transportation. As of 14 May 2020, roughly 780,000 HRH are being assisted by DOTr in the NCR and in other regions nationwide. Free rides are also extended to medical workers assigned at quarantine and isolation facilities, such as the Ninoy Aquino Stadium, Rizal Memorial Stadium, World Trade Center, and Philippine International Convention Center. As of 12 May 2020, a total of 283 vehicle units were deployed, in cooperation with other government agencies and private transport groups4.

• DOTr extended up to 31 May 2020 the fuel subsidy for buses transporting medical workers to hospitals5.

• The Provincial Environment and Natural Resources Office (PENRO) in Oriental Mindoro, under the DENR MIMAROPA Region, donated lumber to the provincial hospital to help furnish its newly constructed dormitory for medical staff and COVID-19 frontliners6.

2 Mercado, N.A. (2020). Philhealth released over P12.321-B funds vs COVID-19 crisis – Duterte report. Inquirer.net. 11 May 2020 [viewed on 12 May 2020]. Available at: https://newsinfo.inquirer.net/1273224/philhealth-released-over-p12-321-b-funds-vs-covid-19-crisis-duterte-report 3 Kabiling, G. (2020). PRRD report: Phil Health releases P12.3-B to hospitals for COVID-19 response. Manila Bulletin [online]. 13 May 2020 [viewed on 13 May 2020. Available at: https://news.mb.com.ph/2020/05/11/prrd-report-philhealth-releases-p12-3-b-to-hospitals-for-covid-19-response/ 4 Note: This is a developing report by the DOTr. Source: DOTr. (2020). Free Ride for Health Workers. DOTr [online]. 16 May 2020. [viewed on 16 May 2020]. Availble at: http://dotr.gov.ph/55-dotrnews/1445-non-stop-service-2.html 5 Eagle News. (2020). DOTr: Fuel subsidy for buses transporting medical workers to hospitals extended until May 31. Eagle news

[online]. 14 May 2020 [viewed on 16 May 2020]. Available at: https://www.eaglenews.ph/dotr-fuel-subsidy-for-buses-

transporting-medical-workers-to-hospitals-extended-until-may-31/

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C. Facilities, Equipment, and Supplies (FES)

C.1. Direct operations of privately-owned hospitals, health facilities, and transportation

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C.2. Expeditious processing and distribution of donated health products

• As of 07 May 2020, DOH donations team facilitated a total of 190 foreign and local donations. Out of the 190 donations, 132 transactions (69.5%) had already been completed. The medical products donated consist of 2,415,200 pieces of surgical masks, 51 units of ventilators, 221,210 pieces of N95 masks, and 183,819 PPEs/medical coveralls.

C.3. Expeditious procurement

• From 01 to 07 May 2020, a total of 221,205 PPE sets procured by the Procurement Service (PS) of the Department of Budget and Management (DBM) had been distributed to various health facilities.

• DBM released funds to DOH for the procurement of 1,500 units of mechanical ventilators.

C.4. Liberalize incentives for manufacture or importation of needed equipment and supplies

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C.5. Others (FES-related but do not directly fall under C.1. to C.4.)

• The government continues to mobilize resources to provide health and medical supplies and equipment. Table 1 summarizes contributions, either procured from respective agency budgets or donated by the private sector.

Table 1. Summary of Health Commodities Delivered, in Process,

and Pending Allocation by the DOH*

Items Donated Procured Delivered Processing Pending

Allocation

Apron 0 126,500 84,000 9,000 33,500

Coveralls 7,800 647,467 569,465 12,800 73,002

Facemasks 610,200 4,216,600 2,773,750 270,800 1,782,250

Face Shield 10,972 152,000 14,746 15,000 2,226

Gloves 92,000 1,225,100 928,670 16,100 372,330

Goggles 28 663,490 447,828 17,200 198,490

Gowns 5,252 785,274 491,800 29,700 269,026

Head cap 30,000 854,900 653,825 15,800 215,275

Kn95 300,000 808,700 366,720 8,700 733,280

N95 99,035 438,000 246,500 1,000 289,535

Shoe Cover 1,000 980,054 512,420 38,700 429,934

Thermal Scanner 82 3,000 2,392 200 490

6 DENR MIMAROPA. (2020). DENR donates lumber to benefit frontliners,build quarantine facilities in Mindoro. PNA [online]. 10 May 2020. [viewed on 16 May 2020]. Available at: https://www.covid19.gov.ph/denr-donates-lumber-to-benefit-frontlinersr-build-quarantine-facilities-in-mindoro/

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Non-invasive Ventilators

30 0 30 0 0

Sanitation Tent 10 0 10 0 0

*per President’s report dated 11 May 2020

• Government is constantly expanding its capacity to address a possible surge in COVID-19 cases through conversion of facilities (e.g., evacuation centers) into quarantine facilities, emergency operation centers, food hubs, and quarters for health workers. Table 2 presents the accomplishments of various agencies in converting facilities into quarantine centers.

Table 2. Facilities Converted or for Conversion into Health or Quarantine Centers*

Facility Name Estimated/Target

Capacity No. of Persons

Occupancy

Ninoy Aquino Stadium, Manila 116 Updating

Philippine International Convention Center (PICC)-Forum Halls, Pasay City

294 Updating

World Trade Center, Pasay City 502 380

Rizal Memorial Coliseum, Manila 97 to 112 0

ASEAN Convention Center, Pampanga 150 0

New Clark City-National Government Administrative Center, Pampanga

688 0

Philippine Sports Complex, Pasig City 132 91

Floating Quarantine Hospitals 546 123 OFWs as of 30 April

2020

South Harbor Passenger Terminal Building, Manila

211 202 OFWs as of 07 May

2020

Philippines Arena, Bulacan 300 0

BRP Ang Pangulo 28 16 suspected cases on

board

New Clark -Athletes’ Village, Pampanga 520 0

Las Pinas Rehabilitation Center, Las Pinas City 50 25

Quezon Institute, Quezon City 100 105

Nayong Pilipino - Being considered

Filinvest Tent, Muntinlupa City 108 0

Property in Bagac, Bataan 20 patients at any

given time

49 20 active patients

29 discharged

Alta de Tagaytay 30 0%

Various locations 1,132 establishments

with 65,115 rooms

*per President’s Report dated 11 May 2020

• The Metro Manila Development Authority (MMDA) completed the construction of a quarantine facility at the MMDA headquarters which can accommodate 48 persons.

• The Department of Education (DepEd) approved the use of 2,110 school facilities for COVID-19 related concerns. It is evaluating 366 requests from LGUs to use additional school facilities.

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• The Bureau of Quarantine (BoQ) is manning a total of 73 quarantine facilities (58 are hotels or facilities while 15 are cruise ships) covering 10,210 repatriates.

• There are 1,721 COVID-19 referral and accepting hospitals across the country, with 23 designated DOH COVID-referral hospitals.

• DOST and partner institutions piloted the Enhanced Tracing for Allocation of Medical Supplies to display medical resource needs of hospitals so that donors can identify and assist these facilities.

COVID-19 Brief Situationer

Total Confirmed Cases, Recoveries, and Deaths

• As of 18 May 2020, the DOH recorded a total of 12,718 confirmed COVID-19 cases in the Philippines. This is 1,632 individuals (14.7%) more compared to the 11,086 figure reported on 11 May 2020.

• A total of 2,729 individuals (21.5% of all confirmed cases) recovered from COVID-19 while 831 died (6.5% of all confirmed cases), as of 18 May 2020. Compared with the 11 May 2020 figures, 730 more individuals recovered (36.5% increase) while 105 more (14.5% increase) succumbed to the disease.

Figure 1. Cumulative Number of Confirmed Cases, Deaths, and Recoveries

(06 March to 18 May 2020)

Source: Department of Health

• The growth rates in cumulative cases and cumulative recoveries from 11 to 18 May 2020 were lower at 14.7% and 36.5%, respectively, compared with the 16.9% and 52.0% rates recorded from 04 to 11 May 2020. Moreover, growth rate in cumulative deaths declined to 14.5% from 16.5% for the two periods mentioned.

• Note that the slope of the curve for cumulative number of recoveries is relatively steeper compared with that of cumulative deaths, as the latter remained rather flat. This means that, on relative terms, far more COVID-19 patients are recovering than dying.

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• Table 3 presents cumulative figures for individuals tested, confirmed cases, deaths, and recoveries, their growth rates, and the shares for the following: (a) cumulative confirmed cases to total individuals tested, (b) total deaths to cumulative confirmed cases, and (c) total recoveries to cumulative confirmed cases. Figures are presented every seven days, starting 13 April 2020 until 11 May 2020. Note that DOH has not released data for total and daily individuals tested since 15 May 2020. Moreover, note that more details on testing are provided in the succeeding portions of this situationer.

• The total number of individuals tested increased from 38,103 on 13 April 2020 to 166,389 on 11 May 2020. For the period 04-11 May 2020, total number of individuals tested rose by 47,065 or 39.29%. Confirmed cases, on the other hand, went up to 11,086 from 9,485 for the same period, or by 16.88%.

• The share of cumulative confirmed cases to total individuals tested has been declining from 12.94% on 13 April 2020 to 6.64% on 11 May 2020. This implies that the two are not moving proportionately, with the number of individuals tested rising faster than the number of confirmed cases. Note, however, that the testing protocol (i.e., DOH Department Order No. 2020-0180) in the Philippines remains rather limited to symptomatic persons and may not account for the large number of asymptomatic COVID-19 cases.

Table 3. Cumulative Individuals Tested, Confirmed Cases, Deaths Recoveries, Growth Rates, and Shares (13 April to 11 May 2020)

Cumulative Values 13-Apr 20-Apr 27-Apr 4-May 11-May

Individuals Tested 38,103 58,072 85,596 119,774 166,839

Confirmed Cases 4,932 6,459 7,777 9,485 11,086

Deaths 315 428 511 623 726

Recoveries 242 613 932 1,315 1,999

Growth Rate (%)

Individuals Tested 52.41 47.40 39.93 39.29

Confirmed Cases 30.96 20.41 21.96 16.88

Deaths 35.87 19.39 21.92 16.53

Recoveries 153.31 52.04 41.09 52.02

Shares (%)

Confirmed Cases-to-Individuals Tested

12.94 11.12 9.09 7.92 6.64

Deaths-to-Confirmed Cases 6.39 6.63 6.57 6.57 6.55

Recoveries-to-Confirmed Cases 4.91 9.49 11.98 13.86 18.03 Source: Department of Health

• The share of cumulative deaths to total confirmed cases hovered around 6.5%. Meanwhile, the share of cumulative recoveries to total confirmed cases has been on an uptrend, from 4.91% on 13 April 2020 to 18.03% on 11 May 2020.

Average New Daily Confirmed Cases, Deaths, and Recoveries

• Based on their weekly averages, new daily confirmed cases and new daily recoveries of 233 and 104, respectively, for the period 12-18 May 2020 were higher compared to the 229 and 98 figures reported during 05-11 May 2020. The latest figures are 1.9% and 6.7% higher, respectively, compared with the figures for the preceding period.

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Figure 2. Weekly Average of New Daily Figures (31 March to 18 May 2020)

Source: Department of Health

• Average new daily deaths for the period 12-18 May 2020 remains at 15, similar to the number reported for the preceding period.

• There is an upward trend in the average new daily recoveries when considering the period 21 April-18 May 2020. Meanwhile, weekly averages for new daily confirmed cases and new daily deaths fluctuated.

Regional Statistics

• As of 18 May 2020, NCR remained to have the highest number of confirmed COVID-19 cases at 8,245 or 64.8% of total. Central Visayas and CALABARZON followed at 1,764 (13.9%) and 1,407 (11.1%), respectively. Note that Central Visayas had the second highest number of cases since last week.

• Sixty one repatriated Filipinos were confirmed to have COVID-19. The number represents 0.5% of all confirmed cases.

• Higher confirmed COVID-19 cases in regions do not necessarily translate to higher prevalence of the disease in these areas, partly because of differences in testing capacity (see succeeding section for information on testing) and the presence of asymptomatic cases.

Table 4. COVID-19 Cases by Region (as of 18 May 2020)

Particulars

Recorded Share to Total (%)

Confirmed Active Cases

Deaths Recoveries Confirmed Active Cases

Deaths Recoveries

PHILIPPINES* 12,718 9,158 831 2,729 100 100 100 100

NCR 8,245 5,699 608 1,938 64.8 62.2 73.2 71.0

CAR 46 8 1 37 0.4 0.1 0.1 1.4

I-ILOCOS 64 24 12 28 0.5 0.3 1.4 1.0

II-CAGAYAN VALLEY 34 4 1 29 0.3 0.0 0.1 1.1

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III-CENTRAL LUZON 430 271 29 130 3.4 3.0 3.5 4.8

IV-A-CALABARZON 1,407 1,029 96 282 11.1 11.2 11.6 10.3

IV-B-MIMAROPA 36 13 4 19 0.3 0.1 0.5 0.7

V-BICOL 73 63 4 6 0.6 0.7 0.5 0.2

VI-WESTERN VISAYAS 106 34 10 62 0.8 0.4 1.2 2.3

VII-CENTRAL VISAYAS 1,764 1,682 28 54 13.9 18.4 3.4 2.0

VIII-EASTERN VISAYAS 27 23 - 4 0.2 0.3 - 0.1

IX-ZAMBOANGA PENINSULA

146 137 2 7 1.1 1.5 0.2 0.3

X-NORTHERN MINDANAO

21 8 6 7 0.2 0.1 0.7 0.3

XI-DAVAO 199 73 25 101 1.6 0.8 3.0 3.7

XII-SOCCSKSARGEN 17 2 1 14 0.1 0.0 0.1 0.5

XIII-CARAGA 3 1 - 2 0.0 0.0 - 0.1

BARMM 11 - 4 7 0.1 - 0.5 0.3

Repatriates** 61 59 - 2 0.5 0.6 - 0.1

*28 cases are “for validation” and are not reflected in the regional breakdown **figures for repatriated Filipinos or those from abroad are reported separately Source: Department of Health

• About 62.2% (5,699 of 9,158) of all active COVID-19 cases (i.e., persons with an ongoing infection who are under quarantine and/or treatment) are in NCR. Moreover, 18.4% (1,682 individuals) and 11.2% (1,029 individuals) are in Central Visayas and CALABARZON, respectively. The three regions account for 91.8% of all active cases in the country.

• Around 73.2% of all COVID-19 deaths (608 of 831) occurred in NCR. Meanwhile, 71.0% (1,938 of 2,729) of all recoveries were recorded in the region.

• CALABARZON recorded higher shares of deaths and recoveries to total compared with Central Visayas, given that CALABARZON accounted for around 11.6% (96 of 831) and 10.3% (282 of 2,729) of all deaths and recoveries, respectively, while Central Visayas accounted for 3.4% (28 individuals) and 11.6% (96 individuals).

Dedicated Beds and Ventilators

• As of 18 May 2020, figures for COVID-19-dedicated facilities are the following: 1,303 intensive care unit (ICU) beds, 9,468 isolation beds, 2,686 ward beds, and 1,963 mechanical ventilators in the country. Note that the figures are based on reports of 99% of all health facilities.

• NCR leads the regions in terms of COVID-19-dedicated beds and mechanical ventilators, having 37.3% (486 of 1,303) ICU beds, 23.8% (2,251 of 9,468) isolation beds, 33.4% (897 of 2,686) ward beds, and 41.1% (807 of 1,963) ventilators. CALABARZON follows with 9.9% of ICU beds, 11.2% of isolation beds, 13.5% of ward beds, and 12.9% of mechanical ventilators. BARMM has the least share among the regions in terms of COVID-19 facilities, with 0.2% of ICU beds, 1.7% of isolation beds, 1.1% of ward beds, and 0.4% of ventilators.

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Table 5. COVID-19-dedicated Beds* (as of 18 May 2020)

Region

Actual Figures Utilization Rate (%)

ICU Beds

Isolation Beds

Ward Beds

Mech. Ventilator

ICU Beds Isolation

Beds Ward Beds

Mech. Ventilator

PHILIPPINES 1,303 9,468 2,686 1,963 35.5 37.7 34.8 19.4

NCR 486 2,251 897 807 43.0 63.7 64.7 26.8

CAR 38 494 58 28 15.8 12.3 6.9 14.3

I-ILOCOS 84 413 161 75 34.5 28.3 16.8 13.3

II-CAGAYAN VALLEY

58 343 73 34 50.0 15.2 2.7 23.5

III-CENTRAL LUZON

117 958 127 182 51.3 54.9 33.1 18.7

IV-A-CALABARZON

129 1,058 363 253 53.5 46.5 38.8 23.7

IV-B-MIMAROPA 31 293 107 46 3.2 21.5 1.9 6.5

V-BICOL 45 253 93 26 2.2 11.1 20.4 -

VI-WESTERN VISAYAS

53 527 96 84 - 14.8 6.3 2.4

VII-CENTRAL VISAYAS

60 704 175 98 36.7 38.9 34.3 17.3

VIII-EASTERN VISAYAS

16 316 60 23 - 18.4 13.3 4.3

IX-ZAMBOANGA PENINSULA

30 351 50 29 16.7 28.8 12.0 6.9

X-NORTHERN MINDANAO

42 329 60 53 21.4 14.6 - 17.0

XI-DAVAO 44 256 65 50 31.8 27.0 23.1 14.0

XII-SOCCSKSARGEN

22 300 109 36 - 16.7 4.6 2.8

XIII-CARAGA 13 171 31 93 38.5 11.1 3.2 1.1

BARMM 3 160 30 7 - 13.8 - -

*Based on the report of 99% (1,906 out of 1,917) health facilities in the country; 32 ICU beds, 291 isolation beds, 131 ward beds, and 39 mechanical ventilators were reported as “for validation” and were not included in the regional figures Source: Department of Health

• As presented in Table 5, little over a third of all COVID-19-dedicated ICU, isolation, and ward beds are being utilized as of 18 May 2020. Isolation beds have the highest utilization rate at 37.7%, followed by ICU beds (35.5%) and ward beds (34.8%). Moreover, 19.4% of all COVID-19-dedicated ventilators are being utilized.

• While NCR has the highest number of beds and ventilators for COVID-19 patient treatment, it also has the highest utilization rates for isolation and ward beds, and mechanical ventilators. More than half of the region’s isolation beds (63.7%) and ward beds (64.7%) are currently in use. Moreover, 26.8% of its mechanical ventilators are being utilized. Meanwhile, its ICU utilization rate of 43.0% ranks fourth among regions. Note that NCR utilization rates for all types of beds and ventilators are higher than the national average.

• The three regions with the highest ICU bed utilization rates are CALABARZON (53.5%), Central Luzon (51.3%), and Cagayan Valley (50.0%). In addition, two of these regions – Central Luzon and CALABARZON – posted higher isolation bed utilization rates of 54.9% and 46.5%, respectively.

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• In terms of ward bed utilization rate, three regions recorded use of at least a third of their capacities. These are CALABARZON (38.8%), Central Visayas (34.3%), and Central Luzon (33.1%). As for mechanical ventilator use, two regions posted utilization rates of almost a fourth of total regional capacity: CALABARZON (23.7%) and Cagayan Valley (23.5%).

Table 6. Ratios of COVID-19-dedicated Beds and Ventilators per 10,000 Population* (as of 18 May 2020)

Region

Ratio per 10,000 population

ICU Beds Isolation

Beds Ward Beds

Mech. Ventilators

PHILIPPINES 0.12 0.88 0.25 0.18

NCR 0.35 1.64 0.65 0.59

CAR 0.21 2.74 0.32 0.16

I-ILOCOS 0.16 0.79 0.31 0.14

II-CAGAYAN VALLEY 0.16 0.94 0.20 0.09

III-CENTRAL LUZON 0.10 0.78 0.10 0.15

IV-A-CALABARZON 0.08 0.67 0.23 0.16

IV-B-MIMAROPA 0.10 0.93 0.34 0.15

V-BICOL 0.07 0.41 0.15 0.04

VI-WESTERN VISAYAS 0.07 0.67 0.12 0.11

VII-CENTRAL VISAYAS 0.08 0.89 0.22 0.12

VIII-EASTERN VISAYAS 0.03 0.67 0.13 0.05

IX-ZAMBOANGA PENINSULA 0.08 0.93 0.13 0.08

X-NORTHERN MINDANAO 0.08 0.66 0.12 0.11

XI-DAVAO 0.08 0.49 0.12 0.10

XII-SOCCSKSARGEN 0.05 0.61 0.22 0.07

XIII-CARAGA 0.05 0.62 0.11 0.34

BARMM 0.01 0.39 0.07 0.02

*Based on the report of 99% (1,906 out of 1,917) health facilities in the country; 32 ICU beds, 291 isolation beds, 131 ward beds, and 39 mechanical ventilators were reported as “for validation” and were not included in the regional figures Source: Department of Health

• Bed and mechanical ventilator ratios per 10,000 population are presented in Table 6 to assess the relative capacity of regions to accommodate COVID-19 patients. The ratios indicate the number of dedicated facilities for every 10,000 people living in each region. The national ratios, as of 18 May 2020 and with 99% of all health facilities reporting, are 0.12 (ICU beds), 0.88 (isolation beds), 0.25 (ward beds), and 0.18 (mechanical ventilators). Note that there is a wide variation in bed and ventilator capacities across regions, with those in red indicating figures that are lower than the national ratio.

• For ICU beds, NCR (0.35), CAR (0.21), Ilocos (0.16), and Cagayan Valley (0.16) all have ratios that are above the national average, with NCR recording almost thrice the national value. Meanwhile the remaining 13 regions have ratios that are below the national figure. The ratios form a wide range of values, from BARMM’s 0.01 ratio (6.01% of the national figure) to Central Luzon’s and MIMAROPA’s 0.10 ratio (79.4% of the national figure).

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• In terms of isolation beds, NCR (1.64), CAR (2.74), Cagayan Valley (0.94), MIMAROPA (0.93), Central Visayas (0.89), and Zamboanga Peninsula (0.93) have ratios above the national figure. On the other hand, 10 regions have ratios below the national figure, with BARMM’s 0.39 (44.1% of the national figure) being the lowest and Ilocos’ 0.79 (89.8% of the national figure) being the highest.

• Only NCR (0.59) and CARAGA (0.34) posted mechanical ventilator per 10,000 population ratios that are above the national figure. Note that NCR’s ratio is more than thrice the national value.

Quarantine Facilities

• Table 7 presents a summary of evacuation centers which were converted into quarantine centers by the DPWH and other agencies. Note that the numbers in Table 7 do not include those for NCR and BARMM, and may not reflect quarantine facilities managed by local governments.

• A total of 52 evacuation centers around the country (excluding NCR and BARMM) are being used as quarantine centers, with a capacity of 1,913 individuals (per 18 May 2020 President’s Report). One quarantine center was added (i.e., Zamboanga Peninsula) from last week’s list, increasing total capacity by 30 persons (i.e., last week’s reported total capacity was 1,883).

Table 7. Evacuation Centers Being Used as

Health or Quarantine Facilities*

Region No. of Centers Estimated

Capacity (No. of Persons)

Share to Total (%)

Quarantine Beds per 10,000

population

CAR 1 65 3.4 0.36

I-ILOCOS 10 223 11.7 0.42

II-CAGAYAN VALLEY 2 70 3.7 0.19

III-CENTRAL LUZON 2 67 3.5 0.05

IV-A-CALABARZON 3 122 6.4 0.08

IV-B-MIMAROPA 2 200 10.5 0.63

V-BICOL 2 64 3.3 0.10

VI-WESTERN VISAYAS 6 280 14.6 0.36

VII-CENTRAL VISAYAS 8 280 14.6 0.35

VIII-EASTERN VISAYAS 3 92 4.8 0.20

IX-ZAMBOANGA PENINSULA 4 120 6.3 0.32

X-NORTHERN MINDANAO 1 65 3.4 0.13

XI-DAVAO 3 85 4.4 0.16

XII-SOCCSKSARGEN 2 60 3.1 0.12

XIII-CARAGA 3 120 6.3 0.44

TOTAL 52 1,913 100 0.21

*per President’s Report dated 18 May 2020 Note: red marks indicate values below the national ratio (excluding NCR, and BARMM)

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• Western Visayas and Central Visayas continue to lead the regions in terms of quarantine capacity at 280 persons each (14.6% share to total for each region). Ilocos follows at 223 (11.7%). Meanwhile, SOCCSKSARGEN (60 persons or 3.1% of total) and Bicol (64 persons or 3.3% of total) have the lowest capacities.

• Ratios per 10,000 population are presented to take regional population into account. MIMAROPA (0.63), CARAGA (0.44), and Ilocos (0.42) post the highest figures while Central Luzon (0.05), CALABARZON (0.08), and Bicol (0.10) have the lowest figures.

Personnel Protective Equipment

• The following refer to available personnel protective equipment (PPE) as reported by 95% of all facilities (1,827 of 1,917) through the DOH DataCollect app (as of 18 May 2020):

o Coverall: 665,168

o Face shield: 604,323

o Goggles: 404,901

o Gown: 539,831

o N95 mask: 1,002,446

o Shoe cover: 1,052,318

o Head Covers: 4,670,003

o Surgical mask: 10,477,158

Testing

• As of 17 May 2020, a total of 244,800 tests7 have been conducted. This is 33.9% higher compared to the 181,668 figure8 recorded on 11 May 2020, and is equivalent to 0.2% of the total national population. Unlike in previous monitoring reports, the figure presented are for total tests conducted (i.e., includes re-testing of individuals for diagnostic or medical clearance purposes) instead of total individuals tested due to non-availability of data on individuals tested (i.e., daily and cumulative) since 15 May 2020. Per DOH Advisory dated 17 May 2020, some testing data are under review9.

• The total number of accredited testing facilities stand at 30, with five new laboratories added to the 25 facilities listed on 11 May 2020. The following are the five new COVID-19 testing facilities: Allegiant Regional Care Hospital in Central Visayas, Asian Hospital and Medical Center in NCR, De La Salle Medical and Health Sciences Institute in CALABARZON, Eastern Visayas Regional COVID Testing Center, and Jose B. Lingad Memorial Regional Hospital in Central Luzon.

• Based on the average daily tests conducted (12-17 May 2020) that are presented in Table 8, NCR laboratories accounted for 84.9% of all tests, while Central Visayas and CALABARZON testing centers accounted for 2.9% and 1.1% of all tests, respectively. The three accounted for 88.9% of average daily tests for the period concerned.

7 DOH. (2020). Beat COVID-19 Situationer No. 21. DOH [online]. 18 May 2020 [viewed on 19 May 2020]. Available at: https://drive.google.com/drive/folders/1YWLkmsKjVYT9DjWfIGQx3E_iBPYznjf2 8 DOH. (2020). Beat COVID-19 Situationer No. 15. DOH [online]. 12 May 2020 [viewed on 19 May 2020]. Available at: https://drive.google.com/drive/folders/1YWLkmsKjVYT9DjWfIGQx3E_iBPYznjf2 9 DOH. (2020). Technical Notes on COVID-19 Data. DOH [online]. 17 May 2020 [viewed on 17 May 2020]. Available at: https://drive.google.com/drive/folders/10VkiUA8x7TS2jkibhSZK1gmWxFM-EoZP

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• Note that because estimated capacity of almost half (13 of 30) of all accredited laboratories have yet to be determined, this report uses average daily tests conducted instead of the estimated testing capacity used in past monitoring reports. Caution is advised when interpreting average daily tests conducted since the daily figures per laboratory fluctuate, depending on number of specimen received and processed. The figures in Table 8 are only indicative of the capacity of laboratories per region.

Table 8. Average Daily Tests Conducted by Region*

(12 to 17 May 2020)

Region No. of

Laboratories

Average Daily Tests Conducted

Share to total (%)

Ratio per 10,000

Population**

NCR 19 8,559 84.9 6.20

CAR 1 420 4.2 2.33

III-CENTRAL LUZON 1 123 1.2 0.10

IVA-CALABARZON 1 114 1.1 0.07

V-BICOL 1 51 0.5 0.08

VI-WESTERN VISAYAS 1 226 2.2 0.29

VII-CENTRAL VISAYAS 3 288 2.9 0.36

VIII-EASTERN VISAYAS

1 56 0.6 0.12

IX-ZAMBOANGA PENINSULA

1 79 0.8 0.21

XI-DAVAO 1 163 1.6 0.31

TOTAL 30 ***10,078 100 1.26

*Average of daily tests conducted for laboratories in each region for the given period ** Figures in red indicate figures that are below the ratio for combined regions ***Sum of average daily tests conducted; this is different from the national average of daily tests conducted Source: Department of Health

• Expressing average daily tests conducted as a ratio per 10,000 population accounts for differences in number of people living in each region. Note that interpreting the ratios in Table 8 should be done with caution given the non-exclusivity of testing laboratories to residents of the regions in which these are located. For instance, specimen of residents in Central Luzon and CALABARZON can be sent to NCR facilities for COVID-19 testing. In addition, populations of adjacent regions were not considered in the computations (e.g., populations of Northern Mindanao and SOCCKSKSARGEN not included in computing the ratio for Davao). Also as pointed out earlier, the figure presented are for the number of tests conducted (i.e., includes re-testing of individuals for diagnostic or medical clearance purposes) instead of the number of individuals tested.

• NCR leads the regions in terms of the ratio per 10,000 population, after posting a 6.20 figure, which is almost five times the ratio for the combined regions (1.26). CAR, with a 2.33 ratio, is the only other region to have a ratio above 1.26. Meanwhile, four regions posted ratios that are less than 10% of the 1.26 ratio for the combined regions – CALABARZON (0.07 or 5.63%), Bicol (0.08 or 6.54%), Central Luzon (0.10 or 7.89%), and Eastern Visayas (0.21 or 9.27%).

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• As shown in Figure 3, the average number of daily tests conducted for the period 12 to 17 May 2020 went up to 9,124 from the 6,990 figure during the preceding period (05 to 11 May 2020). This is equivalent to a 30.5% increase, which is slightly lower than the 44.6% increase recorded for the previous period.

Figure 3. Average Daily Tests Conducted

(08 April to 17 May 2020)

Source: Department of Health

• Compared with the pre-expanded testing period (08-13 April 2020), average daily tests conducted increased by 7,094 tests, from 2,030 to 9,124. This is equivalent to a 349.5% improvement.

Issues and Problems

A. General Policies for the population (GP)

A.1. Prevent and suppress transmission and spread of COVID-19

• Achieving the 30,000 target for the number of daily tests by the end of May is a significant challenge, considering that the latest figure for average daily tests conducted (12-17 May 2020) is at 9,124 or merely 30.4% of the target. Less than two weeks before the end of the month, the country needs to boost its daily capacity by about 20,000 tests. Given the pace of weekly increases (i.e., the highest weekly incremental increase in average daily tests is only around 2,000 or a tenth of the needed 20,000 additional daily tests), the country is on an uphill climb in meeting the target. Note that a higher testing capacity is crucial as the country gradually eases mobility and re-opens its economy. More people will return to work, venture outside of their homes, and take public transport. All these pose higher risks of COVID-19 transmission, and a relatively low testing capacity can easily overwhelm laboratories and result in massive backlogs. This can lead to a domino effect, with more people who are waiting for test results being housed in quarantine facilities or asked to undergo home quarantine.

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• Regional or geographic disparities in COVID-19 testing capacity can hinder the ability of certain parts of the country to promptly identify people with COVID-19, and distinguish individuals who need to be isolated and treated from those who do not need to be quarantined. Based on Table 8, NCR testing centers account for about 84.9% of average daily tests conducted. The remaining 15.1% is shared by centers from all other regions. NCR also has a testing per 10,000 population ratio of 6.20 or about five times the ratio for the combined regions (1.26). Meanwhile four regions have figures that are below 10% of the ratio for the combined regions, and two others have ratios below 25%. Seven regions do not have any accredited laboratory. Note that per DOH Administrative Order No. 2020-0016 on Minimum Health System Capacity Standards, each region should endeavor to have at least one biosafety laboratory 2 with RT-PCR testing capacity for COVID-19.

• None of the regions meet the 1 ICU bed per 25,000 population (i.e., 0.4 per 10,000 population) peak-day critical care capacity ratio, prescribed under DOH AO 2020-0116. In addition, only NCR meets the 1 mechanical ventilator per 25,000 population (i.e., 0.4 per 10,000 population) prescribed ratio. Meeting these minimum health system standards on bed and ventilator capacities ensure that local health systems will not be overwhelmed in the event that COVID-19 cases spike.

• The relatively high utilization rates of COVID-19-dedicated beds and mechanical ventilators in some regions, as presented in Table 5, pose a threat to the ability of local health systems to accommodate additional COVID-19 cases. For instance, while NCR has the highest number of COVID-19-dedicated beds, it also has the highest utilization rates with more than half of isolation and ward beds currently in-use. Moreover, its utilization rates for all types of beds and for mechanical ventilators are above the national averages. Note that there are other regions (i.e., Cagayan Valley, Central Luzon, CALABARZON) whose ICU bed utilization rates are above the national average and above half of their capacities.

• Compared with its neighbors, the Philippines has a higher COVID-19 death per 1 million population ratio at 7.46 (as of 17 May 2020). Indonesia, Malaysia, and Thailand posted 3.98, 3.49, and 0.80, respectively. On the other hand, its developed country neighbors – Japan, Singapore, and South Korea – recorded 5.88, 3.76, and 5.11, respectively.

• There is inadequate information on the overall state of the country’s contact tracing system. While the pilot and use of online and smartphone applications (e.g., TanodCOVID and StaySafe.ph), as well as the deployment of epidemiology and surveillance officers, have been reported, there is insufficient information to get a full grasp of the country’s and the regions’ readiness insofar as contact tracing is concerned. Tracing and disease surveillance are integral in monitoring the spread of COVID-19 among LGUs and in preventing a surge in cases.

• Only a relatively small number of LGUs are prepared to use the FASSSTER disease surveillance tool. The relatively small number can impair the ability of LGUs to monitor the situation, especially with the easing of mobility in many areas. Per the President’s 11 May 2020 report, only 35 provinces (43.2% of all provinces) and 24 municipalities and cities (1.5% of all municipalities and cities) were either using FASSSTER or undergoing training for its use.

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• The release of timely and relevant testing data has been stalled by the need for DOH to review information being submitted by testing laboratories. This has led to information gaps in monitoring the country’s testing capacity.

• Public transport poses heightened risk of disease transmission. Over two million commuters will swarm public transportation facilities in NCR once the enhanced community quarantine is lifted. Of the estimated 3.5 million, 70% or more than two million will be commuting while the rest will be using private cars and bikes10.

• Tens of thousands of people fled to cramped shelters as Typhoon Ambo slammed the Philippines last week, raising fears that without proper safety precautions in place, evacuation centers could become a hotbed of coronavirus infection11.

• A surge of people in malls and commercial centers was observed with the shift to modified enhanced community quarantine for NCR12. This poses a serious threat of a sudden increase in COVID-19 cases in the region. Earlier, the WHO warned that there is no guarantee that easing restrictions would not trigger a wave of infections13.

• Accessibility of reproductive health services has been severely limited by community quarantine since individuals, especially women, cannot visit clinics and facilities continue to be understaffed14. While relevant agencies resorted to door-to-door delivery of reproductive health products and made hotlines available, community quarantine makes it difficult for health workers to reach every individual in need of services.

• Free hotlines providing telemedicine and psychosocial support during community quarantine are only available to NCR residents. Residents of other regions may find difficulties in accessing these health services.

A.2. Testing, Isolation, and Treatment

• The widespread use of rapid antibody test kits, especially among companies resuming operations, can result in public misinformation on the purpose and implications of rapid test results if public messaging is not well managed. Note that per DOH protocols, rapid antibody tests can be used as a complementary tool, provided that confirmatory PCR testing be conducted to determine whether or not a person has COVID-19. In addition, rapid antibody test kits have varying levels of accuracy, and the RITM has yet to release results of the evaluations conducted on FDA-approved rapid kits. It should be noted that the WHO does not recommend the use of rapid kits for clinical decision-making and that PCR-based testing remains as the gold-standard for diagnosis.

10Cayabyab, M.J. (2020). 2 Million Commuters to Swarm Public Transport After ECQ. Philstar [online]. 12 May 2020 [viewed on 18 May 2020]. Available at: https://www.philstar.com/nation/2020/05/12/2013336/2-million-commuters-swarm-public-transport-after-ecq 11 UN News. (2020). Philippines typhoon recovery, complicated by coronavirus concerns. UN [online]. 15 May 2020 [viewed on 18 May 2020]. Available at: https://news.un.org/en/story/2020/05/1064202 12 CNN Philippines. (2020). Another total lockdown may be needed if COVID-19 cases surge – DOH. CNN Philippines [online]. 17 May 2020 [viewed on 18 May 2020]. Available at: https://www.cnn.ph/news/2020/5/17/doh-vergeire-coronavirus-cases-surge-new-lockdown.html 13 Millard, R. (2020). WHO: Coronavirus may never go away. Philstar [online]. 14 May 2020 [viewed on 18 May 2020]. Available at: https://www.philstar.com/lifestyle/health-and-family/2020/05/14/2013956/who-coronavirus-may-never-go-away 14 DW. (2020). Philippines: How women pay the price of pandemic-induced healthcare shortages. DW [online].

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• OFWs who escaped from quarantine facilities risk spreading COVID-19 to their families and the community.

• The growing number of COVID-19 patients continues to be an issue insofar as Philhealth fund sustainability is concerned. The COVID-19 reserve fund can easily be depleted without monitoring and augmentation. Note that other than for patient treatment, Philhealth also pays for facility-based quarantine.

B. Human Resources for Health (HRH)

B.1. Special risk allowance for HRH

-

B.2. Philhealth mandate to cover healthcare and work-related injury expenditures of

public and private health workers

-

B.3. Financial support to public and private health care workers and their families

-

B.4. Ancillary services

-

B.5. Temporary HRH to complement to supplement the health workforce

-

B.6. Others (HRH-related but do not directly fall under B.1. to B.5.)

• Infection rate among HRH remains high at 18% all confirmed cases in the country (as of 14 May 2020)15. In Quezon City alone, 390 healthcare workers have been infected with COVID-19, as of 11 May 2020. This accounts for 24.7% of the City’s 1,578 COVID-19 cases. Data reveals that many of the City’s recorded cases can be directly traced to health workers’ family and household members16. Moreover, the moderate to severe shortage of supplies, particularly of N95 masks, was cited as a possible reason for HRH COVID-19 infections by respondents of a survey conducted by the Alliance of Concerned Teachers and Alliance of Health Workers17.

• More contact tracers are needed to help in identifying and isolating COVID-19 cases. According to DOH, there must be at least one contact tracer for 800 persons in a community. This requirement is included in AO 2020-0016 or the Minimum Health System Standards for COVID-19 Preparedness and Response Strategies issued on 04 May 202018.

15 GMA Network Online. 14 May 2020. Health workers with COVID-19 now 2,165; no new death recorded. [viewed on 16 May 2020} Available from https://www.gmanetwork.com/news/news/nation/738259/health-workers-with-covid-19-now-2-165-no-new-death-recorded/story/ 16 PIA, 14 May 2020 (Online). Belmonte appeals to hospital administration to ensure safety of healthcare workers. [viewed on 16 May 2020]. Avilable from https://pia.gov.ph/news/articles/1041838 17 Magsaysay, B. (2020). Why is infection rate of healthcare workers in PH high? Survey shows answers. ABS-CBN News [online]. 13 May 2020 [viewed on 14 May 2020]. Available at: https://news.abs-cbn.com/spotlight/05/13/20/why-is-infection-rate-of-healthcare-workers-in-ph-high-survey-shows-answers 18 B. Magsumbol. Rappler Online. 14 May 2020. Duque: To stem infections, at least 1 contact tracer needed per 800 people. [viewed on 16 May 2020]. Available from https://www.rappler.com/nation/260871-duque-response-contract-tracer-needed-per-800-people

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C. Facilities, Equipment, and Supplies (FES)

C.1. Direct operations of privately-owned hospitals, health facilities, and transportation

-

C.2. Expeditious processing and distribution of donated health products

-

C.3. Expeditious procurement

-

C.4. Liberalize incentives for manufacture or importation of needed equipment and supplies

-

C.5. Others (FES-related but do not directly fall under C.1. to C.4.)

• There are information gaps on PPEs insofar as the country’s and regions’ buffer needs are concerned. Note that AO 2020-0016 prescribes at least 30 days buffer supply of PPEs for all health facilities.

• Inadequate information on quarantine beds per region or geographic area (i.e., including LGU-managed facilities and isolation centers) limits a thorough understanding of the readiness of LGUs in accommodating new, suspected, and probable COVID-19 cases.

Recommendations

A. General Policies for the population (GP)

• Substantially improve the country’s overall testing capacity to meet the 30,000 targeted daily tests by the end of the month; consider factors such as availability (i.e., easily-produced in the market) and speed of processing specimen in the type of kits to use; understand if there are laboratories which are sub-optimally used and if there are also those which are overburdened, and come up with a comprehensive plan on how laboratories forming a network (e.g., those belonging to the same geographic area) can complement one another to maximize testing capacity (A.1.)

• Fast-track the accreditation of the 109 laboratories whose applications are currently pending; explore bottlenecks in the accreditation process (e.g., DOH manpower involved in processing papers, conducting inspections, trainings) and study ways to assist facilities, both public and private, in expediting compliance with requirements; provide subsidy, if possible, to help these laboratories meet physical infrastructure and equipment requirements, especially in regions or areas with relatively low testing capacities (A.1.)

• Address regional disparities in COVID-19-dedicated beds and mechanical ventilators; ensure that regional targets of 1 ICU bed and 1 ventilator per 25,000 population (i.e., 0.4 per 10,000 population) are met; consider not only the total number of beds and ventilators prescribed per region but also the strategic distribution of these facilities across LGUs or clusters of LGUs to ensure accessibility; regularly assess the trend in occupancy or the utilization rates of beds and ventilators, and consider this in regional and local planning (A.1.)

• Study the reasons for the relatively higher COVID-19 death rate in the Philippines compared with its neighbors, open findings to the public, and use the information to develop appropriate policy response (A.1.)

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• Consider presenting holistic information on the government’s contact tracing efforts in the DOH dashboard, including readiness of LGUs in terms of presence of epidemiology or surveillance officers, number of contact tracers relative to population, share of population using contact tracing applications, and awareness and understanding of the public about contact tracing initiatives (A.1.)

• Promote readiness of LGUs in using the FASSSTER disease surveillance tool by conducting trainings to more LGUs; spearhead surveys to understand LGUs’ awareness and proficiency in managing disease surveillance (A.1.)

• Facilitate the release of timely, accurate, and relevant testing data, as well as other useful information on COVID-19, in the DOH dashboard to promote transparency and accountability (A.1.)

• Ensure observance of safety measures in shared spaces, especially public transportation, since these spaces can facilitate COVID-19 spread; consider the capacity of public transport vis-à-vis population availing of transport services, given limited operations during general community quarantine and the need to observe minimum health standards; amid the re-opening of the economy and resumption of work in many places, seriously consider alternative working arrangements (e.g., work-from-home) for jobs that do not require physical presence of employees to minimize the risk of infection (A.1.)

• Strictly monitor the condition of people in evacuation centers due to typhoons and other disasters, and ensure that minimum health standards are followed; assess the preparedness of regions and LGUs in providing temporary shelter to residents in disaster-prone areas, amid the start of the typhoon season; consider the need to observe minimum health standards in local disaster risk reduction and management initiatives (A.1.)

• Regularly review the guidelines on access to malls, commercial centers, and other similar areas to regulate the number of persons, ensure observance of safety measures, and prevent the spread of COVID-19 (A.1.)

• Promote information on how individuals can access reproductive health services and products; expand channels through which information can be made available (e.g., social media, hotlines) and through which individuals can contact relevant government agencies (e.g., DOH, POPCOM, LGU) (A.1.)

• Explore ways to improve accessibility to telemedicine and psychosocial support; expand coverage of free helplines to other regions; promote information on the availability of these helplines through various media (A.1.)

• Monitor the incremental lifting of lockdowns to reduce the risk of new outbreaks. The WHO recommends that the easing of lockdowns be evidence-based and data-driven. Ideally, there should be a minimum of two weeks (corresponding to the incubation period of COVID-19) between each phase of the transition to allow sufficient time to understand the risk of new outbreaks and to respond appropriately19 (A.1.)

• Review security protocols for quarantine facilities to prevent persons under quarantine from escaping facilities and possibly transmitting COVID-19 to their families and the community (A.2.)

19 Deutsche Welle, (2020). Coronavirus: When will the second wave of infections hit? https://www.dw.com/en/coronavirus-when-will-the-second-wave-of-infections-hit/a-53435135

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• Ensure widespread dissemination of information on the purpose of rapid antibody tests and its proper use, especially to companies and employees returning to work; publish results of RITM evaluation of rapid test kit accuracy (A.2.)

• Continue to monitor utilization of the Philhealth COVID-19 reserve fund and anticipate possible sources of funds should augmentation be needed (A.2.)

B. Human Resources for Health (HRH)

• Consider the hiring of COVID-19 contact tracers en masse to boost efforts to stop transmission of COVID-19 and to match increasing need for testing. Those who lost their jobs during the enhanced community quarantine can be prioritized. Note that the tasks of a contact tracer include profiling, data encoding, and assisting callers and inquiries20. (B.5.)

• Make an inventory of HRH’s requirement for temporary housing and ensure that such requirements are provided to help mitigate transmission of the virus to the community or to HRH’s family members and vice versa21. (B.6.)

• Conduct comprehensive study on the reasons for the relatively high infection rate among HRH in the Philippines, including a review of infection control protocols in facilities with the most number of HRH with COVID-19; ensure availability of PPEs; prioritize HRH in testing (B.6.)

C. Facilities, Equipment, and Supplies (FES)

• Consider presenting information on estimated PPE needs of the country and of regions, considering the prescribed 30-day buffer under AO 2020-0016; consider presenting information on PPE stockouts, if any, of facilities (C.5.)

• Collect and present real-time and disaggregated information on all COVID-19 quarantine facilities, including LGU-managed ones; consider including the information in the DOH dashboard (C.5.)

20 CNN Phils. Online (12 May 2020). Finance chief proposes mass hiring of workers displaced by lockdown as COVID-19 contact

tracers. [viewed on 16 May 2020]. Available from https://www.cnnphilippines.com/news/2020/5/12/mass-hiring-of-displaced-

workers-contact-tracers-.html 21 Ibid.