Exactly 100 days have passed since the first confirmed COVID-19 case was announced in the Philippines on 30 January 2020, with a 38-year old female from Wuhan testing positive for the novel coronavirus. On the same day, on the other side of the world at the WHO headquarters in Geneva, WHO activated the highest level of alert by declaring COVID-19 as a public health emergency of international concern.
The Philippine government mounted a multi-sectoral response to the COVID-19, through the Interagency Task Force (IATF) on Emerging Infectious Diseases chaired by the Department of Health (DOH). Through the National Action Plan (NAP) on COVID-19, the government aims to contain the spread of COVID-19 and mitigate its socioeconomic impacts.
The Philippines implemented various actions including a community quarantine in Metro Manila which expanded to Luzon as well as other parts of the country; expanded its testing capacity from one national reference laboratory with the Research Institute of Tropical Medicine (RITM) to 23 licensed testing labs across the country; worked towards ensuring that its health care system can handle surge capacity, including for financing of services and management of cases needing isolation, quarantine and hospitalization; and addressed the social and economic impact to the community including by providing social amelioration to low income families.
The World Health Organization (WHO) has been working with Ministries of Health worldwide to prepare and respond to COVID-19. In the Philippines, WHO country office in the Philippines and its partners have been working with the Department of Health and subnational authorities to respond to the pandemic. The country level response is done with support from the WHO regional office and headquarters.
Surveillance is a critical component and is used to detect cases of COVID-19 as well as to understand the disease dynamics and trends and identify hotspots of disease transmission. The Department of Health included COVID-19 in the list of nationally notifiable diseases early in the outbreak to ensure that information was being collected to guide appropriate response actions. Existing surveillance systems were capitalized upon to speed up identification of cases as well as identify unusual clusters. Laboratory confirmation is a critical component of the surveillance system but cannot be the only sources of information. The non-specific symptoms and the novel nature of the disease means that the DOH, with support from WHO, are looking at all available information sources to guide response decision making. WHO also provided technical assistance to selected local government units to strengthen field surveillance for timely data for action at the local level.
Contact tracing is crucial to the response. It is a system to detect and isolate cases and identify close contacts who will be advised for quarantine. It allows the investigation the system to tracjk the chain of infections as well as the settings, places, events or other avenues that where transmission have occurred or may have been amplified. A major bottleneck to doing this is the availability of timely and complete information from the hospitals for suspected, probable and confirmed COVID-19 cases. WHO assisted the DOH Epidemiology Bureau in developing COVID KAYA, a case and contact tracing reporting system for epidemiology and surveillance officers, health care providers and laboratory-based users, expanding the capacity of the previous COVID-19 information system. WHO also continued to support the government to establish the system and improve capacity for contact tracing at the city and municipal levels.
The COVID KAYA interface available on Google play store. Photo: WHO/G. Maramag
Infection prevention and control
Patients and health workers must be protected from the possible transmission of COVID-19 inside health facilities. Infection prevention and control (IPC) is vital in minimizing the harm caused by the spread of infection in these facilities. In the early part of the response, WHO supported the DOH with the provision of personal protective equipment (PPE) for health workers. To strengthen IPC, WHO and DOH developed modules and conducted online IPC training of trainers for frontline health workers in health care and community settings. The training has since been rolled out more widely by partners USAID-MTaPS and UNICEF to cover over 5,500 health workers to date.
Screenshot of the IPC for COVID-19 webinar for home and community settings conducted by UNICEF. Photo: WHO/J. Kitong
Laboratory and therapeutics access
Laboratory testing for COVID-19 is critical to be able to rapidly identify, treat and isolate the positive patients, and be able to see the bigger picture of how many people are infected and ultimately stop the transmission of the virus. Since the beginning of the response, WHO provided support to the DOH’s Research Institute for Tropical Medicine with laboratory supplies and extraction kits. WHO also assisted the DOH in the accreditation of COVID-19 testing laboratories. To date, 23 real-time reverse transcription polymerase chain reaction (rRT-PCR) laboratories nationwide are now conducting COVID-19 diagnostic tests. The Philippines has also recently joined the WHO Solidarity trial to find effective COVID-19 treatment.
A lab worker at the Research Institute for Tropical Medicine prepares the samples for rRT-PCR testing. Photo: WHO/F. Tanggol
With a new disease, there are a lot of unknowns regarding the proper clinical management of suspect and confirmed cases. But when clinicians are armed with the necessary knowledge and skills to care for sick patients, the more the patients are likely to recover. WHO supported the frontline health workers through a webinar series on clinical management, providing up-to-date WHO clinical perspectives. At the same time, WHO also supported the DOH and the Department of Interior and Local Government in preparing policies to form health care provider networks for COVID-19, from primary care that includes telemedicine and community management, to tertiary care linking to referral hospitals.
A screenshot of the webinar series on clinical management. Photo: WHO/A. Domingo
Non-pharmaceutical interventions and mental health
Non-pharmaceutical interventions (NPIs) refer to public health measures, which are not related to medicines or vaccines, that people and communities can do to prevent the spread of infections like COVID-19. These interventions involve personal protective measures, environmental measures, physical distancing measures and travel-related measures. WHO supported the DOH in the development of a policy on NPIs as well as assisted in rapid assessment on local government capacity on NPIs and policy-gap analysis.
In times of extreme experiences brought by COVID-19, it is likely that people feel fearful and anxious. Providing mental health and psychosocial support (MHPSS) during the time of COVID-19 pandemic is important. WHO assisted the DOH in developing policy guidance and advice on integrating MHPSS within health and social services and increasing access to care to these services.
Virtual coordination with the health sector mental health and psychosocial support partners. Photo: WHO/J. Vergara
Risk communication and community engagement
Effective communication and engagement with communities is essential for people to understand the situation, know the situation and practice protective measures to protect their health, their family and the larger community. WHO supported and amplified DOH messaging by releasing various communication materials on the risk of COVID-19 and how people can protect themselves through social media and traditional media. WHO also worked with partners such as UNICEF and OCHA in reaching vulnerable groups, getting their feedback and understanding their information needs.
A CFSI representative chats with a participant to get her feedback on the COVID-19 response and information needs at the communities. Photo: CFSI
With lots of moving equipment and supplies required for COVID-19, logistics support is an important part of the response. WHO provided technical support to the DOH in the recalibration of PPE requirements by using WHO projection tools, provided cost estimates, and advised on streamlining the distribution flow of PPEs and other essential supplies. WHO also supported DOH in the development of a commodities dashboard that provides real-time PPE stocks at the facility level, as well as assisted in building an information system for tracking essential COVID-19 commodities.
A screenshot of the DOH commodities dashboard supported by WHO. Photo: WHO/D. Garcia
Subnational operations support
Aside from national support to the DOH, WHO is also providing subnational support in the Philippines by working with the DOH Field Implementation and Coordination Team (FICT) and the Centers for Health Development (CHDs) at the regional level. WHO conducted scoping missions in 10 out of 16 regions outside the National Capital Region to assess the needs and capacity of CHDs in responding to COVID-19. WHO staff have also been deployed in specific high-risk subnational areas in the country to provide technical support for the response. At the same time, contact tracing in subnational areas is also being strengthened with WHO, DOH Epidemiology Bureau, and UP College of Nursing developing a training programme and learning resource materials on contact tracing to build the capacity of epidemiology and surveillance officers and local contact tracing teams.
WHO staff meet visit the Regional Interagency Task Force of Cordillera Region to discuss the regional response to COVID-19. Photo: WHO/R. Santos
Responding to outbreaks in high risk areas
Closed settings like prisons and hospitals have seen clusters of confirmed cases. WHO, the DOH Epidemiology Bureau and the International Committee of the Red Cross (ICRC) worked with prison authorities and hospitals in joint contact tracing and infection prevention and control investigations. The teams provided them with guidance to prevent the further spread of infection to ensure the protection of persons deprived of liberty, hospital patients and people with mental health conditions.
WHO also supported the strengthening of community-based interventions and social support and addressing the needs of specific populations such as people with pre-existing mental and substance use disorders.
A team from WHO, DOH and ICRC visit a detention facility. Photo: WHO/H. Doroteo
Moving forward with the response
Much more needs to be done to break the chain of COVID-19 transmission. Some of the challenges that the Philippines continues to face are containing transmission of infection, mitigating the impact in high risks communities and confined settings, as well as ensuring the uniform enforcement of non-pharmaceutical interventions that are already in place. The continuation of the community quarantine will have substantial social and economic impact and thus a heightened effort to control transmission of infections through rigorous contact tracing, isolation of cases, quarantine of contacts while ensuring timely and adequate treatment to save lives will continue to be the primary public health measure. In addition, while the government is exerting all its efforts in this current situation, it also needs to prepare its health systems for surge capacity in the event that a wide-scale community transmission occurs.
In the next few days, the government will carefully consider the next steps, especially on deciding whether or not the communty quarantine will be lifted or levels of quarantine will be differentiated based on the situation of provinces. WHO strongly recommends that when the government considers adjusting public health and social measures in the context of COVID-19 the following requirements must be in place:
- COVID-19 transmission is controlled through two complementary approaches – breaking chains of transmission by detecting, isolating, testing and treating cases and quarantining contacts and monitoring hot spots of disease circulation
- Sufficient public health workforce and health system capacities are in place
- Outbreak risks in high-vulnerability settings are minimized
- Preventive measures are established in workplaces
- Capacity to manage the risk of exporting and importing cases from communities with high risks of transmission
- Communities are fully engaged
View an infographic on WHO Philippines’ support to the COVID-19 response in the Philippines