 Good evening nasaianman ko kayo sa Boong Mundo. Welcome to the 48th installment of the Stop COVID-19 webinar series and we are glad that you continue to join us in our learning journey as we try to learn more and more about COVID-19. So almost a year to the date ko, almost a year ago, the World Health Assembly passed a resolution recognizing that managing the infodemic is a critical part of controlling the COVID-19 pandemic. So sa ngayon po, marami po tayo na rinig. Ano po ba ang totoo? Pwede po bang gamitin ang gamut na ito? Ano po ba ang fake news sa ating mga social media? How do we bridge the gap and bring that truth to our lay people, to those who would really require that kind of true knowledge po, especially when making those decisions with all of this cacophony of voices and all of the large spectrum. Social media platforms that we are inundated with the different amount of content that we are getting. So in this webinar po, we will be providing science-based data from credible experts to dispel misinformation and disinformation ko. Ako po, I see Dr. Raymond Francis Sarmiento, Director of the National Telehealth Center, National Institutes of Health, University of the Philippines, Manila. It's always nice and very happy and pleased to share my hosting duties with my partner in crime and my mentor po, also our adjunct research faculty at the National Telehealth Center, the special envoy of the President for Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie? Hi Raymond and good day everyone wherever you are. Magandang hapon. Those of you who are watching on the playback or who are watching us on YouTube or on Facebook live stream, welcome to the webinar. It's a difficult time I know for everyone. Of course we're here to learn, we're here to become better at serving our people but we also do realize na papagod na nang kayo. And Raymond said na parang there's a cacophony of, you know, there's so much information going on around. So I thought, you know, we have a moment to breathe. You know with these webinars, mayong kayong kontin, kind of paingan ng kontin para makinig, matuto, madag-dagan natin ang kaalaman natin and that way maybe the burden is a little bit less but we do recognize that it's a difficult time for everyone now especially in the National Capital Region. But we like to greet everyone from Surigao, from Batangas, from Pangasinan, from Bagu City, from Cebu, from Bacolod. You know, we're always so happy palawan. We're always so happy to have everyone here with us. We wouldn't be here without you and all of the hospitals of Metro Manila that are watching among Rodriguez, the National Center for Mental Health, Philippine General Hospital, Kirino Result Medical Center. So we welcome all of you. We are all one family here trying to make it and we're going to make it. So I know that the mood is not optimal but nalabat tayo. We're going to fight. Okay, Raymond, over to you. Thank you, Dr. Susie. So for those who are joining us po, na, for the very first time, nalala mo natin, marami po tayong mga new attendees po every week. Just to let you know kung paano po ang structure of the webinar, we will have our main speaker, main presenter po, give essentially all of the inputs with regards to the topic and then we will have a set of reactions po from our credible panel of experts. We then move on to a panel discussion with a Q&A aspect po wherein we will also be entertaining questions for those po na who may, which may be yung ma-questions po, which may be up-voted as pinakapatok na questions po no. We will be allowing those, if they are in the audience, allowing them to ask those questions live in this webinar po. So please stay tuned and hopefully a lot of your colleagues, your friends, your families, if they are free right now please enjoying them na tayo po ay magsama-sama na matuto this afternoon po. Dr. Susie. Okay, thank you Reymond. Before anything else, I'd just like to make an announcement. We are making a call for photographs of your loved ones who have left us because of COVID-19. We were looking around and seeing if there is an attempt to have a memorial. I mean, next week we will be celebrating a one-year anniversary for this webinar series. And we thought it would be fitting to launch the COVID-19 Heroes Memorial to honor all our global Filipino medical frontliners who have succumbed to COVID-19. So this is a call to all of you to send us photographs. Maybe if you want to put a little story, this will be on the stock COVID deaths Facebook page and a special audiovisual presentation for the virtual launch of this memorial will be shown next Friday. So next Friday because it's the one-year anniversary of the webinar and I cannot believe that for the past year, every Friday we have been here. We would like you to share with us memories, photographs of people who gave their lives for the pandemic and for serving others. So please send them to us and this will be on Facebook. So we need a high-resolution portrait of at least 300 dpi with date of birth, pixel by pixel. So you need to send us their high-resolution photo, date of birth, date of death, their occupation to TVUP. So I think it's there, okay, television at up.edu.ph. Honor before April 19 to make it for the launch, okay. But we will continue to, kung erong mga humahabol, we will continue to do this and we just thought it's so important for us to never forget what has happened in the past year and to dedicate our lives to the memory of those who actually had to give their lives fighting for others in this pandemic. So I hope you'll all participate and if you know of people who have lost their love once at the front line, we want to put that all together and remember and honor those who went ahead with us. Okay Reymond, parang nanunong pag-pick. Thank you Dr. Suzy. I will just reiterate that we will be honoring po our Filipino medical frontliners, not just in the Philippines but all over the world. We understand that we are being viewed all over the world and if you are able to provide that information, those details po as part of our COVID-19 Heroes Memorial will be very, very appreciative of the gesture po. I'd also like to take this opportunity to say sa ikyo kaybuturan po na aking po so ang very hard working team behind the stop COVID-19 webinar series. Maraming-maraming salamat po without you, we will not be viewed every week po and those who are wondering, we are also live streaming right now. Facebook pages of the UP system, stop COVID deaths po, TV UP, we are also being viewed po sa YouTube channel ng TV UP po. So for those who are asking also that if this will be recorded or if they will watch in the playback, all 47 webinars and then after this, all 48 webinars po can be viewed and will be viewed po sa YouTube channel ng TV UP and all of those pages that we have already mentioned. I will also segue immediately to those who are asking about sa aking mga certificates po. So TV UP please, thank you. We have already distributed all the certificates po up to webinar 47. So if you feel that you should have received one, please let us know at stopcoviddecks.up.edu.ph. But those who will be receiving should have attended at least 50% of the webinar duration po. Kaki bat po nang dibenid po namin kayo ng copy ng mga presentation po ng ating mga resources speaker. So hopefully will be able to address all of your concerns if any with regards to the certificates. Okay, thank you very much. So we're going to start of course with opening remarks and our very special guest to give the opening remarks is not someone who you have not seen. She's been with us a number of times and she was with us from the very, very beginning. So it's my honor to welcome the Director of the Institute for Clinical Epidemiology at the UP National Institutes of Health and the President of the Philippine Society for Microbiology and Infectious Diseases or PISMID. So welcome Dr. Marisa Alejandria or Isa. Isa, how are you? Hi Susie, hi classmate. Ongano, isang taon na tayong ganpa Isa. You know the other day Isa and I were talking as we were preparing for this webinar and she was just mentioning that there are patients who actually are for admission in PGH, I think, right? Na may daladala silang mga PAC ng Ivermectin, tutubuto Isa? Yes, classmate. Unfortunately, these are some of the experiences shared to me by colleagues, our fellows who are managing patients. So darating sila, papakita nila ang paketen ng Ivermectin, din tatanungin sa amin. Doc, pwede din ba namin ang inumin? Or mayro naman? Doc, kasi pag nag-history kami, tatanungin din namin kung ano na yung inum na gamut. Kasama yung sa mga inum na rin nilang gamut bago sila mga hospital. Okay, so inin ang nilang gamut, pero na hospital pa rin sila. Yes. That's part of our message for today. So we're going to talk about these things later. And we've got great infectious disease specialists, but I'm going to turn over to Isa now to just welcome everyone and matiin ang audience natin. Go ahead, Isa. Okay. Thank you, Susi. So magandang hapon, a warm virtual welcome to all our viewers sa lahat na mga takapakinig natin from all over. So mukhang global ang audience natin ngayon. So actually one year has passed na as Raymond mentioned since SARS-CoV-2, the virus causing COVID-19 was born. And what do we know now? What do we still need to know? How sure are we of what we know? And what we do not know about this virus, SARS-CoV-2, and then this infectious disease condition, COVID-19. As you know, we are now entering the third wave, second third or pang ilang wave na ba to? The COVID-19 pandemic continues to surge, not just here in the Philippines but in other areas globally. Together with that, the COVID-19 infodemic likewise continues to spread in a viral fashion. So we need to flatten not just the pandemic curve but the infodemic curve. How do we determine which is fact and which is fiction? How do you determine whether the item you are buying is real, genuine and of good quality? So when you do your shopping in Lasada, how do you decide which one among those products are you going to choose? So we look at who made it, where and how was it made? How much does it cost? And I think the similar principles are applied when we read information about COVID-19. How was the information generated? Who wrote it? What is the source? What is the purpose of the information? How do we determine if a particular drug or medicine is effective and safe? How do we determine which interventions to recommend and not to recommend? So in a nutshell, in developing actually clinical practice guidelines or practice guidelines, especially for this COVID-19, we actually follow a rigorous and reproducible process in developing the recommendations. There is actually a science in developing practice guidelines in appraising evidence. So essentially, evidence from scientific literature is searched and reviewed by independent reviewers who are trained to do critical appraisal. So the quality of the evidence is appraised by these independent reviewers. Then that evidence is synthesized and then presented for discussion and consensus among a panel of experts representing various stakeholders, relevant to the intervention we debuted. All conflicts of interest are declared, assessed and managed before the consensus meeting. Then during the deliberation, the panel will consider not just the quality of the evidence, but the trade-offs between benefit and harm, issues on cost, applicability, feasibility, equity in the event that the intervention will be recommended or not. So this is the process that the Philippine living recommendations for COVID-19 is following. So this initiative is led by the Institute of Clinical Epidemiology of the National Institutes of Health UP Manila. In cooperation with several professional societies namely PSMID, PCP, PCCP, PAFP, Philippine Society of Public Health Physicians, PSEM, POGS, PIDSP, Philippine Hospital Infection Control Society and the Philippine Medical Association. So marami po tayo mga societies na nagdutulong-tulong sa panggawa ng guidelines and then we present this to the Department of Health. The recommendations are leaving. We term it leaving because it is updated as new evidence comes out. This is the challenge that we are facing with the new disease, this COVID-19. The information changes over time as we learn more about the science. So we need to be agile and adaptive. We need to recognize uncertainties as well. Hence we need to be able to discern whether what we are reading is true and worth sharing. We need to protect each other not just from COVID-19 but from misinformation and disinformation. We need not just hand hygiene but information hygiene. So let us all work together to prevent the spread of COVID-19 and misinformation and disinformation. So today's webinar will help clarify to us which are facts and which are fiction and which ones are still uncertain in the prevention and treatment of COVID-19. So happy listening to everyone as we move to the presentation of our speaker. Susi, over to you. Thank you very much Isa. Thank you for that very inspiring talk. Really, you mentioned it na napakabilis ng pagbabago ng information. So kailangan tayo, mabilis din tayo mag-bigay ng bagong information sa mga hikinig. I think when we call this webinar fact or fiction, but Isa is also saying that what might be fictitious right now could actually become fact in the presence of evidence. But right now what we're going to do today is we're going to talk to you about practices in management, prevention, prophylaxis, and whether or not there is enough evidence on some of these things that we're hearing that seems to be, what should I say, picking on a life of its own. So let me turn over to Raymond. Isa, you're going to stay with us for the Q&A? Yes, all right. So if you have questions for Isa, please put it in the chat in the Q&A box. And even for our other speakers and when they're not speaking yet, they will try to answer your questions. We try as much as we can to answer your individual questions. Okay, Raymond over to you. Thank you, Dr. Susin. Thank you, Dr. Marisa Alejandria for that inspiring message po. Actually setting the tone for our webinar for today. We hope you'll be able to stay on until the panel discussion ng Isa. Thank you TVUP for putting up our fun quiz, our fun polls. As mentioned po, in previous webinars, the first two questions really will be more about demographics, punasan po sila. We hope that you'll be able to participate. We have a little over 2,600 attendees po, at least for our Zoom webinar with more than 5,000 registrants for this particular webinar po. So ganun po ang hunger and thirst of ating mga kababayan for facts po with regards to COVID-19. We are seeing that more and more are getting in their responses. Majority are coming in from the National Capital Region. Batiin lang po natin ang mga nag-register po locally in the Philippines all the way from La Union in Ilocos Region from Marinduque State College in Boa, Marinduque, in Nimaropa, from Balete Municipal Health Office in Balete, Aklang, from BOH CityHor, Lorena CityHor in Central Visayas, Tolosa LGU in Tolosa-Late, the Provincial Health Office, Surigal-Gal Norte in Taraga Region, and Buluan District Hospital in Buluan, Magindanao in the Bangsamoro Autonomous Region in Muslim Mindanao. Internationally, we are also being viewed po from the National Center for Global Health and Medicine first time po ito, from Iroma, Saitama in Japan, the University Hospital in Bunkyo, Tokyo, Japan, Chunin Hospital Taipei City, Taiwan, Clinic Kasihatan Manggatal from Kotakinang Balusa, Bahmalaysia, Universitas Admet Indonesia, West Bandung Indonesia, from Ho Chi Minh, Vietnam, from Singapore, from, oh, Knowledge University College of Pharmacy, Erbil Kurdistan, Iraq, from the ITM University, Gwalior Betaya, Bihar India, Doroyal Hospital, Mustak Oman, from Riyadh, Saudi Arabia, from King Abdulabit Abdulaziz University Hospital, Amana Dental Clinic, Alpharwania, Kuwait, from Doha, Qatar, Maryland, U.S., Michigan, and the United States also, California, both from Contra Costa County and Los Angeles County, from Long Beach, from the American Association of Clinical Chemistry, American Society for Clinical Pathology, and Pamet USA from Porter Ranch, California, Niagara Falls, Ontario, Oniwa Doctors, Auckland, New Zealand, and our regular from Saseel, Fort Denone, Fort Denone, something. In Italy po, maraming-maraming salamat po for joining us. We will move on to question number two, what is your line of work? So, majority po, as always, coming in from the medical and the nursing fields. Third placer po are those from the, immediately, is from education and media. We have a lot of teachers. So, very, very important naksanggarin po natin sila ngayon. Sa pag-intindi, along with the pharmacist po, dun po sa mga facts na kailangan po natin i-share. I will be moving on to the more technical aspects of the questions. Towards the end of this webinar, we will be asking our panelists to repeat, if they have mentioned this in their talk, to repeat the correct answer po so that they could hear the correct answer specifically and directly from the expert po. Question number three, is team inhalation or soob is effective against COVID-19? 26% say totoho po ito, 74% say hindi po ito totoho. Okay, we will know more later on. Number four, lahat na may COVID-19 ay dapat ma-admits hospital, 91% say it's fiction, 99% say it's fact. Ivermethin can prevent and treat COVID-19 infection, 86% say hindi, 14% say o-o. And second to the last, sorry, third to the last question pala. Dalian Hua Ching Wen drug, ito po ay mabisa laban sa COVID-19, 88% as of the moment na nang nagsagot po, say na hindi po ito mabisa, yes. Number seven question, wearing a face mask gives you at least 60% protection, wearing a face shield with a face mask gives you at least 30% protection. 89% say this is true and our final question has to do with vaccination being one of the pillars to control COVID-19 infection. Nearly 100% 97% po and magsabi na ito po ay fact, 3% say it is fiction. So we will not be ending the poll anytime soon. Please continue to key in your answers as we move on to the webinar proper. Dr. Suzy. Thank you very much Raymond. At this point we'd like to share with you. We do this person on the street interviews, TV, UP, talks to people, asks them questions and so we just get a sense of how people are looking at the topic that we're taking up right now so over to you TV. Sangin po kasi na laganap nil COVID-19 ko ang Pilipinas sa bumundo, pinapanila ang ko yung mga doctor na alam ko na centipi ko magbigay na kanilang official page ng UH at saka sa mga doctor na pilap ko ang may alam ako sa COVID-19. Of course, bilang nurse kasi sa PGH, more or less maraming resources kung baga na pwede nating pagberipayan doon mismo sa hospital. Malaming hong pinopost ngayon na yung ibabawa na naman basis. So basically, pag agad-agad kawong assume or na conclude based on sa info na nakita mo lang, tapos hindi mo binasa. Medyo negative ko yun. Sa Facebook anaming kumakalat na theories or mga faith news. So for me, I go to the, yung mga health institution ko talaga DOH or news outlets kasi verified pa yung information doon. Yung mga taong iba, yung hindi critical mong story ay madalas na na tatakot ng mga paniwala doon sa mga walang centipi kong batayan na mga datos na mga balitan lumalabas. Parang second nature ko na na pag may issue na dapat itanong igugugil ka agad and then pupunta sa mga reliable na mga portals para eberipay yung mga issue. Any medium naman or any platform, as long as may basis o yung study. Sometimes po ay I double check doon sa health institutions ang ibang bansa to cross check lang po kung tama po yung information ay lumalabas. Kasi yung kapatigong po, itatapong po yung kapatigong na nurse tapos yung doctor namin, anytime, pwede po namin siyang matanong or makontap. So doon po kami mong nag-realize, yung parang confidence po kami na kaya namin dito. To help out, siguro po, we could first focus on getting the right information out there in a timely manner din po. So if there's any updates po about COVID-19 programs or the vaccination programs, it will help po if it's being disseminated to a lot of people. So yan, iwas lang po sa pagbabasan ng mga hindi lihiti mong mga social media page or yung mag-entertain ka po ng idea or yung mga sinasabi lang na iba. Yung halibawa po isa-send lang sayo. So dapat mo mga ingat tayo chaka li-verify po natin yung mga babasan natin. Maging mas ma-critical tayo sa mga information at titig na natin kung may katutuhanan talaga bat ay sa siyan siya ang mga balita na yun. Thank you very much, TVP. So for our personnel on the street, the question was kung pag nag-ugulongan tayo dahil, iba ibang narilinging nito mo sa COVID-19, kanina-bukay na nilinguada. And I think this is a good question for us to keep on asking ourselves kanina tayo nilinguada. And so today we have somebody na gusto natin. We try our best to bring you the most credible practitioners in the country. And I'm very honored to introduce to you our main presenter who is a clinical associate professor of the division of infectious diseases at the department of medicine of UPPGH. And he's also the chair of infection control of the patient hospital. And he's also a balik scientist from 2014. And before we ask him to make his presentation, let us welcome Dr. Joseph Adrian Buensalido. Hi, good afternoon. Good afternoon. Hello. So we said adaming ko makalat ng mga balitan, ivermectin, melatonin, lean washing when, vitamin C, zinc, soog, and any of these help us. So I think you're on deck to talk about this. But I wanted to ask you first, John B. You're a balik scientist from 2014. That's right. I came from Michigan. After my training, I came back to the Philippines. Okay. So why did you come back? It was really the plan. I just went to the U.S. for two years of infectious diseases training. And then it was really the plan to come back. Okay. So hindi ka naman nag-sise-sise? Hindi. Not at all. John B., go ahead. I don't understand between you and your presentation. People want to hear what you have to say. So please go ahead and make your presentation. Okay. Let me share my screen. Please tell me if you see the slide. So I can start. All right. I'm sharing now. But I'm going to... I hope I don't start. Okay. You're almost there. Okay. All right. Here we go. It's opening. It's not yet open, though. Do you see the slide? Yeah. It's very clear. Okay. All right. Slowly opening. Suspens pa. Okay. Okay. Mag-contin lang. But I won't be talking about this movie, although I might go a little bit fast. Medyo meron lang tayong delay sa... sa clicking pala. What I'll be talking about will be facts. The facts and the fiction, as mentioned already. I have disclosure. I have been a speaker for Unilab, BSV Bioscience, Philcare Pharma and have received sponsorship from Pfizer. The topics that I have spoken of were on various topics and different infections. So Dr. Issa mentioned the Philippine COVID-19 living recommendations. These are the guidelines and I don't need to dwell on this. Dr. Issa also talked about the rigorous process of making recommendations. Hindi lang siya basta-basta. It has a whole methodology that has to be done. And she mentioned also that there's a steering committee who leads the effort and then from different groups, the consensus panel is also from different specialties and groups. But I would like to focus a little bit on this slide. It says here that randomized control trials or RCTs are actually the best evidence. This is widely known. Let's just focus on the yellow highlights. On the left side, we see the quality of evidence and on the middle, we have the study design. Usually we can say that some the form of evidence is high quality if it's based on RCTs. So it's a gold standard. And then if we look at the low quality of evidence, it's usually from observational studies. Now, sometimes RCTs are not as good so they are downgraded to moderate and sometimes observational studies look pretty well done and they are upgraded into moderate. Note that case series or reports of cases kung ano nangyale and expert opinion, mga sinasabi ng mga experts such as me or other experts are graded very low in terms of quality, especially since randomized control trials do a lot of things to make sure that the risk of bias is low. So remember, RCTs are the best evidence. I also wanted to show how to interpret a forest plot in a meta-analysis. A meta-analysis is a way of combining studies so that the power of the studies becomes stronger. So let's first focus on the green. There's a box and there's a horizontal line and that represents a study. The box represents the result of the study, the effect of the study and the horizontal line is actually the confidence interval. How much confident we are regarding the result. If we look at the green, the horizontal line is narrow. That means that the confidence interval is good. We are confident with the study. We are confident with the result. There is precision with the result. Now look at the yellow ones. The lines, the horizontal lines are long and that means there is a wide interval confidence. So confidence is lower. It's more imprecise. Now the next thing that we should focus on is the line in the middle, that vertical line. That is called the line of no benefit. If the horizontal line crosses that line, then we can say that the result of that study is no benefit, no significant benefit. Now if we look at the green again, it does not hit the line of no benefit or since it's on the side of blue, it favors treatment, it means that the result of that study shows that treatment being studied is pretty effective. Here we see multiple studies being combined and it yields an overall effect. The overall effect is represented by the diamond. Look at the diamond. It's the result of those different studies on top. Look at the diamond. It's not so wide. So it's precise. And it doesn't hit the line of no benefit and therefore it is beneficial. Look, it favors dexamethasone. That's one of the treatments. It's really one of the main significant beneficial treatments of COVID-19. That's just an example. Now let's go to the agents themselves that we will be talking about. I was tasked to talk about just the controversial ones. And ivermectin is, as we know, one of them. It's from the class of avermectins. It was approved by the FDA as an anti-parasitic agent and we see there below all the parasitic conditions. And here are the multiple mechanisms of action of ivermectin. Let's look at 11 o'clock. There is activation of gated chloride channels and there's opening of these channels that cause things to rush out and rush in the parasites and that causes parasitic death. Now let's look at 2 o'clock. There is inhibition of nuclear importation of proteins that the RNA virus needs. So that's the antiviral effect that is being looked at with ivermectin. And let's look at the 7 o'clock position wherein we see that ivermectin also has an anti-inflammatory effect, anti-pamamaga. Now this slide just shows the many on-going studies, randomized studies that are still on-going all around the world. So I think there are around 50 plus, 53 on-going clinical studies. I've even heard some say 70 plus. But what does that mean? Madami pang on-going clinical trials. It just means na marami pang naniligaw sa isang nililigawan. For example, in this picture marami pang naniligaw, so hindi pasigurado kung sino yung pipiliin ng babae. At yung, for example, if ivermectin is one of the suitors, hindi pa talaga kilala nung babae yung maniligaw na ivermectin. Marami pa siyang kailangan daan ang pagsusubok trials. Para malaman kung yung naniligaw ba mapagmahal, masipag, mainitin ba ang ulo nito? Palaaway ba ito? Makakabuti ba to sa buhay ko o makakasama sa buhay ko? Similarly, those are the things that ivermectin still need to prove to the scientific and medical community. Is it harmful? Is it beneficial? So the panel, the consensus panel in the living guideline says that there's insufficient evidence for ivermectin as treatment for COVID-19 and this is very low quality evidence. We see here the many technical reviewers and the consensus panel on the right. The first question they ask is their mortality benefit from the RCTs and looking just at this forest plot, let's practice. The yellow diamond on the side of ivermectin does not hit the line of no benefit so it looks like merong benefit might be. It looks like there is significant benefit. However, let's look at the blue highlight. Those are the number of participants who had some events. So around 1,000 plus. So not so many included. So that's why there's a question mark. Is it good for reducing mortality? So what do the consensus panel members and the technical reviewers do in cases like this? Of course they look at the data. They delve into the data. Here you see most of the studies that were included were actually pre-prints not yet published and not yet peer-reviewed. There are only two highlighted in yellow that were published by Lopez, Medina and Chakor. Those are the ones. We highlight the published and peer-reviewed because published data actually means that other experts and independent experts looked at the study and evaluated it. Usually ang mga gandang studies yung na papublish so mostly unpublished pre-prints. Also, they looked at which ones were of high quality. Similarly, only two of the studies were really high quality studies. The rest had serious or very serious risk of bias. If you look, there's no mortality benefit if only the high quality studies are included. There's benefit in the low quality but again quality is not as good so is it reliable? Then we have to think twice. Other ways of looking at the data it looks like there is no mortality benefit in severe COVID-19. However, looking at the forest plot for a mile to moderate, the diamond does not hit the line of no benefit. There may be some benefit. It looks like there's benefit but look at the bubbles on the right. There are a lot of red and yellow. Red represents serious risk of bias in those studies. And yellow, unclear. So unsure yung reviewer if there was really a risk of bias. Looking at the data also it looks like the high dose ivermectin is the one that appears to have some benefit. So red area it doesn't hit the line of no benefit. The low dose hits the line of no benefit and therefore it looks like the high dose is much better. And for clinical improvement look at the diamond it's smack in the middle of the line of no benefit therefore no benefit. And no benefit as well for time to symptom resolution and hospital discharge. So in the middle the diamond is not hitting the line of no benefit so possible benefit looks like there appears to be benefit in terms of number of symptomatic days na babawasan. Now harm is very important it does not seem to be so that ivermectin causes more harm compared to without ivermectin. So the statement of the different societies and the living CPG itself is that based on the current evidence from randomized trials we do not recommend ivermectin for the treatment of COVID-19. This recommendation though will be updated as more evidence is generated from ongoing trials. And as we mentioned 50 plus pa or even 70s na. So I'll stop for a while I'll ask are you still hearing me Yes. Okay. So now I'll go to prophylaxis. So the consensus panel also look at the evidence and they recommend against ivermectin as COVID-19 prophylaxis for the general population. Let's look at the data. Two RCPs six observational and there are nine ongoing RCPs at the moment. And let's look at the two the two RCPs one was a preprint so again not yet published not yet peer reviewed and the second one although published non-blinded with dropouts both seem heterogeneous because of they consist of health care workers and then household contacts and the other one is solely household contacts. I highlighted in red the N 200 and 340. Those are the number of participants in the studies and that's a couple of hundred. So with the evidence there seems to be some benefit but based on very low quality of evidence and based on a small number of participants I wanted you to compare that so 200 plus 300 moa 500 plus however let's compare that to how vaccines are studied. Vaccine candidates usually go through phase 1, phase 2 and phase 3 studies and look at phase 3 I highlighted that phase 3 studies usually enroll thousands of volunteers so that we can test whether the vaccine is safe effective and to know what common side effects there are no and look on the right side Pfizer more than 40,000 participants more than 30,000 AstraZeneca more than 30,000 Sinovac more than 12,000 Gamalaya more than 19,000 and J&J more than 43,000 participants. So clearly so much more participants compared to ivermectin preventive capability assessment. Which is why let's just remember that this is the case if we go back to panliligao kung baga yung vaccine medyo kilalang kilala na nung nililigawan kasi yung dami ng try ang dami nang nakita nung nililigawan dami ng napagdaanan but yung isa hindi pa yung ivermectin for prevention hundreds lang it. So how about secondary outcomes and particularly adverse events for prophylaxis, mild side effects not so high 0.4% although diary is the most common and you can see the others below. So the draft recommendation of the panel again is to recommend against the use of ivermectin as COVID-19 prophylaxis as post exposure prophylaxis and that's for first the first one was for the general population second one for household contacts of confirmed COVID-19 patients and the third is a recommendation as prophylaxis for healthcare workers. Again, why? Because the quality of evidence is very low only a number of participants and not very robust. So we're done with ivermectin we'll go to melatonin which is a multifunctional molecule present in plants and animals and it regulates our sleep wake cycles and has been used to treat sleep disorders among others. It's been said that it's a potent anti-inflammatory capacities. This figure just shows many different things that happens when there's a SARS-CoV-2 infection and melatonin actually reduces inflammation affects that part, may reduce some immune response, may reduce oxidative stress and helps in sleep by increasing sedation. So the panel again technical reviewers looked at the data, the consensus panel discussed it and they found that there is insufficient evidence to recommend melatonin as adjunct treatment for COVID-19. Again, very low quality evidence. And this is based on one randomized control trial and here it shows the very serious risk of bias in this study very low certainty for mortality benefit for time for recovery, for length of stay at hospital and for pulmonary involvement. Similar to Ivermectin, there are a lot of ongoing studies that can help us decide whether this can be used in the future. But right now there's insufficient evidence. Now how about melatonin as prevention for COVID-19 infection? Now this one even more, it's only an observational study with some serious risk of bias but there seems to be some benefit but based on an observational or looking back study still it's just one observational study hence insufficient evidence. There is however one ongoing study on melatonin for COVID-19 prophylaxis on healthcare workers using two milligrams of melatonin once at bedtime for 12 weeks so we can wait for that but again just one ongoing study. Now we move on to zinc which is an essential trace and element that's important for growth development and immune function. In the lab zinc appears to have activity against coronavirus number one and rhino virus number two and in human clinical studies zinc also has antiviral activity against the common cold. Why do I mention the common cold for COVID topic? Because for URTI or viral upper respiratory tract infection or common cold rhino virus is the main cause but coronavirus actually number two 8.5%. Now let's look at the studies on viral URTI. Here we see another forest plot and look at the green diamond. It does not hit the line of no benefit so therefore it reduces or shortens illness by two to three days. Here you see in the yellow one it doesn't work as well in children. Next high dose zinc is much better in shortening viral upper respiratory tract infection. So look at the diamond for high dose zinc. It's very far from the line of no benefit comparing to low dose zinc. Still doesn't hit the line of unity but not so much. So there's a two to three day almost three day reduction in viral URTI duration with high dose zinc. And then what does high dose zinc mean? More than 75 milligrams of elemental zinc is the one that is able to reduce viral URTI duration. And just to give an idea, these are the different zinc preparations available in the Philippines. There is zinc gluconate, zinc sulfate although they have their own milligrams, zinc gluconate only has 14% of elemental zinc and zinc sulfate only has 23% of elemental zinc. So sometimes most of the time we really have to compute for us to reach the target of at least 75 milligrams of elemental zinc. The panel of our guideline looked at the evidence and they said that there's insufficient evidence to recommend zinc as ad jump for COVID-19. However, when they looked at non-RCPs there seemed to be some mortality benefit with zinc in COVID-19. Look at the diamond it's an overall effect of three studies and it looks precise it's very thin, narrow diamond it doesn't hit the line of unity so there may be benefit. However, again this is non-RCT based observational studies. Okay, so we move on to prevention using zinc preventing COVID-19. There's no direct evidence for COVID-19 itself. There was only one open label RCT however it was a combination of zinc, vitamin C and other drugs as shown. And therefore they did not again recommend they did not recommend zinc for prevention of COVID-19. So next up is vitamin C an essential micronutrient antioxidant co-factor in many processes in the body support cellular function barrier function and accumulates in our killer cells to aid in killing other microbes. It's also needed for program cell death and removal of spent neutrophils or cells enhances differentiation of proliferation of immunity cells and supplementation with vitamin C has been said to prevent and treat respiratory infections. So let's look. The panel showed that there was insufficient evidence to recommend vitamin C as adjunct treatment. Why? Because of this study and they saw the therapeutic vitamin C no significant benefit in terms of number one mortality and number two need for respirator. If you look at the OR that means odds ratio it's similar to yung effect as a line and as a box if you look at the confidence interval or the numbers beneath it it actually crosses if it's in a line form it will cross the line of no benefit. Now these are just characteristics of the studies included but for viral URTI mostly green so it looks like most are low risk of bias. What they found when they looked at vitamin C for viral URTIs and remember that viral URTIs number two cost is coronavirus in general there's benefit if you are that population that has exposure to short term physical stress and or cold but for general community no benefit and here we also see that regular vitamin C is better than therapeutic vitamin C so regular intake of 1g and above has some benefit but very modest 8% in adults 70% in children and reducing duration of symptoms and 13% reduction of severity kung magkaroon sila ng common cold and look at the red therapeutic intake of vitamin C 1.5g to 4g no benefit kung kakasakit kayo pa lang kayo inom ng vitamin C no benefit however pag 8g of vitamin C it reduces short ends viral common cold by 19% but again if you take high dose I don't say take high dose because that puts us at risk for more side effects kung high dose and Harry Hemila is one of the nutrient experts in the world he says this and it's expert opinion so remember we mentioned earlier expert opinion is actually very low quality he says that because of the small benefit prophylactic vitamin C under normal circumstances is not worthwhile but in the time of covid he feels and that's expert opinion that there's no reason to assume that vitamin C would be completely ineffective against covid 19 in observational study that in some critically ill covid 19 patients 94% had undetectable vitamin C levels and one patient had low levels so para na kakaobusan na vitamin C sa levels in the blood ok now we go to lianhua king wen classical Chinese medical preparation used in the SARS outbreak in 2002-03 in the lab there seemed to be some signs against SARS-CoV-2 through inhibition of replication modification of viral morphology and anti-inflammatory it's regulated by the FDA because of ephedra so it usually causes some risk sa cardiovascular system now let's look at the evidence the panel recommended against lianhua for covid 19 because as you see there's no evidence on mortality hospitalization respirator need however there is some evidence in symptom recovery at day 14 and improvement in chest CT scan but most others no significant benefit ok and for scheme inhalation it's traditional practice used as a home remedy for treating common colds again it's thought to provide relief by loosening mucos opening nasal passages inflammation and inhibiting viral replication by heat in activation the expert reviewers only found two observational studies and when presented to the panel they recommended against it's used because of the very low quality of evidence so how about prevention steam inhalation for prevention only one high risk of bias also observational study where it is so they also recommended against it not enough data so in summary the living recommendations resulted from a rigorous and scientific process by people from different fields rcts are the best evidence ivermectin is not recommended yet as treatment for covid 19 there are many trials ongoing and then also for prevention as well and there's insufficient evidence to recommend melatonin as adjunct treatment or prevention for covid 19 same with zinc as adjunct prevention although there was some or tadi benefit in observational non rct studies remember viral urtis coronaviruses the number two cost and the panel recommends against zinc for prevention of covid 19 for vitamin c insufficient evidence for both treatment and prevention vitamin c is low to very low in severe covid 19 and then the panel recommends against both linhua and steam inhalation based on the very low quality of evidence available so thank you for your attention remember covid 19 is our enemy let's gather the facts and let's not be too furious thank you so much thank you doctor john b for that it's very informative na presentation we will now move on before we ask you any questions I know a lot of people are very very furious and just really hungry to ask questions but we'll hold off from asking the questions we'll move on to our very first reactor she is a renowned health social scientist she's also part of the interim national immunization technical advisory group on covid 19 vaccines I'm proud to say that she has been my mentor for a long time she's also a professor at the Department of Clinical Epidemiology at the UP College of Medicine other than Dr. Nina Castillo-Parrandang ma Nina, welcome to the webinar ang tanghale Dr. Raymond, thank you Dr. John B for your presentation and Isa and Dr. Rasusi I'll start my slides already mohan and tell me if you see it yes ma you see it na mohan not yet ma ok wait ok, yan, nakita mo na right, there we go if you could go to presentation view ok, yes thank you ma so magandang tanghale po ang pamagat po ng aking remarks for today is day 398 gusto ko lang kung ikumemori itang araw na ito kasi ganin ito na po tayo katagal na na ka-lockdown in whatever form and whatever we call it so for me as a health social scientist context always matters and we need to watch out for bias I come from a family of scientists and let me quote from my late nana national scientist Helia Castillo who said, I've always believed when the best science and scientists are devoted to the problems that those who have less in life that is equity and ethics at its best if science to serve a human purpose what better human purpose is there so aside from being a scientist I'm also a teacher so as with my late parents and other relatives too so na nintindi ako po ang role natin bilang teachers whether you're in the medical profession you also have a teaching role let me now go on to a segway to pasasalamat for all of our frontline workers in the medical profession and otherwise who have kept our society going and a prayer for all of those who have lost and a prayer also for God's healing grace for all of those who are still struggling to recover from COVID-19 and other challenges they are facing nowadays I'm the only social scientist in the college of medicine so I'm used to working with the so-called helping professions why am I bringing up the term helping professions physicians nurses med techs, pharmacists all of these are helping professions and many others even the midwives and none of them are used to just sitting around and just watching things go by when they see people suffering they want to help but sometimes their help can also be confusing hence there's a lot of discussion now in social media for example or even in Congress as to who is supposed to help whom and I analyze the noise that we are currently experiencing and the confusion to the sense of agency as a sociologist this is defined as the capacity of an individual to actively and independently choose and to affect change free will will serve self-determination so ito po yung ating kalakasan sa ating serili para mamili kung ano ba ang gusto natin gawin para magbago po ang ating hinaharap na challenges po and the loss of agency and other things is also fueling the demand for action and also for therapies even if they are unproven as Dr. John B. has shared earlier so here is our situation gutom kawala ng pagkakataon pagkali ito at tugon so gutom for our foreign participants is hunger that's why we are going out of our house and risking traveling in public transport meeting other people going to places even if we are insured that we are free from the virus we are also hungry for food for livelihood, for assistance and the right medical attention that we need we are also hungry for excellent and permanent solutions that should be laid out by government and we are also hungry for tamang information kawala ng pagkakataon in English this is the loss of opportunities or chances and what am I referring to it's the loss of our opportunity to be with our families and to also socialize with our loved ones our relatives, our friends, our office mates and our community members face to face it has been day 398 nawalan din tayo ng pagkakataon at mag-alaga sa mga may sakit because as you know those who are sick need to be isolated if they are sick with COVID-19 nawalan din tayong ng pagkakataon, magpaalam at magluksa para sa mga pumanaw napakasakit po nyan no time to actually properly grieve nor the opportunity to do so nawalan din tayo ng pagkakataon magpunta sa mon lugar para sa pananan palataya whatever fate you believe in we are not allowed to go so ka wala ng pagkakataon then I go to pakalito or confusion hindi natin lubu sa mga intindihan we cannot fully understand ang mga sinasabing panganib ng virus kasi kumakalam ang sikmura we can't really understand the concept of risk because we are hungry and we need to go out and earn a living we also are confused because of the constant changes in policies of the government and because we are ready in day 398 seems like the situation has not even gotten better na asan na po ang pinangako na maayos na pagtugon sa COVID-19 pabago bagong Q ECQ, MECQ, GCQ lahat ng Q na napakahirap matandaan maintindihan at sundin ang mga bagay-bagay na pinangaralan pa at di palubusang maipalewanag ng shensya ay binibigyan ng compassionate use permit ng FDA at ay bang ahensya litong-litong na po ang mga tao sino ba ang dapat paniwalaan at bakit ang mga tagubili na mga doktor at mga experto lalung-lalung ako iba-iba ang kanilang opinion ano ba ang gagawin dapat natin kung merong nakasalimuhan na positivo sa COVID kailangan mag-patest kailangan mag-quarantino mag-isolate na hawa ng COVID na kasakit ng takarana sa mga sintomas ng COVID kailangan ang pangangalangan medical kailangan ang pagpapa-hospital litong-litong pa rin ang tao ko anong gagawin at kawala ng tunay na malasakit at makikipagkapwa siguro yun po ang isa sa pinakamasakit ba well-down wala daw dapat na mahusay na evidentia pero bakit yun piniagan bakit ang mga tao o bansa may kapangyarihan kaya manan o perbilehiyo ay pinalulusot sa mga paglabag sa mga Q-restrictions kung ano man yung Q-restrictions pati na rin sa sobiranya ng Pilipina so habang lumalaban po tayo sa COVID ninanakaw na po ang ibang parte ng ating bansa yun di po kakahasan sa gitnan ng pandemia talaga bang kailangan maging marahas sa gitnan ng pagdurusa na asalang tunay na malasakit at makikipagkapwa ang tugun po kailangan po natin ng agham science and technology agham na maintindihan at teknolohe ang magagamit ng taong bayan kailangan din po natin ang pakakaisa, solidarity at pagkakapantay-pantay or equity so may call is for solidarity and equity science and technology but also risk communication anchored on mutual respect sensitivity, honesty and transparency so ayaw ko po makadenig na ang Christian na mga tanong or magtiis na lang kayo hindi po siya sympathetic sa paong bayan so ako po ay advocate for vaccination and we are now in the midst of a surge there is a limited amount of vaccines available so when the vaccines are available please do it considerously consider having yourself vaccinated ang siya share ko po dito ang aking pulsa frame love kita, halina at magpabakuna pulsohan, kausapin ang taong bayan nga agam-agam we should find out what people are worried about what their questions are alamin ang mga agam-agam katanungan at togunan mga katanungan so we have lots of different town halls different media to get through but we aren't reaching those who are not digitally connected pakikipag-usap at dialogo so it's a conversation it's exchange it's a dialogue we need to embrace every Filipino who has a right to the vaccine because we want a vaccine and vaccine protected public vaccination is a act of love love for yourself love for your fellow men love for our community it is also an act of citizenship and an act of solidarity maraming salamat po maraming salamat Professor Nina Castillo-Carandang and you can see in the chat box the response to your talk I think maraming sa mga sinabi nyo ito matamat sa puso ng tao maganda mayang marabi pa tayong mga kagusapan tapak ahusay po ng mga sinabi nyo makikita nyo lahat makasubasa ngayon dito so we have another reactor and it is my yeah thanks mommy now we're still going to talk my privilege to introduce somebody who alam nyo rare kasi sorry pasensyo na sa mga doktor pero tuto naman ito karami na mga doktor pagdating sa communication ay hirapan sila so I would think our next speaker Dr. Jason Ligot is probably one of the best health communicators of his generation and we invited him because sabi nga natin sa paghanap ng solusyon dito sa situation natin kailangan gamitin natin lahat nang talino ang bansa natin at sorry sa ring pamamara na pag-iisip hindi pwede yung one track lang dahil so I'm very happy to introduce International Health Promotions Specialist and the Director for Development Communication with Organic Intelligence Dr. Ais Ligot Ais, welcome to the webinar Hi Doc Susie, thank you for the invitation and what a compliment to Ais, go ahead go ahead and do your reaction ok, thank you very much to UP for this invitation to this webinar as Doc Susie mentioned earlier good morning, good afternoon, or good evening from wherever you are listening to us today or in the replay so I was asked today to talk a little bit about communication and how health communication plays a role in an uncertain environment and in preparing for this talk I remembered an editorial that was published in the New England Journal of Medicine two years ago and in that editorial they said that the key problem in medicine is that we have an ongoing assumption that clinicians and patients are in general rational decision makers when the reality is we are actually very irrational we are subject to our emotions we believe gossip we accept fake news as fat and we make all of these seemingly irrational preferences about reward, risk, time, and tradeoffs so just jumping off the very excellent presentation of Dr. Karandang and the excellent presentation as well of Dr. Ben Salido on the different facts that we have I wanted to share with you today just some perspectives about bias our own biases and why people believe fake news even in the face of all of this facts and information some thoughts about risk and how that is perceived as a professional so we can communicate about risk in this environment and also some general thoughts about how do we communicate in what's been described as a post truth world that's a very heavy description of the reality that we're in and there are some strategies being offered and I'd be happy to hear the thoughts of my co-panelists as well later about this and finally the outcomes of a recent study that was carried out by WHO precisely on this topic focusing on young people and how they interact digitally and how they perceive fake news etc so Dr. Ben Salido already earlier talked about bias in clinical studies and how that is rigorously evaluated and we do that because inherently we have so many biases our minds have what we call heuristics or shortcuts that have just evolved because in our day-to-day interactions our minds have to process an enormous amount of information and because of these heuristics we have so many biases that can influence how we perceive what solutions are out there for COVID-19 so on the left I just highlighted a couple of very common biases and I think a lot of us can relate to these biases especially in the past two weeks and so many messages have been flying around so many anecdotes, articles being shared on Viber one is the bandwagon effect and the concept of illusory truths and what this says is that we tend to believe what others around us believe and what we hear over and over again and I was in conversation with a friend of mine, she's a doctor as well but her father is a believer in ivermectin and the conversation goes something like opinadela to sakinan tita mo itong same article pinadala din yung compari ko nabasa ko to sa news so then there is this perception na napakadaming taong naniniwala na may cure or may benefit yung ivermectin at dahil araw-araw ko siya nababasa araw-araw mo yung nagpapadala sakin naniniwala na rin ako baka naman talaga mayro benefit talaga yung ivermectin another common bias that we have is what we refer to as the availability bias easily remember o yung nga yung quinento sa aking nung compari ko na alala ko sinabi nyo sa aking nung isang araw na ito daw yung na rinig nyan na sinabi din sa kanya these are conversations that happen because our minds are trained to recall information and that information that we can easily recall is what we tend to believe there is also such a thing as called confirmation bias especially in this environment because we tend to believe facts that already confirm our previously held beliefs or worldview alam mo kasi doc ako mahilig ako sa mga natural na rin or naniniwala ako kasi na ito talaga dapat din gamot para sa COVID-19 because of those previously held beliefs may nabasa kang article online may nagpapadala sa yun ng message over viber sinabi ko na eh yun talaga yung pinaniwala ako ang gamituloy naniniwala and therefore na rin reinforced ng yung belief natin and my final common bias that I'd like to share which is my personal favorite is blind spots we tend to believe ourselves more than others and fail to recognize our own biases and this is a bias that's very true even amongst doctors and health professionals we have a degree we have a certain level of self-confidence therefore if somebody comes with an alternative fact or a different point of view that does not conform to our understanding we tend to be very defensive and we're not open to those facts so how do you counter these biases one is to be aware of them so it's good that we're having this conversation today because a lot of the times we only stop at the facts and the evidence why do people believe what they believe and it is starting in that point of understanding that you can start to have a genuine conversation by really understanding where these motivations are coming from now on the right is just a diagram of what health literacy is so this is a concept that's very familiar with many of us working in public health but for the rest of us health literacy basically unpacks the different characteristics and supports a person needs to make decisions about their health and the health of their family and community and as you will see actually behind these decisions are so many different factors our own skills, our knowledge motivation, beliefs, our own confidence madami dyan ayo na hihiyang magtanong for example ng questions sa doctor tatangapin na lang ko anong sabihin ng doctor and then on the other hand navigate this very complicated communication environment that we have it's not enough for people to receive the facts but they should be able to have access to it so it's wonderful that we have these webinars nowadays so that more people can be made more aware of different facts it's also important for them to be able to appraise the evidence for themselves so I appreciate the introductory slides of doctor Ben Salido when he took the time to explain to us how do you interpret all these complicated diagrams in the first place and then be able to retrieve and use this information if and when they need it in the future now the second point I wanted to raise is about risk and doctor Karandang highlighted this in her talk when she said that we need good risk communication and I totally agree with her and the classic formulation of risk is risk is hazard and outrage and depending on what level of hazard and outrage you have is the communication intervention so that's the explanation behind the diagram on the right where we are right now, we are in a situation where there is a very high hazard COVID-19 is a very deadly infection but there's also a lot of outrage madaming taong takot, galit, nalilito hindi alam po ano yung gagawin so the intervention here is crisis communication and on the left are a couple of recommendations that were put forward way back in 2003 when we were dealing with SARS and I think now is a good time to revisit our different recommendations and how we can properly communicate with risk with each other and with the general public I won't go through all of them but I'll just highlight a couple of points and one thing I think we have to understand as communicators is we have to acknowledge the uncertainty with humility that we do not know all the facts, facts continue to be generated and we continue to generate evidence and we go as we go which is I think why it's very wise that we labeled our recommendations as living recommendations because that's the reality that we have sympathize with the public's emotions understand that people are outraged that they are anxious that they are afraid and one way to address that is to simply acknowledge yes we understand you are afraid we are here tell us what is bothering you and let's have a conversation about that and one thing I'd like to highlight here is I think as health professionals we have to we have to offer people things to do and I think this goes to Dr. Kandang's point about agency we cannot end the conversation with a list of of non-recommended interventions because the message that we could be sending there is that there is nothing they can do which is totally far from the point and I'm sure that is not the message Dr. Ben Salido wanted to send or our other scientists have wanted to send all this time for example a common recommendation for those with mild COVID is to do supportive therapy and for those of us doctors we cannot do that but for many patients and lay people out there when we say supportive therapy ang kailangan it can be misconstrued as which is not the message that we want to send out there so it's important for us to be proactive give them something actually that they can do for themselves, for their families and their communities so my last point is about this we apparently live in a post-truth environment where objective facts are less influential in shaping public opinion that then appeals to emotion and personal belief and this is a reality that we are faced with now people are not just driven by rational thoughts or facts, they are also very much influenced by emotion and you can see this playing out in very important issues such as vaccine hesitancy where for the past few months we've been tracking this willingness to be vaccinated for COVID-19 and that number has more or less stayed stable for the past few months and what it's telling us is that 1 out of 2 Filipinos are actually not willing to be vaccinated for COVID-19 and that's a very big challenge because even if for example once we resolve our problems with supply and distribution that's not going to matter or they don't want to be vaccinated in the first place so being able to convince or persuade these people we will need to channel not just facts or information but really try to get to the heart of the matter what are their concerns what is it that it is bothering them what are the different reasons is it a problem of access they just don't know enough about the vaccines is it because of previous controversies so this is something that I think we have to unpack collectively for us to be able to respond properly these are just some suggestions or strategies that we can apply and how to communicate evidence in a post-truth world number one we should continue to generate high quality evidence so the important work that is being done by our clinical epidemiologist has to continue especially now when people are not easily convinced with facts it is important to have good quality data second we have to strengthen our own institutions and that speaks to our institutions at all levels of government but also the institutions of communities and the institutions of families they need to be able to access information that is easy for them to digest that they can have conversations with and that they themselves are empowered to communicate to more and more people within their social circle and then last we have to foster evidence appreciative populations what does that mean a lot of the work that we really need to do is to build our basic health literacy because it's only when we have a high level of basic health literacy can we really ensure that people are empowered to make wise decisions for themselves and their families and their communities so here are just some top-line findings from a recent global study that was spearheaded by the WHO on social media and COVID-19 so this was a study done among Gen Zs and millennials and what we can see from this data is one national mainstream media is still a very important source of information for this population and science content is seen as share worthy meaning to say they like to share content related to science and evidence on social media so I think this speaks this should give us some reassurance at the content we're putting out there is very relevant especially at this time of COVID-19 the awareness of false news among young people is relatively high but the problem is a lot of them also don't care they're very apathetic they just ignore the content they know that it's there but they don't take proactive steps to either counter it or to come up with alternative content that is fact-based that they can share with their own families but another concern is that they have a lot of different worries beyond getting sick they are afraid for their families they are afraid for themselves about getting a job in this current environment about the economy and I think this really talks a little bit more about those other social determinants of health that we also should be considering when we talk about risk and benefit of these different interventions the interest in COVID-19 vaccine is picking up so that's a good thing but the problem is there is also a lot of as they said the infodemic is not just a matter of quality but also quantity so much information out there it's a sea of information so how do we help people navigate so that they can better understand and embrace the information for themselves and then finally when the survey asked respondents what are the different sources of information that they highly trust and we seem to see that organizations such as the WHO science and health experts are still the most highly trusted sources of information in the digital space but one way of reading this also is that the family, government they are equally important they may not be the highest rank but that doesn't mean to say that they are not popular or they are not trustworthy resources for the population and this is the global picture is more or less the same so generally speaking young Filipinos they trust global health authorities science and health experts but they also put a lot of trust in families in government in what they see in mainstream media like television and radio now going into the sources that they don't trust well according to the survey there's not a lot of trust when it comes to science to information that they find on messaging apps, very interesting and alternative movement leaders and the picture is more or less the same in the Philippines in fact a lot of young Filipinos they don't trust information that they just see on messaging apps I think this is something we can build on later on as we design strategies and campaigns targeting this population so I'll stop there and again thank you very much to the UP community and to my mentor Dr. Susie for allowing me this opportunity to share some thoughts and perspectives and to my co-panelists a good day to everyone please continue staying safe Thank you Dr. Ace Dr. Susie, anything you'd like to tell Dr. Ace I was just going to thank Ace for an excellent presentation go ahead Raymond to our next speaker Thank you Dr. Susie Thank you for that comprehensive and crash course Dr. Ace We will move on to our final reactor for today she's a very good friend and also a special assistant to the Secretary of Health but more popularly known as the Director of the Health Promotions Bureau she's none other than Director Beverly Doctor Bev Good afternoon Good afternoon I'm Susie, hello Please go ahead with your reaction Okay, thank you First of all, thank you to the organizers for inviting me and the DOH to take part in this webinar I actually personally learned a lot listening to the speakers this afternoon There are three points that perhaps are lessons or learnings that we have picked up along the way I personally haven't been in health communication prior to the pandemic and it's really a challenge not just to me but the entire team who are made up of a lot of new people also We know that where we are now it's a world where new information comes in almost every second and it's not just new information coming in to say spaces where we traditionally publish but they come into a space where it's basically public sphere agad Second is that everyone becomes inherently a content creator and there's no such thing as an editor for the millions of posts that are actually being published and even in comments to commentary sections in prestigious journals there's actually no editing so sometimes even if it's a comment whether it's cleared or not accurate or not it really gets published even in the spaces that are traditionally set out only for peer reviewed articles for example Third is that overall in general we have to acknowledge that the trust among institutions or by the public to institutions or certain individuals in those institutions are not as strong as it was before and then finally the technology have the propensity to increase the bias that Jason or Dr. Ligott has discussed a while ago so yung sinasabi po niyang biases or availability biases actually the technology that we're using mga platforms sa ginagamit natin they actually are using our algorithms their algorithms to a certain extent amplifying those biases you have groups wherein you're really with your family so kung sampo yung groups mo with your families then the same messages gets passed around your social media tracks people that you want to see or whose comments you want to hear about so in essence it amplifies those biases and if we're not aware then we become victim of those infrastructure so that said there are a few things that we think must be in place so that as a society we can see what's actually happening so at the individual level it seems like the digital age will continue and while it can improve health literacy in the long run then it also seems like fact checking will then inevitably become a habit or a skill that everyone should have so even younger kids now when they go on YouTube fact checking must become a skill and a habit at the same time how do you get people to actually acknowledge that whatever they're reading can change later on because what they're reading becomes their opinion and people usually have difficult time changing their opinion especially after they've adopted to certain thing they believe that but the idea now is minutes or every in a short period of time what usually becomes an opinion is very very difficult to change and pag nasyere mo na yon nasyere na nang ka-pamily mo ang hirap ba we-end second is learning for the healthcare professionals I guess in many of our expert groups which Doc Issa are part of we often talk about this first is when do people talk about or when do healthcare professionals or experts really need to talk about their individual opinions versus the institutional consensus or the institutional position this is very important especially in recent debates when a particular opinion is attributed to one person and that it seems like the entire community medical community or the entire association of those specialists suddenly are supporting that specific stand I mean for the general public din naman nila kilala yon or we can also say that perhaps in our country hindi pa rin establish the way other national organizations are as established in other countries so you have a lot of individual physicians, nurses, et cetera who speak about their own opinion rather than really waiting for or coordinating whatever their public statements are with their organization but on the other hand it's also difficult who do they coordinate with the fact that they're putting it out in their social media in their individual platforms inevitably makes it their public statement already another thing for healthcare professionals is really that as I mentioned a while ago when to take a debate public so in many instances in the past probably we can very liberally say okay let's debate online because that's the most transparent way to do it but in certain cases we need to recognize that the audience online won't be, not everyone will be able to contextualize the medical debate or discussion and it can be taken both ends positively or negatively and so we're very happy that actually in fact for COVID-19 vaccines there's actually a commitment among the different medical professionals that the debates will actually be taken in a manner that they're going to be more careful significantly more careful because of what happened in the past and then finally some just learnings for the institution like us no said DOH first is really knowing that the message the messenger is the message and in the same way perhaps the platform also becomes the message and we recognize that there are limitations the formality of DOHS and institution past issues there may be things that people wouldn't want to receive that same message from us and so there is a very very clear I guess objective also from within our institution that we really need to partner with other stakeholders who might be able to provide the message also to other people more effectively so it's the same message however our partners want to tweak it or craft it in a way that it's going to be more palatable and more understandable for specific audience segments go po kami doon second is really to meet where the audience where our audience are there are platforms that most of them are going to be at so kung yon ay television at alam namin for Philippines it's still primarily television even if we think everyone is in social media the numbers show that then it also means that considering that we have limited budget for ads then we always have to try in the news outlets and so related to that would then be media literacy so same way as you want to build individual or population health literacy we have clearly know now that there's a big need to invest in our media practitioners so in fact we're very happy because WHO is helping us track the coverage at least at COVID-19 vaccines and COVID response in general and we're seeing that at least for adverse events the way that the media practitioners are covering it is pretty positive and accurate so we track that on a week to week basis really look at all the articles and it's just really a testament also on how much effort we've collectively put the media partners with our partners WHO to do these capacity building activities on how to get the media to understand this and this would be the best way to report it and then finally it's really also recognizing what the limitations of the institutions are so unlike perhaps more informal organizations they will have easier or faster decision making process the agility in terms of okay in one hour whether you have a statement about but for the DOH we do have our expert groups and I guess very similar with some colleagues with the WHO there's a formality to the institution that we need okay this level of evidence before we decide in favor of this and that's not the nature or that's not the pace that the audience wants it so it is going to be very important for us to know those limitations and really be able to work with certain partners, certain groups so that to a certain extent these processes will actually be facilitated so actually madame pa but I really learned a lot of English notes from today but just to highlight that it might look easy like everyone talks about infodemic and stuff but our technologies we can't take advantage of them but we also need to know inherently what they bring about to the table for us and additionally there are additional solutions but then really new challenges and we're hoping that with the help of our partners the community who continuously provide feedback to hold us and the different government offices accountable we can actually improve the way we do health communication risk communication and in general improve the COVID-19 response so maraming salamat po ok, thank you very much Bev for that very candid and I would say from the hard response of what you believe you're doing with the department of health and the challenges that you face and I think our audience wants to go into the panel discussion so we'll call everyone back first let's have Dr. Issa let's have and Bev first Raymond let's tell our panelists who is in the audience ok, so well at the very least those who inputed their answers majority of them came from Metro Manila and the next two regions are from northern and southern Luzon and then from central Luzon we have a sprinkling po from outside of the Philippines thank you po staying up late or taking time to join us po for today what is your line of work well there are half of our attendees po are coming in from the medical and nursing fields medyo malami po yung others maybe we want to be able to piece that out but after others we have those coming in from the education and from the media sector yung po ang ating attendees for this webinar ok, thank you very much we're going to go to the questions later but let me ask so let me start off our discussion and we talked about an infodemic so there's a pandemic and there's an infodemic which seems to be also quite infectious so I want to ask our panelists so we'll start with oh everyone to start how do you protect yourself from being overwhelmed by the infodemic because me, I believe the public is smart I believe the audience is very intelligent and they can filter things and they can do things and I think if we're teaching them how to prevent being affected by COVID we can also teach them how to be not affected by the infodemic so anyone can start how do you protect yourself from the infodemic maybe I would start by saying a recommending to attend webinars like this because this is these are excellent venues for you to learn not just about facts or fiction but also about the latest perspectives but I think when it comes specifically doxy to the infodemic one I think we need to curate our sources of information so that would be my first advice have a couple of sources that you have deemed worthy or that you've done your due diligence and then filter out the noise because now I think the tendency is we tend to react to everything that we see, that we hear or that we learn on different chat groups on different media and there's just so many people out there with most of them I hope may have good agendas but some frankly they do not have good agendas so filter the sources of information that you have would be my first point of advice and my second advice would be also be aware or be conscious of your own biases the biases that I spoke about earlier the biases that Dr. Ben Salito highlighted when he was talking about clinical evidence because it's only really when we start being honest as rational or as logical as we think we are that we can be more honest with how we appraise information and then make sure that that information is ultimately trustworthy and useful for us Kanina yung video maganda yung sinabi ng isang nagsalita sa video na to meeting in sa mga reputable and reliable sources and their keywords are first reputable and these institutions have a reputation because they have been doing it for a long time meaning ito na yung ginagawa nila looking at evidence trying to get the best evidence for the public some of them are academic institutions meaning yung talaga yung pinapag-aralan nila kaya sila reputable and reliable for a long long long long time tapos they are well known they do fact checking et cetera for the public and then also look at the other side but sometimes pros and cons are difficult to weigh in to yung pros kasi syempre very emotional sila syempre yung anti-emotional din a lot of the academic institutions and like for example the living CPG di naman kami pro di naman kami anti we are just looking at the evidence and pinakita ng Dr. Issa during my presentation yung levels and methodology kung pa paano gumagawa ng recommendation mahaba and then hindi lang infectious diseases marami ding ibang mga specialist ang kasama ng recommendations so yung I think should reassure the public lalo napag when they have to choose which sites to go to for their information Nina you wanted to say something go ahead thank you for the question Susie I always start all of my talks in whatever audience I talk to with context context matters and we all have our biases so before we even check anything online or talk to people we need to check our context and understand our own bias I was just messaging a friend who just watched today's webinar she's a doctor in Mindoro so sabi ko nahihiya ako actually that I am privileged to be able to give this talk because I am safe at home Papano na yung mga million na Pilipino hindi safe at home at kailangan sila lumabas ng bahay so ang context kung ano ang totoo o hindi ay affectado din personal context second point ko is hindi natin aabot ang mga taong wala sa digital space I've been hounding sa DOH lahat na ati pinag-usapan ay yung digitally connected paano ang mga seniors na hindi naman digitally comfortable paano yung mga nasa malalayan lugar na walang internet hindi na ba sila entitled to the right information so let's look also at equity of access to the correct information let us also look at the issue of access dahil hindi siya connected dahil nasa nabas siya ng bahay so marami saan ang gusto makinig nitoong webinar na ito pero nagkiklinik nagtikinda sa palingkit they're working they're working and they're not in the digital space so how do we reach those people yun na akong worry yung seniors, napakit na ming seniors na may mga kagigano ko seniors so nag-mese sa akin nins dito ko ba ito sabi ko pag hindi ko alam ang sagot itina tanong ko kay isa kaya Raymond kung ko sinaman kasama ko hindi ako clinician ako po ang role ko ay to lie for information so the clinicians have this information and not all of our clinicians are able to communicate it in a layman's fashion so yun po yung role ko pero I'm very worried about the millions of Filipinos who are not in the digital world san sila kumukuhan ng kanilang tamang information to which they are entitled to thank you po thank you very much Nina, Bev I'm sure your information environment is terribly overwhelming so as a person as an individual how do you protect yourself from the infodemic? I think mam from our and we use certain tools to say which issues we need to respond to and which probably shouldn't be parang really be able to prioritize kasi we can also debunk say everything especially if we based on our monitoring there's actually little traction for a certain issue but again even that we are questioning our tools because a lot of the tools eto lang online pa lang ang we're actually unable to track what goes on on chat groups the one that you have family chat groups or even yung SMS exchanges and that's really where a lot of the messages from families to family members are passed on so may technical challenge don't abort from adaptive challenge but as what mam Nina has been mentioning our constraint in getting ourselves more on radio on TV is still money no so we have tried to do some radio radio advertisements but have also partnered with certain radio programs so they allocated say 5 to 7 minutes of every episode for us, our guests so it could be DOH or we can get sila mam Nina sa mga experts to guests on those shows so really being out there free pero para marinig kami and then more recently we have brewing partnerships with some agriculture, fishery NGOs who are really better at communicating with certain segments of the population para sila and then for for P families that would be the SWD so using channels of certain agencies or even NGOs to get to the other people dun sa mas parang below the line communication because di naman may achieve lahat through normal communication pero akong mam sorry I'll ask you about you because our audience are doctors and nurses and front-liners all over I'm sure they're also inundated with information right? So you in particular, how do you manage this? First my family members is to ask my brothers and sisters to help inform my relatives I was like ko yun na magsabi because I actually don't have as much time to tell them and andami talaga even among family members personally in my chat groups happily with med school classmates et cetera there are many people who also try to counter already the information so medyo hindi ako hirap no siguro mas nag-zone out ako mam that's my coping mechanism meaning to not respond to everything You know I think that what you said about zoning out and I'm gonna ask Isa also because classmate ko jang ako Isa, are you there? Yeah, I can't open because Isa, Isa ikaw din, di ba? Ito si Isa halos ni na natutulog to and apart from the external information I'm sure many of us na dikit din tayo sa scientific literature right? So how do you cope Isa Yup, okay Personally Yeah, personally I don't read everything as I said so I curate also no so I have my list of journals websites where I will get the information and how to verify information as well no I don't have facebook actually so I don't do facebook so and really it's choosing which ones are critical to address in which ones are just noise because we can't answer everything and we've also always said that we have to acknowledge what is uncertain actually that is probably the most difficult part no in expressing that uncertainty that is where personally I also have difficulty no because there's uncertainty so how do you communicate that in but that's science science is never really exact no that's why we do research and I've seen also it's both a science and an art so when I talk to patients and they tell me I try to explain and ask also kung saan yung ngagaling yung information and then take it from there and I read also the cons so that I will understand also where it's coming from kasi yung I think Ace also mentioned this yung humility threshold what we know what we don't know and there might be something there also look at that look at a balanced perspective no that is not easy but that is how I think we should do it no it has to be a balanced perspective and it's a skill kasi with this digital technology google to tell you so how the skill that we need to learn is really where to get the credible source of information whether digital print paper as Nina said not everyone has access to technology so it's really a skill where to get the right information and then once you get that information how to process that information how is it true credible quality appraising it so that's another skill now that we also need to learn and as delivering information it's also our responsibility the media everyone who delivers information has the responsibility to also screen what we are saying what we are writing what we are delivering or disseminating so it's really having the skill to screen to appraise and then choose to prioritize which ones are critical to address I think that's a good summary of what everybody said I would imagine that at no other time in history have people been scambling for information before what did they care when people care about health it's very low but it's almost as if we are agitated into getting information but when you think about it I kind of like Bev's comment that sometimes you just need to zone out how much information do you need do you need to have information every two hours every three hours but I remember we were talking about this in one of the webinar people when they receive something on their phone I'm mindful of what Nina said that everybody is not digital in that space but this applies to chismis as well pag may na re-neg o may pumunta sa telepono siya nashare ka agad pero actually ang pinaniwalaan nila yun nakikita nila sa TV what they see in mainstream but they keep on sharing everything and the same thing with chismis pagkasabi natin yung mga logit nakikipagusap sa palenke sa ganyan sa mga parlor ko ano ano sinasabi nila but it doesn't really mean that they believe it or that they're going to act on it so I think one of the skills we need to acquire and one of the interventions we have to push forward I mean just listening to to all of you is to really help people protect themselves from too much information it's just too much eh parang it's not even the wrong information it's just too much so sometimes just turn off stop talking stop reasoning we have a couple of questions that have been anong ba ito? voted question mo reyman actually we have a total of 100 and how many is this? 120? something 121? so it's a lot of questions probably our webinar has had the most questions to date but we'd like to ask mamhana moril mamhana po to ask for question live to the audience may we ask you to open up your camera and ask your question po mamhana moril po okay I think she's having technical difficulties po no so we'll just we'll try to choose which questions po if we could have our next audience participant who will be asking the question live Reyn Sindayan sorry hi hi good afternoon perhaps my question would center around the idea of education and communication I completely agree with the interventions made by Dr. Karanda particularly on the fact that a lot of people are not digitally connected in million families do not even have electricity so the challenge with us especially here since we're all experts in some way not only in the medical field but in research, statistics, epidemiology how do we improve the level of education of the Filipinos because it's quite ironic that the Philippines has a very high functional literacy rate but our literacy when it comes to media and science remains very questionable I think the data and the research is out there about how biased we are so how do we address this challenge of really communicating with the people and appropriately educating them siguro idadag ako na lang din yung context that sometimes the government would even have back and forth when it comes to policy pronouncements let's admit that it's not a secret pronouncement and ECQ for today but the rules will be set for tomorrow that creates a void of anxiety and uncertainty in people so I believe the panel to react to that Susie, pwede ba akong sumagod kay Mr. Rain? Thank you Rain for the question Go, go, go Kadulag po ang paki-lala ko sa aking sarili ang nani tatay ko po ay parehong scientists at teachers din po sila paano po ako naging interesado sa science? Sumasama po ako sa nani tatay ko sa kanilang mga gawain whether it be in the laboratory and my father making the best milk yogurt and ice cream or visiting some farmers or talking to the urban poor ko anuman yun? Sumasama ako that was my parents philosophy so that's how I fell in love with science so yun yung isa kailangan may role models ka ding pipiliin para may expose ka at may interest ka paano ka magiging interesado sa health and science? Kung di mo siya na intindihan hindi ka nakakarelate ang isa pa alam ni isa to ayo ko nandugo I don't like the smell, the taste the flavor of blood that's why I did not become a physician but I am very happy to help mold physicians of the Philippines so may kanya-kanya po tayong role ako po ayo ko nandugo period and if I can help you make a better physician or a better health worker I am very happy to do so kasi ang multiplier effect so ano po sinasabi ko lahat po tayo teacher ka nurse ka, doctor ka ordinaring mama may ang Filipino lahat po tayo ay may pappel na gagampanan para punoan yung kakulangan ng tamang informasyon putulin po natin ang mga daliri natin kung nakapag-send tayo ng misinformation itong daliring ito na paka powerful po nya it's so easy to send the wrong information and share it on our phones but it's so hard to take it back so ano gagawin so siguro may ramin ang laputo baka hindi na lang sampo dapat ng daliri ko baka isa nalang na iwan na no so yun po sinasabi ko is we need exposure to the right role models we need to understand where people are we need to communicate and everyone of us has roles my special shout out to the teachers here kayo po so bang importante po ang inyong pappel sa ating kasalukuya ang problema sa inyong po tumiting ala ang mga tao para sa tamang informasyon sa encouragement alam po pampagod na rin po kayo pero hugot lang sa kalihuat kahanan at meron siguradong yaya po sa inyong so wag po natin kalimutan po yun embracing each other in this time of great difficulty thank you John B go ahead just to add to sinas but teachers really are very important I see my 6 year old and my 11 years old and sometimes I hear sa kanilang mga klase tinutroan sila kung papano mag delineate is this fake or is this true so but then of course the effects of that will be in the future so definitely we still have a part in helping others become critical of resource hindi lang yung tanggap ng tanggap kung baga parang sinechek natin dapat kung anong information whether it's true or not pero yung mga sa mga klase nila napagusapan yan and I'm thankful to the teachers thank you very much actually passed the top of the hour and we'll have to wrap up soon let's go back to the opinion polls kung ano yung mga tamang sagot we're going to ask Dr. Issa to help us answer the questions and John B as well so over to you Raymond on the questions for the poll thank you Dr. Susie we have 6 questions po no it's binary you just say back or fiction so we'll ask this to Dr. John B question number 3 states is it fact or fiction steam inhalation or suob is effective against COVID-19 um it's I answered it in the chat box no it should not be the sole reason for us to treat COVID kung nang may COVID tayo we will not rely solely on suob it can help it can help us for our symptoms ok so hindi naman bawal pero dapat we measure yung risks and yung benefits kung maganda yung pakeland mo after two of ok yun pero watch out for the risks watch out for scald burns kung may COVID ka at that time lalayaw kasi ebang tao or do it in your isolation area kasi baka na aerosolize yung virus pag hindi kong mga ibang tao baka mahawa sila so gagawin mo yung pag malayo sa iba so hindi siya pagsinabi namin insufficient data hindi namin yung sabihin bawal siya hindi siya yung gamot para sa COVID pero pwede siya makatulong kung yung yung gumagamit feeling niya gumagaan yung kanyang pakeland mo and second that's for treatment again, wala ng evadention that it can prevent pero hindi na makasamasa yung kung, for example, wala ka naman sakit at gusto mong gawin yun mura naman siya wala naman gastos doon but hindi siya yung soul dapat natin gagamitin para to prevent yung vaccine pa rin yung number one na dapat mag-prevent ng lahat Thank you, Dr. John B. The next question will also be for you you're the head for Asian hospital for infectious diseases lahat po ba ng may COVID-19 ay dapat ma-admit sa hospital? Hindi, lahat. May 4 naka-classing coronavirus disease yung mild yung wala ng pulmon niya yung second may pneumonia pero hindi kailangan ng oxygen yung severe may pneumonia kailangan ng oxygen at siyempre yung critical yung pangapat sa ICU yun definitely yung mga mild hindi kailangan sa hospital kasi yung mga presentation parang may sipon lang may sore throat lang basang hindi sila na yung hirapan huminga puwede silang sa bahay lang o sa community isolation ang importante lang kung sa bahay kayo dapat talaga kang mag-isolate kasi baka mahawa ang bohong pamilya So kung kunwari na mention ka dito sa chat box na kung kunwari wala solo CR mesmeng ganda sa isolation facility pero kung kunwari hindi talaga kaya puwede silang gumawa ng mechanism nag-CR ako layo muna kayo lahat mag-isol ako after going through the hallway and CR for example pagbalik ko magpupunta dyan for 15 to 30 minutes and then kung may pupunta mag-isol then something like that but definitely hindi lahat kailangan mag-admit Thank you Dr. John D. Pagpapahing ngayon pumuna namin kayo and the next two questions will throw it to DOH Pumuna Dr. Beverly Ho The first question of two FAC or Fiction Ivermectin can prevent and treat COVID-19 infection ko Meridig na po natin din sa lecture yan ni Dr. John D. So merong promising evidence pero hindi pa tayo claro dyan So as of now din muna natin siya gagamitin for those indication Thank you Director Bev The next question would be Belinwa Chingwen Ito ko ay mabisa laban sa COVID-19 FAC or Fiction Fiction Is there anything that you'd like to add to that? The medicine is approved for a specific indication for COVID-19 Thank you ma'am Next question po will throw it to President of Pismid po Ma'am Isa The statement states FAC or Fiction Wearing a mask gives you at least 60% protection but wearing a face shield with a face mask gives you at least 80% protection Ma'am Isa? Siguro kahit wala yung numbers what I'd like to say is that wearing a mask prevents transmission of COVID-19 and pag dinagdagan pa natin ng face shield it's an added layer of protection ang ginagawa kasi ng face shield it prevents us from touching our face kaya yun yung added protection na binibigay ng face shield So sa literature you can see different percentages can go up to 80% and then akit pa with addition with face shield pwede umabot pa yan ng 90% 90% yung nababasa natin na yun kung hindi naman natin gagamitin hindi siya magiging effective So yun yung meron kasi nagtanong diyan na efficacy siya kaya effectiveness efficacy o mabisa pero magiging effective lang yan pag gagamitin natin ng tama So tama ang paggamit ng mask at tama ang paggamit din ng face shield ganun din sa mga gamot magbisa effect sa clinical trial pero pa hindi mo naman ininom ng tama hindi pa rin siya magiging effective hindi ka gagaling So yun yung effectiveness So kaya hindi lang tayo nababasa sa clinical trial yung una magpuprove kung pwede ang gamot gamitin tapos para maging effective yun doon napapasok ngayon ito mga communication strategies natin implementation strategies access providing access to this effective para maging effective siya kailangan natin i-communicate ng tama at i-bigay ng strategies para magkaroon ng access dito sa mga tama ang intervention na ito So yun na Thank you ma'am Isa and then finally I will call on po Dr. Nina Karandang it's a vaccination question and billang night tag or fiction, vaccination is one of the pillars to control COVID-19 infection mo Yes po and apat-apat pa rin face mask, face shield proper distancing good ventilation and limited interaction time huwag po natin akalain napag-bakunado ng po tayo Pwede na ako lumabas O yapos yan ang aking mga kaibikan at kaanak Hindi po ganun ha So isa lang po siya sa mga paraan para tayo madagdagan ang protection Hindi po siya ticket para lumayas po tayo at gawin na ng ating mga gusto Salamat po Thank you very much Okay, thank you very much So it's time to wrap up and we're going to ask all of our panelists to speak maybe for a minute or less and I think I'd like you to reflect on, you know you have maybe 5,000, 6,000 frontliners who are watching us right now and oteka mo na si Raymond para naglalagay ng ano o again engineering evaluation where you're doing the evaluation So it's just a quick evaluation that we will just put it up on the screen We'll not close it but please let us know your thoughts It's mostly well, your feedback on the webinar how you found it how informative was it and how it increased your knowledge about the webinar po Go ahead Dr. Sisi Okay, thanks Okay, so everybody As parting words maybe can you just address I said we probably have right now 5,000, 6,000 frontliners who are listening to you So I think the question is what is your advice what is your advice to them on how can they be more effective in stopping the spread of information that is not correct So again let's start with Bev So the frontliners how are listening to us Anong advice nyo how can they help what can they do to arrest the infodemic Bev go ahead First of all Thank you ma'am Sisi Thank you sa lahat po nang nanonood sa atin Sana wag kayong magsawa to follow platforms like this where you can really get correct information Two things lang po So first is to spread better information and to do that please coordinate closely with leaderships of the organizations where you're in Currently HVAC brings together all of the professional societies but also institutions like Institute of Clinical Epi and PISMID they do have guidelines and they're now structured in very simple ways para po yun yung gagamiti natin lahat Let's try to make sure that all of our advice because now everyone looks up to all frontliners regardless of what our positions are and so it's important that we're very much aligned in what we tell the public So please use the resources that have been made available po and sana we align our advice to anyone based on that So that's the good information part The second part is help the spread of misinformation and to do that we are hoping that you take advantage of the many public spaces where we are invited Alam ko marami parin ahong friends na medyo nagigiya to talk in several platforms pero I think now more people need to hear about the correct information and yun mas maraming good mas maraming accurate more than the incorrect ones So let us use as much of our platforms to get people to hear us So marami po naging imbitad yun nga yun As long as we aren't with the correct information we should be able to maximize all these platforms out there Thank you ma'am Susie Thank you very much Web Ace Thank you ma'am Susie First of all, thank you again to UP for the invitation Thank you to all my co-panelists I learned a lot as well for this webinar I guess my two messages would be number one as Bev said I think because of the situation that we're in, if you're a health professional we're all health promoters So we all can promote health and good information accurate information in many different ways We have our own social media accounts most of us probably do anyway We have our own families our friends our chat groups People may invite you to speak People may invite you to or may just even have a question So, wag po tayong mahiyang makinig at also wag po gudlilin tayong mahiyang sumagot And my second message would be I really go back to what Mamina mentioned about agency that's very very important in this current environment What I mean by that is we should empower people and not just stop at telling people about things that are not proven for example I think it's very important for us to say Yes, the evidence may be does not support this or there's no evidence for this medicine Instead, this is what you can do to protect yourselves And there are so many behaviors that we need to reinforce nowadays wearing your mask properly washing your hands regularly practicing physical distance staying at home, knowing the symptoms All of these are very important behaviors So let's empower people Let's not discourage them by just telling them Ano ba yung mga fiction because there are many many facts that we can share as well Thank you Go ahead And I run my poll How many of you still have your 10 fingers? Kasi antanong ko ilan nalamban daliri ang naiwan after you have spread the bad news So count your fingers first Again, thank you to all of our medical frontliners for taking care of us for the sacrifices you have Sampong daliri para sa inyo Kulang pangap Patipa'a, bilangin na rin nyo So we all have our roles ke teacher ka ke frontliner ka lahat po tayo may role tayo So importanti po yan na we spread only good news and the correct news Sometimes we are looking for hope in these very dark times So ang hirap maghanap ng hope when we hear all of the bad news But I'd like to think that let's look up to the sky and see where all the blessings come from So I still have my 10 fingers and I will inform doctor to see if I lose any one of them Thank you po Thank you Nina Jonas, go ahead Okay, ako nabah So for me ako, I would like to remind everyone that we are in a war Ang mga lololola natin ang ancestors natin World War I, World War II This is our war It's up to us to win the war Pano natin, we don't need guns We just need to starve, gutumin yung virus yung virus very selfish wants to go from one person to the next One person to the next anggang kumalat na sa lahat Ang kailangan natin Don't allow it to go to one of us so that it won't go to three others or two more others or five more others Gutumin natin where our masks properly na sabi na facial apat-lapat and the vaccine 40,000 yung mga participants So we have data and preventive measures So far ngayon nilibre So gamit natin yan and I always end some of my talks with history I love history Pandemics in the past have been two to three years and it's no different I believe that we will be able to finish or end this pandemic but we need to help each other We're not enemies We might have some differences in opinion, in assessment of evidence but eventually lahat nang ginagawa natin para ma-laman natin kung ano talaga yung dapat nagawin pa natin para maitigilit yung pandemic matatapos din to and dapat buhay tayong lahat pagkatapos nito Thank you very much Thank you, John John is our speaker next week John, thank you so much Isa, your final word Thank you, Susie and thank you to TVUP for this webinar taking off from John also We are in a war The virus is our enemy and having said that the virus is not them this pandemic we are not here to challenge each other's expertise instead we really need to work together in crafting implementing the interventions needed to control this pandemic and unfortunately it started with the virus but the impact is really multi-sectoral global so the interventions it's not just one intervention it's not one drug that will stop this pandemic it's a multi-factorial multi-sectoral approach that's needed for us to fight stop this virus it's a bundle of interventions that we all need to work on and agree on Yes, there are still uncertainties but let us not be distracted by all these uncertainties by all this noise in this fight against the virus that we are fighting not each other again we are looking for science based solutions there are science based solutions but for these science based solutions to be effective we have to work together in solidarity as we move towards controlling this pandemic in time Thank you Thank you I'd like to thank all our panelists we're going to have a wrap up from UP Manila Chancellor Manchit Padilya Thank you The webinar was opened by Dr. Issa Alhendria and according to Dr. Issa as COVID pandemic as COVID pandemic continues to surge infodemic continues to spread and there is a need to flatten the infodemic So Dr. Issa shared the rigorous process for developing clinical practice guidelines and in a nutshell she said the guidelines must be reproducible evidence from literature is reviewed by a panel of experts synthesized and presented to a panel for consensus building and in the process there are trade-offs in decision making the recommendations are living and they change with time as the data comes in Thus we must be agile adaptive and must recognize uncertainties. This is a strong collaboration among health professional societies and associations with the Institute of Clinical Epidemiology of NIH SHP Manila as the lead Our main presenter was Dr. John Di Buensalido and he had a different format for better appreciation of the recommendations given by the panel of experts Dr. John Di gave a brief but in-depth review on the various types of studies and it was very firm in saying that randomized control trials RCTs are the best in giving evidence He also gave a simple explanation and met analysis which combines the results of several studies Now I urge you to watch again to appreciate the process presented by Dr. John Di as well as the answers to the fact or fiction for the following interventions ivermectin, melatonin zinc, vitamin C, lima puhing wen and steam inhalation The current recommendations are based on real-time data and as he said again and again quality of the data is important Again he said this these are living recommendations and with more data, recommendations will change We had three reactors and let me start with Dr. Nina our health social scientist and I don't want to start with the quotation that she cited from her mother national scientist Helya Castillo because it's still very relevant today and I quote best science and scientists are devoted to the problems of those who have less in life and that is equity and ethics at its best close call Discussing the Filipino psyche Dr. Nina talked about the loss of agency, the capacity of an individual to actively and independently choose to affect change, free will or self determination So it's not just a COVID disease that we must consider. Dr. Nina said that there are so many factors that we have to consider now it's an interplay of other issues that are happening kawalan ng pagkakataon pagkakataon para makiramay pagkakataon para yakapin yung pamilya Third is pagkalito at yung pangapat ahitugon. Our next Reactor is Dr. Jason Ligo who actually discussed the biases that influence our day-to-day thoughts and interactions and I think it's nice to just understand the biases bandwagon, availability, confirmation and blood biases and I think his advice of knowing what our biases are is actually probably a first that we must undertake and he gave us a series of ways on how we can counteract these biases. I urge you to go back to that table, rather the graph showing the risk with two factors of hazard and outrage and I think just going through that slide will help us understand on how you will actually acapan the challenges that we have right now in the midst of the COVID pandemic. Indeed I think the survey he presented on social media and COVID-19 I'll just mention two actually and it's quite heartwarming to note that the national mainstream media is still number one and the major source is actually WHO and science and health experts in the digital space. Our last Reactor is Dr. Dr. Bev from DOH and their nice things to pick up from what she said everyone in this digital age becomes a content creator. There is no editor to screen what is going out directly to the public and he moved on by giving the challenges actually at different levels. He said for the individual level digital age will continue and fact checking will need to become a habit in a skill for the health professionals she said that you know just exactly when do experts use their individual opinion as against the institution stand and do we really want to take a public debate because the viewers may not necessarily be medical and for the institution she said that there's a need to partner with other groups for better messaging and as we build population literacy there is a need for media literacy for accurate messaging. Just a few words for each of our speakers from Dr. John Ding appreciate the value of quality data as a basis of recommendations our cities are still the best unless us face our war together. From Dr. Nina spread only the good news and the correct news and on the area of vaccination is an act of love, citizenship and solidarity. From Dr. Jason curate your sources filter out the noise in the chat groups be conscious of your biases be honest and from Dr. Ben digital age is here to stay and I repeat we have the responsibility to check the information we are sharing let me end with a message from Dr. Isa she said during her opening remarks it is not just hand hygiene we also need information hygiene back to you Dr. Susie and Reina thank you very much that was our Chancellor VP Manila Menchit Padilla and for next week please join us it's the anniversary of the webinar we have lots of surprises for you but we also have so our topic is isan taon na kamusta na ba tayo kamusta na ba tayo and the tayo is frontliners we are going to have Dr. Nonit Tronco talking about the impact of the pandemic on your psychosocial health your well being how it has affected you we will have Jonas Del Rosario who survived COVID the spokesperson of UPPGH and we'll have R.D. Lopez who won an award for the song of our webinar he just recently won an award and this question is what made him write that song and I think we are focusing on how do we continue to do this work John D said it might be two years, three years how are we going to continue so our session next week is going to be about you and how can we all what should I say how can we all persevere be hopeful and be strong in this pandemic Thank you Dr. Susie and thank you for that well excellent as always, synthesis from our U.P. Manila Chancellor Armentita Padilla so next week po isang taon na po tayo na nagsasama-sama irirektir, reiterate ko lang po uliting ko lang po that there is a call for those photos for those details that will be part of our COVID-19 Heroes Memorial so that we won't forget the sacrifices and also the experiences that we have encountered po this past year and hopefully that's something that will remind us not just to persevere but also just to give hope that there are those who are working very very hard well to stop COVID-19 and also to be able to take care of all of us so marami salama po sa atay mga frontliners and next week po makita-kita po tayo let Friday 12 noon to 2 p.m it's a date together let's stop COVID-19 so keep safe keep healthy and see you online before my fears the other's life before my tears but right behind the mask I look into myself and ask do I have strength to carry on my God, how long must this go on and need you here to keep me strong I'm here to hold the line I'll keep my word until my say his name to realize it's fine to be afraid just hold on to the word he gave this time we'll come to pass because this salvation makes it last you carry you to see the break of day the other's pain before my fears the other's lies before my tears but right behind the mask I look into myself and ask do I have strength to carry on my God, how long must this go on and need you here to keep me strong I'm here to hold the line I'll keep my word until my head's dying my fears the other's lies before my tears but right behind the mask I look into myself and ask do I have strength to carry on my God, how long must this go on and need you here to keep me strong I'll keep my word until his pain before my tears pushing on the spite of tears these things through another day