Gov. Arthur Yap called for the STRICTER implementation of protocol during a virtual meeting participated in by various mayors of Bohol, chiefs of police, Bohol doctors and medical frontliners, members of the Bohol Chamber of Commerce and tourism industry players and stakeholders on Friday, July 2, 2021.
The virtual meeting’s main topic was about the Covid situation in the province, according to a report from the Provincial Information and Media Relations (PRIMER).
The said virtual meeting was also attended by Dr. Jaime Bernadas, regional director of the Department of Health (DOH) in Central Visayas, Dr. Mary Jean Loreche, chief pathologist of the regional office of the DOH, Dr. Junjie Zuasula and Dr. Nene Cañal of DOH region 7, Leocadio Trovela, regional director of Department of the Interior and Local Government (DILG) in Central Visayas and Usec. Bernardo Florece of the DILG, the PRIMER in its report continued.
The PRIMER also bared that In the said meeting, DOH’s Niel John Oclarit presented the data and statistics regarding the Covid situation in Bohol. He presented the following data: 48% of the confirmed Covid cases are asymptomatic; about 46% of the positive Covid cases are consideted to be mild; around 4% of cases are identified to be moderately symptomatic; while 2% of cases are considered to be severe.
Oclarit added that most of those who have contracted the virus belong to the 20-40 years old age group. He also said that based on the recent surge in the number of cases, the two-week growth rate of Bohol was pegged at 32% while the average daily attack rate (ADAR) is placed at 8.2%. This means that 8 out of 100, 000 Boholanos are believed to have been infected with Covid, according to the PRIMER report released to The Bohol Tribune. Oclarit added that the Covid situation is considered to be at a critical level when the ADAR reaches 7.
In its report, the PRIMER pointed out: a) that 23 out of the 48 local government units (LGU) in Bohol has an ADAR of 7 or higher; and b) that in the period spanning June 16 to 30, 2021, the positivity rate is at 26%. This means 26 out of 100 swab samples taken from individuals yielded a positive polymerase chain reaction (PCR) test result.
Moreover, the critical care utilization in Bohol is already at a critical level as Level 3 hospitals already reached 100% utilization of their Covid intensive case unit (ICU) beds, Covid ward, and Covid isolation bed capacity, the PRIMER report reveals.
Upon hearing the statistics, Yap asked about the cause of the surge and also about the possible lapses of the LGUs in the implementation of the protocol.
The governor said that LGUs are supposed to implement all the established protocol, which has kept the number of Covid cases relatively low compared to other provinces, until May 2021, when the number of cases started to increase.
THE DOH’S TAKE
DOH’S Bernadas and Loreche pointed out the reasons for the surge in cases in the province.
The DOH officials said that the health department discourages the home isolation scheme for Covid positive patients. However, in Bohol, there are several LGUs that have allowed/tolerated the home isolation scheme for Covid positive patients.
Bermadas and Loreche pointed out that LGUs are implementing household lockdowns when there is a confirmed positive case. Yet, the LGUs are unable to implement the zoning containment strategies, which may lead to the spread of the virus even if there is a household lockdown.
DOH protocol says that all close contacts of the confirmed positive case must be contact traced, quarantined and subjected to PCR tests. However, a number of LGUs, allegedly, are not testing asymptomatic first generation close contacts of a Covid positive patient.
There are some LGUs being unable to locate, test, and isolate those asymptomatic patients which are possible spreaders of the virus, the DOH officials pointed out.
The DOH officials say that the critical care utilization rate of Bohol is a reflection of an under-utilized temporary treatment and monitoring facilities (TTMF) or isolatiom facilities. Based on the data of the DOH, only 16% of the TTMFs or isolation facilities located in various LGUs in Bohol are being used properly. These TTMFs should be the area to be used to isolate Covid patients who are asymptomatic or with mild symptoms. With the low utilization rate of these TTMFs, the Level 2 and Level 3 hospitals are now filled with patients that are not supposed to be hospitalized in the first place, the DOH officials quipped.
It was also revealed during the meeting by DOH officials that there are 10 LGUs in Bohol found to be not compliant with the right isolation bed to population ratio.
An LGU is supposed to allocate 1 isolation bed for every 1,000 persons in the locality. Worse, the DOH reports that there are LGUs here in Bohol which are not operating any TTMF at all.
DILG CHIMES IN
Usec. Florece of the DILG chimed in by sharing his observations regarding the Covid situation in Bohol. He said that for the period spanning June 1 to 30, 2021 about 5,000 individuals were arrrested for violating the minimum health and safety protocol here in the province.
Florece also noted that in some LGUs, only 30% of the contact tracing efforts are done within 24 hours from the time the patient yielded a positive PCR test result.
Florece added that this must be increased to at least 80%.The effective ratio for contact tracing is 1 positive case to 20 close contacts. However, several LGUs are registering only a contact trace of 5 people for every 1 positive patient, Florece said. The DILG official also said that there is a need to activate the Emergency Operation Center of every LGU in order
to manage the spread of infections in their respective localities.
GOV’S ACTION
In this regard, Yap admonished the mayors and ordered them to STRICTLY implement the protocol to avoid the imposition of more stringent restrictions. He ordered the mayors to build a credible Emergency Operation Center at the city/municipality level to manage the spread of infection in their respective areas of responsibility.
The governor said, “As correctly pointed out by Dr. [Mutya] Macuno and the DOH, you can call it Emergency Operations Center or you can call it the BIATF [Bohol Inter Agency Task Force] but the functions seem to be the same. There must be stronger coordination between the provincial level down to the city and municipal level especially on points stated by Dr. Macuno in data collection and referral system, on contact tracing, testing, and one-hospital management system.”
The governor added: “Dr. Bernadas also reminds us of the ILI [influenza-like illness] surveillance system. Mayors, I will be issuing renewed orders to remind you. [I am] reminding also BM [Board Member Romulo] Cepedoza and the mayors to inform all the barangay captains to be strict with regards to reporting people in their localities who have influenza-like illnesses. We must report them so we can have [these] people [with ILI] tested when there are symptoms and we can then isolate those who are determined as positive. [I am also] Reminding all the mayors that we should not shun testing. Ignorance is not bliss. At this point in time, if we ignore the number of people who are positive because we choose not to test, then we are endangering ourselves and our society. I heard from the report of the DOH by Niel Oclarit that there are towns that are not testing. We will reach out to those towns and tell them they must test.”
Furthermore, Yap reminded the mayors to be strict with their home isolation guidelines.
On contact tracing efforts, Yap reminded the mayors that the ideal ratio is 20 close contacts per 1 positive patient and not the current 1:5 ratio.
The governor also said, “I would also like to go back to the findings of Usec. Florece. In Bohol, contact tracing capacity is 30% close contact traced within 24 hours. This is not ideal. The ideal is higher than this. This is another problem that we have. Although, according to Usec. Florece, we have adequate contact tracer personnel to population ratio which is 1:365. If our contact tracer personnel to population ratio is okay, why is it [that] our close contact tracing within 24 hours is only 30%? Why [is] our close contact ratio only 1:5 when we have enough contact tracing personnel?”
On the issue of TTMF, Yap said, “In terms of isolation capacity, Usec. Florece also says that our in-home isolation of asymptomatic at 27% is too high. Mild with no comorbidities at 36% is also too high. The rate should be one digit. It should be below 10%. It should be 9% and below. I remember when I used to make personal reports about this, we reached 11,000 beds. My question is why these went down to 5,000 beds? We used to be at 11,000 beds ready to accommodate those who are infected. Why is it back down to 5,000? What is worse is we have allowed people to go home. I think this is one of the very important lessons that we have to absorb at this point in time and understand.”
In this regard, Yap ordered the mayors to work on the step-up and step-down referral system and the use of the TTMFs. He said, “Hierarchy of care must also be followed. Moderate, and severe must be assigned to different level 1, level 2, level 3 hospitals. Decongest hospitals in Tagbilaran City. The observation is very correct. We close down our TTMFs. We allowed people to stay home. Anybody who has a problem goes to Tagbilaran City. That is the reason why Tagbilaran is drowning right now and we are overwhelmed. Mild cases must now be handled by TTMFs.”
The governor appealed to all the mayors, chiefs of police, doctors and other stakeholders to go back down to work. He said there could be stricter measures that may be implemented in a couple of weeks, if the Covid situation does not improve.