 Magandang tanghali, magandang gabi po sa inyong lahat. Welcome to the 82nd episode of the Stop COVID Dex webinar series brought to you by the University of the Philippines. Maraming salamat po for being part of our credible online community and to all those who have just discovered us for the very first time ngayong araw po ito, isana po masayaan po kayo at patulip po kayong tumangkilik sa ating webinar series. For today, I believe you have already seen yung ating bangaposter po and really our topic which is very, very timely especially since we are ending the year and there are still a lot of targets in particular for vaccination that we need to attain. There are public health measures that we continue to adhere to, public health measures that we espouse and try to promote even if we have already well a relatively high vaccination rate especially in the natural capital region. Pero for today, we will be talking about what are the public health measures na kailangan po natin to combat infectious diseases ngayong in this day and age. We want to be able to know ano po bang pakakaiba ng iba't ibang mga terminal, epidemia, pandemia, ano po ba yung outbreak, ano po ba yung tinatawag nilang herd immunity, population immunity, all of these terminologies. We hope maliliwanagan po tayo for today's webinar. If you are looking for the latest science-based and evidence-based information, lala po sa ating mga distinguished panel of experts, then keep it right here. I'm Dr. Raymond Frances Sarmiento, Director of the National Telehealth Center, National Institutes of Health, University of Philippines Manila. Always a pleasure to be with all of you during our regular Friday lunch date and this will be our last Friday lunch date for the year 2020. Very, very special po ang ginawa po namin para sa ating last webinar of the year because we will be featuring aking partner, an international public health expert po natin. Also the Special Envoy of the President for Global Health Initiatives and that's what we announced and have been seen in the posters in the past few days. So please stay tuned if you want to hear more about what Dr. Susie Pineda-Bercado will be talking about. So for today, kasama rin po ito ng specialness ng ating webinar for today, I get to share hosting duties. One of the many phases behind the scenes of our production team. Very, very hardworking po. Hindi po siya kailas ay nyo because she has been subbing for Dr. Mercado when Dr. Mercado is unavailable. Please welcome to our webinar for today and the Assistant Vice President for Public Affairs and also the Director of the Office of Alumni Relations, Assistant Vice President Maria Angelica Rica Abad. AVP Rica. Hello, good afternoon Dr. Rima and welcome to all our participants here in the live broadcast of Zoom webinar. And to all those watching via live streaming on the TVUT YouTube channel as well as the UP System Facebook page, the TVUT Facebook page and the Stop COVID Deaths Facebook page. As Dr. Rima mentioned earlier, this is our last webinar for 2021 before we go on a season hiatus over the holidays. Kaya nga, document we're talking about sa meetings, kailangan talaga bongang pasabog natin with our main presenter. So we are already seeing in the chat box, everybody so excited to hear from Dr. Susina. So let's go ahead and read those who have typed in their messages here in our Zoom chat box. So some of them, we have Dr. Joseph Tertonov, Loma De Gato, Marila Obulacan, Dr. Jokoso, PCSO, Maria Severa Fick, Katalbas from UTB Sayas, Ilo Ilo City. Arnaulfo Kliensya from Tresa Matires City, Cavite. Marisa Garim from Santa Rosa, CH01 COVID Lab, and Felito Sampilo from Manila Health Department. Marami pang ibay si Lourdes Ilagan from Barangay 739, Zone 80, Trisik 5 Manila. So much more, ilo ko sa Sbanyas, Bataan, Albay. Even from abroad, we have our viewers leaving messages from California, Saudi Arabia. So please let us know where you're watching us from by typing in the chat box and we will give you a shout out later on as we move along the program. We would like to hear from you. Most especially those who are having the watch parties for the stop COVID-19 webinars. Please send your photos to our FB page and we will post them or even share them here in future webinars. And now, Dr. Rabod, I know many members of the UP Alumni Association in San Francisco are watching us today as well. Yes, AVP Rika. So ngayon po, no? Very, very special in our very special webinar and this is in line with the season spirit. At alam namang punatin ang Pasco ay panahon ng pagbibigayan. Meron po tayong maikling mensai po from the UP Alumni Association in San Francisco and the Apple Day Up Foundation International. So please watch this. Greetings from San Francisco. I'm Sonia Dellen, director of the Apple Day Up Foundation International and director and immediate past president of the University of the Philippines Alumni Association of San Francisco. We are thrilled and proud to announce with the kindness of the UP Alumni Association of San Francisco, the Apple Day Up Foundation International, Together with fellow alam Yobi Benjamin and the Zymo Research Corporation. This group is donating 227,000 units of COVID-19 saliva collection test kits or $2.85 million or about 145 million paces to the University of the Philippines. While the world continues its battle to end COVID-19, the scholars on buy-in in the United States carry on its effort to support our cup of buy-ins in the Philippines. These COVID-19 test kits will be a great help to the university, especially in the Philippine General Hospital for its patients, the students, the medical frontliners and the community. These test kits can also be used to strengthen the university's resumption of the face-to-face classes in the upcoming months. The UP Alumni here and around the world are always in support of UP as our national university in providing academic excellence to the young Filipinos, as well as the Philippine General Hospital as a nationally designated National Hospital for COVID-19 cases. As UP namin mahal ses, malayong lupa in aming mga marating, di magbabago ang damdamin. Mabuhay ang UP, maraming salamat po. Okay, thank you so much to the UP Alumni Association and the AppleDapp Foundation International for your... I didn't know the equivalent amount, the AVP Rika, so I was stunned and pleasantly surprised with that donation. Over to you. Yes, as Dr. Raymond mentioned, important talagatong donation ng UPAA San Francisco with AppleDapp Foundation International because they're going to help with the testing of our students, our faculty, your staff at Philippine General Hospital. Okay, so as Dr. Raymond has mentioned also, the case numbers have been going down in the last weeks, not only in the Philippines, but in many countries as well. And that's why some restrictions like mobility and masking have been lifted in Europe and life seems to be slowly going back to a semblance of normalcy. However, we were all stunned by the spread of Omicron, leading many people to wonder if this means another round of lockdowns and overwhelmed health systems. So in this webinar, we will ask the question, will we ever control COVID-19? Thank you AVP Rika. For those who are joining us for the very first time, we usually have a brief video prepared by TVUP. What we call the person on the street video. It's what we do to put our discussion into context and essentially set the tone for our panel discussion. The question that we pose to the person on the street is as follows. Sa tingin po ba ninyo ay matatapos itong COVID-19? Kailan kaya matatapos ang COVID-19? Please watch this. Sa tingin ko ay mahubuwayin nalang tayong may pandemiyang ngayon. Kasi siguro baka tawag-tabuti nito. Kaya siguro rali nalang natin ko pa na natin magpatuloy ang ating buhay habang may pandemiyang. I think matatapos lang yung pandemic. If globally, lahat ng countries ay magharmonize ng plans and strategies kung pa ano i-ma-maximize o i-utilize yung mga resources, especially the vaccine. Pero tingin ko naman matatapos yung COVID-19 na bakonahan na yung mga 90%-80% sa Pilipinas. Nag-ikiisa naman yung iban tao sa pagbabakuna. Pero meron pa rin nga ilang tao na ayong magbabakuna. Ang masasabi ko lang talaga ay lalaban lang kasi may solution naman. Once yung nga, once may maramdamantayin sintomas, magpatingin na tayo para hindi na natin makalat pa yung virus sa ating kapua, sa ating komunidad. Tingin ko matatapos na itong next year kasi kung asikasuin lang ng maayos yung mga nagbabakuna siya asikasuin nila yung mga taong ayong magbabakuna. Syempre magpalakas pa rin ng immune system ang bawat isa kung kaya makapag exercise, makapag vitamins, makakain ng healthy foods. Siguro magandang mag-practice natin yung. Kailagang magkarantay ng healthy living. Pagpatulin natin kong yung inagwalati sa araw-araw dahil matatapos din naman yan kung tayo mawala ng pagasa dahil nating nga nang matatapos din yan. Magbabakuna na ayong para nandunawli tayo sa normal. Maalabas tayo, wala tayong pacemus, magala tayo kung sanating gusto. Hindi tayo basta-basta masisita kung sa kaling wala tayong kumain tayo sa labas. Matatapos din tong laban natin sa COVID-19 kung sama-sama naman tayo at tulong-tulong tayo na gagawin yung solution, yung mga dapat at hindi natin gawin ngayong pandem. Thank you TV UP. It's always good to know what people on the ground are thinking. Pag-good na almost two years dito and we all want the pandemic to end. So I think this webinar will help empower our viewers, especially our healthcare workers with the correct information so they can confidently answer the question of their patients, colleagues, friends, family, relatives. If they ask them, kail ba matatapos tong pandem yang to? Go ahead, Dr. Raymond. Okay, well that was really an interesting take by our persons on the street. So maraming-maraming salamat ko for TV UP for preparing that brief video and I hope that's something that over the holiday break that we could ponder upon and reflect upon and something that everyone could hope for in terms of a better 2022 and that year ahead. Anyway, our webinar is able to accommodate a maximum of 3,000 participants. I'm seeing 620 plus attendees at least in the Zoom. We all know na marami po ang ano-nood sa Facebook at sa YouTube po natin na where we are being live streamed. So please give us a shout out dun po sa comment section and please let us know if you are watching na kayo lang po mag-isa or may kasama po kayo whether it's your family, your co-worker or your relatives po and friends, we hope that you'd be able to join us sa Zoom po, makapasok po kayo sa Zoom para po mas makasalip po kayo and get the full interactive experience in Zoom. We also like everyone to participate in our fun quiz. Ito na po ang ating, as you know, will be our final fun quiz for the year. Meron po tayo sa Zoom at meron din po tayo sa Mentimeter. So lahat po nang hindi po makakasali sa Zoom ay sana po mag-participate sa ating Mentimeter poll for today. So for today's fun quiz and ito po ay very, very targeted for those who are not in the Zoom, open your browser, type in www.menti.com and use the code 70489589 that's 70489589 for you to be able to participate in our fun quiz. And for all those who are asking whether sa ating Facebook Messenger nag-direct message, nag-e-mail, et cetera, certificates of attendance will be given to those who have watched at least 50% of the webinar duration. Alam po namin na marami po ang nag-attend outside of the Zoom. Mag-message lang po kayo because we have already distributed all the certificates for the previous 81 webinars po natin so we hope na kung siya naman po ang hindi nakatanggap and should have received one there are staff from the webinar series team who will be taking care of all of your certificate needs. A-V-P-Rica? Yes, wow, paskupasko na. We are all looking forward to sana. Very peaceful Christmas and we always try to bring you innovative ways of learning and also to give you hope some hope about our situation. So please join us for this very important session as we will learn the latest information here in your credible online community. We always bring you a distinguished panel of experts for a meaningful discussion on current COVID-19 issues. Okay, so for those who are again joining us for the first time mayan po tayong standard structure for our webinar using the standard panel discussion format that we have a main speaker whom you already know who will be presenting about the topic at hand then we will be hearing a set of reactions from other speakers that will be followed by a Q&A session those who will be let's say prompted to open your videos and audios dahil po mayan po kayong katanungan sana po ay makapag-join po kayo and you will be able to ask any of our speakers live sa ating Q&A session mamaya. All questions coming in from Zoom, from Facebook, from YouTube will be entertained in the Q&A session. Okay, so to set the tone for today's webinar we are very pleased to have as our opening remarks speaker the Dean of the College of Public Health and also he's the director po of the semiotrop med which is also the College of Public Health at the University of the Philippines Manila none other than Dr. Vicente Bilizario Jr. or Dean June Bilizario. Dr. Susan Pineda Mercado Secretary Enrique Ona Dr. Annette David Dr. Vivian Fadrilan Camacho University officials are friends from PVUP faculty, staff, students ladies and gentlemen a very warm welcome to stop COVID deaths webinar number 82 where we will discuss a special topic this time on public health aspects of the pandemic control of COVID-19 will we ever be able to control COVID-19 just when we thought we would be on a positive trajectory with less transmission and lower hospitalization rates the identification of omicron as a new variant of concern has sent new waves of uncertainty and frustration throughout the world a question in so many people's minds will we ever be able to control COVID-19 what can we learn from previous epidemics and pandemics that can help us build reasonable scenarios around what we expect what are the public health measures needed to continue to combat COVID-19 and other major infectious diseases in this day and age who will need to take on major roles in leading overseeing and implementing these public health measures in this episode of stop COVID deaths public health expert doctor Susan Susie Pineda Mercado a contemporary in pre-medicine and medicine days hi Susie will reflect on what it will take to control COVID-19 using the lens of history and the perspective of public health that entails looking beyond the biomedical solutions to health problems but rather understanding the ecological and social contexts political systems culture and economics that drive infections and inequalities in health reactors will be very familiar figures in public health first Dr. Anet Dabil another contemporary in med school hi Anet I will not say how many years ago Anet is a public health expert and active leader in the medical community of Guam so we were together recently in a WHO Western Pacific Regional Office Forum we will hear from our former professor in surgery in the college of medicine former secretary of health Dr. Enrique Aikona hi sir and last but certainly not the least a colleague in the deans management team in the UP college of public health trochmed Philippines Dr. Vivian we call her Ping Fe Padilan Tamacho associate lean for research the UPCPH trochmed Philippines is very pleased to be part of this last episode of stop COVID death series for 2021 we look forward to next year's episodes of stop COVID deaths hopefully more public health related topics that remain so relevant to our fellow Filipinos pre during and beyond the COVID-19 pandemic as we are in the Christmas season allow me to wish one and all isang kumukutikutitap mapayapa at mapapalampasko po sa ating lahat kasama ating mga malsa buhay stay safe stay healthy stay connected together we can stop COVID deaths okay thank you very much Dean June Belisario of the U.P. College of Public Health for your very inspiring words our webinar title nga naman Doc Raymond Stop COVID Deaths and that is our goal by disseminating the latest information for a clinical management and treatment as well as to combat the proliferation of fake news kasi nga during times of uncertainty dyan talaga lumalaganap yung mga incorrect information na umi-equot na Doc Raymond Yes, the IVP Rika so thank you so much to Dean Belisario for taking the time out to give us well, that video message and it's not every day that we are able to get a very, very busy to Dean June so hopefully we'd be able to get him live next time in our webinars for 2022 before we proceed we'd like to ask everyone to participate sa ating fan quiz so ito na po ang ating there we go sa zoom lumabas na po siya sana po sa mente lumabas na rin po siya meron po tayong dalawang ka tanungan for our fan quiz for today the first question reads which of the following diseases have been eradicated in the world so isa lang po ang pipiliin po natin dito I'm seeing a whole lot of attendees medyo papasok na po sa pag-participate dito po sa zoom at sa mente may malapita po mag-90 sa mente at meron na po 140 plus sa zoom the choices are smallpox option 2 polyo option 3 tuberculosis option 4 mesels and option 5 dengen so bago po tayong mag-question number 2 we'd like to greet those who are joining us from mid sayap from the senate of the Philippines also which is in Paasay meron din po tayong joining us from the Bicol region those also coming in from the house of representatives in Quezon City the doctor Andres Lociano district hospital in Magalampampanga from the DOH Malinao treatment and rehabilitation center in Albay senior citizens association in Barangay Tisa in Sibu City and Negros Oriental provincial hospital in Domageti City finally we have those from general Santos doctors medical school foundation in general Santos city in south Kotobato for question number 2 we have this question which of the following infections contributed to the highest mortality across all ages sa taon po ng 2020 ang mga choices po natin are COVID-19 option 2 tuberculosis option 3 HIV option 4 pneumonia and option 5 diarrhea disease meron po tumatalon po doon sa ating MNT na siya sa COVID-19 ok na ok po yun those who are joining us from Sambuanga City Medical Center and Technological University of Philippines maraming-maraming salamat po there are also those who are joining us from Bangkok, Thailand Jakarta, Indonesia Taipei, Taiwan Doha, Qatar from Dubai United Arab Emirates from Hail Saudi Arabia Lunichi Alley University of Bleeda 2 in Algeria the University of Fiji, Laotoka Sacramento, California St. Catherine's in Ontario, Canada and the School of Health Care Practice University of Bedfordshire Luton, England I think that's the very first time that I'm giving a shout out in Luton, England so maraming-maraming salamat po humabul po ang ating participant from Apalit Doctors Hospital and the University of Perpetual Health Molino in Cavite so maraming salamat po we will not be closing our fun quiz dahil alam po namin may mga magpaparticipate po kagaya po ng ating attendee from Hospital Nambinyan Laguna so hopefully maraming pa po ang sumali sa ating fun quiz for today kasi 63% palang po ang sana po mas maraming pa po magparticipate of our attendees at least in Zoom have participated in our fun quiz over to you AVP Rika So I think the answers of our viewers at Zoom poll and Mentimeter gives us a good sense of what our viewers are taking out the agreement so let's go ahead and introduce our experts panel it is with great pleasure that I will be introducing our main presenter she's an internationally renowned public health expert and was formerly the strategic advisor for COVID-19 in the Philippines she served as a director of non-communicable disease and health with the World Health Organization and has served as undersecretary and chief of staff of the Department of Health in the Philippines please welcome and adjunct faculty with the UP National Telehealth and one of the pillars in our Stop COVID Deaths Family our friend our idol Dr. Susan Pineda Mercado Dr. Susie Hello, hi Rika and Daka parang maguloy Okay, so hello Rika and hi everyone it's a little different to be on the other side of the other side of the what should I say the other side of the the panel and presenting and I just want to greet everyone Merry Christmas in advance nice to see everyone here and we're all going to miss each other during the during the break but we all have to take a pause so I'll go ahead and go ahead with my presentation Rika just go ahead everyone's so excited to hear from you Dr. Susie oh my goodness the pressure is on okay okay so alright okay so I've been given the difficult topic of will we ever control COVID-19 and I have to admit I had to think very deeply about what I was going to say because I don't have a crystal ball no one does I think as we gain more information we learn more we can look at certain trends and sort of see what might happen so let me start by just talking about this closure so I have no interaction or research with any commercial entity involved in products or services for COVID-19 okay so I've summarized my work into a couple of messages so the first message is that the key to control of an infectious outbreak is for everyone to understand the mode of transmission and when we say understand the mode of transmission it means that we just won't know it in our head but we also behave in ways that will prevent us from getting infected so how do infections spread there are just a few ways that any infection will spread would be through direct contact such as touching the bodily fluids for example of an infected dead animal those of you who saw the movie Contagion that was how that outbreak was described somebody a chef touched a pig that had just been slaughtered that had a virus and the person the chef had the virus and that mutated okay another way would be droplet spread and we have heard a lot about this for COVID-19 inhaling from another human being expulsive let's say cough or laughter or sneezing and for the most part we had worked on the assumption that the spread is mainly through droplets recently however there's been increasingly concern increasing concern about it being airborne and aerosolized microbes are inhaled we knew this in in the hospitals but lately with the delta variant there's increasing evidence to show that maybe we do have or airborne spread in closed spaces where all being advised not to be in poorly ventilated and congested areas fomites which is getting it from surfaces such as touching things and I think nowadays we know that this is less the means of transmission in the early days we thought yes you know might be because of touching different surfaces but it seems that it's more about droplets and about airborne transmission and then of course our vectors mosquito sticks fleas flies and of course food and water are other ways of getting infections now I was looking for a good example for us to look at how this plays out in history how understanding the mode of transmission is very important because if we don't understand the mode of transmission then we will not be able to prevent it so one of the biggest causes of an infection that cost many deaths was in 1347 to 1351 called the Black Death or bubonic plague this was believed to have originated in China and moved through trade of Genoese ships to Sicily, North Africa, Italy, Spain, France, Hungary, Switzerland, Germany, et cetera and as you can see the pathology is that they had these bubbles or parang pas that was collected all over the body and they thought that this was a punishment from God so you can see somebody praying here or that it was caused by bad air or by poisoned wells or even by foreigners so at that point in time they didn't know what the cost of bubonic plague was now fast forward to 2012 bubonic plague reappeared and has consistently reappeared throughout history but it did reappear in Madagascar in 2012 and this is what the hand of a person with bubonic plague looks like there were 60 deaths in 2012 now what we know about this disease is that this is not because of bad air or foreigners or poisoned wells but that certain fleas that were found in rats carry the plague bacteria so it's a bacterial infection it's not a virus that bites human beings and then creates those bubbles ito yung mga parang mga pigsang malalaki that affect the lymph glands and in Madagascar in 2017 there were 209 deaths so this can be treated through antibiotics when it's diagnosed but you could see that you have a significant number of deaths for a disease that we clearly understand the mode of transmission okay so what they started to do then was there were many slums in Madagascar they started disinfecting the slums but there was too little too late and more than 200 people died the carrier is a rat that carries this bacteria your sinia pestis but the rat doesn't get sick so the rat carries the flea and the flea has the bacteria and the rats are all okay they're happy they move around but it can kill people so instead of thinking about the bad air or foreigners actually the carrier of the black plane were rats that were on ships and the rats had fleas and they bit people and that was the reason why there was a big epidemic okay so let's go to viruses and you've heard about many viruses and our discussion will not be about bacteria but I wanted to talk about the bubonic plague because I wanted to say that we have to understand the mode of transmission and once we understand the mode of transmission we are here to control the infection but sometimes we don't want to accept what the mode of transmission is we have other ideas about how we get the virus and with viruses so these different viruses corona, rota, influenza etc very important to know how we get them so I'm going to do a little quiz if this is okay Raymond and Rika because I can't see the chat box but I'm going to ask the question and please answer in the chat box what do you think there are in the world no open no google yung how many viruses do you think are in the world are there in the world so ang mga sagot ang mga sagot partner in the billions in the thousands may sumagot ng 6 may sumagot ng 500 100 trillions may sumagot din na infinity and 200,000 so iba iba po okay so viruses are very much a part of our world and when I tried to look at this National Geographic in 2020 said that there are 10 noninillion I don't even ever heard of noninillion it's not even billion or whatever noninillion or 10 to the 31st power is the number of viruses in the world and it's enough to assign one virus to every star in the universe and timing stars times 100 million times now of all those viruses only 219 are known to infect humans the problem is if a new virus starts infecting humans and our body doesn't know how to recognize it it can kill us so despite the 10 noninillion viruses in the world it takes one new virus that the human body does not recognize to cause as much disaster as has been caused by SARS-CoV-2 okay, message number 2 as long as there is a desire for animal meat mutations of viruses from wild animals will continue to mutate and infect humans so this was a statement made by Godin Galea the WHO representative to China and this is just going back a little bit to the history of where SARS-CoV-2 came from now what's happening is we're destroying our environment we destroy our environment we destroy our forests and therefore the animals and the insects come closer to human beings because a lot of those noninillion viruses actually are in the wild and they are part of the lives of wild animals or wild insects and if we destroy the habitat of in the wild then they come closer to human beings and where you have close interaction between human beings and animals from the wild so for example chickens yung mga chickens ano domesticated sila but sometimes they interact with wild ducks or flying birds that carry viruses that can mutate and affect human beings so when we take a look at recent outbreaks so the first one was SARS 2003-2004 came from the civet cat now the civet cat is very cute as you can see but this is a delicacy soup it's used for soup and if you butcher a civet cat that has a coronavirus and you have a human coronavirus the possibility that these two viruses will meet and decide to level up and become an infection for human beings is a possibility so in the SARS epidemic the coronavirus of a civet cat and by the way many mammals have coronavirus dogs, cats civet cats, camels, pigs you name it they all have coronaviruses but the coronavirus of a civet cat is only for civet cat in the same way that the coronavirus for a camel only a coronavirus for a camel but the coronavirus of a camel and the coronavirus of a human being can decide to live together and make a new kind of virus a mutation so dealing with wild animals and eating wild animals actually increases the risk for new viruses to come out so SARS epidemic 2003-2004 27 countries 8,000 people sick 744 died now in 2012-2015 another coronavirus emerged from the Middle East so this is the Middle East respiratory syndrome coronavirus and 27 countries were affected 2006 and 720 died now SARS-CoV-2 as we know it is most likely a mutation from a coronavirus of a bat and coronavirus of human being and so far well the jury is not out on this yet but this seems to be the closest connection and 219 countries have been affected 266 million people have gotten sick and 5.2 million people have died and this again comes from consuming animals from the wild now to understand an epidemic we have to go to some basic public health principles and I would like to introduce and I did talk about this last week the concept of the epidemiologic triad so this is a triangle at the center you have to have an agent so like a virus you have to have a host which could be human being and the host and the agent are interacting inside an environment now our agent SARS-CoV-2 there's alpha, beta, lambda delta, mu, omicron so mutating we have a mutating agent the host could be poorly nourished could have comorbidities like diabetes or hypertension or a weak immune system and the environment is where the Philippines has a double whammy because we have crowded living conditions many OFWs who had to return from places where the pandemic was and congestion in the cities so even if you do everything you need to do about this but you still have this kind of an environment and you have poor immune systems of the host it's very difficult to control an infection or an outbreak so what do we need to do for the agent vaccine of course is the most important one and if we had to choose between modifying the environment and doing something about the host the easiest thing to do is to vaccinate and we have shown, I'll talk about two examples later how vaccination is probably one of the biggest breakthrough of public health that we've been able to stop some diseases in their tracks through vaccination programs now under the host there are many things we have to do the host has to be has to have availability of tests of treatment the host needs food so when you lock down and there's no food what should I say you create more risk because people's immune systems go down when they're not eating properly if tests are not available there's no way for them to know if they have the virus or not and even if treatment is available in the hospitals if they have no access because they have no money for transportation how are they going to get treatment now in the environment how are you going to do isolation in people living in an intergenerational house and that's typically what we see in the Philippines in the Philippines one out of six individuals lives in a slum area safe transport how would you have safe transport we don't have we're not a nation of cars or everyone has their own car people have to ride public transportation which may be poorly ventilated workspaces may also not be not be good like factory conditions we have very poor ventilation and then the cities are so congested you just go to the drug store 60 canay wherever you are in an urban area of the Philippines so if we don't address some of what we call the social determinants of health you can you can vaccinate and vaccinate but if people go back to this and people don't have what they need to be healthy then your infection can continue so we have to think about in public health we think about those three things we cannot be sort of single minded and just have tunnel vision in terms of how to control a disease we have to think about this now let's talk about stages in the control of infections because I was very disturbed when people said we're going to eradicate COVID-19 really? I'm like are you serious? so when we talk about control of infections there are certain stages and so from pandemic which is the worst and I'll talk about what the definition of pandemic is which is more global and you have epidemics which is more local and then you have status where you always have the disease there and then control where you beginning to see a decrease in the number and elimination where you purposely purposely do extraordinary efforts to to get rid of an infection and eradication where you actually remove the agent so we said agent, host, environment you actually remove the agent so for a pandemic you need to have three continents and that's why we have a pandemic actually all continents have community transmission in an epidemic you have a steep increase in numbers in a locality but if for example a disease does not have you have no cases so for example in a particular city measles is zero and has been zero for three years if you have one case it's an epidemic because it is a steep increase in an infection that you never had for three years endemic means it's always present in a locality and there are a number of diseases that are endemic to the Philippines I'll talk about this shortly it includes tuberculosis it includes dengue, it includes a number of pneumonia is endemic for our country and okay and then control occurs when you have a program in place a program in place that reduces the number in a certain locality so the program is important because it means you're going to continue to do it over a period of time you're not just responding like it's an emergency but you're doing it over a period of time and then in elimination you have extraordinary measures that are done so for example in some cases we have you give mass treatment that say for the whole community so that you are slowly removing the agent from the environment and in eradication the agent is removed globally so this is usually accomplished through global vaccination programs okay so one of the things I wanted to talk about was that the word herd immunity has been used very loosely during this pandemic actually herd immunity only occurs after decades of routine vaccination meaning you have to have a program in place to continuously vaccinate people because people move around because new people are born babies are born there's a lot of migration there's a lot of interaction there's a lot of travel so routine vaccination is very important as long as there's community transmission re-infection is always possible so herd immunity cannot be bandied around as a target that we're going to achieve in the near future it takes a long time to achieve herd immunity unless not unless so I put an asterisk there so you get one shot and you never get COVID-19 again we don't have that shot yet in fact we don't even know what the level of neutralizing antibodies is for the vaccine we don't know if your current vaccines will last 6 months or 8 months or 12 months so science will have to catch up and most likely come up with a vaccine that can be given to children so that they get that shot once and they're protected for the rest of their life but we are not there yet so I think herd immunity okay that will require a lot more work than we think okay so smallpox was the first infectious disease to be eradicated globally by the World Health Organization in 1980 and this campaign lasted from 1958 to 1977 so I don't know how many years that is 58 I don't know I don't know Ramon ano ilan ba yan so this campaign lasted for a long period of time how many? 19-20 years 20 years okay to eradicate smallpox and buti na lang it was eradicated because you can see the suffering from smallpox now polio first epidemic was in 1894 and the World Health Organization campaign started in 1988 now when I talk about the World Health Organization we're not talking about that office there in Geneva the World Health Organization is made up of member states so the different countries think about it like a club there's a club and it's called the World Health Organization and all the ministers or departments of health are members of that club so when I say the World Health Organization campaign it means all of the ministries of health all over the world started this campaign in 1988 and by 2000 there was a 99% reduction in cases and the Philippines was part of the success story of polio in fact in the year 2000 we did eradicate polio in the Philippines from 2000 onwards this ended in all continents eradicating polio except Asia where both Afghanistan and Pakistan still have cases so polio is not globally eradicated because Afghanistan and Pakistan still have wild polio virus still have children developing polio and in 2020 there were 140 cases but as you can see when we're getting to the point of eradication we're actually counting and reporting the numbers of people who have infection and 140 is not a lot of cases for the whole world but it still means that you have 140 kids out there who got it because of some kind of transmission so it's not completely eradicated so what are tools for managing infections the most important one is of course information and information is important for changing our behavior for surveillance or understanding what's happening in a population for treatment at STAPCA with deaths we talk about treatment and the changes in treatment environmental modification so we did over the past few months many months we have talked about the importance of well ventilated environments and then prevention which includes vaccination now just a quick look at some of the endemic diseases in the Philippines we have 100,000 infections per year about 200 to 300 deaths per year but in the world we're one of the top 10 that has not been able to control rates tuberculosis we have 1.1 million active disease cases and a high multi drug resistant TB rate despite the fact that we have vaccination we have medications we have what we need tuberculosis but we have not controlled it we have 74 deaths per day and we have the highest TB rate in Asia or the third highest rate in the whole world for dengue we have about 80 to 90,000 infections every year there were less this year 324 deaths per year but the highest risk and as you know this is vector born and then for COVID million cases over the past 2 years with 39,000 deaths I think this must have changed already from the last time I made this slide for 24 months or about 53 deaths per day and second in the ASEAN by rate cases per million so if you compare the number of deaths from tuberculosis and COVID of course it's not fair to make that comparison we wonder how is it that we have allowed these infections to continue in our country at the rate that they do and tuberculosis is airborne mind you the tuberculosis Basila can live in the air for 8 hours so if you are in a crowded movie house and somebody with active TV and multi-drug resistant TV starts coughing you come in 2 shows later and that Basila is still there in the air so how is it that we have the means the instruments the tools to control these diseases but we don't do it alright so we can ask the question right if more people are dying from TB than COVID-19 then why do we respond this way well COVID can kill quickly so unlike TB where it takes months or years of suffering before death COVID-19 seems to pose more danger because it can be short and very intense and requires ICU rich people don't die of TB well there are some people who have money who do get tuberculosis but the great majority of people with tuberculosis are poor and they are often blamed for getting tuberculosis hindi kasi nila inina mong gamot matigas ang mga ulo yan ang mga sinasabi natin di ba nobody notices when a lot of poor people die but when rich people start dying of something aba iba na yan di ba kabadong kabadong na tayo so this is a situation it's really not acceptable because we do have all the means that we need to be able to control tuberculosis and if we have not done it then it's endemic in the early days we did not know much about COVID-19 and we didn't have good drugs and medicines and health workers got infected and so this is a reason why there was such a big outrage around COVID-19 because there was a fear that the health system could collapse and it still can go to handle this properly it can still happen. All right message four risk communication is one of the most important control measures of a pandemic and when we understand the mode of transmission prevention is possible risk communication is the key but when people don't trust the government or they don't trust the authorities we have what is called a destabilized communication environment that causes decision makers to panic so Peter Sandman who is the guru of risk communication says that the perception of risk comes because of our outrage or our reaction in the actual threat so in the case for example of tuberculosis you have a big threat but people are not outraged they don't really care and therefore we don't think that there's a big risk but actually there is a big risk okay in the case of COVID I would say maybe we could say you have big threat and big outrage sorry big threat big outrage and therefore big risk perceived to be a big risk and then in another condition for example you could have a small threat right but a large outrage people are you know very very scared of something and therefore you know a big perception of risk or malaki ng takot so all of this depends on how we perceive the threat and what our emotional reaction to it is now let me just share a one minute video from from Europe a few days ago this was yesterday Vienna's famous Christmas market rammed with people cramming and some last minute festive shopping before the country was once again plunged into lockdown and indeed this was the same market today Austria is facing soaring COVID cases increasing deaths and some intensive care units reaching capacity but a despite outrage on Saturday protest is making their feelings known not just about lockdown but about the mandatory vaccinations plan for February organized by the far right freedom party the placards read coronavirus dictatorship unvaccinated equals 100% safe Austria has one of the lowest vaccination rates in Europe just 66% have had both jabs across Europe the Delta variant is spreading fast and so too are the protests in Brussels last night police used water cannon against some protestors they in turn reportedly used smoke bombs and fireworks the Belgian government has introduced mandatory mask wearing and working from home in the Netherlands a three week lockdown led to three days of protests five police officers were injured in Rotterdam on Saturday this morning the Dutch Prime Minister Mark Rutter described it as pure violence by idiots while the German Health Minister said this the UK's infection rates are significantly below Austria's 1,092 per 100,000 over the last seven days compared with 425 for every 100,000 but they are four times higher than Italy something very strange would have to happen okay so I just wanted to show you this to give you an example of what's happening in the rest of the world so I just wanted to show you this to give you an example of what's happening in the rest of the world while we are lining up to get vaccinated in these developed countries there are protests against vaccinations how are we going to control this this virus if people aren't agreed on what you know on how this is transmitted and what kind of danger it poses to us okay so message number five and I'll try to go through this as you're faster I promise not to take too long we were handicapped from the start of decades of neglect of the public health system in the Philippines the early constraints we only have one biosafety laboratory level 3 and that's why the testing was very slow if you remember the first few Chinese travelers who had COVID we had to send our results to Japan and Australia because we could not verify them here we did not have local PPE production which resulted in deaths of health workers who were using and reusing their PPEs and a big strategic mistake in the beginning was that we allowed all hospitals to accept COVID patients and therefore we had outbreaks in hospitals, some of the big hospitals had to close down entire wards so these were our early constraints we knew that something was coming but we were not prepared and this is as I said it is because of decades of neglect of public health it's not just because one decision was made no, matagal na ito hindi natin pinagplanunghan I'd like to talk about the global proliferation of high-containment laboratories because we obviously got left behind in terms of developing laboratories that could test for manipulate and actually track down viruses and their mutations so right after 9-11 there was a big fear about bioterrorism and so China built 20 level 3 laboratories Taiwan built 20 Finland built 13 France had 12 Germany had 97 more than half of which were in Berlin India had 6 Indonesia 2 Ireland 31 Singapore had 10 Russia had 84 Pakistan had 2 Mexico had 4 Malaysia had 3 Japan developed 200 biosafety level 3 laboratories Italy had 4 Sweden 40 Switzerland 26 Thailand 23 the UK has 600 the USA had 1643 and the Philippines had one and only one biosafety level laboratory the research institute for tropical medicine and when former secretary Quasi Romaldes was alive he was the one who set up the research institute for tropical medicine early on he was already saying we have to have more of these laboratories in different parts of the country and actually we had plans for vaccine production that were going to be done in alabang with the late Remy Olvedo it's not like we did not think that we have to prepare now why is the biosafety level laboratory 3 important it's important because you cannot set up biosafety level 2 laboratories which have the RTPCRs unless you have the mother laboratory which is a biosafety level 3 laboratory so right now I think we only have 3 in the country if I'm not mistaken RITM NIH and possibly the Philippine General Hospital are level 3 but is that enough for 110 million population in an archipelago look at what the others have invested in look at how they have seriously taken very seriously at the threat of a pandemic so in 2020 in March 16 we had one testing laboratories and all the hospitals accepted cases and that was a disaster by August we had 110 testing laboratories so this is to the credit of the NIH and RITM then 3 COVID referral hospitals including the Philippine General Hospital plus community isolation beds and so we got a little bit more organized but by March of 2021 we went under general community quarantine there were more testing laboratories multiple COVID hospitals and yet we had full ICUs and full ERs this was the start of Delta so okay again as I said our double WAMI is continuing community transmission of the urban poor and returning overseas workers and somehow our officials can only focus on one or the other pag maraming moawina OFW all our resources go there or pumukutok sa isang urban slum area lahat na attention natin and we have to do both we have to be prepared to handle both of these because we are in a very unique situation we are the only country in the world with 10 million overseas workers who may be coming from COVID rich countries so the other thing is we don't have electronic medical records so right now contact testing is still a mess testing is done manually I don't know where we would get a record and say this person tested for COVID got sick got well got vaccinated got a booster wala para ang gulogulo kasi we don't have electronic medical records message six if we do not invest in public health and social determinants of the health COVID-19 will become a chronic and lingering disease of the poor like tuberculosis and we are already people who have the access the money are traveling to other countries to get the vaccinations that they want to get the boosters whenever they want it they have their own homes they have their own doctors they have their own nurses so what do we need to do okay we need to invest in a Philippine CDC we do not have the surveillance capability that we need to be able to track every port every island every city what's happening everywhere we just haven't invested in it and I said as I said when quasi-rumual this was secretary of health we already had a floor plan for this and the money but as it happens in our country when things changed and when leaders changed then all the good plans changed we need more laboratories level 3 and 4 and we need more genome centers through the hard efforts of Chancellor Padilla and our colleagues in the Philippine genome center at least we have one but that's not enough for us we need more genome centers all over the country for treatment okay we need to seriously treat infectious diseases in every province and every city and I'm not just talking about COVID we're talking about tuberculosis dengue rabies malaria all of those infections that we have neglected we have to be very serious about treating them and this means specialty training for infectious disease for doctors and nurses we need to do something about the environment we have to decongest our cities we have to implement family planning there are too many Filipinos too many babies being born we heard this already in the webinar how many are born to teenagers 52 every week I don't know that's also a disaster in itself and then water and sanitation how can we say wash your hands when there's no water we need to manufacture our own vaccines here and we need to invest and we need a strong autonomous health promotion agency a group like public health England that does nothing except tell people what their behavior should be or explain the mode of transmission of infectious diseases or non-communicable diseases I won't go into this in detail but surveillance in the country is so weak we need to have the best kind of surveillance and we do have very intelligent epidemiologists but they need the support to be able to contain international movement of strains contain spread within the country prevent further spread in localities quickly detect a cluster and contain the spread remove the agent from infected host and work on eradication when that time comes message seven the full implementation of universal healthcare is the only solution to COVID-19 can we control yes but we need to change the system currently if you see all this orange graph this is how much out-of-pocket spending Filipinos are doing so it means that over time since 1991 even with health insurance the orange one is our out-of-pocket payment we are still personally paying for all our health needs so there needs to be serious reforms in health insurance I won't go into detail and for universal health coverage to be implemented there are 33 provinces that are ready if we implement universal healthcare money goes to the governor and the governors can use that money to implement good control programs we continue to be in an emergency response mode what we need is a COVID-19 control program with proper resources what do we need right now we can do this we need a program that seeks to control COVID-19 by locality guided by national protocols there should be free and I've said this many times free testing maybe it's selective maybe it's not everyone for essential workers and students we have to allow testing to be accessible people don't like it because it's expensive no but if people know that they're positive then they'll avoid transmission so I go back to knowing the mode of transmission we need a six-year vaccination program just let's vaccinate everybody right now and that's the end that's not going to work we're going to have to look at this as something like the vaccination for flu where you have one or two shots every year that means you need a program in infrastructure and the very strong program for infrastructure was set in place by secretary Alaran Bengson right after the EDSA revolution that was why secretary Flavier was able to work on eradication of polio because there were midwives on the ground who were prepared who had resources who were trained to do vaccination program we cannot be ad hoc about this I understand now it's an emergency and hats off to all our to the national task force for what they have done but unless this becomes programmatic continuing we will not be able to go forward we need to deploy electronic medical records I can't understand why this can't be done all of you use an ATM for banking why can't we not have some kind of electronic record for our medical needs we need short courses on COVID-19 on prevention treatment and management for all professionals at all levels even if this is online there has to be national and subnational COVID strategies and then health financing for the treatment of COVID-19 people are still paying for their own treatment for COVID-19 this is my last two slides in Baseco, Manila when we were doing measles vaccination I was working with the Red Cross at that time and these two kids they break my heart so I keep the picture because we talked to them about why it was important for them to get all their EPI expanded program of immunization vaccines and really this is for the next generation to survive so finally this is a marathon and not a sprint self-care of our healthcare workers is the most important strategy for the control of COVID-19 so when you can you conserve your energy take care of yourselves and your loved ones okay, thank you very much thank you very much, doc Susie wow, na windang akong sa presentation ng doc Susie andaming talagang pwedein go in no, doc Raymond andamin natin pwedein go in to help stop COVID deaths and control COVID yes, from end to end ang ginawa ni partner sa kanyang presentation thank you so much not every day that we get a comprehensive lecture from doc Susie master class talagang na to doc Raymond, it's a master class by doc Susie it would seem that it inipon lahat ni doc Susie ang kanyang learnings for the past two years so we appreciate all of that doc Susie okay, so let's go on and get the reactions from our other experts in the panel, our first reactor is really surgeon extraordinaire but also a dedicated teacher and researcher has been a public servant when he was the secretary of the department of health during the Aquino administration please welcome again to your screens, former secretary of health of the Republic of the Philippines Dr. Aikona Good afternoon to everybody this UP Webinar topic today entitled stop COVID deaths will we ever control COVID-19 is both seemingly simplistic or very complicated but most interesting and challenging especially for us Filipinos here in the Philippines as doctor Susie Pineda has historically and statistically discuss it will take more than just pure science to defect to defeat our infectious disease threat it will entail a wider socioeconomic and political interplay in our society both nationally and globally for us to control this pandemic and other global health gorgeous that will definitely come to hound our health system as a whole the partial control today of this pandemic is the victory of pure science but the global control will entail the need for a more equitable social economic and political distribution of wealth and knowledge as well as supplies among our people to contain all these future gorgeous few days ago President Duterte was reported to be aghast at the seemingly sudden significant reduction of Filipinos reported positive for the PCR test as well as the reduction of those has hospitalized or dying from COVID-19 as of today these deaths that are reported and in the morning paper today or yesterday there were 171 deaths and 370 infected for positive test these deaths are no more than our daily deaths from tuberculosis pneumonia or heart disease let me just give you an idea of the number of deaths last year before COVID really became so extensive in our country our number one cause of death last year was ischemic heart disease and they were reported of 97,500 deaths that is 267,000 I mean 267 deaths per day as I said as of yesterday there were 171 deaths reported from COVID for number two for example there were 178 deaths from cancer per day last year from stroke or CBA there were 167 death per day of course tuberculosis there were 61 deaths per day these are all reported deaths and in pneumonia this is pneumonia very similar of course in terms of symptomatology to COVID there were 172 deaths per day last year again very similar to the number of deaths of COVID today and so where is the other side of pure science that is needed for us to preserve or mitigate another similar devastating new catastrophe and thus this presentation of Dr. Susie Pineda that is most informative interesting and challenging for all of us the challenge therefore for us is how do we as a people respond to the demand of the times and of course how do our government respond to the challenges that Susie Pineda has presented this morning thank you and before I end let me greet all of you a very merry Christmas and please stay safe and healthy to this merry season thank you thank you very much Dr. Ike Onna para yung sinabingan yung Dr. Onna na how will we respond to the demands of the times and the challenges meron sa chat natin sana yung advocacy sa recommendation si Dr. Susie mapanood do mga tumatakbo for elections para maging part na ng plataporma nila if they become part of the government so thank you for that Dr. Ike Onna I also like what you said it takes more than science pati ang sinasabi ni Dr. Susie in our webinars anong classin talino kailangan talaga ginagamit 19 and also I really appreciate your mentioning the need for equity important po talaga yung equity okay so we look forward to having you later on for our Q&A session I'll be here thank you so our next reactor is a consultant with the Guam Department of Public Health and Social Services and serves as the chair of the Guam State Epidemiological Outcomes Work Group please welcome to the webinar Dr. Annette David hi Dr. Annette hi thank you so much magandang hapun sa inyong lahat whenas yan half a day from Guam work 26% of our population are Kababayans salamat sa classmate ko si Dr. Susie Mercado for inviting me to participate I was very excited to see Dr. Susie introduce the Epidemiologic Triad as the mental model that we can use to understand this pandemic importante na may framework tayo and to my view that is a very important framework to use so let's talk about it agent, host, environment of course agent yung virus and I will challenge you to think about this pandemic from the perspective of the virus ang virus kasi hindiyan completely alive it needs a host to survive whether the host is animal or human it needs a host to survive so itong virus is going to be very keen on improving its efficiency in infecting the hosts so it's not surprising for me that as new variants come on board that maybe what will happen is they will become much more transmissible kasi yung virus is trying to find a way to increase its ability to infect as many hosts as possible para mabuhay siya as a species and the other thing that the virus wants of course is not to kill the host kasi kung pinatayan yung host pati siya na matay so a really efficient virus can infect a lot of people but keep them alive so I'm hopeful that the Omicron variant will turn out to be a much less severe mutation of this virus and these are really all evolutionary pressures that are working to create a more effective virus which means it's important for us from the science perspective to address its ability to be highly transmissible so yung vaccine is fundamental to the control to the end game of this pandemic so I'll ask some of you are very young you might not remember but those of you who are my age or older na nunod ba kayo ng Star Wars or Star Trek imagine that the Philippines is a spaceship that is under attack by COVID-19 what happens when there's an attack on a spaceship the first thing the captain will say is shields up shields up the vaccine is the shield and when your shield is 100% your protection is at its greatest but every unvaccinated person is a gap in that shield which is why it is so important to be able to ensure that as many people in the community are completely and fully vaccinated and protected because ultimately as new variants come up and come out they will be looking for those gaps in the shield to get to us the community and this is why it is so important to ensure that every person as much as possible gets the full protection from vaccination which takes us to the second part of the triangle the host so if it's important to get as many people vaccinated us as possible then the issue of vaccine access becomes so critical for the host defenses kasi ano pa ba ang meron jyan to counter the virus back to basics physical distancing masking hand hygiene all of which are behaviors and as you know behaviors are not always reliable because not everyone is consistent so the vaccine which can reduce infectiousness which can reduce severity of disease and which can reduce death becomes so critical but access has to be assured kaya important dito yung health equity for as long as there are pockets in our community in our country who have no access to the vaccine this will continue to spread for as long as there are countries in the world that have only 5% of their population vaccinated it doesn't matter if your country if your island is 100% vaccinated you will still get that virus circulating so I think this perspective of the shield 100% is a way of ensuring that people realize that when they make the decision about getting the vaccine or not it is not an individual choice it is not an individual decision but it really affects the outcome in the health of everyone inside the spaceship that is the Philippines or the spaceship that is the world and the other part to that equation is sometimes the vaccine is available but people choose not to get it because they're anti-vaxxers they're vaccine hesitant which takes us to the third part of the triangle environment and we talk about the social determinants of health which affect health equity and vaccine access but there's also the communications environment and doctors who mentioned this it is so critical that we do not allow misinformation to win this war because if you think about it misinformation is also a virus it infects people and they can spread it very readily so in that sense we have to always consider that when we talk about the environment we're not just talking about ventilation and the physical environment and the policy environment and the cultural environment but we always consider the communications environment especially with the advent of social media which has now made access to misinformation so easy and so I think I'll end by saying for this pandemic you need not just one vaccine but you actually need three vaccines you need a vaccine against the virus you need a vaccine against health and equity and you need a vaccine against misinformation and that's from my end over to you again Thank you Dr. Andy very well noted comments and that's something that we really appreciate given that different nuances especially for the Philippines as well in the United States we really look forward to your insights additional mo maya po sa ating Q&A session later on as we move on to our final reactor for this webinar our final reactor will be should be coming in with a public health perspective but slight nuance po with regards to prioritization in terms of research so please welcome to the webinar the college of public health associate dean for research with the University of Philippines Manila Dr. Vivian Fe Fadrilan Kamacho Dr. Bing Yes, bagandang hapon po sa lahat good afternoon to everyone thank you for that kind introduction I would like to thank of course the organizers for this invitation for this timely discussion on COVID-19 at this point I would also like to thank our presenter Dr. Susi Mercado it's always a pleasure naparati ako na excite pag nalalaman ko ang speaker Isidok Susi I'm thankful for her comprehensive discussion sharing her expertise and insights as we answer the question ang topic natin will we ever control COVID-19 I really appreciated how Dr. Susi's talk was streamlined as key messages with historical background and also sharing of experiences for better understanding and impact and I'm also honored to share this virtual floor as a reactor with Dr. Enrique Ona and of course Dr. Anette so as the end of the year approaches sa Bingano we are nearing the second year anniversary of the pandemic globally over 5 million have already died and we all know that is actually an underestimate especially there are still many countries that still lack resources to properly test and vaccinate populations but in our country we are seeing a decreasing trend so may good news naman sa ating decreasing trend of COVID-19 cases and deaths in the last few weeks and also a 36% 36% of our population is already fully vaccinated while booster administration has started and our eligible pediatric population also starting to receive their vaccines our positivity rate is at 1.31% malaking improvement na po yan compared to the last few months and of course from last year and with these promising numbers the emergence of the Omicron variant poses another threat so ayan, kinakabahan na naman tayo we don't know whether this will lead to another surge of cases or deaths or probably and we're hopeful sa Bingano na sana hindi naman ganun ka serioso but we still do not know enough to tell and good news na is that the latest genome sequencing run of the Philippine Genome Center does not show any evidence that it has made its way into our country very quick lang na I would like to point out the discussions of Doc Suzy na talagang tumatak din sa akin especially na na mention na yung the principle of the epidemiologic triad with special mention of the social cultural determinants of health. She also clarified the concept of herd immunity to share goals for managing infections by having the relevant information and the role of risk communication all of these leading to public health interventions for COVID-19 prevention and control. We also discussed how handicap our health system is na naramdaman natin particularly at the start of the pandemic at atung later part of 2020 with the surge of cases and also this year in 2021. She gave recommendations based on the social cultural determinants of health to guide investments for COVID-19 control. She also emphasized the need to ensure that our health care workers health and welfare are protected so binanggit niyang self care very important talagang role ng ating mga health care workers because they are the frontliners. She also reiterated the importance of our universal health care to reduce the burden of the disease by addressing issues of course on social protection and health equity. All of us are already ready for the pandemic to be over. Gusto na natin bumaliksana sa normal but it is still unclear what that would look like. The highly transmissible nature of the COVID-19 variants ongoing vaccine hesitancy and incomplete protection against transmission. My current public health measures mean that a goal of zero COVID-19 is very unlikely at this point. It looks like we need to learn to live with COVID-19 at least over the medium term. Since eradication of the virus is still unlikely, the goal is to at least control it to reduce morbidity and mortality in the community. With the current promising COVID-19 statistics in our country and some parts of the world it seems like some form of control is definitely possible. Pandemics and epidemics usually end in several ways. Either we close off all chains of transmission. Taking note again of the epidemiologic and drive cases to zero as with all the Ebola epidemics to date or the disease becomes an ongoing part of the infectious disease landscape or becoming an endemic as tuberculosis. Occasionally as with small packs na bangkit kanina na eradicate naman siya but for the most part endemic diseases are here to stay and at least control. Societies our communities will have to adapt to living alongside COVID-19 by making some deliberate choices about how to co-exist. This global pandemic once again highlights the importance of research, stable research infrastructure and funding for public health emergency disaster preparedness, response and resiliency. So the stakes are definitely high in terms of a worldwide pandemic wherein many lives have been lost. Economic losses and lives have radically changed. So that ultimate mitigation and crisis resolution is dependent on high quality research aligned with top priority community goals that yields trustworthy data and actionable information. Meanwhile the highest priority goals are treatment and prevention. Biomedical research also provides data critical to manage and restore economic and social welfare. The number of communities related to COVID-19 has definitely increased and the scope and magnitude of the engagement and the extent of global collaboration are remarkable. Researchers have led to the development of diagnostic tools, drugs, vaccines and other public health interventions that have helped control COVID-19. University of the Philippines, particularly UP Manila, continue its mandate to conduct research to contribute to the pool of COVID-19 knowledge and coordination. Of course with our partners such as the Department of Health, DOST and other relevant local and international agencies. Na-mentyo na po kanina yung vaccines so we all know vaccines have significantly helped in curbing the COVID-19 cases and deaths but there is this issue of waning immunity over time. And also there are many there are still many left unvaccinated including our children which highlights the need for continuous research for effective and more sustainable interventions. Relevant researches on new normal set ups in schools and work are helpful in providing insights on how to navigate these new arrangements ensuring health, safety and productivity. Our situation makes it unlikely at this point for us to eliminate the virus so the short term goal is to control by reduction of incidence on acceptable level due to deliberate efforts although this will come at the cost where we will still have COVID-19 deaths and additional chronic outcomes such as long COVID. Luckily the combination of vaccination, infection induced immunity and novel treatments should reduce the risk of serious infections and death from COVID-19 over time. Annual vaccination may be banggit nganom o kailangan ng continuous vaccination to keep immunity high and to respond to any variations in circulating virus. Minimum public health standards such as wearing of masks, regular washing of hands, good ventilation, indoor scuff etiquette are now part of our new normal. For now it seems like COVID-19 will likely always be here but with scientific driven and scientific driven interventions it can be controlled. This highlights the need for interventions enabled by a reformed health system driven by science and consideration of social cultural determinants of health leading to evidence based policies, programs and services utilizing a whole society and systems approach involving all sectors and the whole community to collectively work to fight against the virus. With that maraming salamat po at magandang hapon po. Thank you very much Doc Bing. Please stay on for the Q&A session later on. At the point that Doc Rima let's ask everyone to join us in the panel. Can we ask Doc Susi, Doc Andy David, Doc Icona and Doc Bing, Fadilan Camacho to please join us on the panel as they're switching on their videos. Let us take a quick break for a special public service announcement today. Umpisahan na ninyo. Magpabakuna na kayo. Okay. Very very nice commercial or public service announcement from the team. The public service announcement po is what we call our COVID communication PSA. It's one of the many outputs of the UP research entitled COVID-19 First Quarantine Philippines. It's headed by our UP vice president for public affairs, Dr. Nanny Perna and funded by the DOST Philippine Council for Health Research and Development and the Department of Health through its AHEAD HSPR project. So we are privileged to have the project leader also to join us for our panel. So Dr. Nanny Perna will be coming in also and giving from a communications perspective with regards to the topic at hand. AVP Rika? Yes. PSAs are continuing commitment to push for COVID-19 vaccination for everyone who is eligible. So unless an overwhelming majority of our people are vaccinated this virus will keep on mutating. So please get vaccinated as an act of love for yourself for your family and your community and your countrymen and so that our health systems will not be overwhelmed. So one of the control tools in our arsenal to fight the pandemic along with the standard public health protocols such as wearing of the face mask frequent handwashing physical distancing avoiding crowded places and proper ventilation. And also, you know we understand that everybody's so busy so we have some selected presentations that we will feature in its entirety in what we lovingly call we stop COVID-death shorts so you can watch them at your convenience at the TV UP YouTube channel. So ito po yung mga presentations lang na nga atay mga speakers. TV UP, do we have a graphic for our SCD shorts playlist? And you can watch them at the TV UP channel and cute channel. Back at your shorts, it's a very short clip of the entirety of the video po. So thank you so much for that and for giving us a laugh in terms of how we'd be able to better appreciate ang ating webinars and our outputs po sa ating TV UP channel. Okay! To start the ball rolling since we don't have much time I'd like to ask the very first question before we call on our live audience who will be asking the questions po, no? So Dr. Suzy in her presentation as well as our reactions that we have heard from Secretary Ona, from Dr. Andy and from Dr. Bing laid out po yung mga recommendations on how to go about with regards to dealing with the pandemic. I have two questions and this is mostly an aggregation of what we have called from outside the Zoom and in the Zoom. Number one would be group with regards to vaccine mandates. We all know that the WHO has already released a statement that as a last resort vaccine mandates po ang gagawin but what's the opinion of the group with regards to that and then number two it will have to do po with so we talk about the silver lining the good things that we could do and over with but just to put it in balance so to speak what would be let's say have we seen the worst of the pandemic or is still something else that's worse than where we are right now that we have not seen and something not to be a Doomsday seeker but something that we might need to put in our consciousness as part of it. I'll pose it to Dr. Suzy 19% So vaccine mandates. The difficulty with vaccine mandates is it's like a shortcut for what should be really a very purposive communication campaign I don't think it's I don't think that we cannot explain to people why it is important I think we have not done enough to explain it in a way that people can understand and therefore the shortcut is pilitan natin lahat ng tao Now the problem with pilitan is that the reaction becomes political it's about why are you forcing me to do this instead of how do we get people to understand they need to understand so for example when secretary worked on the eradication of polio in the 1990s there was no mandate hindi sinabing kailangan bako nahan kayong lahat but there was a campaign there was a campaign he went around the country he talked to the mayors the midwives media etc I would use mandate as a last resort what I haven't seen is a very clear powerful campaign on why people need to be vaccinated there are bits and pieces of it but not the kind that at that time we mobilized 9 million children for vaccination even in the most rural areas but it took time and it was really a campaign like an election what was your second question Raymond something about how we've seen the worst of the pandemic doctor Susie I have no crystal ball I don't know I don't know because I just asked doc Susie no we have VP Nanny here we talked about communication about we need a campaign so VP Nanny can you help us out on this what are your thoughts there is no mandate for good communication good communication is what is necessary what Dr. Flavier did was phenomenal when it comes to communicating science it was really bringing down the science to a level that was understandable by target audiences and I reiterate what Susie just said there was no mandate for vaccination as is there is no mandate for good communication it is incumbent upon upon department secretaries to be able to to speak with communication is not a one way transfer communication is we all understand this it is a recurring process it is iterative it is continuous it doesn't end and that's what's important it's also something that should be not scary and that is often what happens when we talk about health because a lot of our health communication is fear communication and that should change maybe that's why people are hesitant regarding vaccinations in the first place we're very fortunate to have a former secretary of health so Dr. Aik just to just to frame also your response how would you say the major difference during the 90s and up to now and what would be your advice to the current team with regards to pushing forward with vaccinations sir I think you hit it right and difference because when we are talking of all you or maybe even small parts alam na natin masyado yung sakit na yun and it's been there for several several years now when COVID-19 came along you know it went just like a para bang a super typhoon for the whole world practically and that's reason why I kind of disagree with Susie on this that I really think that the mandate should be very strong now I think there has been more than enough information and I think it's very clear to me that when you mandate somebody to have a to be immunized it's really a protection not only of himself but for the whole public it's family and everything and every person that he meets and since this was an acute situation and really arranging so-called pandemic and with not enough information right away at the initial first year of it but today where we are now on our second year and we would like to make sure that no resurgence of this comes along I think a well planned so-called mandate wherein public will be given a certain incentive full information the public is already getting from so many sources especially with a more a more global information that's coming into to the whole world and to the country especially in the Philippines I think there is already time for us to mandate it without necessarily without necessarily giving so-called severe or significant so-called mark punishment for those would not like to be vaccinated May I ask Dr. Annette David because you're based in Guam are there vaccine mandates in Guam? Yes, yes we do Our governor is a nurse she's an ICU nurse and she's very courageous when our vaccination rates are going down she pushed for the mandates and stood firm to all of the people who stood against her today we have of the eligible population in Guam 89% are vaccinated and of the total population 82% and that really made the difference in their numbers but having said that I think we also need to talk about what is at the heart of this issue because it's an issue of trust if communities trust their leaders if they trust the healthcare system if they trust the political leaders then the communication is well received and people will act accordingly when there is a lack of trust then that becomes an uphill battle Can we hear from Dr. Fadilan Dr. Bing Yes Thank you very much for that question For me regarding mandates actually I agree with Dr. Suzy para sa akin last resort akurin po kasi I haven't feel that we have exhausted all the possible ways on how to communicate properly with our target population and yan po yung sa akin but I would like to raise another concern with this aside from the mandate kasi aside with the communication proper communication to the population to the public it's very important to have an enabling environment as well because we keep on saying magpabakuna tayo wala naman pung bakunang available particularly in the far flung area so I think we should have an enabling environment so that we can properly implement our vaccination programs Thank you Dr. Raymond I think we have some questions from our audience Yes we have one from Sir Camilo Nogoy He has several questions but I'll let him ask the questions that he prefers and please address your questions to any of our expert panellists Sir Camilo Good afternoon to everyone Most of the things I heard are coming from authorities what they should do regarding public health but what's the role of the citizens because it is public health and if we go to the news here in the Philippines it's always one way what the government should do but how about accepting responsibilities from the citizens regarding public health is Dr. Suzy willing to be the DOH Secretary Thank you I don't know much about the last question Dr. Suzy go ahead the citizens role in terms of public health I think I'm a health promotion person so for me citizens are the solution for me I think we have 110 million solutions to this problem if everybody was careful doing what they need to do we would have less transmission now having said that as I mentioned in the epidemiologic triad what do you do when 10 of you live in the house and suddenly one person develop COVID so there is a balance here between what the responsibility of the citizen is able to is able to provide for our needs and I do believe that over the years so I'm not talking about one president or whatever over the years we have really neglected neglected public health including the most basic things that people need housing water decent jobs who can afford to take all the precautions it is your responsibility to be careful but we have to bear in mind that for many people they don't have that choice sabihin natin stay healthy eat healthy so there are two what should I say two parts of this but I do believe everyone with a little information can do better in terms of health so I'm going to just add a little example in the time of Secretary Flavir we were severely criticized for coming up with a campaign on preventive cardiology on preventing heart disease and the criticism came from the public health experts of the country who said why are you going to have that program the government cannot buy medicine for everybody and Secretary Flavir was very firm he said if I know I have hypertension I'll eat less chicharon I won't eat bagoong with my kare kare he could explain very clearly what the role of the citizen was so not everything is the responsibility of the government but having information in the hands of the citizens I never underestimate the ability of Filipinos to know what is the way to fix the problem So many of you have answered our questions I'm not sure if you are able to there we go, our Menti the two questions are as follows version number one which of the following diseases have been eradicated in the world 55% in zoom and 59% in Menti chose smallpox so what is the correct question so the only disease that has been globally eradicated is smallpox as mentioned polio has been eradicated in all continents except Asia so it is only smallpox so I think na naginip tayo that we are going to eradicate COVID-19 so I just wanted to put this in it takes a lot of time to eradicate a disease or to remove the agent thank you so much and question number two which of the following infections contributed to the highest mortality across ages last year which is the year 2020 75% in zoom and 77% in Menti chose COVID-19 so what is the correct answer okay so the leading infectious disease the leading infection that causes death in the country is pneumonia and through all ages through so many years among the infections it's pneumonia and we have treatment for this there's medication, there's diagnostics and yet people still die of pneumonia it's because they don't have access to healthcare so the answer to that is pneumonia okay thank you so much doctor Susie marami sa amadin po sa more than na sumagod sa zoom and then another 95 na sumagod po sa Menti ng ating fun quiz hopefully that's something that you were able to learn not just in the press but also sa ating fun quiz for today we will be asking each and every one of our speakers their parting words essentially their final messages po sa ating that they will be able to carry on through the next few weeks up to next year po and something that we could really look forward in the next few months while they are nagmumuni-muni we are going to pose our evaluation poll we are seeing almost 200 or past 200 na po attend this responding to our evaluation poll as mentioned po in previous webinars wala po kaming nilalabas na separate na evaluation po ito na po yun so we hope that our 770 plus attendees are able to input their answers the questions are as follows the panelists demonstrated thorough knowledge of the topic the panelists were well prepared and organized the panelists spoke clearly and audibly the panelists used appropriate language with technical medical jargos adequately explained and finally the panelists contributed to new perspectives and knowledge on managing virus KCOVID-19 health issues medyo nakakapobliwang po kami sa aming evaluation poll po we will be relaunching it and will not be closing it anytime soon as we move on to our final when we launch the poll pwede huwag pin-dutin yung red button in the lower right hand corner you can press the X circle sa upper left hand corner at the middle bit on your screen thank you AVP Rika no it's okay kasi mayjo bumalik yung ating problem with the evaluation poll but anyway we'd like to ask our speakers na po and we'll do it in reverse chronological order for their final messages we'll start off with associate dean for research of the college of public health Dr. Bing Kamacho your final message to our audience thank you very much Dr. Raymond thank you very much to everyone for listening and attending this last webinar for this year so for my parting words the horizon is not as gloomy as before but many things are still uncertain the important thing is that we continue to work together making use of a whole society approach empowering everyone especially the community learning from history and experiences and making use of evidence based public health interventions to help us thrive against COVID-19 and with that thank you very much for this opportunity let us all have a blessed healthy and safe holidays maraming salamat po sa lahat okay thank you so much Dr. Bing before we go on to Dr. Andy would like to ask our communications expert VP Nenny for her final message to our audience yes good afternoon when Susie was presenting a little while ago about that triangle who has responsibility for what it reminded me of Ambition 2040 Ambition 2040 is the collective vision and aspirations of the Filipino people and in that vision one of the things that we want as a people is to have a good quality of life which includes a good quality stable comfortable lifestyle which includes quality health care and when somebody asks what should the citizen do it's always government what government should do well citizens vote in their government it's both if we want if we want government to be empowered to do what it is that leads to our our own good then we should also be thinking about putting in people in positions of leadership who are true leaders and among that is having the heart and soul of our country as well as being good exemplars and so a good communication is incumbent upon good leadership thank you so much we move on to our expert also coming in from Guam Dr. Andy David remember that we need not one vaccine but three vaccines one to counter COVID one to counter health inequity and one to counter misinformation so hang in there stay the course and help each other to make the right healthy choice yun galing very short and sweet but we really appreciate it Dr. Andy thank you so much Sir Aik, Dr. Anna your parting words to our audience well my my parting message is essentially that pure science will give us all the information on how we can possibly control it but it's the socio-economic limitation of the society both in our country as well as globally that will be needed to eventually make sure that we live a healthy life and comfortable life for everybody thank you Secretary Onah and finally we have our main presenter my partner Dr. Susie Pineda Mercado your final words Dr. Susie yeah you know conserve your energy so I know many of our audience are frontliners, doctors, nurses all over you have to conserve your energy kasi mahaba pa to e parang when I was preparing for this I thought jeez this is so difficult to talk about an end game but we joined this profession knowing that there will be sacrifices that we have to make when an emergency like this happens and you have all shown your ability to sacrifice to serve and to do your best for other people so conserve your energy so that you don't burn out look for opportunities to take little breaks and to take care of yourself because as I said this is a marathon and it's not a sprint we have to raise ourselves for new things that will come and I agree with Sek Aitno there will be new drugs there will be faster tests there will be more efficient vaccines but if in our society there's such a big difference between the rich and the poor yung mga may hirap ang mga makakakaran ng magiging dehado so I know that all of you are working very hard and this Christmas season I hope that you'll find some time to as I said recover, revitalize and conserve your energy because what we need to do like in a war is we need to survive we need to survive this epidemic hindi tayo hindi tayo masungit hindi tayo agitated hindi tayo nagwawala di ba, we need to keep our families intact we have to take care of our teenagers who are so stressed out so conserve your energy take care of yourself and this Christmas season spend some time in silence and thank our Lord that we are here and that we're making it and because we're alive and we are we are able to serve that is the way that we return our thanks we continue to serve and sacrifice thanks everyone thank you very much doc susil medyo naging emotional thank you very much inyong lahat to our panel I think doc Raymond let's show our appreciation to our panel by showing them the panel evaluation poll results from our audience can we have that on the screen okay so it's very very similar to our previous webinars very high marks at least 95% across the board sa ating evaluation so maraming salamat din po patin na rin po sa mga nag input sa chat ng kanilang evaluations we really appreciate all of these and that's something that we collect and try to put forward in terms of being able to improve our future webinars po over to you evp rika for the introduction of our closing remarks to formally close this webinar let us now hear a brief synthesis and closing remarks from the deputy director for health operations at the philippine general hospital please welcome dr. Stella Marie L. Jose good afternoon everyone this has been a very enlightening webinar atalagang we ended our year with the bong atalagang exploding information from dr. Susy Pineda she explained the epidemiologic triad of the agent the host and the environment so the agent here is the SARS-CoV-2 and the host what is important with the host is the nutrition if she has comorbidities and the status of the immune system and in the environment our environment the crowded environment the OFWs and the contested cities so for the agent what we need is at the vaccine so paulit-ulit in our webinar that we should all be vaccinated we owe it to ourselves and we owe it to our country and as mentioned for the host yun na we should all be wearing masks we should all be tested and all these all these things that we should do for our environment yun na dapat there should be safe transport isolation safe working place and we contest the cities and the slums another message of Susy was the herd immunity paulit-ulit yung sinasabi in our webinar madaming speakers ko na yan na remade about herd immunity but from the public health point of view herd immunity of course after decades of protein immunization as long as there is community transmission re-infection is possible so ang message ni Susy so what can we do now? health programs that sit to control COVID-19 locally guided by national protocols yan ang kaylangan natin we should have free or selected testing initially for essential workers and students because right now it is not free and people spend per testing we should have a 6 year vaccination program and infection control and we should deploy electronic medical records for contact tracing so that's important here in PGH we already have electronic medical records but in other places that is very lacking and we should have short courses for COVID-19 prevention and the national and sub national COVID-19 programs so also health financing for the treatment of COVID from Dr. Aikona he mentioned that it is more than science and it is really the social economic environment which is important his challenge to us is how will we respond to this time so we can see how will we as medical practitioners or healthcare workers and to him there should be a strong mandate to immunize from Dr. Annette Dabean Annette also bolstered the presentation of Susie as a public health official she mentioned that vaccines is very essential to control this pandemic when compared to Star Wars he said when we are vaccinated and every unvaccinated person there is a gap in the shield so let's remember that when we as doctors, nurses when we explain to our patients that's a good analogy the host the vaccine we can vaccinate and social health equity which is most important and as mentioned the vaccine is our shield so the environment we should not allow misinformation to win in this war you know how fast you can see the message in all your other biber groups so the vaccines we should have vaccines against the virus we should have vaccines against misinformation and as mentioned by Annette the basic issue here is trust so the important we should trust our government our healthcare system, our doctors from Dr. Bing Camacho she mentioned that ang good news doon sa Philippine Genome Center that Omicron has not yet entered our society and I hope that it will not enter and also she mentioned the importance of the social cultural economic which are factors which are the determinants of health ang sabi niya, zero goal is unlikely and there should be some degree of control may be possible with vaccines yun na nakakaron ng waning community over time baka later on magiging every year na ang vaccination like flu vaccine ang short term control is the reduction of transmission and it is science driven and as being mentioned we should involve all sectors so it's hard to make a summary of all your presentations they are all good and I congratulate all the speakers Dr. Susi, Annette Sir I can be Thank you for your attention Thank you very much Doc Stella Ang galing-galing talaga ni Doc Stella nga gano'ng synthesize I don't know how you do it I try on my own to take down notes pero talaga ang very comprehensive si Doc Stella so thank you po and may we ask Doc Susi to please join us as we say goodbye to our viewers for our Christmas break and we hope to see everyone back again next year for our regular Friday lunch date Doc Susi So everyone I hope you have a merry Christmas and take care ang pag-iingat doi na nating part ng buhay natin especially for this holiday season Okay Doc Rayman Yes, thank you so much Thank you Dr. Susi Something that we normally will tend to forget just because of our partying, the holiday cheer the holiday spirit etc but very very important to remember still that we still have the COVID-19 pandemic at hand we will still need to adhere to the minimum public health standards and for those who are still unvaccinated bagpabakuna na po kayo and we look forward to be able to see you again all of you, nanan dito po sa ating webinar ating mga avid viewers when we are back again in January 2022 but before, we conclude our program for today, let us first acknowledge the very hardworking team behind the Stop COVID-19 webinar series without each and every one of you Hindi po talaga magagampanan natin ang hard work na ito and the ability to be able to churn out quality content week in and week out so at least magkarapot tayo ng very very brief break makita kita po rin po tayo next year when we try to come up with quality topics and our roster of speakers for the future webinars finally, we have our archiving of all of the Stop COVID-19 webinars po from webinar number one to webinar number 81 at least and after this webinar, may webinar yung number 82 will be archived also in the YouTube channel of TVUP maraming-maraming salamat po sa inyong lahat lalo na po sa mga gusto po ang uliten ang papapanood sa playback o yung meron po na kaliktaan, nakalimutan di po nakanood, you'll be able to watch each of those webinars in the TVUP YouTube channel so this formally closes our webinar for the year makikita ko tayo ulit next year po and we look forward to seeing each and every one of you same time from Friday 12 noon to 2pm it's a date together we can stop COVID-19 stay safe stay healthy and see you online one more time i know you long for home but i am here you're not alone i'll stay with you until the coast is clear the other's pain before my fears the other's lives before my tears but right behind the mask i'll look into myself and ask do i have strength to carry on oh god, how long is this going on and if you're here to keep me strong i'm here to hold the line i'll keep my i'll tell my pain to realize it's fine to be afraid just hold on to the word he gave this time we'll come to pass because this salvation makes a last you'll carry you to see the break of the other's pain before my fears the other's lives before my tears but right behind the mask i'll look into myself and ask do i have strength to carry on oh god, how long is this going on and if you're here to keep me strong i'm here to hold the line i'll keep my i'll tell my pain to realize lives before my tears but right behind the mask i'll look into myself and ask do i have strength to carry on oh god, how long is this going on and if you're here to hold the line i'll keep my i'll tell my pain to realize it's fine to be afraid just hold on to the word he gave