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Calibrated response

calibrated response - Calibrated response

To calibrate means to adjust, or to take into account all factors and to compare all available results data. At this point in our fight against COVID-19, it is not too late for our leaders to reassess our situation and to fine-tune the medical interventions deemed necessary. But this also means listening to all resource people and accepting assistance from all willing to help.

Policy makers should consider the findings of the staff of UP-Philippine General Hospital, which have been reported on in recent days. Please allow me to devote more space for the conclusions of the Aug. 10 paper authored by doctors Regina Berba, Eric Berberabe, Bill Veloso, Rodney Dofitas, Lilibeth Genuino, and Gap Legaspi on behalf of the PGH COVID Crisis Team.

The big challenge now, as we “reopen” the economy, is how hospitals and workplaces can be made safer from COVID-19. This is also to help stop the rising number of COVID cases. I believe this is where the UP-PGH experience thus far can make a difference. Despite having plenty of COVID-19 patients, UP-PGH initially managed to keep itself relatively safe from the virus.

Early on, despite the number of COVID-19 patients they accepted and cared for, only a relatively small number of hospital staff were infected in the course of their work. Of almost 5,000 workers tested in June, only 99 tested positive for COVID, or roughly 2%. Of hospital workers directly dealing or who were in contact with COVID-19 patients, the infection rate was an even lower 1.4%.

How did they do this? They rezoned the entire hospital; installed controlled ventilation systems, air purifying equipment, and UV light and automated hand hygiene dispensers; used Personal Protective Equipment (PPE) even in non-COVID areas; fit-tested N95 and KN95 masks for staff; put up unified donning and doffing areas with safety officers; ran a workplace clinic for staff consultations and testing; released information and educational materials; made housing and transport arrangements for frontliners; and ensured on-site access to RT-PCR testing.

“In PGH, the testing has been markedly simplified so the turnaround time (TAT) of the PCR testing at the PGH Molecular Laboratory has gone down from a previous of five days to 24 hours. There is also a fast lane for emergency cases where the test takes only three hours for the results to be released,” the doctors noted in their Aug. 10 paper.

And this was made possible only because UP-PGH now has additional resources to swab test more patients as well as staff. Private businesses like First Gen of First Philippine Holdings Corp. are supporting it with new RT-PCR testing machines and lab equipment that helped expand the hospital’s testing capacity from 150 to 1,500 tests per shift.

But there was another lesson to be learned as well from its COVID-19 experience, UP-PGH noted, and that was that PCR Tests were only point-in-time tests. “The assurance it provides is brief and lasts only up to the point a person was tested. COVID-19 is so efficiently contagious that the only true guarantee that any institution is safe is when our entire community works together to get infection rates as low as possible.

“As the government started to lift quarantine restrictions, we were not able to control the contribution of human movement anymore. These variables were not part of our initial formula. Weeks into the General Community Quarantine, our COVID rates among the HCWs rapidly rose,” it added. Even those who never went close to the COVID areas were getting infected, it said.

Recognizing that the hospital system was not isolated from the rest of the community, UP-PGH said that “to keep our infection rates down in PGH and in all other health facilities and workplaces, cooperation from all inside and outside PGH is needed. Our efforts need to extend beyond our hospital systems and we must work with the community.”

As for mass testing, UP-PGH also noted that “the economics of COVID testing if done routinely does not support an efficient use of resources.” For one, periodic mass testing in places with many workers can be expensive, and the “massive manpower requirement if done routinely will be taxing to a system with competing needs. Instead these huge resources can be channeled to proven and cost-efficient preventive measures.”

Instead of routine mass testing, as what the government seems to be now pushing at the workplace, UP-PGH is advocating for “targeted testing.” In the case of the hospital, it said, it is opting now to test healthcare works “whenever they need to be tested such as when a staff member has symptoms; been unduly exposed to a COVID patient; been exposed without the benefit of adequate PPEs; and, whenever they feel they need to be tested.”

UP-PGH also points to the need for better contract tracing and the urgency of quarantine and isolation. “To cut the transmission, persons with High Risk Exposure need to be identified, alerted and voluntarily go for strict isolation as soon as [they have] symptoms. COVID patients are most infectious from one day before and up to the first three days of start of symptoms. The only way our numbers will go down is to do immediate quarantine as in as soon as exposed; immediate test, and isolate once with symptoms.”

They added, “All of society must know that when they get High Risk Exposures they need to start quarantine, not next week but right away. For instance, living in the same household of a COVID positive case is a high-risk exposure. All household contacts should go on quarantine starting on the same day the positive result is released.”

The UP-PGH doctors also noted that for COVID-19, “the window of best opportunity to intervene and make a difference is very narrow. The time one is exposed to the time one starts becoming symptomatic occurs mostly from Days 1 to 7, averages 4-6 days in most series, and can extend up to 14 days.”

In releasing their findings, based on their experience since the start of the pandemic, UP-PGH doctors are offering a constructive assessment that could serve as a lesson for others. In my view, these lessons should be considered in strategizing a calibrated response to the needs arising from the COVID fight. The UP-PGH paper also conveyed a message of hope particularly  for those who have gotten weary or live in fear.

They wrote, “The COVID-19 pandemic is here to stay for a few more months. Let us gather our best practices and continue to learn from each other. We are one with the WHO when it states what we need to get through this pandemic are: SCIENCE, SOLUTIONS, and SOLIDARITY. Most of all, if there is one thing we learned from the hard work of the UP-PGH community, from the support of the greater community around us: there is hope. We can do this!”

 

Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippines Press Council

matort@yahoo.com

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