 Hello, good morning, good afternoon, good evening, everyone. Welcome to episode number 95 of the Stop COVID Deaths webinar series brought to you by the University of the Philippines. Thank you for being part of our credible online community and to all those who have just discovered us for today. Welcome po at saan na po marami po kayong matutunan sa ating webinar ngayong araw na ito at sa mga future webinars. There is a general sense of relief and anticipation na na sa tail end aput ay patapusta po tayo sa pandemiyang ito. And yet, as we enjoy ating newfound nakalayaan dito po sa Pilipinas, we hear of possible surges, spikes, the potential of the return of the lockdowns po, rising cases in neighboring parts of the ASEAN region. So ano po ba yung mga katanungan sa isip natin? Ano po ba yung mga variant na na kumakalad po let's say sa China na nagresulta sa lockdown of 25 million just in the city of Shanghai? What variant has been increasing in the cases in South Korea a few days ago, the World Health Organization also announced that it was closely monitoring yung pinakabago po yung variant called Omicron Xe. It's a sub variant and a hybrid from two different types of the sub variants and could emerge to be a more transmissible variant than the recent BA.2 ng Omicron. So posibili po ba na ang mga new emerging variants na ito na napag-uusapan, closely being monitored, ay pwede po ba mas maging contagious kaisap po sa Omicron? Sa ipisod po natin for today, we will discuss the possibility if we will have another COVID-19 surge together with our panel of distinguished experts, some Dr. Raymond Francis Sarmiento, Director of National Telehealth Center, National Institutes of Health, University of the Philippines Manila, always a pleasure to be with all of you during our regular Friday lunch date, ang ating Friday po na tinatawang. And I always look forward to Fridays because I get to share a hosting duties with our adjunct faculty at the National Telehealth Center, also the Special Envoy of the President on Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie. Hi, good afternoon Raymond. Magandangapon po sa inon lahat. I hope you're all okay. Raymond, me allergy ako kaya di tingin na masingta-singta ko na naman. Some kind of thing in the air. Anyway, I hope everyone's alright. I was so scared kasi inuobo ako, meron ako sipon, nag-antigentes ako negative naman diba. Pero ano-ano parang we're always, what should I say, we're always being vigilant, we always have to take care if we have any symptoms. And I'm just so happy everyone is here, although I heard, I don't know if we resolved it, Raymond, parang I heard na di makapasok yung iba sa zoom because of the password. So we're looking into it. So kung yung mga kasama niyang di makapasok, swing nyo punten mo na sila sa Facebook or sa YouTube and we'll post now on the chat. We'll post on the chat, the, the, si Ross kasi bumati, tuloy na distraka ko. Maganda doy ang mga book natin. Ross, how are you? I hope you're fine. So anyway, we'll put on the chat, the Facebook and YouTube link so that you can ask your friends to go there just in case di sila makapasok. But the password, Raymond, is, what is it? Webinar 95. Webinar 95 na. 95 na. Okay. So anyway, welcome everyone. We, we are very happy to talk about, to have some experts with us, again, we only bring you the best. So ano, ano, nagpapasalama talaga ako dito sa mga experts natin kasi sobrang busy nila pero pang kayo ang ka-rap, may time sila, no? So we have two very distinguished guests. We're going to talk about, you know, what's going to happen, no? Kasi okay na tayo, men, so nag-open up na tayo sa Philippines. And yet, asabi nga ni Raymond, merong ano, no? Merong mga ibang lugar na nags-surge na naman sila. Parang ano ba yan? So, vaccination has had an impact. Okay, so, importante talagin campaign natin for vaccination and nga yung tulungan yung po kami, no? We're campaigning for the vaccination of children. So malaking impact to rin yan. Pero ngayon, siyempre, tinakabahan tayo holy week man uwiyan, di ba? Palagay ko marami sa inyong uwi. Lagay nyo nga sa chat kung uwi kayo sa kayo. Pupunta. Curious lang ako eh. Uwi kayo, di ba? So, ano, no? Parang, you know, that that could be a source of, you know, some exposure. And then, of course, the elections na hikita natin ang marali, daamin tao sa bagay outdoor naman yung karamihan. Pero pagusapan natin ang mga yan kasi, asyap pre, alam mo, ayaw natin na kumalat uli ang COVID and of course the question is, meron pa bang mga mutation yan? So meron tayong nababasa ngayon na Omicron Xe o unang unan yung narinig dito sa stop COVID deaths. Ano ba yung Xe na yun? Alamin natin mamaya. Sige, so meron tayong, meron tayong, we've got a full packed schedule today but as said, you have the best speakers with you on stop COVID deaths. Okay, Raymond, over to you. Thank you so much, Dr. Suzie. Today pa, we will be putting our webinar into focus by putting it into some sort of context po by a video that has been prepared by TVUP and talapon namin dito ay person on the street interview video or POTS and we really want to take the pulse of the common person po from the street and the question that we post to our interviewees is, do you think that the COVID-19 pandemic has ended? At sa tingin po ninyo, bakit nyo po ito na sabi? Please watch this. I think hindi pa rin talaga nag-end yung pandemic, even though medyo free na ngayon like this, nakakalakadlaka tayo ngayon sa Oval. Hindi, kasi dahit na nilit naman ng government natin yung restriction, hindi naman ibig sabihin mo na clear na yung COVID saka hindi natin dapat ibababa yung guards natin. Hindi naman po basa, basa agad yung nawawala yung virus lalo na hindi natin siya na ikita. Kaya hindi tayo sure kung wala na ba talaga yung virus. Matagal ba yung panaw na? No, na may vacuna, pero sippi na tayo. Though dahil nga nagluwog tayo sa Pilipinas, yung mga tao, mas ano na sila, mas parang do aware sila, pero parang binaba pa rin natin yung guard natin sa pandemic. Kahit na siling ko na may mga vaccine na and booster shots, hindi pa rin siya totally 100% nawala niyong pandemic. Nating ko po kung niluwagan na nila agad-agad, dahil nga po nag-election, di sila mga pag-debatin, yung pang ginagawa nila ng election yung paparade sila yung ganyan. Sa isip ko lang po kaya nila niluwagan dahil dun. Siguro patatapos na yung pandemic kata around 70% to 80% na siguro na total population, tabo world population siguro. Tulad niya na i-encounter ko sa mga pamilyhan. Macrouded na po yung mga tao. So may mga nagtatanggal pa ng pay mas kasi di na ganun kahig bet. Number one talaga dyan, dapat nga ano nila na puli-vaccinated na yung buong Pilipinas. Pwede, mahirap yung mag-anapuhay na ano yung gato lang ganto. Mahina sa ngayong, yung upandimage. Sa ngayong, ala pa eh, matama lang, kumaitalang konte kong pagkain lang. Ano nalang talaga nila yung pansi-screen lalo na yung mga international na mga pesita, turist. Tingkitan na lang nila yung screening siguro. Pero depende po kasi sa tao eh. Marami nangapong sumusunod. Kasungal lang hindi natin, may iiwasan yung tao na hindi sumusunod sa mga protocols po. Tulad na lang, alo may mga sadistang tao na pag nagtangga sila ng pay mas nila, da sinita mo sila pag-alit. Sana mas guided pa yung mga tao sa atin ng government. Especially those people na hindi ganun kasapat yung nakukuan na info about the pandemic. Then para sa mga tao, mas maging maingat pa tayo kasi isa lang yung buhay natin. Lalo na akong, ala tayong choice kung di lumabas para magtrabaho. Yun, doble ingat lang. Okay, thank you very much TV UP. Very interesting Raymond. Parang pin po mga tao, okay, they're enjoying the freedom but they're also thinking na, okay, we still have to, we still have to be careful. So I think some of these health messages have really hit the mark. Pero sabi anong iba, not everyone is thinking that way. Okay, so thank you so much TV UP. I think that's always very nice to start that way. Just a little bit of a reminder. We're celebrating our second year anniversary Raymond. Anong ba yan? Two years na, di pa tayo nagkikita. Okay, and on our anniversary as always, we want to remember our frontliners who gave the ultimate offering, sacrificing their lives for the pandemic. And again, when we look back on the history of the pandemic in the Philippines, we should always remember na. Marami sa ating mga frontliners, e talagang, talagang they didn't make it. Okay, they didn't make it. They were doing their duty in the line of duty na tamansila. So we are asking everyone to, if you have friends or family who passed away during the pandemic, please send us a photo on or before April 9. Uy, bukas na yun na. Five p.m. tamabayan, Raymond, tomorrow, okay? To tvtelevisionatup.edu.ph and we need a high-resolution portrait photo at least 300 dots per inch. Full name, date of birth, date of death and the occupation. So thank you very much and for those who are planning to send. Padalan yun na para tapos na masaman na natin dun sa ating. Memorial. Okay, Raymond, over to you. Thank you, Dr. Susie. Yes, that's correct po. Tomorrow na po ang ating deadline at 5 p.m. Hopefully, you'll be able to send out in yung mga pictures, maybe a little bit of a short anecdote po. We are seeing, actually, we just saw, in Messenger po, may mga nagbimessage, kung pwede pa po mag-submit. Yes, pwede pa rin po kayo mag-submit as part of our COVID-19 Heroes Memorial. We want to be able to, well, as you know, the Filipino Medical Frontliners have been recognized as the best in the world and we hope to be able to immortalize and remember them and their selfless contributions in the fight against COVID-19. Just to let you know, well, right now po kasi we have a little over 600 participants in the Zoom, but we are able to accommodate up to a maximum of 3,000 participants. So please join us in Zoom at this interactive program. But if you are watching right now in YouTube or Facebook having this watch parties, hopefully you're also still able to engage with us by putting in your comments at comment section po and also participating mamaya sa ating fan quiz. For those who are asking, we have already distributed the certificates for all 93 webinars po. May mailan ilan pa po and these are the certificates of attendance. Again, those who have watched at least 50% of the webinar duration, sila lang po ang makatatanggap ng certificate of attendance and also a link doon po sa mga materials that we have, that were used during the webinar po. We also would like to invite everyone to participate in our fun mini quiz which will be held dito po. Both in Zoom, kung sasalip po ka sa menti meter if you open your internet browser and you type in www.menti.com and when you are prompted use the code 4922-6009 that's 4922-6009 for you to be able to participate in our fun quiz. We will be utilizing our standard panel discussion format wherein we have our speakers presenting after you in a session will ensue thereafter on Facebook and YouTube. So if you are selected po may makita po kayong prom kung niya rilal na po sa Zoom being asked if you want to ask your question and participate as a part of the panel please sana po paunlakan niyo po kami para paitanong niyo po ng live ang yung katanungan sa ating panel of experts. And without further ado, Dr. Susie will now introduce our opening remarks speaker. Pero nga ganda naman ng mga tanong so kung mayanong kayong question mayasana, makasama kayo sa on-camp pero kung hindi okay lang then we'll ask your questions. So for today, let's start. We have an opening speaker who is one of our favorites. Many of you don't know may magikaudin mo siguro na alalapon. Yung National Institute of the University of the Philippines in Manila that was created by law and I remember before the one who was really pushing for it was the late Dr. Perla Santos at it was her dream na magkaroon ng NIH kasi sa ibang bansa meron talaga para leading research institute for health and then merong centers for disease control magkaiba yun e para yung CDC more of nag-monitor ng mga magagawa ng Surveillance and I think John mentioned this earlier oh by the way nas na mention ko na rin John Wong is going to be one of our speakers today so he mentioned this makakaruna tayo ng centers for disease control but na una itong National Institutes for Health and we are very very privileged to have the National Institutes of Health really at the core of a lot of the work that we're doing parang naalala ko in the early days when we were starting talagang full support na and besides boss ni Raymond dito kasi ang National Telehealth Center nasa National Institutes of Health so it is our privilege to welcome the Executive Director and Vice Chancellor of UP Manila Executive Director of the National Institutes of Health Dr. Eva Kutyong-Kodilapas Eva, welcome to the webinar Thank you, thank you Okay, start my video Thank you Dr. Susie Hello Dr. Raymond always a pleasure to be here may correction lang po ako Ma'am Susie we were able to separate already the Vice Chancellor from the Executive Director of the National Institutes of Health we have a new Vice Chancellor for Research that's already Dr. Edward Wong he's the OIC following after Dr. and I'm happy to inform you pa that we had as of before March of 2022 we had 14 Institutes and Centers of the National Institutes of Health and that includes of course National Telehealth Center but now the last week of March during the BOR the last meeting of the Board of Regents they have approved the NIH National Clinical Trials and Translation Center so that's the latest from the National Institutes of Health I'm here to deliver my opening remarks Welcome everyone to the 95th University of the Philippines Stop COVID Deaths webinar series In the last few weeks Filipinos have experienced freedom to be out of their homes finally after two years we see children playing outside and also traveling in tourist destinations around the country going to the malls, eating out and just enjoying this new found freedom sabi nga ni Dr. Raymond bangabagong laya kanina sabi nga yun as part of the task force on COVID-19 variants we have been asked many times have we reached the end of the pandemic that was your question too Dr. Susi why are there surges in Hong Kong and other places while cases in our country continue to go down will we be experiencing another surge soon we are witnessing different patterns of B8.2 infections in different countries across the globe experts say that in some parts of the world hospitalizations and deaths due to B8.2 increase like in the UK together with the rising cases but other countries surges were short lived and did not impact tremendously to the hospitalization public health specialists predicted areas with lower vaccination rates and higher population density and also places where people spend more time inside will be more likely to have a rising cases and have new surges do we need to be concerned about the emergence of the variants of concern may be coming to our shores experts in infectious diseases have laid down some important facts fact number one is that the virus is going to continue to circulate fact number two areas that have lower population density or high vaccination rates are probably going to experience less illness and fact number three with so many people infected with Omicron they believe experts believe against B8.2 and lessen its impact so many questions still need to be answered which keeps us all on the edge of our seats and today's TV UPs stop COVID deaths webinar is so relevant and timely with experts Dr. John Wong from EpiMetrics and Dr. Cynthia Saloma of the Philippine Genome Center joining us today whether the next wave is due it pays to be prepared so what better way to be prepared for another variant or another surge than to stay informed through this very educational TV UP webinar before I end the NIH extends its deepest gratitude to the people who made this program running successfully for almost two years or actually not almost two years for more than two years now Dr. Susie Mercado and Dr. Raymond Cerviento are very engaging hosts who I think have a huge fan base by now they make everyone just want to come back every week so have a good time to come back at the next wave so what better way to be prepared to be prepared for the next wave and productive afternoon learning from our experts back to you Dr. Raymond and Dr. Susie thank you very much okay thank you so much that's Dr. Eva Kutanghodala the head of the National Institutes of Health and Eva we were looking forward to having you in the open forum and thank you for framing our webinar so what should I say so concise yun parang nakungli talaga ni Eva okay Raymond over to you thank you Dr. Susie and thank you to my boss also Dr. Eva for really expiring us just to know more about our today's topic we want to remind everyone din pod that the Q&A session for this webinar we will be picking questions that you will be putting in the Q&A box for zoom and then also in the comment section if you already have any questions in my please go ahead and type them in we encourage everyone to really participate in this Q&A session so that you'll be able to really gain more of the interaction and the engagement with us before we proceed we'll ask everyone to participate dito po sa ating fun mini quiz naititan yun na po ito on your screen ang English ang tagalog po first question what is Omicron Xe is it a hybrid of Omicron and Delta is it a hybrid of Omicron BA.1 and BA.2 or it's a hybrid of two variants of the Delta po ang din po ba dito sa ating three choices ang tama pong option or tama pong kasagutan to the question what is Omicron Xe would like to greet those who are joining us from the city health office in the Gupan Pangasinan from the Notre Dame Short Tres Hospital in Baguio City Agon Cilio Rural Health Unit in Batangas Bicol Regional Training in Teaching Hospital in Legaspay City albai sa Xavier University at Ineo de kagayan in kagayan de Oro City for question number two anong mga bansa ang meron ng Omicron Xe multiple choice po ito so you'll really have to choose multiple answers for this question ito po ba ay sa United Kingdom ito po ba ay sa Estados Unidos ito po ba may kita na sa India or sa China or sa Thailand so we have five options here feel free to select po ang mga bansa na naapektuhan din po na meron na pong kaso ng Omicron Xe would like to greet naman po those who are joining us internationally Bigawan in Brunei from Taipei Taiwan from Cantot Vietnam University of Haile in Saudi Arabia Quasim University in Burayda, Saudi Arabia Kim Saud Bin Abdulaziz University for Health Sciences in Jeddah Luneci Ali University of Lida II in Algeria Burbank Carson in California Clark New Jersey Edmonton Alberta, Canada and St. Eustatius Auxiliary Home Foundation from the Netherlands Antilles We will not be closing po muna ang ating fan miniquist we are seeing that medyo kalahati pa lang po ang nakakasale sa ating fan miniquist we hope more and more are able to participate and then now we'll call on Dr. Suzie to so we can go ahead to our webinar proper Okay, thank you very much Raymond, no? Ang cute na naman yung mga gumagalawgalawg na anong jyan parang mga ano ay ito parang mga ano ay naman mga molecules molecules Okay, so okay so thank you very much for engaging in that and yung basen niyo alam ko na gugugal habang tiniting na niyan okay lang yun okay lang sa ating kasi ano ay parang we want you to leave the webinar with some new knowledge that you really really really remember so that if people ask you then you've got a good answer okay so let's go our first guest and ating we bring you only the best speakers and throughout the two years Raymond we have a favorite go-to epidemiologist and I think this past two years has really been a good time for public health na biglang na iintindihan na mga taon bakit mahalaga yung public health bakit mahalaga yung epidemiology dati kasi ano ba yung binagawa nila bilang sila ng bilang nakikita natin gano ko halaga yung meron tayong aasahan, nangmahusay, nang mga buktor na nag-aral ng public health na ang field nila talagang nang bilangin para malaman natin kung ano talagang nangyayari so our go-to for epidemiology has always been Dr. John Wong who is the Senior Technical Advisor of Epimetrics and we always like to have John on the webinar because he's very calm and very tempered na parang kasi John nakikining tayong lahat kasi ano pa talagang sinasabi niya kasi parang pinikisipan nang mabuti ang sasabihin niya so right now given this question that we have ano no are there more contagious variants at meron bang surge ulit pakinggan po natin si Dr. John Wong John, welcome to the webinar nice to have you here Thank you Suzy Good afternoon Good afternoon to everyone Hi Raymond Should I start? Yeah, go Go John, the floor is here Can you see my slides? Yes, yes, perfect Go ahead Okay, so good afternoon I'll try to answer the question is a new COVID wave coming na So let's start with a short or brief answer So in epidemiology let me get my pointer We like to think of disease diseases in this way na it's not just the the agent the virus bacteria or fungi that causes disease na whether or not diseases produced also depends on the host people and the environment So if you look at COVID this way and the possibility but you search this way whether or not we will have one will depend on the occurrence of virus variants how much immunity the population has how people behave and how healthy the environment is the environment is So let's break it down na So let's go back to our favorite SEIR model for looking at the pandemic na So again na the population can be divided into several buckets or compartments na So people started out susceptible na the population started out susceptible in March 2020 na eventually a lot of people got exposed a lot of them got infected most recovered na but unfortunately some people died na March of last year we had vaccines our vaccination program started so a lot more people got immune na and people who recovered na we're also finding out na they actually have some immunity also na So this is the state of the pandemic na na of our 110 million population na only about 41 million is susceptible na we only have about 34,000 infectious cases about 3.6 million have recovered and 59,000 have died na So adding the people who have been fully vaccinated na about 65 million na and the people who recovered na we have about 69 million who have immunity na So are we in a good place? Well we're in a better place than 2 years ago na but I don't think we're in a good place yet na because of this 41 million na maybe 3% of the population na maybe 3% of them will get infected na if they don't get vaccinated and about 1% of that na will die na or succumb to the virus na So that's about 21,000 people who are still likely to die na if they don't get vaccinated So let's look at each of these factors na that can cause a surge na So let's start with the virus na So viruses can can mutate na as we know na So they can mutate to become resistant to the vaccine na because of this immune escape na so people may be vaccinated but they may not develop immunity Second they may mutate to be transmissible and actually this is this is their goal na it gives them an advantage over other variants So they want they want to mutate to be more transmissible so that they will survive na So when they do that na they become more transmissible or have shorter incubation period which results in the same thing na faster transmission na which is which is what we saw at Omicron na they can also mutate to become more virulent or more dangerous na Before we go to the next factor let me go back one slide na This this recovered patients who develop immunity na this we're realizing also na this is an important factor na so a recent question people have been asking is how come we've never except for South Africa na how come we've never seen large surges na or large number of deaths in Africa recently they've seen that about two thirds of Africans have been infected with COVID na but we don't see that same number na in the reported cases na because they don't have sufficient testing capabilities we saw the same in India na India had a very large delta wave na they also had a large Omicron wave but paradoxically it was smaller than delta even though Omicron was more transmissible it was because after delta people in India had already developed immunity or had already been infected and also not reported so going to the second factor what about how do people na contribute to to a surge or to disease na do they have confidence na in the vaccine or in the vaccination program na so this this will increase or slow down na the immunization program are they compliant na to minimum public health standards na distancing wearing masks na and even if they're vaccinated na just being elderly or having comorbidities na can put them at risk for death na so for example in the Philippines na about 80% of people who have died na of this 59,000 about 80% are 50 years old and above comorbidities na especially na diabetes na also multiply the risk na of dying and that's why they were priorities na for the vaccination program I should also add na of the people who have not been vaccinated na about 35% of the elderly are also na are still not vaccinated na so these are the people most at risk na for death and lastly how does the environment contribute to the disease na we know that covid is airborne na so better ventilation na prevents disease na and there seems to be well at least in temperate countries na seasonality na is a major factor na in the spread of disease na when it's colder people tend to stay indoors and that increases the risk na for transmission so let's talk about the virus na so it viruses can mutate to become more transmissible because they become stickier na to the respiratory tract or they have shorter incubation periods na this gives an evolutionary advantage na and the variants that have emerged na have emerged precisely because of this na every variant has become more transmissible na than the previous na another way that variants gain advantage over other variants are if they also have immune escape na if they can reduce na vaccine effectiveness na na and this is because if the vaccine doesn't kill them then they can transmit na or spread to other people na so we've seen that Omicron Formicon reduced the effectiveness of the vaccine by a lot. So it became more transmissible even among people who were vaccinated. However, for immunity against severe disease, it only affected those who were elderly and persons with comorbidities. But for the rest of the population, they still retained their immunity against severe disease. And we saw this, previous infections reduced stronger immunity than full vaccination. So we know that Omicron had about a 60% reduced severity compared to Delta. But of the 60%, only about a third was due to the inherent mildness of the virus. About two thirds of this reduced virulence was actually due to stronger immunity because of previous infections. And then, what about virulence? Virulence can become more virulent or more dangerous if they penetrate deeper in the respiratory tract. But this is the characteristic of the virus that viruses don't care about. They become more virulent or they become less virulent now. But there's no intention for viruses to mutate towards less virulence. That was a misconception that people had earlier. Viruses always mutate towards higher transmissibility and less virulence. So Delta proved otherwise. It was more transmissible but also more virulent. So there's no preference for less virulence as viruses evolve. Okay, what about XE? The XE variant. So we see here the lineages of the viruses. This is the original variant. This is Delta. And then this is Omicron, the two variants of Omicron. So they're very different from each other. Most people expected that the next variant after Delta would have emerged from Delta. It turned out that Omicron was emerged separately and was very different from Delta. And then under Delta, there were other variants or sub variants. These are called recombinations because they're combinations of either Delta BA1 or BA2. So XE is a recombinant of BA1 and BA2. So far, it's just a variant under monitoring, not a variant of concern. We should also know that recombinants are actually very common. So now a lot of people are talking about XE. But there had actually been previously XA, BC, and D which emerged and then died out. So not all sub variants are dangerous. So XE was... Well, they're not found only in UK now. But most of the cases have been in UK. But I think only because UK has one of the strongest, if not the strongest genomic surveillance systems in the world. So they found that it's 10% more transmissible than BA2. But because of the very small numbers, they still can't tell whether it's more severe or it has immune escape properties. But having said that, we know that vaccination and previous infection could reduce the impact of any new variants. But just the same, we still need to control spread because transmission causes mutation. So this is just a map of how the variants have evolved to become more contagious and more resistant to the virus. So this original strain Alpha, Beta, Delta, and Omicron is really factors away from all the other variants. So this is a map of the amino acids of the COVID virus that are targeted by the vaccine. So these are all the targeted amino acids. Delta had two mutations. So that's why Delta had only slight reduce effectiveness against... Or the vaccine had only slight reduce effectiveness against Delta. Omicron, on the other hand, had 15 mutations. So that's why effectiveness against Omicron was reduced to a greater degree compared to Delta. However, each of these 200 amino acids that the vaccines target can mutate 19 times. So if you take this, it mutated once here. It can mutate 18 other times. So there are about 4,800 possible mutations for directions into which COVID can mutate. And we will experience a few of them. So virus evolution has not ended with Omicron. So Omicron is not going to be the end of the pandemic. Since the start of the pandemic, scientists have documented 400 mutations that make the virus... The vaccines are affected with. However, this is just a small subset of all the possible ways that the variant can still mutate and still possibly infect human cells. So we're still a long way away from being immune from the virus with or without vaccines. So what do scientists think is the mostly likely path of COVID virus evolution? So it's not the end. They will always evolve to become more transmissible. Immune escape helps them become more transmissible. But whether or not they become more or less virulent is left to chance. So Delta is more virulent. Omicron is less virulent. We don't know what the next one will be. In the long term, scientists believe that COVID-19 will probably be like the flu. How will it be like the flu? So it will become seasonal, meaning every year there will be variants. And because of these variants, people may be more or less susceptible. So that makes it seasonal. And epidemics are still possible depending on whether there is immune escape from the virus. So we will need probably annual boosters. But this is what scientists are working on. Vaccines that are variant proof so that we don't need to change vaccines with every variant. So far, we haven't changed the original after the emergence of alphabeta, Delta, or even Omicron. On the other hand, for the flu vaccine, we're able to come up with a new formulation every year. But these are not always effective to the same degree as if we're working from a real genetic map of the virus. So how about people? How can people influence disease? So let's first look at immunity. So this is what we call the immunity wall. So this is by regions. These people have the strongest immunity. They're vaccinated and they're boosted. These people also have good immunity. But that's strong. They're vaccinated but not boosted. This is where our immunity is porous. The light green area. They're only partially vaccinated. So they'll get breakthrough infections and some of them can even get severe disease. And this is where we're missing parts of the wall. And the virus can easily jump over it. So this is the part that we need to fill up. So we've seen that NCR has always led. And part of this reason is because when we didn't have enough supply up to maybe November last year, the top three regions were given two times more doses compared to the bottom three regions. So there was inequity, no geographic inequity in terms of distribution. If you look at age groups, we actually also have a low boosting wall, higher fully vaccinated wall, but still a large proportion of the population that are not protected or still susceptible, especially among children. So the immunity wall is incomplete and porous. So what's keeping people from being vaccinated? The story has always been told is because of vaccine hesitancy. But that's actually not true. So when the program started March 2021 and vaccine immunity was measured, it was about 30% quite low. But from this graph we see that across the whole left of the urjuration of the vaccination program, acceptance has always exceeded supply. This is the yellow graph. So there has always been a gap. So that means that all throughout last year, more people had always been wanted to be vaccinated compared to what is available. Supply already caught up end of last year. But now, new problems emerged. So if 85% of the population want to be vaccinated, there's still a gap between that and people who actually get vaccinated. This is about 59%. So from being a vaccine supply gap, now we have a vaccine access gap. So in the last mile, getting doses from the health centers or the vaccination centers into the arms of people, this is the gap now, the logistics gap. So we've done a survey among the elderly of what's preventing them from getting vaccinated. The top reasons are, as you can see, logistical reasons. Waiting times too long. They have physical limitations, mobility issues that prevent them from going on their own. It's difficult for them to find or make an appointment, especially if appointments are made online or digitally. And it's too far away when the vaccination centers are too far away. If you read through all of this, most of these are logistical issues. Okay. So moving from immunity to behaviors, what type of behaviors prevent, what can prevent another surge, getting vaccinated and boosted, ensuring good ventilation wherever you are. If you're outdoors, you certainly have good ventilation. If you're indoors, you have to make sure there's inflow and exhaust of air. You're wearing masks of good quality. N95, K94 or KF94. And you keep distance. But now that cases are very low. Sometimes and people have pandemic fatigue. It's difficult to always practice all four of these. So let me introduce this three out of four rule. So the three out of four rule says that if you can satisfy three conditions, you can skip the fourth. So for example, if you're vaccinated, you're in a room with good ventilation and if you're distanced, you may not need to mass. Or if you mass, you can stay closer together. Or on the other hand, let's say you're outdoors jogging. If you get vaccinated and you have good ventilation and you're alone in a park, for example, running or jogging, may not need to mass. So this is a good rule to observe, to be able to carry on with normal lives. There are also several rules of thumb that you can follow as to when to mass. What is the smoking rule? If you're inside the room and if you assume that somebody were smoking and if you could smell the smoke, then yes, you need to wear a mass. Pero if the room is so large or the ceilings are so high you don't think you would smell smoke if someone were smoking. You don't need to. There's also the most vulnerable rule. So if you're in a room with a group of people, a family or friends, try to identify who's the most vulnerable, the elderly versus with comorbidities. If that person is up to date with his or her vaccinations, meaning boosted, then you don't need to wear a mass na kasi even the most vulnerable person is protected. So some people have been asking whether do we have to wear mass forever with community transmission of COVID so low. Maybe not against COVID but we also see that over the past two years by wearing mass and probably also practicing other behaviors like hygiene, good ventilation and distancing. That's from other causes. Have actually also gone down. So this is this is an analysis of the PSA report on excess mortality during the pandemic. So we see that over the past two years there actually been a decrease in pneumonia deaths and that's due to chronic pulmonary disease. Brokkitis or emphysema. So that fewer 23,000 23,000 deaths due to pneumonia and about 4,000 due to COPD. Not only that if we look at infectious diseases actually over the past two years all the infectious diseases that are not named COVID have actually had actually lower mortality infectious area. From the hygiene practices respiratory TB from masking, sepsis then again for staying indoors and then even measles. So decrease across the board for infectious diseases. So there's some benefit to actually a lot of benefit from masking probably also hygiene behaviors. Okay, what about the environment? So we know that COVID is airborne aerosolized. This is how you can or should protect yourself in terms of designing ventilation for for your buildings or rooms. First, make sure that there's cross ventilation intake and exhaust of air. If you want, you can install window fans or put HEPA filters although these are very expensive. So since we're a tropical country, we can open windows or doors and not be afraid of the cold. Maybe the only downside is pollution. If you were in an air conditioned room, we have to reconfigure our air conditionings. Now we have to install what they call the Merv 13 filters. These are the filters that are these are high quality filters that also filter out viruses. Also ventilate the room before and after the work day and also maybe even add air purifiers. One thing everyone can do is to have this carbon dioxide sensor inside the room to monitor whether or not it's safe. So the safe level is 1,000 less than 1,000 parts per million of carbon dioxide. So as long as you have ventilation they can keep it that low. You're most probably safe from infection because carbon dioxide kasi is a proxiedom for the virus. If it's exhaled by people and it's not ventilated, you can imagine that if you have an infected person inside the room the virus is also not ventilated out. How about seasonality? In temperate countries there's a strong seasonal association between temperature and virus and insurgents only because when it's cold people tend to stay indoors. In the Philippines this is a graph I made comparing the three years to and one fourth year that we have had and these are our seasons. There seems to be a relationship with the rainy season maybe because people stay indoors but the association is not so strong with the other other seasons. So we can't tell for sure. If there's an association it's probably very weak. So in conclusion first first of warning we see a low number of cases now but they're probably underestimated. Omicron is still the dominant variant we have and people with mild Omicron symptoms may not even get tested. There's also more widespread use of home antigen tests and these are also not reported to government. Also many people are done with the pandemic even though the pandemic may not be done with them. So as we see in euro even if they have had BA2 surges governments continue to reduce restrictions. So the response to a way is not similar as to previous waves. We see that interest in vaccination is also raining. So for the past weeks our daily vaccination range from maybe 200,000 to or even less. So if if the cases reports are not that accurate we're left looking at hospitalizations and deaths which are more accurate indicators but these are lagging indicators. By the time we see them increase we already know that there's a large wave of cases behind it. Okay so let me conclude by going back to the epidemiological triad. So how do we prevent another surge? So instead of answering the question now will there be another surge? How do we prevent it? For most of virus behavior there's nothing we can control about whether virus has become more suspicible more severe but we can prevent mutation by controlling print transmission or spread. We can also try to improve indoor air quality and monitor whether that improvement has worked. But this is I mean if we could do just one thing this is the thing that we should focus on build a higher and more solid immunity one. People who need to be boosted should get boosted. People who are not vaccinated should get vaccinated. And as vaccines roll up for children we should get our children vaccinated also. And of course observe the triad of fall rule even though community transmission is though. I think that's my last time. Thank you. Thank you much. Let's talk to John Wong. I na ko, magaling talaga si John Wong mo. Grabe. Mamaya pa pano din ko tolit. I advise you also to go over it to share it with others because really made a presentation that was so logical and John you're going to see the appreciation of our community. And thank you so much for your time in preparing this. I'm sure you did everything to pull in the latest data pero napakalusay po talaga na napakalinao talaga ng pag-explain niya. So the messages are very clear for us and we have one more speaker who Raymond's going to introduce and will have our Q&A and open forum. So go ahead Raymond. Thank you Dr. John. Really very informative just as always pa na and we look forward to you being able to answer questions later on during the open forum sir. For our next speaker she is an expert on molecular biology and genomics po no and currently she is the executive director of the Philippine Genome Center. Please welcome back sa ating webinar and onto your screens executive director Dr. Sincha Saloma po all the way from Bohol. Thank you very much Dr. Raymond and Dr. Sissi. Thank you very much for the opportunity to talk again in our program stop comments. So I'm going to start my presentation. Is my sound coming in loud and clear? Yes ma'am, go ahead. Okay so I declare no conflict of interest and then I'll proceed with my presentation. So this is the global genomic epidemiology of SARS-CoV-2. As of April 8, 2022 there are now 496 million confirmed COVID-19 cases at nearly 6.2 million deaths worldwide. In our country we have recorded 3.680 million cases at about 59,000 deaths. The global epidemiology at SARS-CoV-2 shows the emergence of variants of concern towards the last quarter of 2020 and these variants show greater transmissibility, immune evasion capabilities or increased pathogenicity which have been designated with Greek lepers by the WHO. So in December 2020 we saw the emergence of the alpha first detected in the UK and then we also have the beta variant first detected in South Africa. The gamma variant where we only have found 3 in the country this is first detected in Manaus, Brazil and then there is an appreciable detection of the delta variant which happened in India in April of 2021 and this was followed being D by a very, very rapid global rights or spread of the delta variant because of its high transmissibility and rapid rapidity rate. And of course some people say that it drove essentially the global third grade of COVID-19. On November 26th last year 2021 the WHO added to the list of DOC with a designation of B.1.1.529 in Pangolin and this has been called the Omicron variant. So if you look very, very closely at the latest data this is the data from GSAID or the global in a strip on the sharing of all influenza data as of April 5, 2022 we can see that nearly 100% of sequences worldwide is comprised of the Omicron variants and related interest. So there's actually a lot of Omicron we'll have B.8.x and I will explain that later. So if you look at the data around the world in different continents in Africa, in Asia in Europe in Oceania in North America as well as in South America nearly 99% of sequence cases lately in the past month are really comprised of the Omicron variant. So here in the next slide I'm showing to you the emergence and evolution of the COVID-19 variants are concerned in the Philippines so the Philippine Genome Center with a in partnership with the Department of Health Epidemiology Bureau has sequence more than 28,000 cases at SARS-CoV-2. So if you look very, very closely at this graph to see here between January to July or August of 2021 the detection of the alpha variant side by side with that is the detection of the beta variant and then of course towards the tail end of the beta the alpha wave would be the emergence of the delta variant that we have detected up to December 27th, 2021. Towards the third week of December the Omicron variant has already been the dominant variant in the 40s but what is the key message of this our phylogenetic tree? When we look at the emergence and evolution of the variants of concern at SARS-CoV-2 we notice that none of the variants of concern led to the next variant of concern that is to say that beta this one he did not arise or is a mutation of the alpha variant of concern though could we say that the Omicron arose as a mutation of delta? These variants of concern came out as independent mutational events perhaps in an individual that is the main compromise and with chronic infection or even in an animal host allowing the virus to mutate and explore the mutation space to come out with a variant that is most advantageous to it There was a previous concept that the variants would evolve in a ladder-like pattern of evolution that is it would gradually change as the mutations accumulated This concept has been blown out to the wayside with the emergence of the alpha variant which emerged in the UK in September 2020 Please note that the alpha variant was not related to any of the main SARS-CoV-2 lineages circulating in the UK at the time The same thing happened with the beta variant detected in South Africa and then again with the delta variant first detected in India and now the Omicron variant is first supported in South Africa and that's one So this is a map of the Omicron variant or Omicron sub- lineage and you can see for example that in the beginning of 2021 the Omicron cases worldwide the dominant was the BA.1 sub- lineage whereas in the Philippines at this time even if globally it was very very low the BA.2 sub- lineage was already our most dominant variant in terms of sickness cases But now in the month of May of March and we will we see that the BA.2 comprises 95.4% of sequence cases submitted to the global database called GC To answer the question of will there be more variants will there be common surges it will be worth way to look at the mechanism that drives viral evolution I think Dr. John Wong Awala Grass already discussed this to us at next point So we have here the current SARS-CoV-2 outbreak has been presaged with previous outbreaks in the same virus phylogenetic tree including the SARS-CoV-2 SARS-CoV-2 in 2003 and the MERS outbreak in 2012 All with zoonotic or animal origin This pattern of animal viruses being introduced to the human population makes it inevitable that epidemics and future pandemics will happen What drives viral evolution in the first place? SARS-CoV-2's key feature has been its propensity for genetic recombination across host species with its genome bearing the footprint of multiple recombination events As it moves from host to host with possible contributions of mobile genetic elements randomly inserting in the viral genome while it is in the host cell So viruses also mutate in response to the host immune system as well as to the pressures from the environment Because of their short generation times and large population sizes viruses can evolve very rapidly So I have already presented these definitions of what is a mutation what is a variant what is a lineage and what is a strain So just to emphasize to you that we are using a phylogenetic tree based on pangol pangolinages pangolin means phylogenetic assignment of named global outbreak So whenever I mention something at B.1.1.7 or the output variant is really based on the pangolin momenta So in the next slide I'm going to review or to bring our audience some of the keywords on the lineages and sublingages of our current variants So unknown to many we always report about the detection of the alpha variant the beta variant or the gamma or the delta or the omicron but of course internally within the gamma or the within the delta or the omicron variants we report through the Department of Health Epidemiology Bureau we know for example there are some lineages So what are these? For example in the alpha variant we barely see out the alpha variant now the sublingages are assigned Q.1 to Q.8 So this has been overtaken by omicron as we all know Then the beta variant we have a .1 or B.1.351.1 up to .5 Okay For the gamma variant I mentioned to you that in the Philippines since the beginning of our genomic best of balance effort we have only detected three gamma variants apparently there are also P.1.70 but mostly these are located found in Brazil as well as in other countries in South America Then we have the delta variant So we have B.1.617.2 So that is the pangolinage However, there are a lot actually sublingages more than 200 sublingages of delta and that reflects to the rapid mutation and spread of the delta variant around the world So when you see the word or the sublingage AY.1.2.0.4 up to AY.133 these all refer to the sublingages of the delta variant So this has been the delta variant was first detected in India in October 2022 and it was designated early last year in May 11, 2021 as a variant across Now let's go to the Omicron variant with a pangolinage number of B.1.1 1.529 So when the Omicron variant was named by the WHO and was considered as a variant of concern there were actually three sublingages not just B.1.1.1.529 There were actually B.1 This is a sublingage B.1 which actually was the first to become dominant around the world but now in March of 2022 we have B.A...2 and you'll notice some countries such as Denmark first had the B.A...1.1 also the same as in the UK they are now experiencing the B.A...2 rates and then we have also B.A...3 which is really very few numbers some of which have been found in Africa and also in Portugal So B.A...1 alone has a sublingage of up to 19 so your B.A...1.18 Then we also have for B.A...2 we have up to B.A...10 Okay So many views were detected in September or November of 2021 So I would like to bring your attention now to B.A...2 in a short while but I'll just try to introduce that in the B.A.... sublingages I mentioned about 10, right? So there are actually for example 1 that is closely identified to the four peaks This is B.A...2 0.3 that comprises 97% of the B.A. of the Omicron lineages in our community cases So that's 97% except from cases from community samples are B.A...2.3 and we would like to believe that B.A...2.3 first started in the Philippines we have gone into the global database and the earliest case of B.A...2.3 was actually recorded and also bitten by the Philippines on December 2 2021 from a sample in U.N.A. from a community sample in Nagraman, Alapaganda So the one that was supported in Hong Kong is B.A. a sub-lingage B.A...2.1 that's a UK lineage Hong Kong is B.A. 2.2 So the Philippines is circulating about 97% of the cases we have in the community is B.A.2.3 The one in Japan seems to be like a baby of B.A..2.3 So the Japanese lineage is now B.A.2.3.1 So it's an offshoot of the Philippine lineage and other countries and this has been also reported in Singapore, in Hong Kong and in Japan probably from Philippine droplets The one from Singapore lineage is B.A.2.4 and then we also have 0.2.5 in Portugal and other countries for France it's 2.6 in the U.S it's 2.7 UK again 2.7 because UK has a very robust genetic-visor data system and then we also have the B.A...2.9 which is the European lineage So I would like to show to you here the latest data in terms of the cases that we have observed in the Philippines So as all April 7 yesterday we have recorded 278 cases So as mentioned also with Dr. Wong this might be an underestimation because most of the time people will either go rapid antigen test or if there's really no need for this or hospitalization many people have very very mild symptoms or no symptoms and we cannot get test but at any rate we have 278 confirmed cases yesterday most likely if these are community transmissions most likely be 0.2.3 We compare that with cases So you can see here that we have a case this is our Delta wave this is our Omicron wave which happened and peaked in January 15, 2022 So you have here in the Philippines we peaked very early and that was driven not by B.A...1 but by B.A...2.9 Now we also have to hear cases in Indonesia Indonesia with a population of more than 200 million has recorded about 2,000 cases on So you see the the graph of the Philippines and Indonesia are very very similar Now we are also looking at our neighboring countries are looking at Malaysia Thailand and Singapore if you look at the cases in Malaysia probably they have reached a peak and the tail end is still a little bit long hopefully they have already seen the peak of cases and they're just going to go down we hope so In Singapore also for a country at about 5 million 5 million population they actually experience a daily case of more than 5,000 High but the death rates or the case with alcohol in Singapore is also very low Now we look at cases in South Korea at one point in South Korea the daily case is more than 600,000 in Japan it also reached about 120,000 a day or more and yet also nearly 200,000 actually so for some of these countries or from some of our neighboring countries hopefully they have already reached their peak and now on the decline but we also notice that the tail end is a little bit low as compared for example to the one that is experienced in Indonesia and the Philippines where the the tail or the down that the low number of cases after reaching the peak has really achieved at a very very short period of time okay so we often been asked what could be the possible explanation for the cases the low cases in Indonesia and the Philippines could it be because of the vaccine they have been using the innate immunity of individuals prior exposure and so on and so forth I think this could be due to a combination of factors so let's look at the emergence and evolution of the COVID-19 variants in the Philippines the same pattern of VACs such as Alpha Beta and Delta followed by the Omicron variant was observed so I remember I said to you that it's not a ladder like emergence of the CDC they came from out or somewhere and then they became the Delta variant because of movement and mobility restrictions probably border control measures and other policies the introduction of spread of the Delta variant in the Philippines was actually delayed way above two months compared to Asian not the neighbors but the Omicron wave in the Philippines peak earlier compared to the experience of Delta we saw our highest cases driven by the Delta variant last September 15 or Asian neighbors for example in Indonesia Malaysia, Thailand and Vietnam they experienced their peaks earlier in July or August of 2021 in contrast ISN mentioned our Omicron wave peak early probably January 15, 2022 although the Omicron B8.1 must first detected here about November 21, 2022 in Cordillera this is community transmission so we saw community transmission of B8.1 much earlier compared to B8.2 it really did not take root here in the Philippines whereas in Europe you see first the B8.1 wave in the Philippines really did not experience a B8.1 wave immediately experienced a B8.2 wave and not just B8.2 it's a B8.2.3 that was first supported December 2021 so look at this so just to emphasize see that of course the daily cases of the country versus the daily deaths or the deaths from the alpha and beta as well as the Delta disease have been relatively high the same thing that we said of the Omicron wave and this is also experienced by other countries so we call this the coupling no the coupling this has been observed in other countries but we also saw that in our neighboring countries because the sheer number of cases they're also experiencing decreased nominal deaths of patients particularly probably in South Korea as well as in Japan so now i'm going to discuss about the B8.2 sublinages as well as the hybrid variants that we have observed so these are the B8.2 sublinage mutations these are in the ORF1A gene and the S gene as well as in the ORF3A gene so the Omicron subvariant B8.2 has about 10 sublinages but locally we are BA.2.3 and what are the hallmark mutations of the Philippine BA.2 sublinage or we call this BA.2.3 we have observed two key mutations in the ORF1A gene here these is substitution mutation at possession 2909 from element of the gene and from ORF3A we also may observe an L to 140F mutation in these ORF3A gene and these both of these these double mutations comprise 97% of the detected local Omicron cases and these are the distinct mutations that are identified with the BA .2.3 sublinage now these are latest Omicron sublinages at the local distribution in the Philippines so these are all color coded you will notice that mostly it's all purple of course purple is also the color of the Philippine genome center it's BA.2.3 that is widespread in the Philippines if you see this map or this table this is from November so the last the first time Omicron was reported by South Africa and that's one and also Hong Kong we map our cases sequence cases by the PDC from November to March 2022 so November 2021 so you can see here that you have very very few BA.1 cases in December we have an uptick of cases of course we in towards the tail end of November our cases are really really low of January to February so in total we have sequence about 5,935 cases but if you're going to differentiate or to look at this very closely so by the way everything with BA.1.1 these are all the BA.1 and sublinage which was predominant around the world so it's very few we have detected this in the Philippines but it did not really prove but what we have would be a lot of BA.2 cases so if you look this at this very closely look this one these are the lineage of BA.1 the globally dominant lineage prior to BA.2s increase or rise in February and March of this year you will notice that among our local cases 499 4991 over 5,029 are BA.2 points which can just see the dominance of the BA.2.3 in our community at this measure some people are saying that we open the economy or or we allow people to come into the country because there was an electron actually the decision of the IATF was really driven by data it was because we realized we reported to the IATF that the local transmission or the local cases in the Philippines are driven by community transmission rather than fresh introduction against from our airport and that's why it was more logical to indeed open our borders because the cases were not being spreading and really being 23.3 so but if you will notice of returning of these Filipinos even if they have BA.2 it's very likely that it's not the BA.2.3 version and a lot of our ROAs are BA.1 but as far as our local community cases it's BA.2 BA.2.3 with those two mutations that I mentioned to you previously if you look at the phylogenetic tree and the emergence of this BA.2 on the two mutations we would like to surmise that these BA.2 has been introduced in the Philippines earlier and has acquired these two additional mutations silently until such time that the mutations have made them highly transmissible now let's look at the hybrid variant so this is another take on the graphics so these I would like to thank Aaron Panglinan of the DNA of the core facility for bioinformatics for doing this for this presentation so this is a map of the BA.1 mutations so you know that the genome of the SARS-CoV-2 is about 29,903 bases okay so this is at the map so this is the signature mutations of BA.1 you know that they are really really a lot of mutations and BA.2 these are the signature mutations of BA.2 so some of the mutations of BA.1 and BA.2 are shared but other mutations are specific to the sample image and then we have here delta AY.4 why delta AY.4 is shown because the other HD for example and XF are really AY.4 sublimage of delta the lineage AY.4 so this is delta by the way and there's up to AY.4 AY.153 the AY.4 is actually the dominant delta sample image in Europe okay so if you look very closely here you can see this is the signature mutation of BA.1, point 2 and then delta XD is a combination of delta AY.4 and BA.1 so you can see BA.1 this one is very similar and then these are the others are of course sure delta so the blue of the red ones the box ones are the BA.1 donor segments you can see is very very similar how about XE which is the a topic of interest for many people XE in contrast to XB and XF is a combination of the two omicron sublimates so for XB and XF it's a combination of delta omicron delta omicron but XE is BA.1 and BA.2 combination actually a lot of the XE is BA.2 with some BA.1 hybrid recombinant sequences so you can see here I can see very very clearly that XB has a lot of the mutations signature materials of BA.2 and a few of the BA.1 mutations okay so to summarize you have the XB which is delta AY.4 omicron BA.1 recombinant lineage of delta and BA.1 this was first supported in France and Denmark and the earliest sequence was on January 17, 2022 in France the most recent is February 5 in the Netherlands but there's nothing much we can say about the XB because it seems to be circulating only in these three or four countries in Europe not Belgium Netherlands France and of course at Denmark how about XB so I said to you that BA is an omicron omicron hybrid the two omicrons of variants this recorded in the UK Israel in Thailand also in Taiwan so far it has infected about 637 people in the UK it has three notation that found in the parents some sequences or parent sequences they say it's probably more transmissible by 10% compared to the original already transmissible highly transmissible BA.2 but the evidence is still lacking so we're still and this is really closely close monetary the XF is again at delta AY.4 omicron BA1 combination detected mostly in Britain and so far about 39 people have been confirmed to have this XF hybrid omicron variant so what are the key points of my presentation today it is that mutations occur as part of the natural process of BIOS evolution and that recombinant variants crop up and sometimes at most of the time they tend to disappear on their own of course because of these there should be and we continue to have a robust genetically surveillance system in order to trap these new variants and also to study very fast now the clinical presentation based on available evidence the current couple vaccines are still effective against our four new variants although they may have to diminish efficacy the third shot of booster could block the immune as the mechanism of omicron and some countries are actually can't broken in the fourth booster because of the possibility of bringing immunity from the vaccines and vaccine designers need to design a new couple vaccines that are protected against emerging variants with alternative being an unwell dose of variant-specific farmer by epidemic vaccines so we really need to challenge our vaccine designers if they can design a vaccine that is resistant or is able to provide us protection even in the face of the emergence of new variants so with that I would like to add my presentation and would like to thank many laboratories around the country who have been sending samples to us our close collaboration with the DOH Epidemiology Bureau and the young people of the UPPGC for the effort and sacrifices so that we can deliver to you these genomic sequences at the SARS-CoV-2 thank you very much okay thank you very much that's Dr. Cynthia Saloma na ko nga galing nga galing nga kailangan panuurin din natin ulito ako i'm really so fascinated by the detail the level of detail and you know guys so I think John was talking more about how you monitor people and the environment but that's not enough di ba we have to also monitor what's happening to the virus and you can't do that without this really top caliber scientist like Cynthia and her team no mga bata na nado sa Philippine Genome Center ang huwusein nyo so thank you so much we are so lucky in the Philippines that we have this that you are able to monitor the virus kasi ba yung mga monitor yung mga tao na kakasakit sinong tines et cetera ay ba yung di ba yung tinitig na nila yung virus ano ba yung virus na yan and really so informative so thank you very much Cynthia and again I'm sure our community will be you know clapping their hands again in the chat but we thank you for putting your your effort into this presentation and for for being here with us today we know you're very busy okay i'm gonna turn over to Raymond Raymond over to you thank you Dr. Susey and thank you so much very informative again um marapipong mulaman talaga pag si Dr. Saloma nag mention about especially the genomic sequencing right now we'll try to ask uh our panelists uh so Dr. Eva Dr. John and uh Dr. Racine chaya to open their cameras po uh because we will move moving shortly into the open forum but before that we'll take a very quick break for our special public service announcement today oh sigin nana parang kagat lang lang gam hantik o yung kumikilitilang ito naman parang hindi ka pa nababakunahan dati akala ko pa naman brave girl ka nakakahiya nakaito ok lang po nanay ay ang cute naman ng shirt mo favorite color ko rin yan top favorite ko rin po ang color nito pero ayo ko po ng red hantik masakit kumagat at takot rin po ako sa blood maktudugo po bako sa bakuna ah hindi wala ang dogo sa bakuna kontin pisil lang tapos na kakasugat bako do hindi ka magkakasugat lalagyan lang natin ng plaster pagkatapos para safe di ba nabakunahan ka na rin ng contra measels at chicken packs dati parang ganun lang din ang bakuna para sa covid-19 na tatakot parin ako dog alam mo ang secret sa pagiging brave hindi ibig sabihin na wala kang kinatakutan kundi kahit na tatakot ka hinaharap mo parin ito ok ready na po ako dog una pupunasan ko muna ng bulak na may alcohol ang brazo mo ok tapos mabilis lang na kontin ayos tapos tapos na na pwede mo ng boksana mga mata mo nai sabi sa inyo brave girl na po ako way oh heto ang price para sayo ha wow bagay sa shirt mo that's the color of bravery color in yan for love thank you to thank you nai dahil ako po ay makalming nyo nagpabakuna na ako kaya mga bata magpabakuna na kayo stay safe and stay well mga bata magpasama na sa bakuna center thank you so much tvup the covid communication public service announcement is one of the many creative outputs of the stop covid deaths team to push for the pediatric vaccination for children age five and up doctor susie thank you very much to ako ikaw yun doctor dumti the voice the voice yes po oh we have more surprises for you coming up in the next coming weeks but so we've got everyone we've got Eva we've got John and we've got Cynthia with us and um we'll get the ball rolling Raymond's gonna look at some questions from the from the chat box but let me start by asking okay so John told us about galingan only John pinakita nyo yung ano no yung epidemiology yung through a timeline no sinke naman pinakita rin yung yung monitoring biosurveillance no monitoring of the virus so dalawa yung tiniting na excuse me no question is hindi po to covid ah sorry Raymond it's okay okay, okay i got it question is how prepared are we for let's see there's another kasi maganda yung sabi ni John no just because it mutate doesn't mean that it gets weaker right and then once sin sya was saying naman was that damning ano damning mutation anak anak no so how ready are we for for another variant kami in and and i think one of the issues that was raised by both of you was that you could be seeing less numbers because actually halos hula ng nagpapatest ngayon di ba i can't say that one halos hula but definitely there's less testing going on and i know eva's been really instrumental in getting our testing capability up to the point where it is right now so i'll start with eva no, parang from your point of view are we ready for another surge and if if for example this omicron xe becomes you know something bigger than what it is now ano yung mga pagahanda na kailangan natin doin so we'll start with eva thank you dr susie what i'll say is i think everyone is now familiar with alert level system that the government has put in place and that those alert level system looks at disease situation the daily number of cases the healthcare system how the icu beds are occupied and in terms of disease control yung really um uh accelerating uh no sorry increasing the number of our testing centers especially for rtpcr as well as gene expert throughout the country i think right now we have more than 320 testing labs and then of course we have the genomic biosurveillance in place so if you'll the the alert level systems that the government has implemented since october i think or sometime late last year has allowed us to look at these parameters and then make our responses accordingly and i think those are important because we have to approach this from the whole of government and and whole of society that means everyone looks at the same numbers and the same and will coordinate a a response that that um that encompasses all the the agencies of the government so are we better prepared to answer the question are we better better prepared for a for the emergence of a new variant i i'm thinking we are but it will require all of us to have this coordinated effort that's my short answer now yeah thanks eva john what is your thinking on this you've been in the heart of this look what do you think are we are we really now better prepared or are we going to scramble again if something happens john good so i i go back to my framework so first it will depend on what the next variant will be does it cost more transmission more importantly is it more virulent so if it is more virulent what we need to prepare for is hospital beds ICU ventilators um although we have we have developed surge systems now that allow us to expand and reduce our hospital capacity as needed but uh over the past two years i think what what we needed to have done is uh to actually set up ICUs in at the provincial and city levels right now there's some regions where they have to send patients to the regional center you know just in order to access ICU ICU capacity no so instead of having this surge capacity or in addition to having this surge capacity i think we need to actually build ICU critical care capacity at the provincial and city levels this this period that we have now very low cases unless we have better vaccination rates i would call this the interval between surges so no way is the pandemic over so but we should also call this stage the preparation stage so prepare in terms of hospital bed capacity but also in terms of testing capacity no kasi we can we can react where we'll be reacting late if we don't see the cases coming and if we only see the hospitalization rates go up so i think we there's still a lead we still need to do a lot more no to to be better prepared thank you yeah thank you John let me pick up on something you said before we go to sentia no kasi ano no parang sabi mo who more bigger than tribes been mas mabangis mas mabangising virus we have to be prepared to take care of patients and we've been talking about this for some time na dapat we have more i see us more infectious disease training for both doctors and nurses at the level of the province in fact at the level of the district there are district hospitals around the around the country that can be converted no pwede pwede kasing meron tayong mga infection control designated at the local level as long as meron tayong mga train na taon no but I really like that point no na we have to think about we have to have kind of like a problem tree which is like is it more transmissible more virulent or both di ba kasi nakita natin sa Beijing eh nagpatayaw na naman sila ng ano enang isang katutak na isolation isolation centers and if you were monitoring media no they were really you know parang hinuhuli ng police yung mga nagtatess positive no and they were really closing down neighborhood so iba naman ang approach nila no and of course very difficult to to do that anywhere else China is very difficult difficult different as as as I would say right but I like your point that we have to be thinking about what are the option what are the possibilities here kasi ta mayo ni this is this is a lol no parang walang bagyo ngayon kaya kailangan ready tayo pag nagkaroon ng next pag yon diba kung more transmissible siya anong dapat handa natin kung more virulent siya anong kailangan natin handa so I think this is these are very very strong point so let's go to Cynthia no kasi being able to monitor that virus to see that virus kasi it sabi natin no I'm sure in the audience sabi niya nang parang hindi natin makita ang kalaban actually si Cynthia nakikita niya yung kalaban alam niya kong anong classic itura noon sa nang sinong nana at tatay noon saba siya nagsistei ganoon so Cynthia you know with this period this lol period are we advancing in terms of our preparation to visualize and to identify any new variant oh thank you for the question Dr. Sisi actually there are efforts to strengthen our generic base surveillance to couple the sequencing with the ASA system so that we've ever we see mutations with an immediate test functionally whether that has a higher attachment capacity it increases the the boom time or the reputation of the virus so those preparations the process are increased including a sub-virus testing facility within UQB demand and of course the possibility also of isolating the virus and testing testing them with your variants so that is at the level of the sequence because for example sequence wise we can predict that the possibility of these virus to have to probably have a higher immune erasiveness but we just have to test so there should be a mechanism that we can test at very fast so that is one the other one Dr. Sisi is of course we really be dependent on the nature of the variant that is coming and number three Dr. Sisi of course you are with the strengthen a generic base surveillance country at the Philippine Genome Center we have already been inaugurated three more and I think there are other Sentinel sites that are being up but that is still all in the planning stage so we need to strengthen this genomic base surveillance system to have epidemiology statisticians and for genomicists very informative chance in the team and that is to our other country including of course in the testing of environmental samples as well as long at the infections and if there is something that you have also learned that has become very prominent during this pandemic is the fact that we really really need to strengthen the healthcare capacity of our provinces and cities you remember when they were trying to do a high risk check the rate check that you notice at some places really have very very limited capacity for ICU and also of course for isolation some district hospitals are they tried to to upgrade to higher level hospitals but indeed there is really a challenge and I think for many LGU's to the BLH I think this law in places should be a good opportunity for us to strengthen our preparation we know that this virus may not go away because always they are it's just a question of what kind of mutations will you present and whether it will of course what is the challenges it will present yeah thank you very much thank you very much Nitya I think ano-no sabihan ni John Kenina yung UK pinakamagaling sa sano no genomic sequencing sano one day marimig natin in Philippines ang pinakamagaling sa Asia doon di ba kasi the capacity is there but we just need to be serious and pursue it kasi I think you know Sabi if you cannot visualize the enemy what how you gonna fight it right and I think that's what you're doing at the philippine genomic center now you're helping us visualize it so we know exactly what we are up against to so I think there are many lessons we are picking up and I find it parang parang lumili now yung mga kailangan natin doin sa health system natin napakarami pero lumili now okay Raymond let's look at the time Raymond let's pick up some questions from the audience go ahead I think we have time for a couple Dr. Sousa this one is the most upvote but to I think for a bit of context we've discussed the possibility of having COVID pero hindi po nakakapture dahil hindi napapates et cetera and and the question may be coming in from the fact that if you may have COVID and then you engage in certain activities such as bloodletting blood donations et cetera and the question reads is it possible to transmit the virus via blood transfusion and I think people have not heard anything explicitly with regards to that especially any studies po for that so for the benefit of our ano po of our viewers is that possible that you may have COVID and you may be able to transmit it by a blood see John Sigurian John what do we know about this so far there have been no documented cases of COVID being transmitted by a blood transfusion pero I think may be the the evidence is that it's not yet complete kasi I don't think I haven't seen any studies where they actually look for it pero so far through surveillance there have been no reported cases thank you Dr. John I'll piggyback on that topic in terms of surveillance you also mentioned wastewater surveillance people are wondering gina gawa po ba yan hindi po ba siya gina gawa at ano po ba yung kahalagahan ng paggawa ng wastewater surveillance po I said question for me yes sir yes sir so wastewater surveillance is looking for the for the virus in wastewater no so that's been used successfully in the states no especially when they opened up universities they're able to test dormitories and through that identify I mean clear entire buildings and saying there's no virus there's no COVID here and only select those dormitories that have the virus detected no so it's very cost effective the problem with doing that in the Philippines is that nationwide only 4% of households are connected to essentialize wastewater system in NCR it's only 8% no so it's not very useful here in the Philippines so maybe in selected cases no maybe dormitories inside UP or atanayo pero if it's used to identify buildings or clear buildings that's that's not feasible the most we can do is just maybe test test passing river or or manila bay and say that COVID is present or not but which we all we already know that because there's there are the cases no but maybe several decades down the line no it could be a a useful tool for us yeah let me let me have a follow up to that John because you talked about carbon dioxide monitoring no and Raymond when he mentioned na, tsempre yung tenga ko di ba kasi we used to do a lot of carbon dioxide monitoring for tobacco control di ba and sabing ane ni John por nakamay kaya nang sigurino ibig sabihin hindi magandang ventilation ako nga sabi ko pag nakamay kaya nang sigurino umaris na kayo doon di ba kasi ano no parang that there is that's a the certain level of of air pollution na but to what extent are we recommending this as a proxy indicator for for ano no for poor ventilation because i think that could be really useful for ano ano na na for let's say in closed places malls and those carbon dioxide monitors they're not actually very expensive you know they can be they can be bought by offices if they want to sigurino magandang ventilation nila ano what you're thinking on that using it in a more wide spread way last year the there was actually already a joint duh dole guidance or regulation that workplaces should but aside from the measures to improve ventilation they should also have carbon dioxide monitoring no in in office places in great places but the problem with that is ano in i don't know how much inspection no or government muntoy muntoy in the has been for example ay when i go to new places malls or restaurants i always bring my portable carbon dioxide sector na so much excited depends on online na yeah yeah if it's the central na then i'm i'm comfortable na eating inside without without my mask but i've been to malls also especially on busy weekends no where the pp and carbon dioxide ppm has increased to 1005 2000 so i can't say that whether whether or not buildings or malls have improved their ventilation or are monitoring their carbon dioxide level so we need to be better at that also nga kutaman nijang kung ish na restaurant nga ganyan nga opal siyang James friend ha ha nga kung meron meron matasang carbon dioxide na katap would be 1000 na 1000 ppm pag matasap sa 1000 bunda na kayasas yung surod na restaurant parang gana yeah okay siga Raymond go ahead i think you have a few more questions before ah Doctor Eva has sa comment po at the may next meeting oh Eva Eva Eva hold on na na yeah yeah ma'am I'd like ah to know that ah there's an ongoing research at the NIH we commissioned the group of Doctor Antonio Danz not to look in this exactly you know yung use of CO2 monitor monitoring system in the household in transportation system so hopefully they'll have some results in a few months and maybe they can be featured in this CDEP webinar ma'am oh yung maganda yung maganda yung maganda yung chakano ano parang ako what I want to tell our audience is this no when we say we're monitoring a disease it doesn't always mean that you're monitoring the people you can be monitoring the environment para mas preventive pang ayo yung niya di ba parang hindi yung minam monitor yung mga nagkakasakit yung nag-test positive pwede yung more preventive nand that ma monitor yung yung lugar na kong maaring nandun yung virus o hindi na we're not looking at the virus but when we say it's a proxy monitor a proxy indicator or proxy a proxy monitoring system then if you have high carbon dioxide it means that the air is not circulating well and again right you've seen from the presentations of Dr. Cynthia na we do have the capacity to actually also visualize and monitor the virus so it's ano parang we have we have the tools that we need I think in the Philippines we have the tools that we need nandun yung husay at galing ng ating dalubhasa pero kailangan lang talagang maabut ang lahat ng tao no kasi baka sa ilang lugar lang ng yayaryon so we really have to work work on that and and I think you know I really appreciate our presenters today kasi ang gagaling gagaling talaga nila showing us really how good how advanced we are no in our ability to do these things Naiman, do you have another question there? I mean, we're close to the top of the hour so it probably be our last question Dr. Susie people are asking since we're talking about it and just based on the assertion of Dr. Jan earlier that we treat it at this period as in between surges the question as a pediatrician for ma'am Eva at the FDA has already mentioned I mean within the context of that multiple boosters in a year is not sustainable but also in light of that and just because of the vaccination coverage that we have that we still need to improve upon has there been any discussion with regards to additional boosters for vulnerable population like the senior citizen or immunocompromise which has been done in other countries ma'am ah you're asking me yes ma'am yes ma'am okay but Dr. Dr. Jan may also have sama na he reads all the newspapers from different parts of the world but for from my from my part I'd like to just say that yes there are already in other countries steps to give booster especially for the vulnerable population after six months of having the the first booster shot knowing too well that the vaccine wins within six months so yes the short answer to that is yes Dr. Jan yeah so in in in immunocompromise people receiving anti-cancer treatment or people with connective patient diseases no SLE no who are receiving immunosuppressive medicines or organ transplant patients uh should be treated as a special class eh no kasi they've seen sometimes even with boosters no they can get enough and enough of an antibody response no in fact in some countries they've recommended for a second before those or a second booster no for for these populations no they're also recommending that uh these patients get antibody testing no we don't usually test for antibodies after vaccination but for this population uh some specialists uh specialty societies are recommending that they they should get the antibody test after vaccination just to make sure that they have sufficient protection yeah okay thank you very much John so I think we're running out of time we're going to give you a few minutes to think about your parting words for our audience from this really very very very very informative webinar that you've had and um I just siyempre may comment ako Raymond dima parang Raymond I don't buy the idea that we don't have money ako I can't I don't seriously I feel like we can't afford not to do it that's how I think about it parang I think we have to ano eh we have to really think about an unusual amount of money that's going into the response because unless we do that our whole economy suffer so parang ano eh kelangan kelangan political will channel yung pera eh put it together para marami ng genome center di ba para maraming support for testing for whatever we need to do kasi we have the we have the ability kailangan lang talaga yung tulak anyway so let's go Raymond let's answer your questions and then do our our evaluation yeah go ahead yes thank you Doctor Susie we have our two questions babalikan lang po natin na ito rin po yung pre-test questions natin we had 736 of our zoom attendees and well almost 100 in mente to answer this first question what is Omicron Xe so ano po ba ang tamang kasagutan if you had been listening po ang ating pong tamang kasagutan is really option 2 hybrid of 1 and 2 po siya for the second question anong mga bansa ang meron ng Omicron Xe ah I think it's it's all of the above na Doctor Susie with a possible exception of us because I have not seen anything from the U.S. tanun natin sa kamila kasi actually nagbabago yung information Janine what do you know about this Janine and ano and and and Doctor Jeanine and Cynthia yeah is it UK lang ba or all of these countries have I don't have Doctor I don't have yet confirmation of the U.S. but maron pang ano Taiwan no man man man yung israel mo pero yung U.S. so far para mula pang big news para mula yung U.S. okay Jan how about you anong alam natin siya countries that have reported this new variant are are are just countries who have very good Ginomi surveillance so they're they're not really the countries who who actually have the variant only yeah other countries may we still have the variant but they may not have been doing enough sampling okay so actually when we prepare this question we're saying abangan natin po anong lalabas no siya so Raymond go ahead punta tayo sa evaluation thank you thank you yes everything except the U.S. di ba parang gano'y everything except the U.S. yes that's correct I think the latest was Thailand a few days ago thank you so much so so we would we would like to emphasize po no that is five question evaluation poll it's not really there's no separate evaluation poll it's the one that we have always used so please we enjoying our 800 plus attendees po to really put in your answers into this evaluation poll four point like your scale first question reads the panelists demonstrated the thorough knowledge of the topic number two panelists were well prepared and organized number three the panelists spoke clearly and audibly number four the panelists used appropriate language with technical medical jargos adequately explained and number five the panelists contributed to new perspectives and knowledge on managing various key COVID-19 health issues we will not be closing this up until the end of the webinar as we move on to the final messages from our speakers okay thank you very much let's have our party words from Dr. Sintias okay go ahead so to all our audience I think we have many many lessons learned during this pandemic we are very glad that now the cases I really do on the hospitalizations I know of course we are always nervous every time while there are reported traces but I think these the whole COVID pandemic has given us the opportunities on the academic world very very closely we will do edu each epitome of the bureau and also to have molecular biology in action I think this pandemic has created a consciousness that molecular diagnostics is very very important it's part of our nation's response and that the low cases that we are seeing now is probably a combination of cases and the help of everybody from the government agencies who have been helping us monitor and graph policy as well as the many doctors for blind and sane with local government officials and everyone's for operation so I think this small these low cases now is really just allow let's take this opportunity to prepare very well to spend from the hospital systems and also to remind everyone that we should always continue with the future yeah thank you very much Dr. Cynthia Saloma of the Philippine Genome Center let's have John John go ahead thank you so if there's only one thing that we can do it's to get everyone vaccinated first priority should be the elderly 35% are not yet protected but 70% are at risk second would be children they're starting to go back to school although they're at very low risk they can still spread to spread infection within their households whatever setting you're in home workplace or most no make sure near places that have good ventilation if you have control over it use a carbon dioxide sensor but also try to help improve the ventilation in the building and then lastly I think we still need to continue masking without surges kasi as we've seen it helps prevent other diseases especially infectious diseases thank you yeah thank you very much that's John Wang of Epimetrics and let's go to Eva the executive director of the National Institute of Health Eva go ahead thank you Dr. Susi if in the beginning of the pandemic we were running like chicken headless chicken I would like to believe that we've learned a lot in the last two years and that's why I was very optimistic when I said my statements earlier about whether us being better prepared for the pandemic I mean for the for a new variant that will emerge and I do agree with Dr. with you Dr. Susi and Dr. Wang that we still need many things to learn new skills to to acquire as well as new tools to use to be prepared for future pandemics but just three things we need to keep our eye on our alert levels because they we need to familiarize ourselves with that because there are early warning devices second is remember the basics I think Dr. John also emphasize that staying well ventilated spaces places of white being in crowded spaces wearing the mask and of course if we develop symptoms we seek help and lastly if we are eligible and there's already a move to get of course have everyone who needs to be vaccinated vaccinated and if that time comes when boosters are already also in place or that for those I think we should also have that because it will still protect us from disease severe disease and hospitalization thank you very much thank you very much that's Dr. Eva Cuquilca-Delapas the head of the and national institutes of health okay so unfortunately we don't have mentioned or Charlotte or whoever does our closing summary and I just like to summarize by saying we opened with a question or Stella pala you know it's like we opened with a question are there more contagious variants like Omicron X and I think the answer to this is yes that's possible that's possible that it's more contagious and it's also possible that it would something something could be more virulent according to John and alamin natin kumagaka COVID-19 surgery yet so bala naman tayong crystal ball no we cannot predict what will happen but I think all our speakers are agreed that we are not out of the woods yet this is still this is a good time for everyone because parang nagsurge mo mabah okay but we are closely monitoring what's happening the rest of the world as John said we have to look at virus host and environment and we really have to use this time use this time to prepare wag taing maligaling natapus na now there's many things that we can do which our speakers have mentioned and I highly encourage everyone to go to the playback I'm going to do it I'm going to watch it again because I thought we had really virulent speakers today so on that note next week bala tayong next week Raymond deka tulungan mo nga ako Raymond bala tayong next week it's holy week so we will be taking a holy week break po for next week and we will be seeing each other two Fridays from now that will be April 22nd I think April 22nd pa tayong sakong sakto Dr. Suzie that's in line with our second year anniversary okay second year anniversary natin now we have really bigatin mga speakers secret we won't tell you who it is but we're gonna talk about the pandemic and universal healthcare kasi ano ino parang nasabi na yung datin ang solution talaga dito universal healthcare pero parang hindi hindi pa malinao ang ang pagkainting din natin kung anong connection ng dalawang yun so we're gonna have really very what should I say celebrated speakers because it's our yeah second year anniversary and we hope to see all of you there okay and meron na ron mga pamimigay si Raymond kaya wakay ang mga absent tama ba yun Raymond may pamimigay ka for our masusugid na mga tele viewers yes po okay so meron tayong mga giveaways so hopefully you get them a little faster than last time but that's just our little way of saying thank you to all of you kasi kung hindi senyo wala ka nirito so over to you Raymond thank you Dr. Suzy we we really had a good time today learning more about getting those in-depth information but not to scare everyone off with regards to the likelihood of search but really just to prepare ourselves kumangyari man po yun before we end our program let us first acknowledge the very hardworking team behind the stop COVID that's web in our series without each and every one of you we won't be able to churn out quality content week in and week out doon naman po sa mga nagpapaantok or nas na co-commute or just really have some time sa mga break spoon nila sa kaka coffee break or lunch break or chetera we have prepared very very bite size po na mga videos which we call SCD shorts ito po yung mga consumable po namin ang magdalip po talagang maintindihan at mag gets po kagad ang mensahe very very short videos that you could find if you go to www.youtube.com forward slash tvup.ph and speaking of the youtube channel of tvup you will be able to find all of our 94 webinars archive there if you go to the same youtube channel po and then thereafter after this webinar po you'll be able to find all 95 webinars archive there you feel free to watch it on the playback po because there are really many nuggets of wisdom in each of the webinars that we have held we hope that you will have a safe and peaceful po at really healthy na week long break obviously we won't be able to see each other again but next week but hopefully that will give you some time just to reflect and to be able to prepare ourselves na rin po and our families and loved ones as well we are seeing on the screen at least in the zoom more than 90 90% for all of our more than 91% for all of our questions po no in the evaluation po so maraming-maraming salamat po sa lahat this has been one of our really more informative webinars we really thank our experts for that and really without each and every one of you hindi po namin mapapagtulitong ating credible online community so this formally closes our webinar for the week we look forward to your company again during our next friday august 22nd po which is our second year anniversary it's a date yeah there we can stop po with that so keep safe keep healthy see you online 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 but for my fears the other's lives but for my tears but right behind the mask i look into myself and ask do i have strength to carry on oh god how long must this go on and leave you here to keep me strong i'm here to hold the line until my just hold on to the word this time will come to pass because this salvation makes a last you carry you to see the break those pain but for my fears the other's lives before my tears but right behind the mask i look into myself and ask do i have strength to carry on oh god how long must this go on to keep me strong i'm here to hold the line oh keep my until my just hold on to the word my fears the other's lives before my tears but right behind the mask i look into myself and ask do i have strength to carry on if you're here to keep me strong those pain before my tears and the tears these things through another day