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__
April 20, 2020
DEPARTMENT MEMORANDUM
No. 2020 - _Q1Q7
SUBJECT: Must Know COVID-19 Issuances and Materials as of April 20, 2020
The ongoing response has been crystallized into a set of guiding principles of COVID-19
response (“Must Know for COVID-19”), which was approved by the DOH Executive
Committee and subsequently adopted by the Inter Agency Task Force on Emerging and
Infectious Diseases. In line with this, all DOH offices and line agencies are directed to:
A. Communication: Use the official terminologies set in the Must Know for COVID-19
Responders document and cascade to
all bureaus, offices, line agencies, centers for health
development, DOH hospitals and specialty centers
B. Intersectoral Coordination: Master the COVID-19 guiding principles and current policy
intents and directions to ensure that these are espoused in all discussions particularly in
national and regional intersectoral meetings.
C. Alignment with DOH policy directions: Ensure strategies, operational policies, actions,
and communications are consistent with DOH policies on COVID-19 of current date: as
TESTING CAPACITY
e AO 2020-0014: Guidelines in Securing a License to Operate a COVID-19 Testing
Laboratory in the Philippines
© DM 2020-0180: Revised Interim Guidelines on Expanded Testing for COVID-19
-
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
DC 2020-0184: Clarification on Financing & Reimbursement of COVID-19 Antibody
Test Kits by DOH and PhilHealth
MANAGEMENT
AO 2020-0013: Revised AO2020-0012 Guidelines for the Inclusion of COVID-19 in
the List of Notifiable Diseases for Mandatory Reporting to DOH
DM 2020-0138: Adoption of PSMID Clinical Practice Guidelines on COVID-19
DM 2020-0146: Adoption of POGS, PPS, PIDSOG, PSMFM, PSNbM, & PIDSP
Clinical Approach to COVID-19 Mgt. in Pregnancy and Newborn
DM 2020-0176: Interim Guidelines on the Rational Use of Personal Protective
Equipment for COVID-19
HEALTH FACILITIES
e DM 2020-0142: Interim Guidelines on COVID-19 Referral Hospitals
CASE
e DM 2020-0160: Interim Guidelines on Mgt. for NCR Mega Temp. Treatment &
Monitoring Facilities in PICC, WTC, RMC, Ninoy Aquino Stadium & PH Arena
DM 2020-0161: Interim Guidelines on Step Down Care for COVID-19 Response
DM 2020-0162: Interim Guidelines on the Accommodation Arrangement for Health
Workers During COVID-19
e DM 2020-0165: Interim Guidelines for RNDs in Hospitals on Nutritional & Dietary
Mgt. of Suspected, Probable & Confirmed COVID-19 Patients & on the Provision of
Healthy Diet to Hosp. Workforce
e DM 2020-0166: Interim Guidelines on Preparation & Handling of Food in Temporary
Treatment & Monitoring Facilities for COVID-19 Patients
e DM 2020-0167: Interim Guidelines on Proper Handling & Disinfection of Noncritical
Items Used in Mgt. of COVID-19 Patients in All Health Facilities & Temp. Treatment
& Monitoring Facilities
e DM 2020-0168: Interim Guidelines for Dialysis Centers Catering to Suspect,
Probable, & Confirmed COVID-19 Cases
e DM 2020-0170: Interim Guidelines on Mgt. of Healthcare Waste in Health Facilities,
Comm. Quarantine Units & Temp. Treatment & Monitoring Facilities with COVID-19
Cases
e DM 2020-0178: Interim Guidelines on Health Care Provider Networks During the
COVID-19 Pandemic
REPATRIATION
e DM 2020-0181: Revised Interim Guidelines on the Mass Repatriation & Mandatory
Quarantine of Overseas Filipinos Working in Cruise Ships During COVID-19
e DM 2020-0182: Revised Interim Guidelines on the Mass Repatriation & Mandatory
Quarantine of Land-based Overseas Filipinos (OFs) During the COVID-19 Pandemic
PHILHEALTH PACKAGES
e PhilHealth Circular 2020-0009: Benefit Packages for Inpatient Care of Probable &
Confirmed COVID-19 Developing Severe Illness or Outcomes
PhilHealth Circular 2020-0010: Benefit Package for Testing for SARS-CoV-2
PhilHealth Circular 2020-0011: Full Financial Risk Protection for Filipino Health
Workers and Patients Against COVID-19
e PhilHealth Circular 2020-0012: Guidelines on the COVID-19 Community
Isolation Benefit Package (CCIBP)
e PhilHealth Circular 2020-0013: Provisional Accreditation of Health Care
Providers
I. Case Classification
WITH EXPOSURE
NO EXPOSURE With travel history from a Close contact with a probable
place with local transmission or confirmed case
a
NON-COVID-19 PATIENT PATHWAY COVID-19 PATIENT PATHWAY
ce e
G@E2 BHERT
ow
+
v
\ TTMF with Probable, mild
| = .
Primary Care
Facilities/
Primary Care
consults and
A
indivi
ineliie palroams aa
Suspect, mild
al)
=e
EF
TTMF with
sCCohorting
Confirmed, mild
POT im L1-L3
General
Tertiary Care or
hospitalization
(e.g. Mega TTMF;
PICC, etc.)
Bur
=
Hospitals El
(e.g. District
Hospitals) COVID-19 Confirmed, severe
a
Referral Hospital Probable, severe
L Suspect, severe
L
app eaLeals
_— Seer ees} COVID-19 Level 1/ Recovering
roma
Confirmed
|
Hospitals
2 Local transmission: where the source of infection is within the reporting location (WHO, 2020)
MUST KNOW FOR COVID-19 RESPONDERS 2
DM
ao MEGA LIGTAS COVID-19 CENTER (cohorting) primarily caters to
Confirmed Cases; can accept Suspect and Probable Cases
individual rooms and toilets.
facility has if
For purposes of
PhilHealth reimbursements: TTMFs and COVID-19 Level 1/Field
DOH
»
3 Per 2020-0123: Interim Guidelines on the Management of Surge Capacity through the Conversion of Public Spaces to Operate as
Temporary Treatment and Monitoring Facilities for the Management of Persons Under Investigation and Mild Cases of Coronavirus Disease 2019
(COVID-19)
4 Official branding of TTMFs
5 Per PhilHealth Circular No. 2020-0012: Community Isolation Units (CIUs) - DOH certified publicly or privately owned non-hospital facilities set-up
in coordination with or by the national government (NG) or local government units (LGUs)
to serve as quarantine facilities for probable and confirmed
cases of COVID-19 based on DOH guidelines.
MUST KNOW FOR COVID-19 RESPONDERS 3
—
III. Contact Tracing
A. Goals
i. To interrupt ongoing transmission and reduce the spread of infection;
ii, To alert close contacts to the possibility of infection and offer
preventive counselling or care; and
iii, To understand the epidemiology
of
a disease in a particular population
—_
B. Contact Tracing in Different Transmission Scenarios
No Cases Clustered Cases Community
Sporadic Cases roe
Transmission
+» =
Prioritize
medical and assess all assess all tracing of
office supplies, close contacts closecontacts high risk close
communication *
Testhighrisk «+
Test high risk contacts
lines, etc.) close contacts closecontacts (high-risk
exposure
contacts,
health
workers)
«
Synergize
with other
measures
such as
physical
distancing
C. Process
i. Contact tracing shall be initiated after case investigation of every
reported confirmed COVID-19 case. list of close contacts shall be
A
developed for every confirmed case and turned over to local contact
tracing teams (LCTT).
ii, LCTTs shall locate, profile and classify close contacts into the following
categories. Testing and quarantine shall depend on the classification
close contacts fall into.
MUST KNOW FOR COVID-19 RESPONDERS 4
CONFIRMED
COVID-19 CASES
ASYMPTOMATIC
Undergo laboratory
Monitor for development of
sign or
symptom until end of quarantine
confirmatory testing
NO
laboratory confirmatory testing
STEP 3
P/C/MESU
STEP 4
LCTT
-
1. Current: Ladderized
i. Notification of confirmed cases from EB > RESU > P/C/MESU
ii, Turnover of close contact list from P/C/MESU > LCTT
iii, Submission of close contact profiles and signs and symptoms
log form
from LCTT > P/C/MESU > RESU > EB
M
9 ~ #< A
=M
ce (> ll
2. Future: Web-based submission and validation
i.
atall
All levels will have access to COVID-19 Info System
levels
ii. Different levels can check and validate data submitted to the system
(similar to Google Drive), based on set of protocols
MUST KNOW FOR COVID-19 RESPONDERS 7
IV. Testing
(subject to change once expanded testing capacity has been achieved)
RT-PCR
WITH EXPOSURE
With travel history Close contact with a
EXPOSURE froma place with local probable or confirmed
transmission® case
ae
symptoms
Med Priority y High
9 Priorit ¥ High
g Priorit y
No
ee
Not Priority an
Low Priority eer
Low Priority
symptoms
Prioritization List
Subgroup A: Patients or healthcare workers with severe/eritical
symptoms, relevant history of travel/contact
6 Local transmission: where the source of infection is within the reporting location (WHO, 2020)
MUST KNOW FOR COVID-19 RESPONDERS 9
Technical Recommendation
Adopt a clear delineation between isolation and quarantine’ terminologies
primarily to support the rationalizing of medical attention for monitoring of
patients.
7 https://www.cde,.gov/quarantine/index.htm! (a) Isolation separates sick people with a contagious disease from people who arenot sick. (b)
Quarantine separates and restricts the movement of people who were exposed to to if
a contagious disease see they become sick.
MUST KNOW FOR COVID-19 RESPONDERS 10
(LIGTAS COVID-19
Center or Mega LIGTAS
COVID CENTER
individual rooms and
toilets)
Severe COVID-19 referral - -
hospitals
SUSPECT (FOR TESTING OR AWAITING RESULTS)
Mild TTMF with individual Home-based COVID-19 Level
rooms and individual self-isolation 1/field hospitals
toilets
(LIGTAS COVID-19
Center or Mega LIGTAS
COVID CENTER with
individual rooms and
individual toilets)
Severe COVID-19 referral General and -
hospitals Specialty
Hospitals (Level
2,3)
No Possible TTMEF
with individual Home-based -
symptoms Case/ rooms and individual quarantine
Contact toilets
(LIGTAS COVID-19
Center)
MUST KNOW FOR COVID-19 RESPONDERS 1
Financing RATK
» In compliance with RA11223, DOH and PhilHealth remain precluded in
financing and reimbursing Rapid Antibody test kits respectively since
not yet positively recommended by the HTA Council (HTAC). At present,
is
it
HTAC only recommends the use of RATK as part of a parallel multi-site
clinical trial and not as a sole screening and diagnostic tool for COVID-19
»
due
to limited evidence of
its accuracy or benefit (or absence of harm).
However, other public or private institutions are not prohibited from
purchasing and using RATK as long as FDA and DOH guidelines on its
purchase and use are followed.
MUST KNOW FOR COVID-19 RESPONDERS 12
PHILHealth PACKAGE
EXPENDITURE FACILITY NG/LGU
AMOUNT
Php 335,519.00
If with critical pneumonia:
Php 786,384.00
MUST KNOW FOR COVID-19 RESPONDERS 14
All identified close contacts shall be assigned anonymised identification for the
purpose of information sharing to or data analysis by individuals other than the
personal information controller or those designated to have access
and sensitive information.
to personal
Names and other unique identifiers shall NOT be released publicly or shared
with entities not directly involved in the care of the patient, or entities
unauthorized by law or other legal instruments to process such information,
without the patient's consent. Violations of this provision shall be punishable
by the penalties set by RA10173.
Only information relevant to the contact tracing shall be collected. The DOH
reserves the right to release information on COVID-19 patients that are relevant
for public health interventions without full disclosure of the patient's identity.
The Epidemiology Bureau shall be the personal information controller who will
be responsible for directing all actions related to the data, including the use of
personal information needed for the conduct of COVID-19 response activities
such as contact tracing.
The RESU, the LESU, other surveillance units and deputized agencies shall be
personal information processors and shall be responsible for assigning a data
protection officer and data protection controls such as privacy and breach
management.
MUST KNOW FOR COVID-19 RESPONDERS 15
GUIDING PRINCIPLES
1.
for “new normal”
Whole-of-government, whole-of-system, whole-of society shall
approach
be espoused in
the fight against COVID-19;
2. Science shall inform decision-making at the institutional and individual
level;
3, Recognizing limited resources, response shall be guided by fair and
transparent priority setting;
4. In the event of any conflict of rules or guidelines, human dignity and the
safety and needs of
the individual shall prevail.
National government
National government
(implementation and Local government
(policy and strategy)
coordination)
Lead Interagency Task Force National Task Force Local government
through NGAs through Task Groups units
Main « Strategies « Enforcement of +
Implementation
accountabilities + Guidelines strategies « Service delivery
+ Standards + Roll out plans
Impact monitoring « Resource mobilization
«
Operations monitoring
This document shall be updated regularly as science continues to evolve and guide our decision
making
in the fight against COVID-19.
Should you have queries or concerns, kindly email them to healthypilipinas.doh@gmail.com. You
may also visit http://covid19.healthypilipinas.ph for updated information.