What we know so far: Duterte admin's new plan for curbing COVID-19 infections

After more than a week of a thousand to 2,000 new infections reported daily, President Rodrigo Duterte’s coronavirus task force has come up with what its spokesman Harry Roque dubbed “major changes” to their pandemic response strategy.

In a meeting of the Inter-agency Task Force on Emerging Infectious Diseases (IATF-EID) on Tuesday, July 28, Roque said officials discussed 4 components of the plan:

  • "Massive" targeted testing through pooled testing
  • Ramped up tracing with "army" of volunteers
  • Isolation in government facilities of all mild and asymptomatic coronavirus cases who can't properly self-isolate at home
  • Expansion of COVID-19 bed capacity in hospitals

These efforts have been explained and announced in Roque's recent media interviews and press conferences but the Tuesday IATF meeting pulled these together as part of their recommendation to Duterte on the quarantine classifications for August 1 to 15.

The task force meeting was held a day after Duterte’s 5th State of the Nation Address (SONA) which lacked a concrete plan for curbing the steep rise in coronavirus cases.

The rate of spread is alarming, with the case count ballooning by 11,400 cases in the span of a week (from 72,269 cases on July 22 to 83,673 on July 29).

How the plan works

Pooled testing

The first component is to test more people through “pooled” testing, where the swab samples of 10 to 20 people can be processed using a single test kit. Roque introduced this concept in a July 20 press briefing.

Aside from more efficiently processing reverse-transcription polymerase chain reaction (RT-PCR) test results, Roque said pooled testing will make tests a lot more affordable.

If a typical RT-PCR test costs around P3,000, pooled testing can bring down the cost to P300 per person, he claimed.

“P300 because there will be 10 people using one test kit so it’s divided by 10 so it will be P300. So now anyone can afford to have a test,” he said on Wednesday, July 29, in an interview with CNN Philippines.

But imported RT-PCR tests cost from P6,000 to P8,000. It’s the test kits developed by the University of the Philippines National Institutes for Health that cost around P3,000 and they are not yet widely available for commercial use.

Roque, however, said the P3,000 rate applies to testing conducted through Project ARK, a testing initiative launched by Presidential Assistant for Entrepreneurship Joey Concepcion and major companies.

Apart from pooled testing, testing czar Vince Dizon previously said the government would expand testing to cover all frontliners, not just health workers, and more asymptomatic cases. This expansion was made possible by the arrival of 1.05 million test kits last June 21, Dizon also said.

The DOH had just finished with one round of pilot testing the concept. Roque said another pilot test will likely be conducted after the President announces new quarantine classifications for the country before August 1.

Meanwhile, the country's laboratories are now able to process 25,000 to 30,000 tests a day.

Tracing

Contact tracing, another critical component of any COVID-19 response, will be ramped up to cover even the “3rd degree” of contacts of a confirmed case, said Roque.

“We’re not just going to rely on individuals who are paid to become tracers. We’re going to build an army of volunteers courtesy of training materials to be provided by Mayor Magalong so that we can intensify tracing. Hopefully, do as Thailand and Vietnam did, up to the 3rd degree of tracing,” Roque told CNN Philippines’ Pinky Webb.

He was referring to Baguio City Mayor Benjamin Magalong, designated by Duterte as tracing czar because of his use of police investigation and questioning tactics to trace cases in his city.

Third degree contact-tracing is a comprehensive level of tracing which epidemiology experts credited to relatively low infections in countries like Vietnam.

So far, the Philippines has around 52,000 contact tracers, with the government saying it needs to hire 83,000 more

Magalong vowed to "radically change" the country's contact-tracing strategy by training tracers to use a more comprehensive questioning method and utilizing an online system that harnesses data.

Proper isolation of asymptomatic, mild cases

Another part of the new plan is to make sure asymptomatics and mild cases are isolated in government-accredited facilities if they don’t have a house where they can properly self-isolate. Dubbed Oplan Kalinga (Care), the plan requires local government officials to bring asymptomatic or mild cases in their areas of jurisdiction to isolation centers if found that their homes don’t allow for proper self-isolation.

This new initiative is a late fix to a problem – the lack of clarity and enforcement on rules for poor asymptomatic and mild patients who live in small houses with many people. In the early months of the pandemic, these types of patients were allowed to go home with no authorities checking if they have their own room and bathroom that will enable them to limit their exposure to other members of their household.

Roque admitted there was a lapse in communicating the rules, particularly on the part of DOH.

“I think the DOH wasn’t clear when they said the asymptomatics and mild can stay home, you must have your own room and bathroom. I think that’s one of the reasons why our number of cases rose,” said Roque last July 23 in Filipino.

Dizon said the government has had to look for 2,000 more rooms for this, mostly from budget hotels. Local governments have also built their own isolation centers. Isolation czar and Public Works Secretary Mark Villar is ready to build more isolation centers should the need arise, said Roque.

Adding COVID-19 beds

With infections rising, especially in Metro Manila, a last aspect of the government’s efforts is to increase the capacity of hospitals to take in COVID-19 patients.

In Metro Manila, COVID-19 bed capacity is nearing the danger zone, with 69% of ICU beds occupied and over 80% of isolation and ward beds occupied.

But Roque told Filipinos not to worry because the high occupancy rate can be remedied by asking hospitals to increase the percentage of their beds dedicated to COVID-19. Currently, he said, hospitals have just been asked to set aside 30% of their beds.

If needed, the task force will require public hospitals to expand their coronavirus-dedicated beds to 50% of their capacity and will ask all private hospitals to abide by the 30% allotment. 

For better coordination between the task force and the Metro Manila healthcare system, treatment czar Leopoldo Vega created a “One Hospital Command Center” at the Metropolitan Manila Development Authority headquarters, said Roque.

The center allows Vega to see where beds are lacking in the megacity and tap available beds in another hospital to fill in the gap.

“If the hospital beds and ICU beds in Manila are at critical level, we will tap even the bed capacity of neighboring Region III and Region IV-A to refer patients to these vacant ICU or hospital beds,” said Roque.

Complications due to return of stranded thousands

But what is proving to be a headache for the national government is how to manage the return of locally-stranded individuals (LSIs) – Filipinos who are returning to their home provinces because travel restrictions have gradually eased.

Several towns in Leyte and the Bangsamoro Autonomous Region in Muslim Mindanao have reported that their first COVID-19 cases came from people who had just returned from Metro Manila.

The problem is, how do authorities ensure these stranded persons return to the provinces without carrying the virus? Last June 25, the task force announced it would require all LSIs to undergo an RT-PCR test. But this was apparently shelved because the 8,400 LSIs sent home last July 25 to 26 were only required to take the less accurate rapid antibody test.

With limited public transportation unable to efficiently move these thousands of people, how does government ensure their proper treatment and isolation as they wait for their ride?

This was the problem that confronted Hatid Tulong officials when thousands of people turned up at the Rizal Memorial Sports Complex, causing violations of the social distancing rule.

Rethinking lockdowns

Despite the rise in cases, most of which come from Metro Manila, the IATF and presidential spokesman said the megacity is doing better than it did. It’s case doubling rate is now at 8.9 from 7, which means it takes longer for COVID-19 cases to double in the megacity.

IATF officials also previously reported some good news for Cebu City, including the lowering of its mortality rate. 

As the President makes his decision on whether to ease or tighten quarantine restrictions in different parts of the country, mayors and business groups have expressed support for “localized lockdowns.” This means that, rather than tighten quarantine rules for an entire city or province, only areas within them, like barangays or roads, will be placed under strict lockdowns for a certain number of days or weeks.

This would allow economic activity to continue in the rest of the city or province and allow local governments to concentrate resources on testing, isolation, and treatment in specific hotspots.

The national task force has placed more responsibility on local governments and private businesses for testing, tracing, and isolating as restrictions ease.

Roque, frequently asked to defend the government’s lackluster pandemic response, pointed to two indicators of “effectiveness” – the 2% mortality rate that is below the world average and that, if not for lockdowns, the country would have had over 3 million infections based on a study by University of the Philippines’ OCTA Research Group. – Rappler.com

Pia Ranada

Pia Ranada covers the Office of the President and Bangsamoro regional issues for Rappler. While helping out with desk duties, she also watches the environment sector and the local government of Quezon City. For tips or story suggestions, you can reach her at pia.ranada@rappler.com.

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