CITIZENS’ CALL FOR A PUBLIC HEALTH COVID-19 STRATEGY

CITIZENS’ CALL FOR A PUBLIC HEALTH COVID-19 STRATEGY

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TOWNS Foundation, Inc. started this petition to President Rodrigo Roa Duterte and

CITIZENS’ CALL FOR A PUBLIC HEALTH COVID-19 STRATEGY

The FOUR IMPERATIVES if we are to reduce the toll that Coronavirus is laying on OUR COUNTRY

By BRIAN MICHAEL I. CABRAL, M.D.

and ESPERANZA ALCANTARA ICASAS-CABRAL, M.D.

An Urgent Call Carried by TOWNS Foundation, Inc.

1.      Knowing the enemy.

Well, we know what the enemy is.  It is a highly infective, potentially lethal virus. But we don’t know who and how many among us have it. Only a little more than 2,000 unique individuals have been tested in the 2 months that our one and only testing center has been doing the tests. There is a backlog of thousands of individuals who have been exposed to the virus and are ill who are awaiting their test results. Many have died without their doctors knowing whether their patients really had Covid-19 or not. The promised 24 to 48 hours within which results can be obtained is the biggest painful joke RITM has played on us. We know patients who have had to agonize for 12 days before they got their test results. In clinical practice, we do tests if they will potentially affect the management of our patients. If we have to wait 12 days to get a Covid-19 test result, we might as well not do the test. It is a waste of time, money and effort.

From a public health standpoint, we need to know how many cases we are dealing with so we can plan and act accordingly, revise our plans and react accordingly. At the moment, it is like we are playing “pin the tail on the donkey.” So yes, we need to test on a massive scale, for us to get an idea of where the enemy is and who they have captured.

One set-up can be:

a.     Screen at the community level, over the phone, or online and pre-approve for testing.

b.     Consolidate and take test samples at multiple, at scale, sampling sites in the municipality or city preferably near the testing laboratories

c.     Deliver sample to laboratories for testing.

d.     Deliver results to the city or municipal health offices for proper disposition

An example of a mega sampling site might be the St. Luke’s extension clinic in Malate.  Designed for TB testing and visa medical screening, it is equipped to handle hundreds of cases a day.  This could serve as the off-site testing facility for the Philippine General Hospital in order to segregate patients prior to recommending their transfer to PGH for care. Proximity wise, it could not be any better. Less than a kilometer a way, Pedro Gil could even be cordoned off in order to prevent public contamination. WE NEED MASSIVE TESTING!!! Those 100K test kits have been SITTING somewhere for a week. At this rate, we’ll finish those in months when all might be for naught. We need to test 100K now!

2.      Taking care of the ill.

We need to figure out where to put Persons Under Investigation (PUIs) and Persons Under Monitoring (PUMs) while waiting for test results. Our scarcest resources are our medical professionals. We need to consolidate the care we give to Covid persons/patients  to make our scarce human resources as effective and efficient as we can. We need facilities that can accommodate these hundreds, even thousands  of PUIs and PUMs and mildly ill Covid 19 patients. We don’t have that. No country did, not Singapore, not China, etc. Everybody built makeshift ones - we should too. Take over Araneta, Arena, Ultra, Rizal Memorial, The World Trade Center and make them makeshift hospitals. House the health care professionals in nearby hotels and shuttle them to the Covid facilities. It will make taking care of the patients AND health care professionals easier. We need dedicated facilities for seriously ill patients too. Having hospitals with “designated COVID wings” will not work as well as dedicated Covid hospitals.  You can’t play shifting manpower, PPEs, ventilators, etc on a daily basis. One will go mad doing it and you’ll sacrifice both the front liners and the ill. You can’t predict demand - you have to consolidate demand - and hence supply. All otherhospitals will be “referring hospitals” after triage to these mega-sites. Consolidate. Consolidate. Consolidate. It’s about reducing resource variability (PPEs, ventilators, beds, etc) and increasing effectiveness at the point of care - for both patients and front liners. We are expecting thousands to fall ill at the same time. If it doesn’t happen, great! If it does, at least we’re prepared - albeit a bit late now. Better late than never.

3.      Protecting the Frontliners.

At this writing, twelve doctors have died fighting coronavirus. That is 20% of all who have died from the disease. More health professionals are gravely ill from it. Hundreds are out of commission as PUIs and PUMs themselves. Doctors will fight to keep you alive. Nurses and other health professionals will too. But do not send them to battle without arms. They will die and we will have no one. Then we will die too. Let us protect them. One way is to make sure they are armed with adequate personal protective equipment. Gowns, masks, goggles, etc. we cannot rely on imports. The whole world is scrambling for PPEs for their own health workers. Homemade PPEs are well intentioned and at the moment, the frontliners are wearing them for want of anything better. But there is not enough of even that. Its time for industry to retool and produce what our frontliners need. PPEs that work, that have been tested to work and in numbers necessary to meet the demands of all of them, right down to the last doctor and nurse. Let’s wake the captains of industry up! While some of our volunteer health workers appreciate the P500 per day allowance, the issue goes beyond being given a “below minimum wage” allowance. Beyond the issue of money is proper protection, ample tools with which to practice their art and science, and an assurance that they will be taken care of should they fall ill in the line of duty and the unbreakable promise that their families will not be abandoned should they have to make the ultimate sacrifice. We note that the DOH has promised to look into increasing this allowance so that it does not add to the insult and stigmatization that some of our health workers are experiencing.

4.      Protecting the citizenry.

Getting through this crisis is not just about ensuring the health of the citizens, but the ability of everyone to get through the calamity  in a state where they can get back on their feet - not to mention survive. Workers, business people, government employees - everyone will need aid when the health crisis is over. The time to think through scenarios is now. If there are no assurances on what the other side looks like after the health portion of the crisis is over, the civil crisis that follows may even be worse. The time to think about government policies is now. Set the expectation, control the story, and deliver in due time. We said four things, and yes, those are critical, but we also have to get competent people to run this organization. Get a team of able-bodied leaders with real world experience in every aspect of the problem and who have been proven they can lead – with ability, brilliance, even, with integrity and focus. Enable them. Completely. This is a life and death situation, not just for individuals, but for the country. This is not an exercise for politicians who want to showboat. Unfortunate, but it seems that the IATF and the DOH appear to be fumbling and serving too many masters. The Coronavirus tragedy will not disappear on April 14. We need to build the infrastructure, we need to develop our human resources.  The next disaster is just around the corner. We need to be better prepared.

Let us join hands to guide and help our government. We need to act now. 

IMPORTANT: THERE IS NO NEED FOR ANY DONATION TO SUPPORT THIS PETITION. THANK YOU.

 

0 have signed. Let’s get to 5,000!
At 5,000 signatures, this petition is more likely to get picked up by local news!