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Address uneven distribution of health workers in PH—PIDS study

March 28, 2020

A STUDY of state think tank Philippine Institute for Development Studies (PIDS) found that Filipino healthcare professionals are more likely to work in areas where earnings are potentially high and near communities where they were trained. According to PIDS Senior Research Fellow Michael Abrigo and former PIDS Research Associate Danica Ortiz, authors of the study “Who Are the Health Workers and Where Are They? Revealed Preferences in Location Decision among Health Care Professionals in the Philippines”, the supply of healthcare workers such as nurses, physicians, and midwives are highly uneven in terms of their geographic distribution in the country.   The authors noted that the composite density of physicians, professional nurses, and professional midwives in the Philippines reached 40.8 per 10,000 population in 2015.   This was above the thresholds recommended by the World Health Organization (WHO) in 2006 and the International Labour Organization (ILO) in 2011. The WHO proposed “a density of 23 skilled health care workers, comprising of physicians, nurses and midwives, per 10,000 population”, while the ILO suggested “a density of 34 physicians, nurses and midwives per 10,000 population”.   Subsequently, WHO updated its threshold to 45 skilled healthcare workers per 10,000 population in 2016 while ILO updated it to 41 per 10,000 population in 2014.   While these international metrics suggest that there is a sufficient supply of healthcare workers in the Philippines, Abrigo and Ortiz argued that this is not the case based on the country’s disaggregated data on health human resource (HHR) density.   “Less than 25 percent of cities and municipalities have HHR density above the 41 physicians, nurses and midwives per 10,000 population recommended by the WHO [in 2016]. This leaves as much as three-quarters of cities and municipalities in the country with potentially insufficient number of HHRs to provide healthcare services,” they explained.   The authors also found that these cadres of healthcare professionals are more likely to work in cities and municipalities that have greater access to amenities like hospitals and clinics. However, they are less likely to work in areas with high levels of ethnic concentration.    The continuing maldistribution of healthcare workers can aggravate the country’s problem on limited access to healthcare services.   To address this issue, the authors highlighted some policy considerations in designing programs that will attract and retain healthcare workers especially in underserved areas.   One is to boost household incomes through local economic development, which is “essential in ensuring the economic viability of any professional practice, particularly in health care”. The role of the private sector should also be strengthened in providing healthcare services to the people. “Supporting private healthcare practices through the country’s social health insurance system or a similar voucher scheme may provide greater incentives for healthcare workers to practice in underserved areas,” the authors said. They also proposed for the reassessment of common- and deep-rooted beliefs on healthcare professional practice. However, they pointed out that “although altruistic motives among healthcare practitioners to serve in rural areas may be important in recruiting HHR for rural practice, it may not necessarily be the most sustainable.”     The authors also suggested using technology as an alternative mode of service delivery, particularly in conducting remote medical consultations and diagnosis, and in record management.   Lastly, they recommended the “certification of some primary healthcare skills that may be done by other cadres of healthcare professionals, instead of relying on the limited supply of physicians.” They cited as an example nurses in the United States, Canada, and the United Kingdom who are certified to assess patients’ needs, interpret diagnostic and laboratory tests, prescribe medication, and formulate treatment plans. This strategy may also be explored in the Philippines, the authors said.

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Nast Health Sciences Division Statement: Scientific Research and Development as drivers to win the race against COVID19

March 27, 2020

The current CoViD19 problem caused by the SARS CoV2 virus has raised and continue to raise issues on how programs and strategies can better control and prevent the escalation of the problem. With the recent declarations of the World Health Organization that COVID 19 is already a global pandemic and the implementation of community quarantine and subsequently extended community quarantine initially involving the National Capital Region and eventually the whole of Luzon, we expect greater urgency for countries to implement programs and strategies to stem and arrest this epidemic.      Almost all of these countries, and the Philippines is no exception, have proposed novel and sometimes radical measures as possible solutions. Almost all of them, however, are not based on scientific studies but largely on expert opinion and what we think worked and did not work during the SARS problem in 2003 and the pandemic influenza global pandemic in 2009.     Being caught in the midst of this ongoing epidemic and the consequent rapid rush of research institutions, both in the private and the public sector to find the magic cure for this disease, whether it be a drug or a vaccine to prevent transmission and infection of the virus, the research community should galvanize and unify efforts to spearhead researches that will address current health issues brought about by the CoViD 19 problem.     Dealing with and confronting this problem will require a whole of government-led approach with involvement and engagement of the private sector and the general public. Networking and collaboration among and within these different groups will be the key.      Researches, in particular, will be critical in the fight against the CoViD 19 recognizing that this is a new disease with a potentially different behavior, progression and effect on the health of individuals, the community and the nation as compared to the other emerging pathogens     We, at the National Academy of Science and Technology, fully support the current research initiatives of the government and the Department of Science and Technology.      In the face of limited resources and paucity of knowledge concerning the virus and the disease it causes, researches are being developed and implemented in collaboration with various research groups both here and abroad to address various aspects of the CoViD19 problem. In the light of all these, we propose that the following researches be done or enhanced to identify and implement the most effective measures to address problem of CoViD 19 in the following areas:     1) In the area of epidemiology, modelling studies , which are mostly mathematical, may help us better understand how the epidemic will evolve.      Input of health data into these disease models, as the epidemic progresses, will be very important to provide government planners scientific projections on how this epidemic will progress. The data generated will be very helpful in forward planning by concerned government agencies to anticipate, prepare and dampen the effects of this epidemic on different aspects of national life, including the economy.     2) In the area of diagnostics, whereas current tests are focused on the detection of the virus in affected patients, tests determining the presence of antibodies mounted by the human hosts should also be developed.      These antibody-based assays will help determine the patients who were truly infected, whether symptomatic or asymptomatic. It may catch the cases missed by the tests for detecting infection as these tests may have been done too early or too late in the disease.      The tests to detect antibodies will determine the true burden of disease and as well as provide added information on the infectiousness, transmission dynamics and progression of the disease. These tests may also be used for predicting chances for development of complications as well as mortality, especially if the antibodies are proven to be neutralizing antibodies.     3) In the area of therapy, the country should participate in clinical trials that would have already been initiated by other countries to help us better understand patient responses to this therapy and determine whether different genetic backgrounds, cultures and environment may affect patient response.      Moreover, participation in these multi-country studies can facilitate its availability in our country when the results become significant.     4) In the area of prevention and the development of vaccines, knowing more about the virus, its genetic makeup and how fast it mutates or changes will accelerate its development.      Characterizing the molecular and genetic structure as isolated from patients in the Philippines can be contributed to the international database that will serve as references for vaccine development. This will ensure that the vaccines developed can induce protection against all of the circulating SarsCoV2 viruses isolated from patients anywhere else in the world. 5) In the area of host factors, genetic biomarkers may be identified that may either predispose or make people less susceptible to the infection. They may also be used to determine risk for severity of disease and complications.     In all of these initiatives, sharing of information within and among scientists, researchers and institutions both here and abroad will help us build on each others’ strengths and accelerate the race for finding the solutions and the answers to many of our questions.     Ultimately, winning the battle would depend on how much and how good we understand our adversary- the Covid19 and the virus that causes it.      To many, the virus is like an unknown enemy that works silently easing its way among and through susceptible populations, evading detection and prevention. The experiences of many countries, whether good or bad, will serve as valuable learnings for all of us.      For one thing is certain, this epidemic will not be the only ones we will be confronting in the years to come. It has been established by scientists that in the area of zoonotic diseases that start from animal hosts before reaching humans, only half of viruses have been identified. Scientific research and development remain our most effective weapon to confront them and the SARS CoV2.

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Chambers propose mass screening with RST to curb COVID-19 spread

March 27, 2020

The Philippine Chamber of Commerce and Industry today endorsed to President Rodrigo Duterte a resolution from its affiliate chambers in Mindanao urging the ramping up of mass screening of possible COVID-19 cases in the country through the adoption of the Rapid Serologic Test (RST) as a surveillance tool. In its letter to the president coursed through Executive Secretary Salvador C. Medialdea dated today, PCCI President Amb. Benedicto V. Yujuico also requested the Food and Drug Administration (FDA) to grant Emergency Use Authority to the application for registration of verifiable suppliers of RST kits, and to set up “PCR Sub-National Reference Laboratories” in all regions of Mindanao.  “We urgently need to check the health of our communities and this is only possible using mass testing in the field. Having statistics of sick patients in the hospital is just too late,” said Ma. Teresa R. Alegrio, PCCI area vice president for Mindanao. “We need to know actual cases in the field even before they become symptomatic or no longer symptomatic (unknowingly healed) to make targeted decisions before they even get to hospitals,” she added. PCCI is advocating the immediate rollout of the mass screening program using RST by local government units in partnership with national agencies, Philippine Red Cross and other NGOs starting with all PUIs awaiting access to PCR testing, all PUMs, vulnerable persons within the vicinity of a cluster of Covid-19 outbreak, and among front liners in the hospital and in the field. Persons who test positive from RST mass screening should also be required to undergo priority confirmatory testing by PCR. The chambers are also requesting the Food and Drug Administration Philippines (FDA) to grant Emergency Use Authority to approve the applications for registration of verifiable suppliers of RST Kits that already underwent the registration process with their respective FDAs in their country of origin. Not the least, PCCI also supports the call of many LGUs and regional bodies to set up  "sub-national reference labs" in all regions of Mindanao in addition to the four already being set up in the San Lazaro Hospital in Manila, the Baguio General Hospital & Medical Center in Benguet, Vicente Sotto Memorial Medical Center in Cebu City, and Southern Philippines Medical Center in Davao City. The Western Visayas Medical Center and the Bicol Public Health Laboratory are also being prepared for testing.  In addition to the University of the Philippines - National Institutes of Health (UP-NIH), five private hospitals are also being assessed by the DOH and the World Health Organization as possible extension laboratories.  These are the molecular biology laboratories of St. Luke’s Medical Center - Global City, Makati Medical Center, The Medical City, St. Luke’s Medical Center - Quezon City and Chinese General Hospital. Indonesian Experience A week ago, Indonesian President Joko Widodo ordered the rollout of rapid tests for COVID-19 across the country in a bid to accelerate detection of the disease. Rapid tests are easier to perform than regular polymerase chain reaction (PCR) tests and can detect COVID-19 cases quicker. Since rapid tests like the RST only require blood serum as a sample, these can be conducted by most health laboratories across the country enabling mass testing in COVID-19 hit areas to be performed quickly. It is easier to implement than the regular tests like PCR, which must be performed in level two biosafety laboratories, since they involved the sampling of nasal fluids or larynx substances which contain the virus as main specimens. Since rapid tests are easier to perform, Indonesia expects more people to be tested and sent to hospitals if found positive. To anticipate a rise in confirmed cases, Jokowi called for hospitals to set up health protocols for handling those who had performed the test. PCR too slow to determine virus spread Although PCR (polymerase chain reaction) is a tried and tested method to confirm COVID-19 infection in PUIs and PUMs, it does not give a true picture of the spread of the infection in a community due to the length of time it takes to confirm a test, now worsened by the backlog at the Research Institute for Tropical Medicine (RITM) due to the sheer volume of samples, the shortage of testing kits to meet the demand, and the extended time to send samples to RITM due to the lockdown of the national transport network. RITM is the sole testing facility in the country at present since the four additional regional centers are not yet ready to conduct tests. Indirect Method “RST is an excellent tool to check the presence of antibodies naturally produced by the human body as a defense mechanism to fight the presence of a destructive foreign body, e.g. the SARS-CoV2 /COVID-19 virus,” said Roderico Bioco, PCCI-X Regional Governor. “It is an indirect method of detecting the presence of the virus (the infection), unlike the PCR test which detects the actual virus itself.” “Each has innate limitations, serve different functions, but should be used together to complement each other in combating the global pandemic,” Biaco noted. Biaco said needs a better surveillance tool that is affordable, reasonably accurate and reliable, easily deployable in the field with minimal technical skill (no need special laboratory with HVAC and negative room pressure, etc), and safer (no need to transport live virus samples). It is also important to note that our field operatives and front liners know that they have fair access to the testing themselves to boost their morale, he added. “Furthermore, we can map out (geo tag) the existence of the spread of the virus using GIS (geospatial information system) and updating the GIS database is faster using RST,” Bioco stressed. “This is critical in planning and executing decisions in the field. We need to analyze faster patterns and trends the virus spreading in the community to make proactive policies and timely decisions.” RST vs. PCR explained In the early stage of infection( first 5-6 days), a true positive person may be tested negative by RST (false negative) because his body may not yet have produced enough antibodies that can be detected by RST. RST is not the proper tool to monitor the ongoing infection, that is the role of PCR, he explained. On the other hand, science journals are saying that the infection starts in the lungs and the virus may not still be present in nasal tracts or sputum 1-5 days after exposure for the PCR test to detect possibly yielding a false negative also. PCR also cannot detect the virus if the person has already completely healed from the disease. How RST buys time The IgM and IgG antibodies that are specific to the COVID-19 virus may take around 5-6 days after exposure for the body to produce enough antibodies detectable by RST. At that point, the infected person may start showing symptoms. Most healthy persons are expected to show mild reaction to the virus and may even be asymptomatic, but his immune system already produces antibodies combating the virus. Upon successfully fighting the virus, the infected person gets rid of the virus in his system, but the antibodies may remain in his body for several days. In this event, PCR test can no longer determine the presence of the virus nor diagnose if the person went through the infection in the first place in the absence of prior testing. However, in this case, RST can determine with a high degree of accuracy a past infection of the person from COVID-19. “This is a critical function of RST not doable by PCR. RST is an excellent tool to diagnose the general health of the community, while PCR for the individual patient,” Bioco said. In the event of intercepting by RST a healthy person that went through the disease undetected, we have the opportunity to conduct contact retracing, isolate, contain and mitigate and stop the cluster from breaking out (that otherwise PCR screening alone cannot do). Reports also claim that most of the transmission of the virus is by asymptomatic persons. Thus, it is important to cast a wider net to catch the virus, and do it fast.

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RITM confirmed 1st CDO Covid-19 positive patient

March 26, 2020

CAGAYAN DE ORO CITY: The Research Institute of Tropical Medicine (RITM) has confirmed the first COVID-19 positive patient at the government-owned Northern Mindanao Medical Center (NMMC) here. Dr. Jose Chan, NMMC Medical Director, said during a press briefing Wednesday that the patient is a 71-year-old male who resides in one of the city’s urban villages (barangays) here. Chan said that the patient came from Green Hills in San Juan, Metro Manila, who arrived in Cagayan De Oro City on March 7, 2020. He said that the patient had a medical checkup after noticing a mild fever, but was later released after getting a specimen which was sent to RITM for analyses. According to Chan, the family quarantined the patient in an isolated room in their residence pending the result of the RITM analyses. He said that the family was very cooperative when health officials asked the patient to be re-admitted to the NMMC on March 12, 2020 after the RITM findings found the patient positive of the virus. “The patient voluntarily submitted himself for admission and is now being confined in an isolation room at the NMMC. He is in stable condition,” Chan said. He said that, as of Wednesday, the NMMC has discharged 35 patients while 13 patients remain in confinement waiting for the RITM results and one (the 71-year-0ld patient) was earlier confirmed positive. Chan said that the NMMC is still waiting for the results of the specimen analyses of the two patients, a male and a female, who died at the NMMC on Monday after being diagnosed as severe acute respiratory illness (SARI). As of Wednesday, only one COVID-19 positive patient (PH 40), the 54 year-0ld-male from Lanao Del Sur died at the NMMC. Dr. Dave Mendoza, the assistant Regional Director of the Department of Health (DOH) in Northern Mindanao, said that the wife of PH40 was negative of the virus while his daughter, now confined at the Amay Pakpak Medical Center in Marawi City, was positive of the COVID-19 virus. The government doctors said that COVID-19 positive patients who died are either cremated or buried within 12-hours under the supervision of the local government unit (LGU). 

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Execs pass Anti-Patient’s Dishonesty law of 2020

March 26, 2020

CAGAYAN DE ORO CITY: The City Council of Cagayan De Oro approved an ordinance that would punish patients who tell lies to the attending health personnel in times of state-declared health emergency. Known as the “Anti-Patient’s Dishonesty Law of 2020,” the ordinance penalizes a dishonest patient of a one-year imprisonment or a fine of not less than P1,000 but not more than P5,000. The local legislators approved the ordinance to “protect health workers, quarantine officers, other front liners and the general public from patients who put others at risk by being dishonest about their travel history and symptoms. The ordinance also provides that any person who are required to accomplish information sheet, data form, declaration or any similar document, shall state the truth and disclose all relevant information as may be required or may be asked by the health personnel such as but not limited to nurse, physician or their assistants. Those found to have knowingly and deliberately lie, committed dishonesty and/or withheld relevant information shall be meted the penalty of imprisonment and fine. 

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Moreno’s character, wisdom shines amid COVID-19 crisis

March 24, 2020

Charlotte, North Carolina—Good day to you dear readers,  I sincerely hope that all of you are doing well at your homes as each one of us around the world are on mandated ‘staycation mode’ while our governments and their health personnel wage war against the unseen enemy that is COVID-19. As I write this, I had just finished my online broadcast on Monday (March 23 Philippine time) at 105.5 Bay Radio FM Way Kurat, the radio station based in Balingasag town in which I talked about whether sex is safe in the time of COVID-19 (it is unsafe based the on global health guidelines requiring social distancing).  Truly this virus which came from Communist China had upended the lives of everyone on this planet, including my husband Ronnie and I who had to take extra care of ourselves being senior citizens. It also took me a week to see for myself how Cagayan de Oro City Hall under Mayor Oscar Moreno’s administration had responded to this global health crisis and I can say that, pending a major development, that the mayor and his allies had done quite the remarkable job of keeping COVID-19 out of the city. Let us repeat one fact that the mayor’s most malicious and vicious critics as well as those that either are too panicked that they can’t think straight or those with a hidden agenda—yes, there are still those who think of gaining political brownie points in this time of a global health crisis—conveniently ignore and bury under their  mountain of fake news, social media bashing and unfounded, noisy demands for a citywide lockdown: there is NO LOCAL TRANSMISSION OF COVID-19 IN CAGAYAN DE ORO CITY SO FAR, based on the latest findings by the Department of Health (DOH-10) and the City Health Office. What is being done right now by the Moreno administration is intensified preemptive, preventive measures aimed at keeping everyone in Cagayan de Oro City, including those heading to the city’s hospitals for treatment of ailments other than respiratory illnesses that could lead to COVID-19, such as dialysis and even therapy. **************** Hence the temporary closure of malls and non-essential businesses such as movie theaters which can draw large crowds who are at risk of infection, a 10 pm to 5 a.m curfew and opening of essential services like grocery stores, supermarkets, hospitals, clinics, convenience stores and restaurants and food outlets that offer takeout in order to encourage people to stay at home. Yes, the main point of these intensive, preemptive, preventive measures as Mayor Moreno kept repeating in his daily press briefings at the mayor’s conference room, is to compel people to stay at home and avoid for the meantime unnecessary activities that would expose them to the very real risk of COVID-19 infection. At the same time, Mayor Moreno displayed not only calm, but courage guided by wisdom in implementing a calibrated response to the global health threat of COVID-19 by allowing people to still enter and leave the city provided they are screened and processed at the checkpoints, seaports and Laguindingan airport and declared safe by health personnel to enter or stop over at the city’s borders. Moreno’s wisdom and grace under pressure was prominently displayed in his decision to allow a boatload of passengers who were turned away at a seaport in Nasipit town, Agusan del Norte province to dock at the Macabalan port where they were immediately examined and declared safe by health workers. About 491 passengers of MV St. Francis Xavier were declared safe for travel to eastern Mindanao where they were headed to after coming from Manila, where most of the COVID-19 cases had originated.  The passengers rode in buses and were advised to undergo a two-week home quarantine just to be on the safe side. **************** In deciding to allow the Ro-Ro vessel to dock at Macabalan port, Mayor Moreno cited humanitarian grounds as basis and this incident merely showed to everyone not only Mayor Moreno’s wisdom but his character as both public official and as a person.  Any other public official of lesser or zero substance would have panicked and turned these passengers away. When news broke out about this incident, one idiot in social media who I will not name for his sake questioned why the passengers were not quarantined inside the vessel for two weeks.  This idiot apparently expected both the city government and the vessel owner to feed and maintain all 491 passengers during their imposed quarantine. In fact, I can only describe as idiotic the demand by not a few Cagayan de Oro City based  netizens for a citywide lockdown which Mayor Moreno pointed out time and again would make life difficult for outsiders seeking medical assistance in the city. The demand is driven mostly by their expectation that government will bring essentials like food right at their doorsteps. Last time I checked, Cagayan de Oro City Hall allocated a P7.5 billion budget for 2020 and owing to these extraordinary times, the city government is well-advised to use the funds judiciously including the allocation of calamity funds.  It won’t surprise me if that P7.5 billion budget would be depleted in a few months if the city does decide to bring essentials to the city’s entire 750,000 population. But enough of the critics who don’t have the complete picture of the city’s situation in relation to the countrywide quarantine.  Suffice it to say that these critics should produce incontrovertible, unimpeachable evidence to justify a citywide lockdown and not just their laughably pathetic alibi that Cagayan de Oro City should impose a lockdown because other local governments are doing it.

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