Doctors coming from six (6) medical groups based in Bohol came up with recommendations to halt the Coronavirus disease (Covid) case. The recommendation, contained in a letter, was submitted to Gov. Arthur Yap and to the Bohol Inter Agency Task Force (BIATF).
The letter, sent to Capitol and received on April 15, 2021, was signed by Dr. Jefferson Ong, president of the Bohol Medical Society; Dr. Dorothy Gay Dumaluan, president of Philippine Academy of Physicians, Bohol chapter; Dr. Rey Perpetuo Belderol, president Association of Municipal Health Officers of the Philippines, Bohol chapter; Dr. Kazan Benigno Baluyot, president of Philippine College of Physicians, Bohol chapter; Dr. Praxedes Erma Ladesma, president, Bohol Child Health Care, and Dr. Lalaine de los Santos, president, Diabetes Philippines, Bohol chapter.
The doctors wrote in the letter: “The recent surge in the number of active Covid-19 cases in the province has sent alarm signals throughout the medical community. This has become a cause for great concern due to the possible uncontrolled outbreak of the disease as seen in the epidemiologic pattern in the [National Capital Region] NCR and the surrounding provinces. It has been noticed that characteristic patterns of an impending outbreak such as clustering of cases in households, workplaces and neighborhoods are present in the recent surge. These will eventually lead to ever wider circles of transmission that will be most difficult to contain once it reaches a critical level exceeding the healthcare capacity and the ability of the Emergency Operation Center [EOC] to track and contain the cases.
We therefore make these recommendations to the Bohol Inter-Agency Task Force Against Covid-19 to help control the current surge and prepare for any worsening of the epidemic. “
The letter continued by discussing the health standards, where the doctors enumerated the recommendations,
“ 1. The minimum health standards have been shunned by many due to Covid fatigue or outright denial of the existence of the danger of this pandemic.
2. These minimum health measures should be enforced especially in places where people from different households converge.
3. Wearing of masks in the proper way should be enforced in all places at all times.
4. Wearing of a face shield in addition to a proper face mask in critical danger areas such as supermarkets, offices, churches if these places cannot limit the density of people within their premises or if there is poor ventilation.
5. Face masks and face shields should be worn together when using public transportation where optimal social distancing cannot be adequately maintained.
6. Maintenance of the 1.5 meters social distancing especially in areas where there is prolonged exposure to other people and places where masks are routinely removed (e. restaurants, cafeterias, etc.)
7. Effective enforcement of these measures should be done by safety officers assigned to monitor these establishments and areas where people tend to converge or crowd or where social distancing is poorly observed. “
Furthermore, the doctors wrote about testing protocols by saying,
“1. [real time-polymerase chain reaction] RT-PCR testing for SARS-CoV2 should be required for all individuals on day 5 of arrival from any place outside of Bohol. This will save the passenger the trouble of having to time their tests to fulfill the 72 hours maximum period before boarding the transport vessel. It is also more reliable for screening since persons in port terminals are mixed with individuals who are not tested due to variations in entry protocols among different provinces.
2. It is best to apply this testing protocol to tourists due to the current surge in cases both locally and in the main port cities through which these Individuals pass on their way to Bohol.
3. Counterfeit PCR test results have been found and Intercepted at our Tagbilaran ferry port. This manner of diligence should be replicated in other ports in order to decrease the entry of infected individuals into the province.
4. We still maintain that the exemption of certain individuals from testing and quarantine when entering Bohol is foolhardy as it endangers our community with its limited healthcare resources.
5. Making exemptions in the standard entry protocols will have a deleterious effect on the local people’s adherence to the minimum health standards, therefore consistency is deemed important “
The doctors stated in the same letter the quarantine protocol by mentioning,
” 1. it is a proven fact in this pandemic that negligence of proper quarantine procedures that are based on scientific facts known about SARS-COV2 spells disaster for any given locality.
2. We reiterate the strict implementation of quarantine protocols for individuals Identified as close contacts of positive Covid-19 cases. They should also be tested on the 5th to Biday from last contact with the positive case to maximize the detection capability of the RT-PCR test.
3. Preparedness of Isolation Centers and Quarantine Facilities is strongly recommended as our hospitals can quickly get filled-up in a surge of critically-ill Covid-19 cases. These facilities should be manned by trained personnel and supervised by medical teams. They should also have rapid access to law enforcement services. These isolation centers can help prevent the exposure of vulnerable individuals to active cases.
4. Home quarantine should be properly assessed if they qualify (patient has his own room, no susceptible individuals in the house) The house should also be monitored by barangay personnel to ensure quarantined individuals do not go out or mingle with other people.
5. Isolation of mild or asymptomatic cases should be done in an isolation center but if the household is already exposed and considering that there are no uninfected vulnerable Individuals therein, isolation of the entire household will be done.
6. RT-PCR testing and quarantine should be done for all close contacts including asymptomatic individuals.”
Moreover, the doctors in their letter also stated their recommendations regarding emergency operation center by stating,
“1. The EOC [Emergency Operations Center] is the key in efficient coordination between the [local government unit] LGU’s, health personnel, hospitals, Isolation centers and law enforcement. Included here are transportation, emergency response units and supply units.
2. We recommend that the EOC should be adequately manned with properly trained personnel.
3. The EOC should be equipped as a 24-hours communication and information hub that can respond to a healthcare crisis as well as for the maintenance of law and order in the community.”
In terms of contact tracing activities, this is what the doctors wrote in their letter,
“1. Contact tracers should be given breaks and rotated in order to keep them from going into fatigue.
2. There is a need for more thorough contact tracing especially in the absence of quarantine and testing safety nets.
3. Contact tracing apps and databases employed in different institutions and government units should be unified to be truly effective. The province should spearhead the unification of the digital contact tracing system to create a virtual bubble within the population of Bohol where cases can be easily identified and isolated as well as for contacts to be properly quarantined and tested.
4. Contact tracing apps will also add a layer of protection for establishments to function with a degree of safety and confidence. The robustness and efficiency of this system cannot be overemphasized if various businesses must thrive in this time of rapid community outbreak. “
The doctors also emphasized in the letter about the importance of advocacy and public awareness regarding Covid by mentioning in the letter the following,
“1. Strengthen the public education campaign to counteract the Covid denial mentality that pervades some social media groups.
2. We continue to remind and re-educate the public on the importance of the minimum health standards against Covid-19.
3. Many of these also deny the necessity or totally oppose the acceptance of the Covid-19 vaccination.
4. There are many health issues aside from Covid-19 that need to be addressed urgently and the public needs to be made aware of their presence, risks, prevention and treatment. “
The doctors, in their letter, also emphasized the key strategies in the vaccination campaign by writing,
”1. Vaccination is the best way to end the pandemic but it has to be done fast and with sufficient reach for best effect. We dedicate our effort and share our knowledge to best guide our people to realize this goal.
2. Ongoing multimedia campaign to educate people using social network, videos, infographics, news articles and radio program talks.
3. Inclusion of persons from other walks of life who have received the vaccine to testify to the safety and real experience will shed light on the many questions and apprehensions surrounding the vaccination process.
4. Supporting the initiative of the private sector in procuring the vaccines for the local businesses; their personnel and social circles. This also extends to possible donations to bolster the supply of vaccines in the province.
5. Let us not overlook the foreign workers, expats and residents who also need to get vaccinated.”
The doctors concluded their letter by stating that, “The Bohol Medical Society and its affiliate societies stand ready to help assist in the efforts of the provincial government and the different agencies to have a united front and set aside personal ulterior motives in order to bring about the best outcome for our people. This set of recommendations will be updated to help guide the decision making of the BIATF and the government units.”