A four-point recommendation on community-based management of COVID-19 was presented during another virtual round table discussion (RTD) presented by the Zuellig Family Foundation in partnership with the Alliance for Improving Health Outcomes (AIHO) and Philippine Society of Public Health Physicians (PSPHP).

The four main points of the recommendation are local preparedness and response strategy, guidelines on identification of cases, establishment of local isolation and general treatment areas for COVID-19 cases (LIGTAs COVID), and family-oriented approach for different levels of care.

The recommendation aims to guide local chief executives (LCE) in enforcing preventive measures for households and streamlining protocols for managing suspected and probable COVID-19 cases. The RTD was also designed to encourage people to strengthen the first line of defense at home.

Dr. Miguel Dorotan, Alliance for Improving Health Outcomes (AIHO) executive director and one of the RTD presenters, said depending on the current scenario in each locality, LGUs can follow a three-level local preparedness and response strategy to determine the appropriate preventive, mitigation, or responsive actions.

Alpha alert: no local COVID-19 case

Alpha alert level shall be placed for LGUs with no known local case of COVID-19. In such level, LCEs are expected to: prepare an incident action plan (IAP), organize the incident management team (IMT), establish and test surveillance and notification system, establish referral system, ensure the presence of adequate health human resource, conduct rapid needs assessment, secure necessary healthcare equipment and supplies, conduct training and orientation for health workers, identify vulnerable and high risk areas and population groups, prepare community quarantine and isolation facilities, disseminate timely and accurate information, and monitor ingress and egress of people into and out of the community. This boils down to preparedness of the community to prevent the virus from infecting the population.

Bravo alert: confirmed COVID-19 case

If a positive case has been confirmed, alert level bravo shall be raised and mitigation measures shall be observed. In this case, the LCEs must activate the emergency operations center (EOC) and implement the incident action plan that includes social re-engineering measures like social distancing and prohibition of mass gatherings, household profiling, establishing platforms for information dissemination, and contact tracing.

Charlie alert: COVID-19 community transmission

Meanwhile, if the LGU has already recorded community transmission, alert level charlie will be raised and response actions shall be in place. LCEs shall then issue a directive for implementation of enhanced community quarantine and activate barangay health emergency response team (BHERT) for active case finding, testing of suspected cases, situation report preparations, as well as establishment of community support groups for patients and their families.

As a holistic approach, the four-point recommendation emphasizes preparedness and response to involve government agencies, the private sector, local health units, civil service organizations (CSOs), local COVID-19 task forces (LCTF) and BHERTs, and community members. Sanitation inspectors as well as community isolation unit managers shall also be mobilized to oversee proper waste management and operations of LIGTAs COVID.

The second part of the strategy pertains to guidelines on identification of cases in the community. In this stage, BHERTs play a crucial role in identifying patients for admission. LGUs are also encouraged to set up a hotline which community members can call or text if they develop symptoms or had been in contact with a suspected or a confirmed case.

Spaces for patients

The third part of the recommendation refers to establishing LIGTAs COVID or a facility within a barangay, municipality or province, where patients can be temporarily housed for quarantine or isolation. In setting up quarantine areas, space, staff, supplies, and special services must be considered. LIGTAs COVID spaces should be well-ventilated, and separate for confirmed and for suspected patients. Since LGUs have different spatial, financial, and social conditions, LCEs must explore ingenuous ideas like modular tents, barangay halls, or existing structures like hotels. AIHO also reminded LGUs to use school buildings as quarantine areas only as a last resort as per the guidelines of the Department of Education (DepEd). 

The fourth and final part of the recommendation refers to family-oriented approach for different levels of care. Based on this, families shall follow specific guidelines on hygiene, home sanitation, social distancing, food choices, anticipatory guidance, and family support depending on whether there is no known case of COVID-19 in the family, a family member is on home quarantine or self-isolation, or family member/s should be in a healthcare facility or isolation unit.

Beyond the four-point recommendation

In the recently held Social and Behavior Change Communication Summit, Senior Program Officer of Johns Hopkins Center for Communications Kathryn Bertram shared that while communicating relevant information about COVID-19 is vital, it is also important to emphasize everyone’s social responsibility and ability to do something positive for families, neighbors, and communities. For one, it is every citizen’s duty to know the consequences of non-compliance to existing preventive and mitigation measures. 

Moreover, the Department of Health (DOH) mandated the continuance of essential health services amid the crisis. Dr. Juan Antonio Perez III of the Commission on Population (POPCOM) said rural health units (RHUs) will activate volunteers to provide home delivery of contraceptives for three months. The four sub-clusters of the health response cluster namely medical and public health, nutrition, mental health and psychological support (MHPSS), and water, sanitation and hygiene (WaSH) shall also be continually be provided at this time.

For local governance, Bataan Governor Albert Garcia asked the national government to assist the LGUs in using rapid test kits to immediately identify, treat, and isolate the possible positive cases in the community while DOH and the Research Institute for Tropical Medicine (RITM) roll out regional testing centers. Other LCEs who participated in the RTD also asked the national government to ensure that all issuances related to the fight against COVID-19 be communicated with the LGUs in a timely and systematized manner.

Dr. Aileen Riel-Espina, one of the resource speakers from AIHO, said that fighting the virus is like “fighting an invisible enemy that seems to creep in slowly day by day, threatening our very existence. The call is loud and clear. It is a call to have everyone on board,” Dr. Espina said.

The RTD titled “Community-based Management of COVID-19: Strengthening the LGU Frontlines” was held last April 1. Dr. Lei Camiling Alfonso was also a resource person during the RTD.

Holding RTDs is part of ZFF’s initiatives to help local health leaders in improving health outcomes of Filipinos amid the global threat of COVID-19.For more details about the four-point recommendation, please send your inquiries to mdorotan@aiho.org.ph or atrespina@gmail.com. Follow ZFF’s official twitter account @ZFF_foundation for updates.