 installment of the Stop COVID Deaths webinar series. And we are glad that you continue to join us in this learning journey as we continue the conversation on COVID-19. During our webinar number 18 po, that was our very, very first national town hall meeting for hospitals with a topic keeping our healthcare workers safe, the PGH experience. Today po, we are back with part two of that national town hall meeting for hospitals. At ngayon na po na mayro na po mga bakuna, na tanongin po natin against the backdrop of the vaccination program roll out. Paano na po in ito na tutulungan or nakaka-affect po sa ating mga kaso, lalo na po ngayon na mayro po tayong surge ng mga cases. I'm Dr. Raymond Francis Sarmiento, director of the National Telehealth Center at the National Institutes of Health, UP Manila. And today will be a momentous event just because we have really a spectacular lineup of panelists for today. And as always, it's a pleasure to say that every Friday I get to share the hosting duties with my partner in crime and my mentor, our adjunct research faculty at the National Telehealth Center and also the special envoy of the President for Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie? Hi, hi Raymond. Magandang araw kusay nilahat. Good morning, good evening to all of you who are, good afternoon to all of you who are watching and those who are watching on the playback on YouTube and Facebook. Welcome to another session of Stop COVID Deaths. We are looking forward to a very interesting conversation and I just want to agree, Raymond, from Baguio City, Negros Oriental, Ilo Ilo, Dumagete, among Rodriguez Hospital, Tamulatan Medical Hospital, Nueva Vizcaya, Isabela Bataan, Malay Balay, Bukidnon, Antipolo, Kainta, Davao, Iligan, UP Manila, Santa Rosa Laguna, CAR, San Mateo Rizal, Batangas, Palawan, Angiles City, napakarami po, so welcome to all of you. Thank you for joining us. Kung di pusein nyo, ala kami rito and we hope that this webinar really gives you a chance to access some of the leading, what should I say, not some, but the leading doctors and resource persons and experts in the country who are handling the pandemic and as Raymond said, it's a learning experience for all of us. So today it's a national town hall meeting. We've got three hospital chiefs, the three chiefs of hospitals of the COVID hospitals are here to share what's going on and we have noticed an increase in cases. Merong nga bang surge, di ko pa masasagot kyon, pero samahan nyo po kami. I think there's a lot that we can learn together today. Over to you, Raymond. Thank you, Dr. Suzy. As mentioned po, we have, as shown in our opening billboard, we have a great lineup of speakers for today, but the lineup really and the whole production will not be possible without the very hardworking team behind the stop COVID-19 webinar series. Maraming-maraming salamat po for making this learning series possible and this will be just a testament po since we are now in webinar 44. In just eight more webinars, we will have marked our one year anniversary po. The virus has really shaken us and provide us with several areas of concern, but also opportunities to learn more about, well, more of a biological entities and more on how to combat the need to improve our public health measures. So I hope all those who will be logging in and just based on our number of registrants who numbered 2,879 registered attendees po para po dito sa webinar na ito, we hope to be able to get most, if not all of you, in this Zoom kung kayo man po ay nanonood sa Facebook live streaming, sa YouTube po. Sana po ay mas marami pa ko kayong maanyayahan na makadalo. Over to you, Dr. Susie. Thank you very much, Raymond. And it's webinar number 44. Can you imagine, Raymond? 44 weeks na gina gawat po. Hindi naman po kami magsasawa. There's always so much that we have to learn and we have to keep up with the developments in science. I also want to just recognize that we have many people watching from the hospitals of Metro Manila. So of course from the Philippine General Hospital, from Kirino Memorial Medical Center na bang dikohanin ayong among Rodriguez Tonto Medical Center. And we have more coming in from Indanao. So I think I saw here Surigbao, Davao, Sambuanga. So we're all here. We're all ears. We all want to learn and we're all a little concerned kasi po kang dumami ang mga kaso. But we want to be able to interpret that without being afraid. We want to try to understand what's happening and what we need to do. So over to you, Raymond. I think people want to know about their certificates of attendance. Thank you, Dr. Susie. So thank you to VUP for displaying our sample certificate of attendance. Gaya po nang nasabi na po natin sa ating mga previous webinars. And this is very important information, especially for those who are joining us for the very first time, no? Certificates will only be issued for those who have attended at least 50% of the webinar duration dito po sa Zoom. If you have attended it outside of the Zoom, you will have to inform us about that so that we know and be able to track down and list and give you a copy of your certificate along with a copy of the presentation book of the speakers. Assuming, of course, that they agree or approve of the dissemination of that resource material. Okay. Let's start the ball rolling, Dr. Susie. Okay. So our opening speaker is not somebody you don't know. And in fact, he's our lifeline to the IATF into the National Task Force because Executive Vice President of UP, Dr. Ted Robosa, not only has a huge following on social media, but now more people are following him because he was one of the first to be vaccinated. And I tell you he's our lifeline to what's happening nationally because we usually talk about the clinical aspects of COVID-19 and management, but we also need to know what's happening, what's the bigger picture. So, welcome, Ted, to your webinar. Thank you, Susie, and good morning and good afternoon, good evening. Mabuhay to all the dedicated patrons of Stop COVID-Dets. First of all, congratulations. I'm at the National Vaccine Operations Center. Yeah, I'm at the National Vaccine Operations Center. This is not my house. So, I physically work here. We are mandated at the Vaccine Operations Center to actually come here physically, risk our lives. Hopefully, I got my shot already. This is at the Camp Aguinaldo, in Camp Aguinaldo at the Armed Forces of the Philippines Commission Officers Club. Okay. There are two big halls that've been converted to the Command Center, the National Incident Command Center of the National Task Force, and the other room has been converted to the National Vaccine Operations Center where multiple agencies sit and we have dashboards and monitoring the vaccination program as it happens. So, this is a new, what is it? It's a new space that's been set up. This is what we've been using since the beginning of the creation of the National Task Force. So, this is our headquarters and what was moved out was the response, the task group response. The task group response was moved to the building of the National Disaster Resurduction and Management Council, also here in Camp Aguinaldo. And the task group response is now busy again because of the increasing number of cases. Wow. Okay. So, there you go, right? In the middle of all operations. Okay. Go ahead, Ted. Please give your message. Allah. Wait. Could you try again? Sorry. Well, what happened here? Okay. So, first of all, let me congratulate the many weekly invited speakers and all of you patrons and participants of this Stop COVID Deaths webinar. This was initially just a small idea that became a big project. It started almost a year ago now and it's fantastic how 11 months have gone by and we're now on our 44th episode. How fast time has gone by and in the beginning of the pandemic last year, there was so little reliable information about COVID that was available. Fear and chaos prevailed and many doctors and nurses even died from COVID. And what does this background that Dr. Suzy Mercado approached me about hosting a webinar to give a megaphone to a few experts who initially had real experience on how to treat COVID cases. Hence, the title Stop COVID Deaths of this seminar. With that push of Dr. Suzy Mercado, I connected the dots that were already in place. The National Telehealth Center led here by Raymond Cermento at UP Manila had been a grandfather of health-related webinars since it was established. The TV UP under the office of the UP president was established as an alternative medium for a digital classroom or learning environment, a format with a reach far greater than the geographical spaces of our university campus. Then I asked the help of the UP office of the vice president for public affairs led by Bipineni Pernia that hosts the UP systems webinars regularly. This combination or collaboration created this weekly webinar now actually on our third season. Over 40 webinars have been created and you can return to those previous webinars at our TV UP sites on YouTube. Thousands faithfully attend, watch, and learn from our experts that we invite weekly. Your continued support has emboldened us not to stop and continue improving these offerings. We the community at the University of the Philippines not only offer academic programs but aim to share our research, our experiences, and our knowledge creation in the different fields of expertise that they are involved in. I congratulate all the invited speakers today. They are our today's national heroes who have shown their dedication, sacrifice, and leadership in the fight against COVID by leading three of the top COVID referral hospitals throughout this pandemic. Today is a town hall national town hall meeting as COVID stopped COVID that tries to wade through the new events taking place. Brought about by the current surge not only in communities but also in this healthcare institutions like the Philippine General Hospital, the Lung Center of the Philippines, and the Dr. Jose N. Rodriguez Memorial Medical Center. Is the surge due to the slackening of human behavior or the preventing its transmission? Or is it the proliferation of several variants detected by another UP unit, the Philippine Genome Center at the National Science Complex in UP Diliman? We thank the numerous participants who come back every Friday to support us by sharing your valuable time with us. Sorry about that. Siri is trying to talk to me. Anyway, so I really appreciate the fact that people have been coming here and attending weekly. We do hope we can answer all these questions. Is there a surge? What is our contingency plan? What is the plan of the referral hospitals? And what are we going to do? Maraming salamat po and have a good day. Thank you, Susie. Thank you very much. It's Dr. Tedder Boss Executive Vice President of the University of Philippines and also the advisor to the National Task Force on COVID-19. So Raymond, we're going to talk about, we're calling it a national town hall meeting for hospitals because our guests are actually hospital chiefs, but we have invited also an infectious disease specialist to talk about these increasing numbers and whether or not we're going to call it a surge. I'd like to encourage everyone to put your questions in the chat box. We will talk about testing, we will talk about vaccination, we will talk about treatment, we will talk about health worker safety and protection and I think we want to focus a little bit on with the vaccination. Merong magbabago, is it going to be you or better for our health workers? Because at the end of the day, this webinar series is made for you for the frontliners and hopefully we learn something from what the big hospitals are doing. So over to you, Raymond, for our opinion poll. So the poll is not, there's no right or wrong answer, I think, but it's more about what you think. What do you think? Right, right. This is me, Raymond. Over to you. Go ahead. Thank you Dr. Susie and thank you EVP Ted. I think that was the very first time that someone called me the grandfather of something. Patanda ka na Raymond. Forty-four years ka na ang mabababi. It's a surprise. That was a surprise. Anyway, for those who are in the Zoom po, please input your answers for our just very, very fun audience survey and subsequently our opinion poll. What place are you viewing the webinar from? Wag po kayong mahiya, wag po kayong mga imina mag-answer po. Obviously, we want to be able to just get a good grasp of the distribution of those who are attending our weekly webinar, so please input your answers. We understand that we have those who have registered from Apalit Pampanga, from the Romblon State University in Ojongan, Romblon, from Dr. Pablo Otore Memorial Hospital in Bacolod Western Visayas, from Lano del Norte Provincial Hospital in Illigan City, and from the Dr. Arturo P. Pingoy Medical Center in Coronadal City in Sock Sargent. Internationally, eto po, a very first time, I believe, from Saseel, Italy, I don't know if I'm pronouncing that correctly, from Bonn, Germany, OMAG, Northern Ireland, Lexington, Virginia in the United States, Styler, Texas, Buena Park, California, Niagara Falls, Ontario, Canada. We also have our regulars from the Middle East, Alcobar, Saudi Arabia, Dubai, United Arab Emirates, Doha, Qatar, Kuwait, and then from India, Indonesia, Ho Chi Minh, Vietnam, Terengano, Malaysia, and Taipei City in Taiwan. Next up is what is your line of work? Very consistent po with our previous webinars. We have a lot of those who are in the nursing field, who are tuned in dito po sa ating weekly webinar followed by those in the medical field. Maraming salamat po. We tried to parse it tayong po ating mga others so that mas mapalabas na po namin, lalapoy ang mga dentists, midwives, medical technology, so hopefully we could get a sense of how many you are there. And then the next questions po will be more about the technical aspects and technical questions related to this webinar. I will read them and the options that they're after. The question reads, there is a significant increase in COVID-19 cases. What do you think is the cost? Option A, relaxing of public health measures such as wearing of mask and face shields, physical distancing, et cetera. Option B, COVID-19 variants. Option C, more mobility and option D, all of the above. Next question, why do you think there is an increase in hospital admissions? Option A, increase in COVID-19 infections. Option B, limited access to community quarantine facilities. Option C, more aggressive testing and option D, all of the above. And then finally, our fifth and last question, what should we do about the increasing cases? So we have citywide lockdown, localized lockdown, aggressive community testing, wear mask and shield, avoid unnecessary interaction with people. We pray, we only get information from trusted sources and we get vaccinated. So we won't be ending the poll anytime soon. So please key in your answers po as we move on to the rest of our program. Dr. Susi? Yes, so again, thank you Raymond for that and just continue to answer the questions. We put these poll questions so that we have take away messages and we have something to remember and to discuss later on with our panelists. We're going to ask EVP 10 to stay with us for the panel later. But before that, TVUP has tried to get an opinion poll also from, not a poll, but opinions from ordinary people who are maybe thinking about what's going on. So let's turn over to TVUP for your interviews. So many times, search ngayon. Pero dahil hindi ako epidemiologist, hindi ko maaring sa mga hulaan, I cannot guess, I'm a blood-cost search. Asiguro ngayon, ay kita akong ngayon na mas na tumatas kasi napakabayaan na rin yung di ba kasi talagang din isa mo sense of health protocol katulad sa mga paling kaya, siya na naring ay siksikan. Medyo nga tumatas, pero siguro dahil yung tingin ng karaminan tao ng mga Filipino ay, dahil may vaccine na kaya medyo tumulwag na rin sila, nagpupunta na, hindi na katulad nung datin na mas mahikpit. There is more mobility sa mga, people are more willing to break quarantine regulations. Mas nalala ko na babahala ngayon, lalo na sa pamilya ko at sa sarili ko din kasi nagkocommute ako araw-araw, pag kumapasok ako sa trabaho. Kampanti ba ako sa vaccine situation ngayon? I think the answer for most people as it is for myself is no. Asa ngayon po hindi po, kampanti kasi hindi pa naman napapatun na ayon na talagang effective yung vaccine, pero kung talagang effective siya, mas ok saan para hindi na tayo ngangan ba na mas lang tatas yung COVID. Ok naman yung vaccine, although medyo kontin dumarating, pero so far so good naman yung sa tingin ko, mas tingin ko dapat lang mga bilis na madagdagan pa yung mga parating na vaccine. Masana matapos na tung crisis na nangyari sa ating balsak, hindi na sa ating balsak ng sabong mundo, kasi napakaramin ng apitadong pao na nadadamay, naman matay, naman wala nang trabaho. Goro, wag muna tayong magkampanti dahil akala natin may vaccine na kaya pwede na tayo magkampanti. So medyo strict pa rin sa pagsusot ng face mask, kung kailangan din ang face shield. Asa tao na rin gini, kung may discipline tayo sa mga sarili natin, kung susulat tayo sa mga protocols, kung nga dami gini, tsaka kung marunang kaya makaisa. Thank you very much TVUP for those interviews of persons on the street, ordinary people sharing their views on what the situation is. So without further ado, let's bring in our first speaker again, someone who is not new to you and somebody who has been in there to the public because he was the first one to be vaccinated with Sinovac at the Philippine General Hospital. Good morning. Good morning. It's been almost two weeks since the vaccination and nothing unusual impact nothing at all after the vaccination. But we continue to vaccinate everyone as they come. Great Gap. We are just always so happy to see you with us on the webinar and a lot of people look forward to listening to you. You know, Gap, it's not somebody who hags the limelight or likes to be seen in public, but when we do get to see you, we really do appreciate your views, your reflections and your thoughts on how we're going to get out of this. And I think you said we are getting out of this. There seems to be like coming out of the tunnel. So, Gap, let's go ahead with your presentation. If I may share my screen. I think this afternoon is my fourth or fifth time to appear in the webinar and I'm happy to know that I'm almost 4% of the total webinar hosting that you've had and I'm proud to say that. With a quite difficult topic now because there's a lot of speculation about it. Is there really a search? I think it's a difficult term to qualify, but I guess for now everyone agrees at least that there's a spike. Even the WHO calls it a spike and not really willing to call it a search. But just to give you a background in what's happening and how people are interpreting it, I was in an NTF meeting and I borrowed some of the slides just because I think it drives a very important message for us to understand what's really happening. We all know that the cases have been going up and this is no secret to every one of us that it started when the month of March even before the end of February happened. We already started seeing the number of cases going up and steadily it has been rolled out of increasing numbers. By the day exceeding what we have seen in the last four months. But at least not still quite the peak that we saw in July and August of this year. So there's still some room for us to maybe reflect and intervene before that peak happens again when we were forced to go to another MECQ. So the big question here is this because of the recently announced presence of another variant the B.1.351, the Brazilian, the South African variant which is supposed to be more transmittable but that proven to be any deadlier than the other variants that have been present around us all this time. So it was announced on March 5 but actually tracing back the specimen as early as January there was already one identified in PASI but most of them are starting to be seen in increasing number at the tail end last two weeks of February. So if you map out they mapped out the presence of this different variants UK and the South African variant the dark ones being the UK variant and the yellow ones being the South African variant and you see that the distribution is centered the variants are centered in the very popular areas near the bay, Paranyake, Makati, Manila, Kesun City of course being a highly dense area has its own share, PASIG and Las Pinyas and to our woes of course PH is right in the middle of all of these dots and that's why we were quite alarmed at being caught by surprise so we started instituting ways which I will discuss with you later. So a lot of these variants also were traced to PASI because that's where the entry of our returning overseas Filipinos and foreign nationals are. If you compare this now to the transmission of COVID-19 in areas they somehow follow a pattern that again is concentrated on the central part of the NCR around the Manila, PASI, Nabotas, Malabon Air which are all contiguous again around PGH surprisingly the others that have no that the variants were identified like Kesun City or PASIG or Las Pinyas do not show are not seen as hotspots now. So maybe this growth will support the fact that there's something else that's happening aside from the virus the more transmutable virus being present and as I said the alarming growth rate of around 121.4% in this high risk areas has driven a lot of the hospitals to go into plan B so to speak after all these months of being in a relaxed mode. So this is just again a distribution of the variants the UK variant on the left and the South African variant on the right and you see that there's no increased concentration there's a low percentage of those identified in the specimens specimen submitted again showing a high concentration of numbers in the returning overseas Filipino so there is no increased detection in any given area but if you now compare the two areas of the distribution and the hotspots and the increased transmission rate attack rates there seems to be no concordance between the two Pasig here, Kesun City there and what is quite obvious is that the proximity of the borders of the majority of the borders of these cities affected is being identified now as the factor of mobility among the citizens of the different cities now so if you map it out based on that at the conclusion from the National Task Forces we have become infected because we have been lax with our minimum health protocols and that I think from those data and I hope Doctora Berba will shed light on this later if she agrees or not to go beyond the African variants and not the only reason for the case increase that we see I think it's a common feeling now that it's the probably the pandemic fatigue that we're all feeling and the seemingly low numbers we've had in the last few months that made us bolder to come out and some of us even violate our health protocols I was in Greenbelt the other day just this weekend and there are musicians already playing in the bars there as if it was not pandemic anymore so I guess people are starting to just trying to live out their normal lives and forgetting about the minimum health protocols that could be on a practical basis be one of the reasons so what is all this number doing to us now these numbers have also been reflected in our daily census of COVID related cases both probable and suspect but I think 98% COVID and 2% probable or suspect reaching our peak yesterday at 111 our lowest was around 60 or 58 at one point in fact we closed some of the wards already when more non-COVID patients were coming in there is one day that there are 100 patients in the ER and only two or only three were actually COVID cases so you can now imagine the pressure of admitting non-COVID patients who come to PGH as their last resort and referral hospital as most big government hospitals are so we are now in the process of calibrating our wards into responding to this increasing in number hopefully not prolong but nonetheless we are still responding appropriately to it so what we discovered also is that our ability to transfer patients into PGH from early mid-February to around late February was still okay now we were still able to get in the COVID referrals that were coming in but in the last few days because of the rapid rise in number our ability to admit these patients have decreased hence forcing us to open up our wards and right now from almost 70 before this rise in number happened we are now back to 168 beds for COVID patients what we've seen is that not too much pediatrics patients are coming in so mainly just the adults with concomitant medical problems so we are now we have wrapped up 268 at our maximum before was 230, 240 and we are ready to do that if needed but as I said because of the huge demand for non-COVID beds by our urgent and say my urgent non-COVID patients force us to use the other wards first for them so I think this is a good estimate of I hope this is our a good estimate at a good projection of eventually the beds that we will need until we ride out this spike or this surge later on as we figure it out in the next few weeks to come so how did this affect our health workers I think is apparent that the problem in the hospital is actually a reflection of the problem in the community just like to share with you we wanted to find out in the last 10 months how COVID has crept into BGH knowingly or knowingly we did a zero surveillance of almost 3000 healthcare workers and this was done before we rolled out the vaccine and we found out that 74% of our healthcare workers were never sick and did not have any evidence of antibody reaction to the presence of previous COVID infection of course it could have faded through the months but at least we interpreted it as such for now because it's the data that is currently available to us so that means 26% have had either known COVID infection or a known COVID infection as reflected by an antibody reaction that 8% of them had so it is interesting to note that the 11% who had COVID, known COVID infection still had their antibodies present in the testing that was done in February and those that had COVID infection of which are 7% lost antibody to COVID-19 already so they can still be infected and hence the value of vaccinating this personnel as well but there's an 8% of our population that had no no symptoms at all and detailed questioning but still had antibodies in their serum and was deemed to be infectious at some point so this is an important message for us to say that it could really be with us without us knowing it and I think it's in the days that are coming so again going back to the community report our healthcare worker follows the same curve that the community has been displaying so truly healthcare worker infection is a reflection of community infection so I think it's a spike our HIKU led by Dr. Aroberba issued an alert on March 4 when we recorded 15 positive COVID patients COVID healthcare workers in four days equivalent to the monthly that we've had since December so I think the infection was again linked to infection to sick co-workers who reported without telling their colleagues that there's some symptom that they're feeling and eating together exposing others to the transmission of this virus so in light of these observations we had an early alert and I think that was what was leaked to the media so there was a huge exchange of Bible message a small message becoming longer and longer being other people adding that message until it went viral so just to be more specific with the situation that we had here in February 25-28 Anesthesia reported four residents who tested for COVID when one of them became symptomatic and the exposed colleagues also tested positive and the contact tracing eventually led to four more residents turning positive eventually becoming 12 in the Anesthesia group and forcing us to quarantine 36 high-risk patients and the different subgroups in Anesthesia like the utility workers and the administrative officers so the spike of infection in the Anesthesia group forced us to trace it further of course at the nearest subgroup which is the surgery department because they work closely together although the transmission in the Anesthesia group was traced to a call room where there is close contact between the residents during their off hours rest hours and the whole Anesthesia and the surgery residents quarantined initially and testing was done and ten of them turned out to be positive and as well as four interns who got exposed to the residents and maybe some of the Anesthesia residents also so it was really a nightmare for us to be in such a whirlwind of increasing infection but fortunately unlike before most of the infections were either asymptomatic or mild I think only two of the eventually the 45 maybe three of the 45 who were initially identified that admitted for symptoms so we also got the surprise of our lives when one of the residents in surgery who was positive in February turned out to have the South African variant and again you can imagine what kind of frenzy this cost us because of the reportedly increased transmission of the virus but fortunately tracing back the initial contacts all turned out negative until we were able to trace back after the resident has reported back to work because after two weeks he was allowed to go back to work and when we got the result and I think in March 3 when he was already on duty on March 5 we traced back again contacts and we had two residents that were positive on the second generation contacts after identifying the virus but again all asymptomatic it is really quite disturbing for us to be getting all of this but to our surprise it was not exclusive to the department of surgery and anesthesia psychiatry also had their spot of COVID positive staff members traced back to psychiatric consultant where they had a face-to-face webinar slash hybrid webinar and I think the consultant was annoyingly positive and exposed to the residents and who eventually turned out to be positive in two of the 10 so this is a completely isolated event from the surgery and anesthesia and then we had our child protection unit which is a standalone unit outside of the hospital again giving us a positive consultant with some nurses turning positive on the contact tracing also so in general so in summary this is what has happened with our healthcare workers on March 1 to 8 and I think the conclusions that we get there is that most of the early infections that we got were linked to eating together in closed spaces without their masks and that the actual link to occupational exposure happened in the neuro ICU where a previously negative patient turned out to be positive and had to be intubated and two nursing staff eventually had positive prior to this our only other occupation link exposure was early last late middle of last year again during an aerosol producing intubation residents were exposed without proper PPE so these are the conclusions probably that we can get that most of the infections came from links to community and not from the patient themselves except for maybe one or two that were identified in the ICU so this again sends a message that the occurrence of infection in healthcare workers rise that we have is really more linked to violation of health protocols or relaxing of health protocols so the reflection and the services that we can render is really tremendous in terms of anesthesia and surgical activities so we steps that we took of course were to reduce the number of personnel in the hospital and the easiest to remove from the hospital will be our students at medical clerks and the interns so there are 150 of them at a given time in the hospital we have them to go home but still continue to monitor them we deferred all elective medical and surgical admissions just like what we did at the start of COVID in March and we changed our minimum minimum mask from surgical to KN95 which of and fit tested at that we deferred OPD walk-ins but we still accepted OPD face-to-face OPD consults but pre prearrange through our online consultation network we adjusted the activities again eating being the number one area eating together being the number one factor in the spread of this virus we made more we added more personnel to allow us to do faster and more aggressive contact tracing and we've submitted our samples to gene sequencing just to see how the South African virus is spreading within our healthcare workers and I think we submitted that specimen yesterday groups of specimen yesterday our testing still targeted meaning just based on the exposures and the risks of patients and the probability of spreading it and we noted an increasing positivity rate of at as high as 15% and we were down to around 2 or 3% in the past however the increasing number of healthcare workers being infected forced us to abandon our initial high risk low risk categorization for testing and we just tested everyone of course timed after exposure who got exposed to a positive healthcare worker so I think that's one thing we changed also so we reminded everyone of the universal pandemic precautions and the healthcare worker actually has a lot of risk areas where he can get the infection so that they are forced or they're reminded to again exercise the health protocositor instituted so with this in place we have been giving out daily HIKU alerts and HIKU reminders on how to avoid transmitting this and of course and how to interpret also the data that we're having to avoid any confusion and maybe even panic among the healthcare workers because we very well know there are hundreds of people in the vaccination area and one false information can affect the confidence of our healthcare workers at the vaccination area for their chance so I guess that's how we rolled out our management of the healthcare infection I'm happy to know that it's leveling out as the week is ending we are resuming some of the operations next week already opening some of the operating rooms but still reducing the number of people coming into PGH for now we will round off the discussion and give you an update on the COVID vaccination because I think I presented two weeks ago and the plans for this we have prepared very well for this I think we have done three or four simulations before this roll out and this is the night before when finally the vaccine came on a Sunday and we rolled it out on a Monday, March 1 to a fanfare and festivity that is of course a violation of the health protocols that we had but everyone is so excited we just had to keep reminding everyone of the distancing and the masking so as you very well know I got the first vaccine and I'm happy to note that the first five are actually all from UP that's why I call them the first five Dr. Eric Domingo of FDA Dr. Mingita Padilya of Santa Lucia Eyebank Dr. Edsel Salvagna of the Naitag and of course Dr. Mike T our Vice Chancellor for Planning and Development so we were all together as the first five in the monitoring area after vaccination and of course the big impact came when the Dean and the Chancellor took in the vaccine that was available, Sinovac again I think I heard Dr. Padilya even called in the experts to her office to explain to her what the choices are and finally she had herself vaccinated with Sinovac and the Dean as well so these are the three people who run UP Manila and hopefully set a good example for confidence of on-vaccination and as we roll out the AstraZeneca we are now taking in the more senior ones these are all legends in medicine and in surgery Dr. Charlie Magsanoff 88 years old Dr. Tony Limson 86 years old Dr. Periquette Antonio Periquette former Assistant Director for Health Operations 85 years old Dr. Senon Cruz 11 years old our national scientists Dr. Ernie Domingo and his wife Dr. Camilita Domingo former Director of PGH Dr. Salvador Salceda and our oldest vaccinate was Dr. Dick Chonco our surgeon mentor for the longest time so it was really great to see all of them and I think the biggest thing in Asian is that the hope that it has given us that finally we are in the last step in the ultimate the last two seconds of our fight against COVID but nonetheless still the worst still expecting the worst from our everyday current challenges so far nationally as far the roll out has been 15.4% with NCR showing the highest 35.9% of the healthcare workers vaccinated and 15.4% of 1.7 of 1 million healthcare workers in the master list priority master list of DOH in PGH we have already vaccinated 51.8% both with Sinovac and AstraZeneca I think the numbers have shown that the confidence in Sinovac which is really CoronaVac which is really low at the start started to improve after the initial day of vaccination and we were able to almost completely consume the 2000 allotted to us the AstraZeneca is also getting off a good start I said we are seeing a lot of our senior consultants coming in for this also so I think there is no use comparing the vaccines anymore at this point I think the point is that we already took in whatever was available and I think there is no regrets for any of those in any of these groups so we have five more days to go for our vaccination hopefully target of around 5000 vaccinees in the next 10 days that will ensue for AstraZeneca so just some observations we for Sinovac we observed that there were two severe reactions adapilactic reactions that necessitated epinephrine injection but they are both doing well and most common complaint is local pain followed by headache in AstraZeneca the overall observation is that there are more reported side effects again local pain but fever is more seen with AstraZeneca and the body aches that's why knowing from previous experiences of other hospitals that in UK especially the reports there that sometimes in the vaccination paralyzes one unit because 100 nurses probably are not reporting to work because of the side effects so we decided to just schedule our vaccinees and send only for them to send only 10% of their unit per day so this allowed us to to prepare for any eventuality if the 10% are not able to come 90% of the personnel of that unit are still there so we because of that also we are closer follow up with these patients surprisingly very few seniors report any side effects and I think the pleasant surprise that we had is that we were able to extract 11 doses with the LDS syringes were available so we will have 500 extra doses from our 500 vial supply so with that I'm ending my talk and ending it with a huge expression of gratitude to our vaccination team our hospital infection control unit of course the COVID crisis community the bad boys of surgery directors advisory board the department chairs and the unit heads big support of the department of health and of course the ever present assistance of IATF in the city of Manila so thank you very much rounding off this fight against COVID the vaccine as I said really gives us a big sense of hope that finally you'll be able to defeat this virus thank you very much and good afternoon to everyone thank you very much thank you to Dr. Gap Ligaspi the director of the Philippine General Hospital and always very reassuring I think we all calm down and we listen to Gap and see someone who's in command and in control in a very gentle and very decisive way so thank you so much Gap I think I'm going to turn over to Raymond for our next speaker but Gap you'll still be able to stay for our panel I think there will be some some exchanges and some discussions so Raymond over to you thank you Dr. Susie and thank you for that reassuring message from our director from the Philippine General Hospital Dr. Herardo Ligaspi for now let's call in our first reactor he's the executive director of the lung center of the Philippines not other than Dr. Vince Balanag Dr. Vince hello good afternoon to all good afternoon sir go ahead with your reaction pal well it's a pleasure to be invited once more to the UP webinar series so congratulations on your 44th it has been seven months after my first invitation to this forum at one year after the declaration of the pandemic and the national lockdown well many things have changed hopefully for the better but many other things stay the same and I presume it may stay the same for a little bit longer so I just like to congratulate Dr. Gap Ligaspi for that very comprehensive presentation very informative on how what are the cases that PGH has been having as well as the effect on their health workers now whether it's a surge or a spike we'll just leave it to the experts I agree that most of the variant cases are probably the western part of NCR and as he has said Keson City is not one of the hot spots and actually in my area of Keson City we haven't well at least among the patients we haven't had a case it was a variant and I agree with Dr. Gap that probably it's not because of the variants but rather laxity the health protocols and probably as he said pandemic fatigue so is there a surge already well that's debatable but what is important is the lung center feeling the effects of the surge well with the present uncertainties about the virus and the actual experiences in our hospital it is a good practice really to anticipate a surge as part of our risk management plan so this will keep our staff on their toes continue to practice recommended health standards it will ensure that necessary resources like PPE, drugs and medicines medical supplies other important needs are well-stocked and enough supply for several months are available and of course the most difficult is ensuring enough beds for the incoming wave so it's something that takes time to prepare usually about two weeks because we have to transfer patients to the other wards get them discharged first we have to equip or retrofit rooms and reassign medical and nursing staff so timing is very important whenever there is a surge now when in dealing with the number of cases and trying to find out if we have a surge then of course we look at the numbers in the daily papers I take a look at the daily reports in terms of actual statistics in terms of volume type of patients as well as their severity and we every start of the week we have a meeting of the incident command and it's where we exchange thoughts and experiences in the past week and what to expect during the coming week so I'll go to my slides to give you an idea on the number of cases we have so next slide please so this is a graph of the cases monthly cases we have since the start of the pandemic up to the first two months of this year so you would see that the initial spike was in April then a bigger spike occurring in August then thereafter the cases begin to decrease up to November a slight increase in December and again the lowest so far was in last month last February you can also see the types of cases we have blue bars would be the confirmed cases while the yellow bars would be those without positive tests and you would see that in the early months a lot of our patients are discharged or even die without a result in their COVID but more recently because of the availability of testing within the hospital there are just a small percentage who are discharged or die without a positive COVID test and in the mortality it would follow the total number of cases so we had the highest number of deaths in August and so far this had gradually decreased to less than 20 a month last February next slide please so this will show you the daily case load we have since December 15 the yellow bars I hope you can see them would represent the COVID confirmed cases while the lighter bars would be those at COVID probable the baseline perhaps with us will be just 40 cases of COVID positive in a month so whenever 20 we begin to consider a spike and we observe a spike during the latter part of December from 20 to the end but it didn't increase significantly went back to the normal 20 COVID confirmed cases but starting the last week of February we began to see the spike increased which continued at the present present day so from 20 cases we now have a total of 50 to 56 COVID cases both confirmed and probable at this point in terms of available beds we have maintained 70 beds dedicated for COVID cases even when we had the lowest number of cases but it was only recently that we sought it to increase the number of beds to 81 because of the anticipation that more cases would come in in the coming days next slide please so this is the graph of the COVID cases among our LCP personnel so again just like in PGH the number he follows the cases in the community with the highest number occurring in Coqas I remember this was the time when I reported it was just 14 and actually it went up to 38 during that month and 37 did the following month but luckily we were able to reduce it significantly by improving our health protocols doing routine testing as often as two weeks among our staff assigned rewards but again there have been a small increase about 14 per month from January to February now in March just less than two weeks already have 14 so we anticipate that this month this might be higher in terms of number of cases so we had to do digital measures and which I will explain later next slide so as of March 11 yesterday we had a total of 190 staff who had gotten the COVID infection new cases since March starting March of 1 to 7 are three cases added up 15 active cases so far so we have 171 recoveries and one death during this period from March 2020 up to the present next slide so regarding our vaccination experience just like everybody we were alerted weeks before the before the vaccines arrived we had to make our micro plan we had to do the staff training standardized processes and procedures in the vaccination took care of the logistics cold chain management syringes and all the peripherals ready our venues and emergency emergency services near the vaccination venue and we also did simulations almost every day to maintain our readiness so this picture shows you the waiting area in our vaccination this is where they fill up their vaccine forms and get to read consent forms that they will need before they are registered next slide so this is where we have the counseling where then they are short there is a short orientation on the vaccine that they will receive and the possible side effects that they may have followed by them signing their respective consent whether they will allow themselves to be vaccinated after the orientation after this they are screening and when they are good to go by the physician then they are directed to the vaccination area next slide so this is our vaccination area and we are showing you the first vaccine in our center of the lung center our OPD manager and vaccinated by secretary doke himself so this is the first among our vaccines next slide so after that we have the minimum of 30 minutes observation in the vaccination area where they get to have their blood pressures checked and whether they have any symptoms that may require further medical attention and next slide and for those who have more than mild symptoms they are placed in an emergency treatment area beside the vaccination wherein we have the proper medications cardiac monitors blood pressure and even resuscitation set and measures next slide so we started vaccination in the first day of March just 20 for ceremonial purposes but just like perhaps in PGH there was an initial hesitation in getting the Sinovac which forced us to do a town hall meeting initially to reassure them about the safety of the Sinovac and it was then it was announced that AstraZeneca was also become available shortly and that made it difficult for us because at that time a lot of people were already preparing AstraZeneca over the Sinovac however perhaps after they seen the minimal side effects of their colleagues then more people began to be vaccinated the following days almost a hundred vaccines per day up to Tuesday this week March 9 we allowed our vaccination staff to rest during the weekends and we were able to finish the 600 doses of Sinovac almost 95% were consumed already and we just had a few in store for those who opted for Sinovac but had to be deferred we started our AstraZeneca 10 that was Wednesday and we continue to do it today which is our final day for our mass vaccination and so far the response have been good and as observation of gap there probably are more side effects observed with AstraZeneca vaccine as compared to Sinovac next slide so just to show you the update of the Sinovac and how the different types of health workers received it so among our doctors 47 had it comprising 8% of the total doses our nursing 149 or 26% so we were expecting more among the nurses but only this much I had their vaccines with Sinovac so there were 162 from the allied medical personnel medtech, radtech physical therapies and the others so 30% administrative non-clinical employees 119% were outsourced our security guards and our janitors numbering 97% or 17% avail of the Sinovac which we are really very much satisfied that we were able to convince them that Sinovac is a safe option as a vaccine so basically for the surge and the role of vaccines well the only way to really make a headway is to achieve early control of the surge by of course ramping up and accelerating the pace of our vaccination we hope to vaccinate at least 85% today by the end of this day and just follow up for those who were deferred or still hesitant to be vaccinated the following days of course we have to keep on reviewing the current health practices in our areas and we have to do well we have to check the health practices in certain areas where in some of the clustering are occurring actually this occurred in our outpatient clinic for our TB cases there was clustering of 13 cases at one time and we found out that the same reasons seen by GAP were operative they eat together sometimes without masks and hopefully this were already corrected and all of those 12 cases have recovered so far and just like in PGH we advocated the use of KN95 for non-COVID clinical areas where in before they used to use all the regular surgical mask with now mandate then to use KN95 at all times we also increased the routine testing for our staff still two weeks for the staff in the COVID areas but for the non-COVID clinical areas we used to routinely swab them every four weeks so we also started swabbing them every two weeks because a lot of the results of the swabs for those who were asymptomatic most of them were asymptomatic but actually COVID positive and this were true also for our administrative cases wherein a lot of them were really asymptomatic at the time they were vaccinated so these are the steps we have done in the face of the search and we hope that we are able to have the necessary resources whenever more cases come in during the next few weeks that is all thank you very much back to you thank you very much at Dr. Vince Balana again a very sobering calming and reassuring presentation of what we are seeing at the second COVID referral hospital thank you very much Vince you can't stay with us but thank you for your support for the program and for joining us today moving to our third COVID referral hospital and again somebody that you know all the way in the Tondo area we have the Jose and Rodriguez Memorial Hospital and we've got Dr. Alfonso Fritz Famaran the hospital chief of Jose Rodriguez Memorial Hospital Fritz welcome to the webinar think na commute ka Fritz okay ma'am hindi na po how are you ma'am at the moment ma'am when it comes to the question of having a surge still since the hospital service capability is up to admit no COVID confirmed patients ma'am I think na for us wala pa hong surge dito sa hospital for COVID confirmed patients so but there has been an increase in the number of that's true there's a there's a significant increase in the number of COVID confirmed patients being admitted per day ma'am I see okay so what's your reaction Fritz to the presentation of Dr. Gaprigas ma'am before I react ma'am I'd like to share with you the statistic of the institution prior to reacting to the presentation of Dr. Gaprigas yeah go ahead so can I request the first slide please next slide since we started as a COVID referral hospital we have process more than 2000 COVID confirmed patients last 2020 we expere 20th October 2020 and then this gradually declined during the last quarter of 2020 we then gradually opened our doors our outpatient department and emergency medicine department for both COVID and non-COVID patients next slide next slide please we started the year with 300 COVID related admissions 94 of which were COVID-19 confirmed patients so from the graph we can see that we have an average of three admissions per day presented by the red bar next slide please February 2021 we had 110 COVID confirmed admissions out of 319 COVID related admissions then was a noticeable increase in the number of patients by the last week of February 2021 with an average admission of five COVID confirmed per day next slide please so in this graph you can see that the average admission per day is around five admissions per day for this month March 2021 we can see a rising trend in the admissions by the first week of March from an average of three to five COVID confirmed admissions per day from the first two months we are now admitting more than 10 admissions per day we have decided to close our emergency medicine department because this is the primary source of admissions from non-COVID suspects and probable and to give way for the COVID-19 confirmed admissions so if you try to plot it down in a single graph can you really say that are we having a surge next slide please this red bar shows you the number of admitted patients per day for January 2021 to March 2021 it is obvious that if you look at March 3, 5, 7, 9 and 11 the number of admitted COVID confirmed cases are increasing from March 3 is around eight per day and now March 11 is 27 per day next slide please this is now the truth of the data of the hospital for March 12, 2021 the total confirmed admitted patients is 125 patients in our words this is the highest number of admissions at CHD Metro Manila and our COVID suspects around five with a COVID-19 level of around 50 the total COVID related admissions 100 patients in our words next slide please this is the data on the COVID-19 confirmed HCWs we have a total of 35 healthcare workers who have COVID-19 infections from January 2021 to March 2021 as you can see we have two to four infected staff in a week however as this week we already had 14 new healthcare workers infected consisting of four doctors for nurses, two nursing aides one physical therapist and three therapy staffs and one cook next slide please this is the breakdown of the COVID-19 confirmed in 2021 to present please focus on the exposure exposure side of the the pie chart it says here that the COVID-19 duty data showed to healthcare workers these are healthcare workers who had direct contact with COVID-19 patients at the wards 13 30 of which was linked to community acquired COVID-19 infection from the community and 20, it says here from the hospital so 20 from the hospital the Hospital Epidemiology Surveillance Unit is in question whether the infection came from the community or from the patients that were entering the institution so however these 20 hospital healthcare workers did not have any contact with COVID-19 positive patients at the wards next slide please so when it comes to the vaccination the first vaccine was Sinovac 1800 doses were given to us we have vaccinated 648 and we have a remaining of 1148 from the 1148 we already allocated 655 for the second dose for AstraZeneca was given last March 10 to 11 1000 doses 500 doses were already allocated for the second dose we finished vaccinating 500 employees and we are expected to receive another 1300 doses good for 650 employees this afternoon next slide please so the question of whether the hospital has indeed a surge or not may I read to you the definition of a medical surge it says here it appears when patient volume exceeds the hospital serving capacity in this case the patient volume of the hospital can be can be can be catered by the hospital services hence in our institution we can safely say that we do not have a surge of patients coming in but there is an increase in the number of COVID-19 admitted patients so as a reaction to Dr. Grapligas' presentation the data of EPPJ in our institution is more or less in agreement and that second the target the target for the hospital employees to be vaccinated 90% to 95% at this moment already 60% 60% of the total population already vaccinated so by the coming weeks we expect to increase our vaccination percentage to around 90% to 95% eto lang po mam this is the data of Dr. Grapligas Memorial Hospital in Sanitarium Thank you very much. Dr. Fritz van Baran again we reassured by the presentation I think we're seeing a common thread among the three hospitals which we'll talk about a little bit more. Raymond over to you we have one more speaker. Yes, thank you director Fritz and thank you Dr. Susi. Our last reactor for today is none other than the head of the Philippine General Hospital's medical unit and she's also faculty with the UP College of Medicine Dr. Regina Berba, mam Nina Hello everybody Susi hello and Hi Nina Medyo nervoso ako kasi sinunod-sunod niya ako sa mga chief-chief-chief hindi pa kontrol mas epic ka sa kanina okay So ako naman I'm brave enough to declare that actually we have a problem in PGH among healthcare workers and based on everything we know now we really have a surge of COVID-19 among our healthcare workers Pinakita na ito ni Dr. Gap kanina but I wanted to just say things can really change very fast dramatically this was just less than a month ago noong February 9 to 11 talaga to ay when we collected blood from volunteers and we actually had a lot of volunteers close to 3,000 people came over to have blood drawn for specific antibody testing for SARS-CoV-2 and we were very pleasantly surprised na after 10 long months of intensive exposure to COVID-19 we still had 74% of our staff free from crisis of COVID-19 infection So kung ako nga tatanungin sobrang happy ako noon so kung magbibigay ako ng grades sa sabihin ko excellent job pero and that's because when we compare it to other areas in the world with and matching it around the same time when this was happening kasi siyempre noong February iba na yung playing field noon compared to noong naguumpisa but when you match what has been reported in literature parang okay or even better yung performance ng PGH among healthcare workers based on this table that I made so parang ngayon in February of 2021 maybe we could compare ourselves with the data that came out of India na yung kanilang healthcare workers in New Delhi had an average of about 25% zero positivity which is very close to our 24% tapas kasi tinanong sakin ni Dr. Raymond pano ba nga namin na detect na there was an incoming surge so kasi we had daily reports so people who look at this are at once parang clue din na baka there is something going on when the numbers go up so lo and behold very soon nakitan na namin talagang surge so wala ng question wala ng ibang way to describe this and if you look closely into the numbers we've really been doing well ng November December February and then towards the end of February there was this cases that started to be more and more and then just exploded into several more cases over the next few days so hindi pa to tapos parang we're still seeing increasing the numbers although baka nag-level off na so if you would see in this graph there's the orange part of the bars and there's the blue parts of the bars so we defined this as yung orange community acquired at syaka blue occupationally acquired wala ng genito talagang definitions either ang CDC or WHO and we actually put this together kasi we needed to just describe the infections that we were seeing among our healthcare workers so pa community acquired when we label them as from community we mean that there was a household contact or there's a known community contact or that healthcare worker wasn't actually in PGH so siguro hindi naman niya nakuha sa PGH yun in the last 72 hours prior to the illness or he's not a person assigned to any of the COVID areas konyari na sa office lang siya or konyari security siya na never saw a COVID patient versus yung nakabluna bars which are all occupationally acquired so these are people who worked in the COVID areas or were infected by PGH colleagues so nakuha niya yung infection from colleagues na nag-work din sa PGH so nangyari yung exposure sa loob na PGH so when you look back when we really try to understand what's going on very fast kasi all of this just happened in the last two weeks we can identify two main reasons just what like Dr. Gapp said kanina so most of the initial index cases actually came from community kaya lang ang problem some of them came to work despite symptoms and then had opportunities of eating together and eating together and when we computed how many of this ended up as infections infecting other healthcare workers we came up with a computation for everyone community-acquired COVID nakakainfection of four to five other people in the hospital so total of about six so in a very free even kung kunya re sampo or ngayon ang count namin mga 15 index cases of community-acquired infections na sa mga 70 plus na just in the last two weeks so if you think about it, one might think madali lang to gawin so if you stop people from coming to work if they're sick or were sick in the last three days so dapat wag sila pumasok and if they stop eating together at work baka masol natin yung problem but it's really easier said than done kasi parang hirap talaga ni to gawin so I saw some questions about ano ba yung context why would people come to work even if kasi really the COVID-19 parang there's this it's an entity that sometimes difficult to recognize symptoms are mild deba minsan you wake up in the morning na may sore throat kaya you're not sure ano ba to COVID ba to papasok baka or hindi so many of our residents and the rest of the stuff maybe go through this every day it's really difficult to there are some symptoms that are just not very very clear cut so let's not take a blaming attitude on this tapas pero ito ito parang ito kailangan na talaga to makorek yung still don't know parang hello puwede ba kunyari yung mga tao na tinanong mo sir bakit ka pumasok may lagnat ka tapas ang sagot say ah puwede bang COVID-19 yung lagnat parang di mo na may intindihan where have they been in the last several months there's a denial factor so that means they don't think that they could have COVID and they think it is other things yung feeling indispensable so there are staff and this one hindi ko rin to mag blame kasi parang meron talaga silang feeling na kailangan silo pumasok that our departments or our units won't work if they're not there and economic factors no work nor no pay and of course the pandemic fatigue factor so may feeling na I don't care anymore basta papasok ako so parang these things need to be properly contextualized and addressed para we can help our healthcare workers try to recognize all of this and avoid that situation of coming to work kasi it really leads to a lot of problems so as was mentioned earlier there's been a lot of improvements already that are that have been done and are being done so when people ask me how safe is PGH now so siguro yung tawag nila granular of per area for department depended on where you are working basta if your area can practice universal pandemic precautions your area should be safe so yung hindi na ka sa PGH kasi I don't think meron pang issue on the what we call the minimum health protocols lahat yun sinusunod na nang mga tao we have an enhanced level of precaution and it's called universal pandemic precaution so the concept there is dapat magtanggal na mask kasi yun talaga yung parang lifeline mo the presence of the mask so it really depends for most part I think people are trying to follow pandemic precautions so it should be safe okay how safe is the vaccination rollout at the PGH so we've heard a lot of messages that are passed on in the viber groups of how we've had some positively confirmed vaccinators but all of them have been pulled out we've been monitoring the whole system and I can categorically declare that this setup continues to be safe it complies to all infection control protocols so yung pung hindi patapos magpabakuna you can come today or next week according to your schedule and to our vulnerable faculty and all other staff who still needs vaccination punta po kayo kasi it is safe and what about variants so di ko alam kung alam yun na po pero as of yesterday last night two confirmed cases of South African variants are currently admitted at the PGH so while it might cost some degree of panic or alarm or freaking out it's really all about staying vigilant with the infection control measures so I think this is under control whether it's adding to the problem with the healthcare workers we don't think so so may just separate and we're dealing with it and I'm sharing this with you kasi all the other hospitals who are here baka this will happen to you pero you need to be prepared and just stay vigilant with your infection control measures so dun sa kaninang pinakitan namin na data about antibodies panang ang bago dun ay meron pala sa ating asymptomatic kasi before we used to just think that siguro may asymptomatic pero talagang here parang we were able to give a number to it so there's probably around 8% among us na baka nagka infection along the way so after all has been said and done talagang kailangan na tayong magbabakuna and ang computation po dapat sana yung rpgh population to get over our surge needs to reach a target of 81% of our master list and we're convincing all eligible staff to be vaccinated very soon thank you very much thank you very much it's dr. Nina Burba oops please take over i think i lost you okay okay no problem thank you ma'm Nina so dr. Nina Burba po is the head of the pgh infection control unit at this point may we gather all our speakers and resource persons for today i hope you still have ted herbosa and dr. Vince Balanag as probably left po no to attend to an urgent matter but we still have our main discussion pj's director Gaplegaspi and one of the other reactors director Fritz Famaran from Tala Hospital but before we start with the questions po let's just go through the poll results we have from northern and southern Luzon central Luzon western Visayas and about 11 from outside of the Philippines again we have 30% who are from the nursing field next will be from the medical field and then the third one believe it or not medical technology po tinanggal ko po mo na yung sa others kasi medyo hindi po po siya na himay-himay okay let's start with the questions okay so i think we've got everybody my question is how to get our health workers to stop eating in the hospital siging nga ano ba we saw this from the very beginning remember Gap from the very beginning you're already saying this and we're talking about it again so how are we gonna do this Gap what do you plan to do so you know we have a huge mess hall and we provide meals for everyone so there are two ways of eating in pgh1 you go to the mess hall get your food and sit down and eat with the rest the other one is you send an emisari to get the food for your office and then you get it from that container and you eat together again so those two areas we corrected yesterday one we will start distributing food to the wires themselves and in packs so that they don't have to congregate and get their food so at least for the surge that is happening now so that the next thing that we have to take care of is how to make them eat separately so Anina i think we were pushing through with that corridor eating we will provide seats along the corridors comfortable because it is windy and it is shaded so those are the things that we are employing you cannot stop because Filipinos when they are sad they eat when they are happy they eat so you can't stop Fritz how about in Tala in Nose Rodriguez can you get people to stop eating together wala yata si Fritz can you get people to stop eating together because if you said the same thing that the infection is not coming from the word and it's not coming from the community so what can you do what are you planning to do I already tried delivering food but again so ang most feasible na mingin is to mukhangan-wukhang wulad ng bastonero mam na they have to check during lunch time that's the most feasible way whether there is social distancing during eating time gana na lang mam wala na nga na, wala na ibang choice mami so may police tapos may ticket gana pa what do you think I'm just thinking you can more or less control things in the hospital I mean I think you have some things you can do but can you imagine other organizations other offices so Ted what is the thinking here at the national task force already seeing that this seems to be the way that this virus is moving around with gusto I will say two things hot spots I notice secretary galbes never eats he will wait to get in the car and eat something and bite the food himself so he doesn't remove his mask he really doesn't remove his mask because he said he has to be extra careful because they go to meet the president every time so that level of diligence I admire because I say oh careless like the rest of the healthcare workers but there's an interesting setup that we visited at the research institute of tropical medicine sa our ITM when we visited it we were asked to eat lahat kami patila secretary duke we ate in the cafeteria but we were both given one table we were all facing one direction our tables and chairs were one meter apart and I think that's the standard eating setup and we tried to put the chairs together and sit face to face there was a marshal marshal that avoided us so this is something to be done in the other hot talagang pasaway kasi yung mga doctors and they will eat together face each other and then take that time to chat and relax so I think what's important is really the bastonero that will tell you you cannot rearrange the setup so si lahat secretary duke secretary si nabihan din ng marshal so I think that's one way to change behavior really very strong regulatory forces kasi alam mo yan susi di ba behavior is the hardest to change so kailangan talaga tutukan so but I think now people are again scared of the search baka susunod sila with just monitoring I'm kind of thinking that baka dapat may camera pagtapos may public address speaker sasalita si gap maglayo kay jah no, no, no, no, seriously I'm kind of thinking that if the need is to socialize wala yata si susi am I back we can hear it to you doctor susi go ahead, go ahead so I'm kind of thinking that if the need is to socialize kasi bukang yun ang sinasabi nigape when we eat when we're happy we eat it means that we have an inherent need to really interact with other people so maybe people have to eat separately but maybe we should really have some kind of time where people can interact without removing their mask so they still get to kwantuhan they still get to ganyan pero wala ng food kasi parang by removing their ability to interact during that break we're actually depriving them of some a very human so I'm just thinking there might be something that they can do even in a group they could be in a group they could be in their mask they could be in their face shield and they could be interacting but no food allowed kasi bukang yung root need nila we're gonna try to end the conference at the top of the ARB because some of our guests need to leave but Raymond, let's go through the questions and try to get answers from our panelists okay, thank you Dr. Suzie I'm just going through the pre-test falls okay, there we go anyone can jump in and answer the questions we have three for today number one there is a significant increase in COVID-19 cases and what do you think is the cost the options are relaxing of public health measures option two, COVID-19 variants option three, more mobility or option four, all of the above sas nina nina, kagumadami nagoed pa baka all of the above all of the above thank you pa the next question will be in hospital admissions the most selected cost all of the above but the second most would be increase in COVID-19 infections the other options are limited access to community quarantine facilities and option C, more aggressive testing I think there's more testing available and I think what changed in the last ten months is that the health seeking behavior also improved at the first lesson in the early days pag late ka nandumating sa hospital the probability of you worsening rapidly is very high so I guess that was conveyed to people and now in fact I think you will see a surge of mild infection, mild symptoms requesting admission to the hospital so it's really more aware increase awareness to the course of the COVID infection and of course increase testing okay thank you director gap and then finally what should we do about the increasing cases 82% selected get vaccinated pa as primary primary of their choices but the second most I believe is wear mask and shield ang naniniwala sa public health measures and avoid interaction with people and aggressive community testing round up the top four any comments from the group maybe director fritz at the moment hindi naman natin mapigili pagkakaroon ng infection because of the COVID-19 confirmed asymptomatic no hindi na natin mapipigili ang increase in the number of COVID confirmed because of the massive vaccination we are having right now because it will take some time for the individual to develop antibodies to the COVID-19 virus so ang the best talaga natin yan is to adhere to the minimum health protocols natin wearing of the face mask properly facial properly social distancing at least 2 meters washing of the hands and so forth ok thanks a lot fritz may be dapat anong meron tayong pascrabble siya pa being go sa mga hospital para may transport interakto walang pangkain so we are going to Raymond we need to launch a quick evaluation you want to do that right now yes typically we have this assessment of our panelists just to be able to gauge po ang inyo na katunan I'll go through the list and hopefully our 1700 plus attendees still are able to key in their responses number one panelist demonstrated thorough knowledge of the topic number two the panelists were well prepared and organized number ok I think it got stuck on my end is it moving on yours? I can't see it also but let's just run that and I think well we still have two questions from the audience and we're going to ask ask them to open their cameras I think but we need to make your questions really quick because we want to end on time so can we have the first question please first question I think will be coming in from Sir Rainier if I'm not mistaken Sir Rainier go ahead with your first question sir Rainier Astin Sindayan ok let's go to the next we can't open ok the next question will be coming in from Maria Cecilia Pulido can you message no option to unmute participants what is this ma'am Cecilia Pulido ok hello doctor thank you so much for the stop COVID deaths for your presentation for the information for the information what are the measures that we are doing for to reduce the stress na makipo yung surge sa healthcare workers pati sa ating communities aspa na po yung sa contact tracing din po sa mga communities nating ok thank you very much Cecilia anybody can answer uziyan ulit yung tanong sorry ano what are the measures to protect the healthcare workers both in the hospital and the community well sa PGH and the healthcare workers are provided lahat ng kailangan nila in both for care of the COVID patients and for the care of all other patients so lahat po nang ways to protect them in terms of for example PPEs and other measures are being given to them plus knowledge and IEC materials plus some support yung mga psychological mental social support mechanisms po kasi kailangan rin po yung mga healthcare worker under this extraordinary times so yeah ok thank you and extensive contact tracing yeah so I think right here can not come on board but he has a question can't go ahead sorry I was gonna say for the community what I've noticed in NCR is I think only four cities were able to continue to address the aggressive community contact tracing the aggressive contact tracing yung testing natin parang ok our level of testing is mataase pero tumataas yung positivity rate pero habang tumataas yung positivity rate hindi tumataas yung contact tracing capability nakita namin parang yung contact tracers that were hired and trained during the initial peak natapos na yung contract nila kasi mga job order lang sila wala naman contact tracer so I think very important mabuhay uli yung contact tracing ng bawat local health office local health units kasi that's the only way we can stop the transmission getting the contacts isolating them quarantining them and then testing them yung basic public health basic basic I think Raymond do we have the question of Rainier because he's saying here in the chat that he can't unmute but he does have a question although I don't see what I'm looking at the question that probably is the most upvoted question here thank you sir Rainier, Sindayan I'll read your question po from the Q&A box it reads how do we properly contextualize mga pasaway who continuously being invoked as the drivers of increased COVID-19 cases how do we comprehensively address the observed search of cases where the approach will not only be a return to more lockdowns and curfews po any one good question ano gagawin sa pasaway kailan maggingo sila the regulation talaga sir Filipinos I think that's why the certain people are complaining why we are using the police to impose public health measures and that's basically why if everybody just follow the behavior and got educated about how COVID is transmitted di ko kailangan ng police to impose the wearing of mask and wearing of face shield kita mo nga na sa labas na ka face shield pero headband yung face shield talagang we need the enforcers I think that's basically the same system in the hospital yung kinuento ko kanina yung may marshal even in the hospital you need that marshal to tell you teka muna you're together stay apart or put your mask on or put your face shield I was in a five star hotel I would name it I went to the toilet from the eating place siyempre I'm walking baka madapak ako nilagay ko yung shield gone top may lumapit ka aga sa akin sir so I think that type of reminder should be the way to go for our local chief of secretaries right okay thank you very much that was Ted okay so we're going to ask everyone to give their parting message but to make it a little different I think I'm going to ask you in your parting message just to say where do you think this is going and how do we prevent it from becoming worse so we'll start we'll start from the end we're going to start with Nina where are we going and how do we prevent this from becoming worse ako I think yung prediction or forecast ng OCTA group might really happen it will get worse first before we get better again no kasi ano there's a lot of things that need to be done the higher the numbers kasi the more difficult it becomes to get it down again so yung question kung pano natin may overcome all of this I think key talaga yung discipline we really need to do that siya ka yung timely response alam nyo yung the reason 30 seconds lang do I realize merong mer critical time that the COVID is very infectious yun yung just around the time na magkakasimtoms ka acyaka first few days now when our contact tracing happens like one week later or two weeks later panang useless na yung isolation some people like wait for them to get the results of the test before they isolate panang ganun very mixed kasi yung signals messages natin pag kalang we stick to science and we stay disciplined I think we'll finally get it all aligned and maybe overcome this pandemic problem but there is hope we'll reach it soon thank you Nina Fritz san ba to papunta siya ka pano ba natin mafitigilan na yung dinan dumaming kaso yung unang tanong mam so still ang trend is increasing pa rin yung confirm COVID cases by experience this hospital ko compared dun sa sa graph ng previous in this tip ngayon ng increase as compared before no mukang nalesin yung degree nung nung graph so hindi ko lang alam mam kailan mag-e-end yung yung rice ng cases and then prevention mam agar si vaccination stick adherence to da minimum health protocols tapos in our hospital ako kundi lang yung healthcare workers ko na infected very strict ako din sa protection or level of PPE na sinusot ang akimang healthcare workers and lastly hindi na ko na adhere sa every four weeks na mandatory swabbing ang ginoa ako every two weeks naman sa mas mga mga nauhuling mas mga namin na uhuling COVID-19 confirmed na asymptomatic sa mga healthcare workers ko ok thank you very much we're gonna ask Ted her boss ako he needs to leave so Ted what's your where's it going how do we stop it from becoming this whatever you call it spike surge there's an increasing number of cases at the PGH they have an increasing number of admissions I think we need to go back to basics go back to all the Swiss cheese fences that we've been doing face mask wash hands avoid crowded places stay home if possible and then reiterate this to everyone and then get vaccinated we now have an an added unlike last year we didn't have the vaccine this year we have the vaccines coming even if it's in trickles make sure everybody gets vaccinated I think another one million doses of the sign of up will arrive end of this month so that should complete the healthcare workers when we deploy that we will get another set of vaccines and the senior citizens can now be started the public the lay public so we do hope marimind natin everybody I think talagang talagang tataas if we continue this current behavior we were able to do it before flatten the curve I think we should be able to do it now early on to flatten this curve thank you thank you very much Ted and thank you for being with us today okay so gap the last word is yours go gap na commute ka I think as we have seen in the past it will go down eventually but how high will it go that's for us to see I'm just more optimistic now because there are a lot more things that we know now that we didn't know last July or August and there are a lot more consequences that we know now that we didn't know last July and August so I think we're in a higher baseline to fight whatever this is whether this is whether a spike or a surge and that's why probably the center chief don't sound too concerned because we trust our people despite the healthcare worker infection but thus we trust our people already that more or less they know how to react to the situation and then plan and also participate in how to bring it down I think people tell to all of this is behavioral behavioral modification and control so siguro kung meron tayo na approaches really to think of other ways to modify behavior that will lead them to be more compliant to the healthcare protocol so the unseen factors are coming into play now those that we don't really see on a daily basis and I think a hard and fast contact tracing will really help bring this down quickly also so I think we'll do we'll do better this time than July and August Thank you very much Agap and thank you for your time with us today okay we're going to a brief summary by Chancellor of UP Manila Manchit Padilla Manchit over to you Yes, so the started opened by UP and he shared with his web series was just an idea 11 months ago and it has transformed to a grand project 11 months ago as a but UP through UP offered an alternative platform so this is the backdrop of the TVP webinar series that you are watching every Friday Dr. Ghaplika the question is it a spike or a surge it said it's probably just a spike middle of populist areas it's but it makes PGH in high risk and once you have a high risk in the community it corresponds to a high risk of positivity among the health workers but it specifically cited mobility and laxity in the health protocols as probably the contributing factors in the following factors and I think this is important for our audience now the factors that identify that contributed to the transmission were the following eating together sharing the call room maybe the variant these are factors these are factors that we can actually modify in the hospital setting they have taken major steps in PGH and I think this is something again the reduction in the ski sent on the interns our work reduction deferment of elective surgery they enhanced their health protocols now it's a K95 contact tracing and targeted testing of course we have the the vaccine launch signed back as a message of doctor seeing any vaccine we actually had two hospital director so we acted I'd like to combine their feedback they're quite very similar with some differences for the lung center since QC is not they may not be experiencing the same kind of infections but he said this is an opportunity for us to actually prepare for another together with doctor they had the same the same observations there is a laxity of community health protocols they actually both press the increase in positive cases in the hospital by increase the frequency of testing within the hospital they both launch the vaccination plan convince their community of health workers to take the vaccines available I think the three actually convince are doing their best to convince the health workers to take the vaccines available our last reactor is doctor Nina Berba and I just want to congregate on a few points she raised highlighting the community acquired infection occupationally acquired infection and in a control situation actually there are more cases that you get from the community and I think the reason why we have to work hard in making sure that we control the infection in the community the other message she said is that the mask is a lifeline I think we should remember that and vigilance and control measures just for a few words on the last and the final words from doctor Berba you know oh by the way doctor Berba is the only one who said we have a search in PGH the three directors were saying that it's probably not just a search just a spike but our IDS especially is saying in PGH search just the final messages for doctor Berba he said she said that if we do not discipline ourselves the autoprediction might happen and we have to go back to the basics and the minimum health protocols we heard it from doctor Famaran and also from doctor Gaplegasti and doctor Tether Bossett all of us we just have to go back to the basics and the minimum protocols but doctor Gap actually ends by saying that this time you are more because we have seen we know more about over 19 so this time we have a better chance in this fight at the end of the it is going to be behavior modification as a major factor for the control of infection both in the community and the hospital back to you Susie and Raymond Thank you very much Thank you very much Chancellor Menchit Padilever that very concise summary and next week please join us we're still going to talk about COVID vaccines and our topic is COVID-19 vaccines na iinip ka na ba I think a lot of you want to get vaccinated we're going to talk about the rollout so we're going to have a speaker from the Department of Health and another some other experts to talk about how soon we're going to be able to get that 80-90% of healthcare workers kayo paano kayong mababakon na ano so yun na topic po natin next week please join us Raymond So I think marami po tayo na to tunan for this week we're very very lucky very fortunate and very grateful also to have the three medical directors of the NCR COVID-19 referral hospitals it's not every day that we could get the chance for them to stay with us for at least an hour or so to discuss the status we also have one of the top infectious disease specialist Dr. Nina Burba to join us anyway we will be going back to our main topic of the vaccination rollout program and especially those who are in the outside of the national capital region those who are really excited anticipating kung kailan po wang mabibigyan magtisimula ang mga pagbabakuna sa kailang LG particularly doon sa mga A2 and onwards po senior citizens sina-indigents sana po ay magkama sama po ulit tayo at makimig at magmadaod po next week Friday from 12 p.m it's a date Together let's stop COVID-19 So keep safe keep healthy and see you online When my body remains unseen I'll keep your hand in mine Let's say a prayer one more time I know you long for home but I am here you're not alone Let's stay with you until the Costa spirit The other Spain before my fist The other life before my tears But my pride behind the mask I'm looking to myself Do I have strength to carry on? Oh God, our Lord mistakes go on And need you here to keep me strong I'm here to hold the line I'll keep my hands until my eyes It's made to realize It's fine Just hold on to the word he gave This time we'll come to pass Cause this salvation makes a last You carry you to see the break of day The others pained from my fears The others lost before my tears But right behind the mask I look into myself and ask Do I have strength to carry on? Oh God, our Lord mistakes go on And need you here to keep me strong I'm here to hold the line I'll keep my hands until my eyes It's made to realize The others lost before my tears But right behind the mask I look into myself and ask Do I have strength to carry on? Oh God, our Lord mistakes go on And need you here to keep me strong I'm here to hold the line I'll keep my hands until my eyes It's made to realize The others lost before my tears But right behind the mask I look into myself and ask Do I have strength to carry on? Oh God, our Lord mistakes go on And need you here to keep me strong I'm here to hold the line I'll keep my hands until my eyes It's made to realize