 installment of the Stop COVID Dex webinar series, and we are glad that you continue to join us in this learning journey as we continue to address your concerns about COVID-19. Last year, we talked about the implications for clinical management and vaccine development of the SARS-CoV-2 mutation from the perspective of genetic sequencing research. For today, we are following it up with another webinar, but with a focus on COVID-19 variants of concern in the Philippines. So, with all the news about healthcare systems being overwhelmed in other countries due to the UK variant, the South African variant, the Brazil variant, everyone wants to know, kanda na ba tayo? Are we ready? Good afternoon again. I'm Raymond Sarmiento from the UP Manila National Institutes of Health National Telehealth Center. It's always a pleasure to be with all of you during our regular Friday lunch date. And with me, as always, is my mentor, my partner in crime, and our adjunct faculty at the National Telehealth Center, the Special Envoy for Global Health Initiatives, Dr. Susi Ineda Mercado. Dr. Susi? Thank you very much, Raymond. Magandang araw po sa inyong lahat. Mag-upay na, hang on, masaya nga natin. Mag-upay aga-ugto, maayong buntag, marhay na aga, mayat ay aksaya. Tako amin, naimbag, nga malin, ka-inanya amin. Hello, everyone. Masaya naman, you were doing your greetings in the dialects. Very nice to have everyone here with us today. We'd like to welcome also those who are watching on YouTube and on the Facebook streaming. As Raymond said, we've got a very interesting topic today and amazing speakers who are going to give you the latest information on the COVID-19 variants. But before we proceed, Raymond, I just wanted to make a little bit of an announcement. So we have, we'd like to invite you to another activity of the University of the Philippines that's put that up on TV. So the UP Alumni Association, UPAA is hosting another ka-pihan ng bayan sa UP. By a zoom on the 23rd of Feb, that's Tuesday, next week at 10 o'clock a.m. manila time on COVID-19 vaccines in the Philippines. Their availability, comparative efficacies and affordability. And the resource person is someone you know very well, Dr. Edsel Maurice T. Salvana, the director for the Institute of Molecular Biology and Biotechnology, National Institutes of Health in the Philippines, Manila, and adjunct professor from Global Health University of Pittsburgh. For those who are interested to register with the UPAA secretariat, you can see it here, upalumniaso at gmail.com to get the Zoom meeting ID and their personal participants pass please. This webinar is free. It's open to all UP alumni, faculty, students, the general public. And this is a special public service project of the UP Alumni Association. So more to learn and hearing it from Dr. Edsel Salvana. So now back to our session for today. Everyone is worried. Well, I shouldn't say we're worried. We are hearing about the variants. And of course we want to know about the variants of concern. So we talked about this before. There are variants. There are mutations. But not all of them should be a cause for us to worry. But there are variants of concern. Some of the variants that we tend to watch because we need to know more about them. So we're going to talk about this in the webinar. And we're going to have a great conversation. You have the best speakers we could possibly get today. Okay, one over to you. Thank you, Dr. Susie. So sa latpo ng more than, I think 1,200 na po. Na talagang nakatutok. 1,600 na, Raymond. 1,600 na. 1,600. Okay. Thank you, Dr. Susie. Who are online and those who will be joining us also in the Facebook accounts in the YouTube channel. Maraming salamat po. And again, hope you will enjoy this very, another very informative session today with our experts as the whole nation prepares for the vaccination to roll out. So just to let everyone know of the structure of the webinar, in particular for those who are joining us for the very first time, there is a main discussion followed by reactions from our reactors two of them for today. And then we will go on to a panel discussion and hopefully there will be very, very interesting questions in the Q&A section of this webinar. But before we proceed, let me acknowledge po, TVU, I think you have a graphics card. All of the members of the very hardworking team of the Stop COVID-19 webinar series, maraming, maraming salamat po. Wala po talagang humpay at wala po kapaguran in yung dedication at passion po for this webinar series. So thank you for all the teams that are, that make this learning webinar series possible. Over to you, Dr. Susie. Thank you very much, Raymond. So it's webinar number 41 and I just want to shout out to those who are watching from Sultan, Kodarat, La Union, Bacolod, Batangas, Cavite, Baguio City. Again, from all over the country, we have our, kayo, we have the audience. Those of you who are here to learn, as we are all here to learn and we just want to also thank in advance all our speakers who found time to be with us today. So Raymond, you want to talk about the certificates? Thank you, TVU, there we go. So here in front of us is, well, an example of a certificate of attendance po na maibibigay sa ating mga attendees who at the very least spent at least 50% of the webinar duration for the entirety of it and together with the certificate of attendance, maibibigyan din po kayo ng copy na mga presentations po of our resource person. So please take note, be very, very careful of what you input po dun sa ating registration page. Marali po kasi nagtanong kung pwede pa po nilang papalitan yung kangalan but once we check it, it's really how you had inputed it. So be very careful because that is how it will be reflected in your certificate po. Maraming salamat and over to Dr. Suzy. Okay, so I think, Raymond, I'm just looking at the numbers. Over the past few minutes, another 200, 300 people have joined us. Welcome to everyone, welcome to the webinar. We are so happy to have you here. We're going to formally start our program now with a introduction from our Vice President, UP Vice President for Academic Affairs Dr. Cynthia Rose Bautista. VP Cynthia, welcome to the webinar. Hi, good morning. Morning Susan, thank you Susan and Raymond and good morning to everyone. Okay, so before you give your introductory remarks as the VP for Academic Affairs, what does it look like from where you sit in terms of going back to face to face classes? How about all these students are waiting to graduate? What does it look like? Do you think we're going to soon have face to face classes? No, we are still actually delivering our courses remotely in the second semester which begins in March and basically we're still waiting for clearance from CHED and from IATF for limited face to face activities including the lab work of students are doing their thesis as well as the graduating students. So graduating students might have to postpone at the moment their graduation. But in the last part, in the last quarter of 2020, we were hopeful that by the second half of 2021 we would already have at least we will begin our transition to the new normal in UP and that new normal is not going back to the old way of teaching and learning but it will be a mix of virtual face to face as well as experiential learning. So that was our hope. That's where universities are going except that COVID actually speeded that up. But basically all of the news about the variants and with the local news of the variants are here, the variants actually are spread more easily, in fact more people and in some news accounts is even more virulent. So basically my speculation is that 2021 will be like 2020 for now even if we have developed vaccines already. But having said that, we are not sure whether the speculation is grounding. That's why I'm also excited to hear our speakers today. Thank you very much VP. Please go ahead and give your introductory remarks. Okay so basically in the midst of the loosening of restrictions for business most of us are actually curious and anxious about COVID-19 variants that are now found in the Philippines. Are we ready for them? In 2011 we asked the faculty to establish the Philippine Genome Center the question should the pandemic arise? Are we prepared? That was in 2011. So the proponents argue then that they were proactively pushing for the creation of a domestic genome center precisely for a scenario in which the countries borders are closing. We are unable to send samples abroad for analysis at the time and the country has no capacity to identify these pathogens. So the proposal was approved by the board of agents and PGC grew from very humble beginnings with support from the department of science and technology. We are actually grateful that the pandemic struck slightly more than 10 years after the Philippine Genome Center was established and not earlier when it was still in its infancy. UP PGC is a UP system research center created to be at the forefront of high technical advanced research on the organisms around us at the molecular or genome level using genomics and informatics tools. Its mission includes building the capability and capacity of Filipinos to do genome sequencing and bioinformatics analysis which are crucial for research and product development in the life science particularly in the areas of health and agriculture. With tremendous and sustained support from the department of science and technology for research and its core facilities and with support from the CHED Philippine California Advanced Research Institutes or PICARI for its expansion and acquisition of a state-of-the-art equipment PGC has established a solid track record which on hindsight must have been to prepare it for this pandemic. As the only center in the country with equipment and human resources capable of large-scale whole genome sequencing and bioinformatics analysis we joined the government response together with the Department of Health Research Institute for Tropical Medicine or RITM and Epidemiology Bureau and the UP's National Institutes of Health in the national genomics surveillance of the viruses entering the country in our borders and ports of entry as well as track the circulating viruses in the different regions. As of now only PUP PGC is involved in large-scale whole genome sequencing in the National Genomic Biosurveillance Effort as DOH RITM awaits procurement of its sequencing reagents. Its whole genome sequence data assigns lineage to the National Genomic Surveillance Effort. PGC in fact was the first to flag the detection locally of the UK variant. Data that help and helping government formulate its response clinical researchers are also helping their study of viruses and viruses and clinicians who treat patients are also aided by such analysis. PUP PGC also exerted every effort to obtain a license to operate as a COVID-19 RTPCR testing laboratory in April 2020 or early in the course of the pandemic by converting the entire third floor of the PGC building into a lab with biosafety level 2 plus capability for COVID-19 testing. To date the clinical genomics laboratory of PGC has performed more than 52,000 RTPCR tests servicing the hospitals in Kesson City, Manila, Pasig, Calabar Zone that's IECA in Tabinagonan, Antipolo, Morong as well as the UP community. Together with the faculty researchers, student volunteers from the UP Dilimans National Institute of Molecular Biology and Biotechnology and UP Manila's National Institutes of Health UP PGC designed a hands-on training program and eventually an online training program with modules to expand the country's capacity to perform COVID-19 testing by RTPCR. To date more than 100 laboratories have received their licenses to operate as COVID-19 testing labs because of this effort. The project has been deployed nationally with assistance of the newly established PGC satellite facilities at UP Visayas and UP Mindanao which continue to host medical specialists and RTMTs to practice and get trained in RTPCR training for COVID-19. For us in UP this pandemic is a time for reckoning with the challenges of our mandate as research university on the one hand and as a public service university on the other. In the case of PGC the pandemic brought together faculty and researchers from different disciplines across the UP system in its research mission. The expansion of PGC in Visayas and Mindanao and the work it is doing now are also helping substantiate our public service mission. Time and again we have reminded our colleagues in the Philippine Genome Center that while the center was born and is maturing in UP its mission from the time it was conceived is beyond UP. Thus, while UP sustains it the university is effectively hosting PGC as a genome center of the Philippines. Its shared research facilities are meant to help scientists in and outside UP advanced research that could eventually translate into innovations and technologies for the well-being of our people. Its capacity building programs are intended to contribute to an expanded pool of genomics researchers while its immersion activities even of high school students yes, they do that promise to attract them to disciplines that would open the field of genomics research for them in the future. But while this has been the vision of PGC since 2009 and it was first conceived the COVID-19 pandemic highlighted the significance of having a genome center in the Philippines having a Philippine Genome Center. More importantly however for this particular pandemic our greater challenge is to ensure that PGC is ready to detect more variants of the COVID virus so that the Philippine government and the Filipino people can prevent its spread. So now back to the question in this webinar are we ready for the variants the COVID-19 variants in the Philippines? So thank you. Thank you very much. That was Vice President Cynthia and thank you for mentioning the history of the Philippine Genome Center and I think Raymond for this webinar I think we should really be celebrating the work of these young scientists in fact their students are listening here now you know work in genetics, that's the future for health, for medicine and we are just so proud to have an entire team that's expanding that's able to do all of this work on tracking the genetic sequencing of SARS-CoV-2. So thank you very much VP Cynthia for that excellent introduction. Later on from TVUP we're going to hear from some of these young scientists who are doing this work very fascinating work in fact if we didn't have them if we didn't have this capacity na sanalang tayo di ba umaasanalang tayo na magpapadala tayo sa mga laboratories sa ibang bansa No. We should be proud as Filipinos that we have this capability and that there are people who are continue to push our efforts in in science and technology in the field of health. So Raymond over to you. Thank you Dr. Susie and thank you also to Vice President for Academic Affairs of the University of the Philippine System and VP SINCH about TISTA. But before we proceed we always have this fun opinion poll wala po naman mali dito so please do not be afraid in answering ang ating mga audience survey and opinion poll. I'll start off please key in po your answers actually start off with the first question what place are you viewing the webinar from? So choices po as always and CR Northern and Southern Luzon Central Luzon East Visayas West Visayas Central Visayas Northern in Eastern Mindanao Western and Central Mindanao for Southern Mindanao and outside of the Philippines. So yes for those who are joining us for the very first time tayo po ay napapano odd internationally So magpukayong matakot na magkinang in ang mga sagot at matanong po sa ating Q&A box. For the second question what is your line of work? So we have those coming in from the medicine sector nursing sector from pharmacy midwifery public health education some from policy a few from legislation and media and ang ating others. So very, very curious po talaga ako dito sa others na ito kung anap po yung 18% of our attendees to select others for their line of work. But before we proceed let me take this opportunity po just as I mentioned we are being viewed internationally so let me just look at our registrants that we have we are being viewed from Institute of Biomedical Sciences from New Taipei City in Taiwan from the Yong Lu Lin School of Medicine in Singapore the Hospital Labuan, Malaysia from Semarang Indonesia Bangkok, Thailand, Ho Chi Minh, Vietnam Kowloon City, Hong Kong Doha, Qatar, Riyadh, Saudi Arabia Abu Dhabi, United Arab Emirates from the Al Saba Maturity Hospital in Kuwait Niagara Falls, Ontario, Canada Winnipeg also in Canada London, England from Northern Island and also Tanta University, Egypt from the British Indian Ocean Territory at ito po medyo bago Lyndon B. Johnson Tropical Medical Center Pago Pago, American Samoa so I think it's the very first time that I mentioned that place so, namin salamat po sa patulin na panonood and as we carry on with our next three questions the third question reads a COVID variant of concern is option A, mutation affecting spike protein option B, more contagious slash more infectious option C, more virulent or causes more severe disease or option B all of the above so nearly 90% are choosing all of the above for this question Question number four a COVID variant of concern could option A, affect testing accuracy option B, affect effectiveness of vaccine option C, affect effectiveness of treatment and option B, again, all of the above more than 90% ma 93% po ang pumili naman po na all of the above and for final question a COVID variant of concern can be option A, detected through study of DNA option B, detected through symptoms of the patient option C, through epidemiologic studies on locality and then 76% choosing all of the above so for those who are in the webinar numbering more than 2040 so please gain your answers po as we move on to the main part of our webinar. Dr. Susie Thank you very much Raymond just a reminder last week we started opening cameras and mics of members of the audience who have a very good question so put in your questions in the Q&A box and if it's a good question you'll have the chance to interact with our speakers today so we're going to choose one or two and we just want to encourage you to engage and of course you want to see your faces we wish we could put all of you on but this is all we can do for the moment so participate tayo na sa makaya lagay niya ma questions alright now we are now going into the video that has been prepared by TV UP and as I mentioned earlier we wanted to highlight we are of these young scientists of the Philippine Genome Center and we also want to encourage those of you who are thinking about what should you be studying what should you be doing well look at your options of the Philippine Genome Center over to TV UP Ito ng Philippine Genome Center hindi ko habisadiyo kanilang ginadua pero akalampuan na sa option ng UP Hindi po ako familiar sa Philippine Genome Center PGC of course stands for Philippine Genome Center so we are the institution in the Philippines that handles the sequencing and analysis of genomes for genomics and biological research there is also a diagnostic arm where we get samples from the hospital and perform diagnostics tumutulong ang PGC sa biosurveillance ngayon na new COVID strain U.K. ibaria strain one of our major initiatives was testing one of the COVID test kits the RTPCR kits sa PGC hindi lang hindi lang help yung finofocus so merinding on your aspects like agriculture, marine so basta any sequencing matters for genomics nakikipagtulungan ang PGC sa kasaman ng DOH para mat-trace natin kung nasaana ba yung U.K. variants strain sa ibang presension sa ibang lugar dito sa we take samples of the virus from patients around the country we sequence them and then we analyze them to see how the virus is changing and evolving so that public policy can be based on the science normal naman mag-muted sa virus naging alarming lang siya for this U.K. variant for example nakakarun ng several mutations sa spiked proteins na yung nagiging sabi nalismeng yung naging reason kung bakit nagiging transmissible yung virus mas mabili siya kumalan in general it may affect vaccine development if vaccines would be effective on certain variants so it may make moving forward na tingin ko mas matututo yung tao na mas maging cautious nila sa health nila sa hygiene nila Since ngayong habang nakikita natin na maraming variants magsabihin continuous nina-gawal din yung virus so kailangan ma-catch up tayo ang important din ko na meron tayo science-based policies Thank you very much TBUP for that I really love these young scientists who are like detectives who are tracking tracking the virus trying to see what form is coming out here in the Philippines and this is not the first time we are talking about variants so the last time we talked about variants we didn't have the U.K. variant in the Philippines but now we do so we thought okay maybe it's time to talk about the variants again and to see what else is happening and how prepared we are Raymond, I'd like to introduce our main presenter for today to answer the question of are we ready for the COVID variants of concern. Kasi sabihin natin maraming variants pero gusto natin pag-usapan yung COVID variants of concern mam-yasa sagutin natin yung I'm the very dynamic director of the National Institutes of Health Dr. Eva with Yung Podelapas Eva, welcome back to the webinar ikaw yung isang haligi ng ating program na rito Magandang tanghalipo Dr. Susi at magandang tanghalipo sa lahat ng nandito sa ating TBUP Webinar Okay Eva you know we were talking about this right before we went on the air that we have to be very accurate about what we say about these variants and this is the reason why we have the webinar because there's so much this information out there people are already communication overload and information overload so why is it important that you were just saying earlier that you had a very long four hour meeting on something why is it so important that we only give accurate information to the public Marami, salamat po sa tanong nyo ma'am Susi akakatapos lang po ng aming media presser kasama po ang DOH health secretary secretary dookie at C.U. Secretary at members po of the task force the technical working group for variants na nipresident Duterte nagpresent po kanina Philippine Genome Center Executive Director Cynthia Saloma ng bagong findings po yung mga na sequence po sa Region 7 kailangan importante po ang ating tamang pagbibigay ng information sa public kasi po, katulad ng mga nakita na po natin sa newspaper today nakakita po ng dalawang mutations of concern sa Region 7 pero hindi pa po natin alam ko ano po talagang ibig sabihin ito at kailangan po tayo gumawa pa na maraming investigasyon para po magkaroon tayo ng substantial conclusion to be able to make the necessary measures to beat this problem that we have right now po. Okay, thank you very much I mean so important, sometimes we want our story to go ahead of the facts so importantin talagang saigurado tayo bago nagbibitiw ng information kasi yun ang parang mga tao nagkakaranan ng confusion so we're very happy that you're here Eva by the way Eva is also the Program Director for Health Genome Center so she's with the National Institute of Health but she also works for the Philippine Genome Center. So Eva please go ahead with your presentation. Parami salamat po mam susi magandangapon po ulesin yung lahat thank you po doctor susi for your kind introduction there has never been a point in time when the world has been able to track genomic changes at the speed and scale as now genomic surveillance helps drive public health decisions in real time just like what we are doing now in the country it is closely integrated with existing diagnostic and epidemiologic public health programs and communicates usable and timely results for public health benefit everyone knows by now that it was genome sequencing that enabled the rapid identification of SARS code 2 knowing the genome sequence allowed fast development of diagnostic tests and other tools for response genomics and bioinformatics are the primary tools used for genomic surveillance during this pandemic whole genome sequencing is able to investigate outbreak dynamics in terms of changes in the size of the epidemic over time spacial temporal spread as well as transmission roots it is also able to assist in the design of diagnostic assays drugs and vaccines as well as monitor changes in efficacy of treatment and vaccines over time which may be attributable to changes in the virus genome this is a snapshot of the steps in whole genome sequencing as well as the swabs the clinical samples the samples are processed to prepare them for sequencing in this high throughput next generation sequencer the novastic allows us to sequence 750 samples a week at the philippine genome center and we try our best to get representation from the different regions in the country but also with special focus on where we see the virus subjected to bioinformatics analysis and viral dominant genome sequences are generated what are these genomic changes being tracked why is it important to track those changes the overwhelming number of COVID cases worldwide is allowing the virus numerous opportunities to change a little bit each infected person is for SARS-CoV-2 to reinvent itself scientists believe that the virus is getting better at being a virus viruses constantly change through mutation due to evolution and adaptation processes it has had minor random mutations ever since it jumped from animals to humans natural selection favors organisms that are better at survival and reproduction most emerging mutations will not have a significant impact on the spread of the virus but some mutations or combinations of mutations may provide the virus a selective advantage such as increased transmissibility or the ability to evade the host immune response this are the genes in the SARS-CoV-2 genome which contain instructions to build parts of the virus you have the ORF genes the E, M and N genes and the S gene encircled here contains genetic instructions to build the spike protein the part that allows the virus to attach to human cells during infection this section of the genome serves as a key region for monitoring mutations this can happen in any part of the SARS-CoV-2 genome the SARS-CoV-2 being an RNA virus is not stable mutations can take the form of a single letter typo in the viral genetic code or deletions or insertions of longer stretches of RNA this is a graphic representation of some of the mutations with red x-max associated with the B.1.7 variant or the UK variant the SARS-CoV-2 genome has 29,903 nucleotide bases or letters and acquires around two single letter mutations a month a rate around half as fast as influenza and one quarter the rate of HIV vital applications of virus genomics in informing responses have been built on what we call phylogenetic trees this are analysis to visualize mutational changes over time trees start with the earliest known version or common ancestor of a virus and every branch in a tree equals one mutation away from that ancestor the so-called new strain from the genome sequences A, B, C, D, E here on your right from various samples mutations in the virus that have accumulated over time are characterized here as collared circles the tree on the right is created based on the data and the left most branch in the tree shown here represents a mutation collared blue which is common to all sequences and thus represents an older strain of the virus to the right branches are added to depict new mutations and strains of the virus phylogenetic trees constructed from whole genome sequences investigate hypothesis of transmission roots determine hypothetical source of exposure when phylogenetic clustering of sequences is observed and establish epidemiological links since it spill over into the human population in late 2019 SARS-CoV-2 has diversified into many clades and variants represented here by different colors. The global initiative on sharing all influenza data or jisade initiative promotes the rapid sharing of data from coronavirus including genetic sequences and related clinical and epidemiological data. Many thousands of variants of SARS-CoV-2 subtypes of the virus can be put into larger groupings such as lineages or clades. One can clearly see here the timeline emergence of the UK variant collared orange the South Africa variant collared yellow over here and the Brazil p.1 collared red. The jisade dashboard also shows the countries where the sequences are coming from to help researchers understand how viruses evolve and spread during the pandemic. Because of our capability now to do sequencing at the philipine genome center, sequences from the Philippines have been deposited and also from RIT and previously these sequences from the Philippines have been deposited and not, you can see here we are not a missing link anymore. What have we found so far in the country? There are 1,992 sequences already generated as part of the genomic surveillance efforts since the first week of January to the second week of February 2021. A total of 61 lineages have been identified locally. Most frequently observed lineages are the B.1.63 or the Hong Kong lineage, B.1.1 or the European lineage and B.1.263 or the UAE lineage. In recent months, several new variants of the original virus have been detected that seemingly cost major changes in the way the pathogen acts including alterations to its contagiousness. A variant is a group of coronaviruses that share the same inherited set of distinctive or signature mutations. This variants of concerns have seemingly appeared in rapid succession in different geographical regions such as the UK South Africa and Brazil and in some cases have out-competed the existing variants. This is the phylogenetic tree of SARS-CoV-2 in the Philippines. You saw all the young scientists from the Philippine Genome Center who were interviewed in the video. This is their big, big work for the country. The samples that have been sequenced at the Philippine Genome Center collected since mid-2020 also showed the D61-4 gene mutation in the spike of protein of SARS-CoV-2 which was first detected at the significant level in early March 2020 and then spread globally to have a global dominance over the next few months. In this tree is also showed the B.1.1.7 or the UK variant already detected in the country. There are now 44 cases to date that have been detected in the country and you can see here that we have sample coming from the UK variant detected in the Bontok cluster another one from a returning overseas Filipino from the Middle East and a sample from Laguna. The B.1.1.7 was first identified in late December in the it has spread to 80 countries at the moment. It has 23 recent mutations including the N501Y the P681H the HV69 to 70 deletion plus four more on the spike protein and also stop mutation on the ORF gene. This is the genome of the SARS-CoV-2 and the mutations are spread out in the different genes of the protein. The variant is thought to have greater than 40% increased transmissibility. Increased virulence is suggested but it remains to be resolved but it remains unresolved and there is little concern about current vaccine efficacy as far as this variant is concerned. This graph from Dr. Jan Wong of Epimetrics shows the possible impact of the 1.1.7 variant on active cases. So this is the baseline reproduction number of 1.25 in the country the variant with a reproductive number of 1.95 which is higher and this graph shows us that if the variant becomes a dominant species after a month cases will increase by 28 times instead of 3 times and from there planning scenarios can be derived for variant control. According to Dr. Wong if there will be a reduction in baseline cases by as much as 80% at the end of the month the country can have just a little more cases compared to having no variant. He said that the most important message here is that while the variant still has not become dominant should be focused on reducing the baseline cases. The B.135.2 was first identified in late December in South Africa and now also detected in Africa, Europe, Asia and Australia. The B.135.1 variant appeared around the same time as B.1.1.7 it spread quickly in South Africa to become the dominant version in that country. It has 21 mutations including the N.501Y the E484K and the K417N on the spike protein and mutation also in the ORF-1B deletion which is outside the spike protein as you can see here as well. It is proposed to have heightened transmissibility at the importance of increased virulence. In vitro studies suggest a potential for immune escape following natural infections and a small effect on the potency of vaccine induced antibodies. A new concern also is that it might be able to more efficiently re-infect people. For the Brazil variant there are two versions both seem to have descended from an older common ancestor variant. Although they share mutations with other newly discovered versions they appear to have arisen independently of those variants. The P.1 was discovered in travelers from Brazil during screening at the Japanese airport in January. This variant has been implicated in the surge of infections in the Brazilian Amazon leaving their healthcare system on the brink of collapse at that time. Its effect on transmissibility and or virulence is unknown. There are concerns that the variant may be able to overcome the immunity developed after infection by other variants. Let me just mention notable mutations I've been giving letters and numbers a while ago. Let me just mention notable mutations found in the different variants to better inform public health measures. The UK, South Africa and Brazil harbor an unusual constellation of mutations but they all share the N501Y mutation. This mutation affects the receptor binding domain of the spike protein. It replaces SARS-CoV-2's 500 first amino acid asparagin with tyrosine. The mutation is near the tip of the spike protein changing the shape of that spike protein to have a tighter fit with human cells. The observation that similar mutations have appeared in three different variants in the fact that they are spreading makes scientists suspect that they may have an evolutionary edge. In the E484K mutation glutamine E was replaced by lysine K at amino acid position 484. It is called an escape mutation because it helps the virus slip past the body's immune defenses through a conformational change. B.1.7 variants carrying the E484K mutation may be their thinking may be more efficient at re-infection. An increased amount of serum antibodies needed also to prevent infection of cells. That is what the mutation appears to be doing. Clinical trials clinical trials data by NovaVax and Johnson & Johnson showed that their new vaccines were less effective when they did the trial in South Africa. The Philippine genome biosurveillance is closely monitoring variants of concern. Why is variant surveillance important? The U.S. CDC outlines important potential consequences of emerging variants such as ability to spread more quickly in people, ability to cause either milder or more severe disease in people, ability to evade infection by specific diagnostic tests. Because although many commercial RTPCR test kits have multiple targets to detect the virus such that even if a mutation impacts one of the targets the other RTPCR targets will still work. However there are some RTPCR tests that rely on only one target and mutations may impact their ability to work. At increased susceptibility to therapeutics that employ monoclonal antibodies these treatments are more specific than antibodies that develop from natural immune response and therefore may be less effective against variants. And lastly, ability to evade natural or vaccine induced immunity. I believe our esteemed reactors will talk more about this. A better understanding of variants of concern is needed. What are their differences in properties? How do the variants replicate? Do the variants escape neutralizing antibodies from people who have been previously been infected or from others who have been vaccinated? In coming months we may need to retool these vaccines and administer updated versions much in the same way that flu vaccines are revised each year. So we need to study we need to do a lot of research regarding these concerns about the variants. We have learned an awfully hard lesson about the intrinsic vulnerability of our societies to a single pathogen. As part of a global health community we need to be better prepared for future threats. In summary a national genomic surveillance using whole genome sequencing can investigate outbreak dynamics and assist in the design of diagnostic assays drugs and vaccines. Whole genome sequencing is also used for monitoring changes in efficacy of treatment and vaccines over time. Mutations or combinations of mutations leading to new variants may provide the virus with a selective advantage such as increase transmissibility or the ability to evade the host immune response. A better understanding of variants of concern is still needed. So we go back to the question posted in this webinar. Are we ready for this variants of concern? The most important message is if we are able to keep the number of cases down by being responsible and doing our part in practicing minimum public health standards. This will allow the virus because if we don't do that the virus will have an opportunity to change and get better at being a virus and we don't want that to happen. The national governments PDITR strategies of event, detect, isolate and reintegrate are among the best measures to contain the transmission of variants of concern to minimize chances of further mutations from occurring. Maraming salamat po at manged lang hapon po sa inyong lahat. Thank you very much. It was Dr. Eva Kutiyong Padalapas the director of the National Institutes of Health and Program Director for Health at the Philippine Genome Center. Brilliant presentation. I would encourage you to watch it again and encourage others to watch it on YouTube and on Facebook of TVUP because the more we understand what is happening the better we will be prepared to respond. And I think throughout this webinar series about treatment and how to take care of patients but there is a huge part of the science that is about understanding the enemy understanding how it's changing what it's doing and how we can be better prepared to respond. So thank you very much Dr. Eva, we are going to hear more from you at on the panel discussion. So we asked a question about what's the impact on testing what's the impact on treatment and management. So I'm turning over to Raymond to introduce our very special next speaker. Raymond. Thank you Dr. Suzie and thank you for that excellent presentation Executive Director Eva Kutiyong Padalapas. I'd like to introduce our next superstar resource person also he's a microbiologist infectious disease specialist and is also the Executive Director for the Philippine Genome Center but you probably know him better as the inventor of the first Philippine made testing kit for SARS-CoV-2 and other than Dr. Raul Destura. So Raul, magandanghapon po. Magandanghapon Raymond and magandanghapon sa lahat ng hekinig at nanunood dito sa ating webinar series. Go ahead with your talk sir. Thank you so much. So it was a very comprehensive presentations of our Executive Director of the National Institutes of Health and Program Director of the Philippine Genome Center and much has been said about the variants related to where it came from and how it's actually evolving. There are several areas in which we are I just need to highlight the importance of one biosurveillance. In this particular presentation we actually showed the speaker actually showed the importance of the genomics in terms of monitoring the movement of viruses for epidemics, pandemics or even the naturally occurring ones that we see today. It was also like influenza virus at the HIV viruses although it only has less mutation changes compared to the influenza of about two nucleotide chains per month. It gives us the importance that genomic surveillance to be part and integrated into the biosurveillance program for viruses in the country. And having such capability now than ever before will put us in the forefront in contributing globally to the knowledge base on how these viruses transform and move around the world as we see them in real time. The second point I would like to put in there is the clinical implications of these variants. Studies have shown that overall in terms of which of these variants are actually affecting clinical outcomes has been showing that in a bird's-eye view presentations of these cases the variant of concern versus the non-variant of concern in terms of clinical disease manifestation are not showing significant differences. But when they did prospective review of further analysis of these cases under what we call the 28-day mortality studies between the variant of concerns versus the non-variant of concern, there is somewhat a possibility of an increase of about 1.6% 1.6 odds of developing more severe disease but this still needs to be further investigated as more data are coming in from day to day from the global community. There's also an issue related to the diagnostic test whether it can pick up the virus or not in considering the virus and I would like to agree with our presenter that for diagnostic tests that targets multiple genes has a better advantage than those who are do single gene targets PCR technology that principally targets despite protein but the other gene targets are spared from significant rotations but that doesn't mean that we should continue monitoring such changes because for all you know the mutations will spread beyond the spike proteins and could eventually affect the behavior of this diagnostic test in the future but for multiple gene targets diagnostic assay that targets other genes it would still be able to pick up the variants where being monitoring. The second thing that the fourth thing that I would like to put in perspective is the importance of preventing further mutations. We cannot do something about the virus as we, as they behave it's part of there what we call the survival genome the survival of the fittest. If the virus needs to survive in the environment it must be able to avoid some of the mechanisms that stops them from replicating and what can we actually do to stop them from replicating First is the most common the most logical part is preventing the virus from going to another person because the mutation occurs when the virus are actually replicating so if we avoid further transmission of the virus we are preventing further replication processes among these viruses and should end with one person as the patient recover which means that the minimum health standard plays a very crucial and significant role in reducing the ability of the virus to further transmit to another person further reducing the replications of the viruses as a whole in the community and further reducing its ability to relate further as they may worry is significant again that it will not just be in terms of its transmission potential but also in its virulence and ability to cause severe diseases in the future can actually be prevented I think we lost Dr. Destura for a moment there. Let's see if we can fix that. Go ahead na walang ako for a few seconds My signal is fluctuating here Going back to what I was saying in terms of the prevention of the transmission and how do we prevent further mutations of these virus. The other thing that's very important to us is the importance of the herd immunity. Either an intrinsic herd immunity because of exposures in the community and much more ideal is the coverage in terms of the vaccines Now there are concerns related to will it be effective against the circulating variants overall in terms of its percent efficacy there may be some milder reductions in terms of in vitro analysis but the percent efficacy is still high enough to have an effective herd immunity because the antibodies produced by these vaccines are polyclonal in nature meaning it targets several portions of the spike protein and not just on the ones that actually mutate it. So in terms of reducing the transmission dynamics if we get enough vaccination as fast as we can faster than the mutation rate of the virus then it will ultimately reduces the transmission of the virus in its ability to replicate and its ability to mutate further. So it's really a huge and herculean task to be able to achieve that the question here is how fast how efficient how short and how many can we actually cover Filipinos receiving the vaccines in such a short period of time will actually further increase our capacity in reducing the transmission dynamics but on a global perspective the issue here is if it's for example one country is not as fast as the other in a global scenario there would still be that mutational advantage of the virus if we don't really get this global vaccine coverage is here said and done but there is this initiative from the which is what we call the COVAX initiative that allows us to hopefully be able to get vaccinated almost ideally but easier said than in a simultaneous fashion all over the world but as we see some countries are receiving it now others are not and we're still waiting for our own so there are a lot of nuances around that area and we're hoping that we get to have access to this vaccine the sooner the better so that the coverage will be faster and to achieve a herd of unity to as high as 80% would allow us to control the transmission of the virus at bay so moving forward it's very important that there is an interdisciplinary collaborations at the same times efficient operations and interoperability in terms of how we do things of getting as many people vaccinated in the future but while waiting for that to happen the second very powerful way of reducing its transmission dynamics is following the government's advice on minimum health standards that is a very effective way of further reducing the transmission of the virus while waiting for our vaccines to arrive in this country so with that said I would like to end my reaction to thank the entire TVU community and for the presentations presented by our executive director and for providing us a very good overview of what the virus is all about thank you and good afternoon everybody thank you very much that's Dr. Raul Destura more popularly known who created the first testing kit in the Philippines and we're very proud of the work that you're doing Raul I was just saying earlier when we look at our COVID response part of it is of course taking care of those who get sick but on the other side what you have done in terms of tracking down this virus and understanding how it is changing so that we can fight it so thank you very much for all that you're doing for our country I'd like to move on to our next speaker Raul please join us later in the panel I think there are a lot of things we need to talk about and I think some of our members of the audience have questions for you so please stay with us may I turn over to somebody who is also always with us on the webinar and another what should I say, very important person in our pandemic response so we would like to welcome Dr. Drew Britt Benedicto who is head of the Philippine General Hospital Critical Care Unit Management Action Team and he will talk a little bit about the variant and treatment so Raul talked about can it affect testing I think the question for Drew Britt is is it affecting treatment so Drew Britt welcome to the webinar and nice to see you nice to have you with us again Good afternoon ma'am Susie Good afternoon everyone Good afternoon Raymond and thank you very much Dr. Eva for that comprehensive and concise review and Raul thank you very much for your subsequent reaction well first of all what do the studies indicate in terms of clinical presentation as far as this variant is concerned quite consistently they will tell you that this patients who harbor the variant have more persistent cough one third of them will have persistent cough associated with tiredness, muscle aches and sore throat plus fever so quite consistently mas persistent po yung mga symptoms compared to those who have who has acquired the non-variance strains but ang importante po dito itong may variants they don't report loss of taste and smell so quite consistently yung poong datin ating mga patients nagsasabing bothered sila dahil may loss of taste and smell itong new variants is how giving us that signal na wala po siyang masyadong loss of taste and smell anong implications po nito clinically well on the upper side on the positive side may be more patients will consult earlier kasi most more persistent yung cough, muscle fatigue and with all this information that we have possibly covid po yan they really do consult earlier and sometimes sa mga journals na kikita po natin they have the milder symptomatology so yung clinical presentation nila are mild to moderate but as what Raul mentioned there are some signals there that sometimes they do are associated they are associated with more severe disease pero the signal is not yet that robust so if we're going to go by did it affect let's say treatment remember this variants as what was mentioned by Dr. Eva ang apektohanya protein and that means if you have new protein pag ikaw yung virus when you get introduced into the human body of course the human body is trying to act in a different way in response to that virus so ang sabi nga po nila more transmittable mas infectious ang new variant so that may mean let's say you have a higher viral load sa katawa natin that would mean again higher viral load means higher inflammatory response and definitely that would mean down the line pag higher inflammatory response potentially speaking we are talking about a more chaotic disorderly inflammation occurring in the body you have heard as far as concerned so i would say that our treatment since almost of our treatment are concentrated doon po sa effect ng virus yes there are still some studies to tell us that using let's say steroid like dexamethasone is still effective in terms of reducing the time that that patient may be an oxygen supplementation or ventilator yung length of hospital stena is shortened yes the possibility na magkakarun po ng coagulation disorder, thrombosis itong mga patient na ito is still there but one of our standard of care is really having heparin onboard earlier on especially among those who are oxygen requiring so hindi po magbabago yun ano ang potentialing matatamaan po nito well i'm looking at it that maybe our convalescent plasma transfusion may be less effective considering the the mechanisms that was invoked by Dr. Eva that this variants since we are looking at convalescent plasma among those who recovered so it's just rational to think if you're going to transfuse this convalescent plasma para siyang passive immunization binibigay natin sa mga patient if they have that variant then there's a big question mark if they will react in the same manner as compared to let's say those patients who are not harvoring the variant madalas po kasi nagbibigay kami ng convalescent plasma because signals are there that they may be associated with lesser hospital stay more time to recovery if you capture them within the 7 days of illness may go ang aming golden period if we are going to give the patient convalescent plasma transfusion so for this particular pag may new variant questionable yung convalescent plasma because of the pathogenic mechanism that I've alluded to to us also mention that yung monoclonal antibodies these are beginning to get some good grasp in terms of their study that they may be they may harbor some promise as far as against this COVID-19 but then again the studies are the studies right now are not that strong to compel us to automatically use monoclonal antibodies so they are still being deemed as really experimental and maybe patient selection will really play a major role on which way this this studies goes as far as monoclonal antibodies are concerned yung mga binibigay natin antiviral agent of course there's Remdesivir Fabipiravir especially Remdesivir the new journal which was just the new study which was just published I think yesterday sa American Journal of Internal Medicine books promising for Remdesivir in terms of in fact may mortality benefit na siya shortening hospital stay and of course shortening the time that that patient will need oxygenation so we still don't know how will our antiviral work as far as this new strain is concerned but definitely among patients who gets admitted part na po yung standard of care namin they get oxygenation once they need oxygenation automatic may na po yung dexamethasone heparinization and the possibility of giving let's say Remdesivir especially if the patient does not have hepatic dysfunction the possibility of giving your patient to selizumab is still there it's an anti IL-6 agent because it has good action against the cytokine storm on top of your steroids so automatic yun pa rin po binibigay namin having said that yes there may be implications we still don't know how the variants reacting so nadun paratikin na question sa study will our vaccine need booster doses or as what she mentioned dapat ba anwalto katulad ng flu vaccine we still don't know if we see one in boosting or at least really making robust their message ni doctora Eva that really if we go just go back to the basic remember the longer the virus is allowed to propagate the more mutations it will develop ergo if we don't allow it to propagate then the mutations will not develop so we always go back sa basic gene, handwashing wearing of face mask not being in crowded places so we prevent transmission doctor Eva mentioned as well if we keep the cases down as what she mentioned based on sa epidemiologic curve if we keep the cases down then maybe we can take care of subsequent strains or mutations or variants from being developed right now po sa philippine general hospital at least we are seeing that the cases are going down ang bothersome lang po talaga sa akin although we see less patients in the ICU right now which is good news bothersome sa akin is that majority of our patients who gets admitted are the ones who are elderly may mga comorbids young pero may comorbids are the ones who were exposed in the community so may mga elderly patients hindi uma alis ng bahay magwa one year na silang hindi alis ng bahay big lang dadalawin let's say ng someone dahil nga na miss nila yung grandparent or yung parent then suddenly this elderly individual will develop the symptom and low and behold COVID siya pag nagpatest siya so yun po yung mga bothersome sa akin because it seems like we are really beginning to control the cases they are going down but at the end of the day it's just unfortunate that we see cases who were previously well tapos dahil lang sa isang dalaw or dahil lang let's say yung kasambahay umales may binile then bumalikulit dun sa bahay hindi na huna kalimutan na atapong minimum health standard kawawa yung patient siya ngayon yung nasa hospital because siya yung may comorbid siya ka elderly so hopefully I'm really one with their message that we still conform and we still comply with the minimum health standards and maybe prevent these mutations from being developed in the first place thank you very much again and it's my honor to always be part of this panel thank you very much to Dr.Drewbert Benedip head of the Philippine General Hospital critical care unit management action team and it's always great to listen to Dr.Drewbert because as you can see he's not reading any notes he's just telling you what he's seeing at the Philippine General Hospital and I think for those who are the practitioners who are watching us now he had some very powerful points about treatment which I'm sure Chancellor Menchit will pick up on later so thank you so much very very clear also very clear presentation and very practical advice for everyone so I'd like to call everyone back now into the panel so that we can start our panel discussion and so we're going to have Vice President Sinch Bautista let's have Director Eva Dela Paz of the NIH Dr. Raul Destura of the Philippine Genome Center and the NIH and Dr.Drewbert Benedipto of the Philippine General Hospital so before we start the panel discussion I think Raymond is going to give you our panelists an idea of who's in the audience so Raymond go ahead and tell us who is watching us right now so nearly half of our attendees are viewing from NCR followed by those from Northern Luzon and Central Luzon po we have 27 attendees who indicated that they are located outside of the Philippines watching us internationally for the line of work most of our attendees at least for this webinar are from the nursing profession followed by those from the medicine profession po for those who are na ilam po ba others will make sure to break it down so that you'll be able to select your particular profession in subsequent webinars for question number 3 4 and 5 it looks like 83% 93% and 76% of our attendees answered all of the above po so I think this will be a good starting point po for our panel discussion thank you very much thank you very much Raymond I think in a bit we'll go back to those questions and ask our panelists to answer them and later I think we have selected two individuals who will be able to ask the question live to our panelists but before we do that I wanted to ask our panelists and I think you are all trying to say this virus does not replicate we don't give it a chance to replicate then the possibility that it will mutate will also decrease can you give us a comment on vaccination and how important I think Raul alluded to this a little bit more but let's what should I say let's articulate it better because we still have we still have people who are thinking that you know magpabakuna, mahawa na lang tayo di ba may mahagananin I don't want to repeat falsehoods but I want to get a sense from you from our speakers how important vaccination is going to be in the face of all these variants so we'll start with Eva thank you ma'am Susie the more people who get vaccinated the better it will be because even if they get the virus di ba sabi nga po ang mga ibang vaccines 1% in preventing serious serious disease may mga ganun po ang sinasabi nang results from the vaccine trials so very important po nang ating population get vaccinated dahil iwasan yung serious disease and number 2, to achieve what Dr. Raul Distura mentioned earlier yun pung herd immunity so tingin ko po isa pung responsabilidad ng bawat mamamayan ng Pilipinas na sila ay magpabakuna kasi po kung mahal natin ng ating sarili ating kasambahay ang ating pamilyang ating kaibigan ay magpapabakuna po tayo very well said Dr. Eva the overarching reason why we need to do this kung bakit ka lang natin magpabakuna is so that we can take care of our loved ones Raul, you already talk about this but I want to give you another chance to articulate how important it is yeah, the vaccination is is the most effective means of controlling any form of epidemics or pandemics it's been proven over time that vaccination alone depending on the degree of has the capacity to reduce the transmission and in some cases you actually have one win or remove the entire virus at the planet like a small pass these are very effective mechanisms for which we control our population in terms of the transmission of any emerging viruses now seruing in on the coronavirus it behaves with similar other RNA viruses that it really mutates over time and right now the knowledge on how it's going to be later is still a subject on continuous survey lens on a global scale now seruing in on these particular mutations for example there is a bit of a concern with 8484k mutations because certain vaccines for example like the ones from Novavax and Janssen and Janssen has a reduced x-ray to about 60% based on their in vitro studies but if you think about it it's the same efficacy rate of the influenza vaccine so which means despite its reduction it would still be effective enough to control significant transmission over time the other thing that is important with vaccinations sometimes it may not completely protect but it will modify the manifestation of your disease from a potentially severe one to a mild one that you can just rest up and sinigang on the side which can help you hydrate yourself and get some rest and modifying the ultimate presentations of disease can actually be done as well by these vaccines third is because of enhanced genomic surveillance we are in a situation that's way better than ever before in terms of understanding the behavior of this particular mutations over time which means that company who has the ability to rapidly design, readjust recalibrate the targets of their vaccines can just be for example in this case development of a booster shot the further enhanced coverage on specific mutations in those particular vaccine targets so it's a little bit irrational to say let's just get infected so that we increase our herd immunity because the problem there is what about the vulnerable population around you that may not be able to sustain the impact of the clinical manifestations of the moderate severe form of disease which can cost significant mortalities as we are observing in even developed countries right now so which means that it's more logical to increase our immunity as a population through a vaccine rather than facilitating transmission I think that will be irrational and ethical in fact and it's actually a moral moral obligation by everyone every member of the community to be vaccinated and while we're waiting for it I will cannot be over emphasized importance of the minimum health standard that is being advocated by our agencies so that's my take on the vaccine Thank you very much Raul Juber, your take on the vaccine but I found it very interesting that you said those who get the variant don't lose their sense of taste or smell and for many people that's the thing that drives them to get tested I say anoy parang never have they ever experience not being able to taste or smell but on the other hand you were saying their symptoms although they might tend to be more persistent but anyway Juber what is your take on the importance of vaccination in the face of all these variants Thank you very much again for this opportunity while I leave the molecular argument to Raul and Dr. Eva so umadalas po kasi na encounter namin especially with the offer of this vaccine remember my prioritization po yung government natin frontliners muna-una and then yung elderlies with comorbidities ang madalas kasing argument na didinig ko po kasi is will this vaccine allow me not to wear anymore the mask or facial the answer there is no even if you get vaccinated kailangan pa yun tapos may tanong pangsunod if I get vaccinated will it prevent me if I get it from transmitting the virus to the other persons the answer there is no because right now 100% na vaccine na ganon will it allow me now to go around if I get vaccinated go over na sa parents ko hug them already and everything the answer there is no because we still don't know pero ang quite consistent po na answer across all vaccines is that napakaganda ng efficacy niya in terms of you getting the severe form of the disease and remember it is only the severe and critical which is associated with mortality so ergo kung gusto mo pang mabuhay ayamong matay then you get vaccinated because regardless of the brand consistent po yung studies that it can prevent you from getting the severe manifestation of the disease and that I think is a good gamble kung susugal ka na rin because it will allow you to live a fuller life and then it will trickle down the line what Raul and Dr. Eva mentioned as far as herd immunity is concerned and everything ang take ko po kasi ngayon sa vaccine is of course we still don't know a lot of things but what we know right now as far as vaccine is really sending us strong signals for us to get vaccinated especially kung wala ka naman contraindication Raul mentioned maganda yan kong sabi nga yung fast the rate that we should get vaccinated if we can do it at a pace which is acceptable then definitely yun po a plus points for us there's always that issue of access availability yes those are real issues but if everything is equal yung vaccine then definitely as of now no brainer na magpabakuna ka yun lang po mam Thank you very much Dr. Bert now the thing is I think we have to outwit this virus and we have the tools to do it we have surveillance to do that and now we have vaccines that can protect more people so kailangan talaga utakan natin salvahi just looking at that I love that color chart that you showed the orange, the red the new colors of the spread of dominant viruses that are different we have to put a stop to this so I think this is a very clear message from our panelists Raymond we wanted to go back to the questions that we asked earlier and we're going to ask alternate over to you to get our panelists to answer the questions go ahead Raymond Thank you Dr. Susie I'll start with question number 3 it states a COVID variant of concern is a mutation affecting the spike protein it is more contagious it is more virulent or all of the above maybe director Eva can reiterate from her presentation just for this particular item Raymond, I did not get the question sorry I'll read it again mam Eva the question states a COVID variant of concern is option A mutation affecting the spike protein option B more contagious option C more virulent option B all of the above first, siguro ang pinaka-importante is defining a variant which is different from a mutation a variant is a group of a variant is a group of coronaviruses that share the same inherited set of distinctive or signature mutations ang mga mutation can be a single type can be a single type of letters in a set of letters na yung sa RNA nucleotide basis sa SARS-CoV-2 virus so it doesn't hindi po siya equivalent so yung mga UK variant yung pung Brazil variant yung South Africa variant they have a set of mutations that set them apart from the other the other strains that are are circulating in different parts of the globe so ang sagut po doon sa katanungan ay all of the above I think ang mga ba okay po, thank you thank you ma'am Eva thank you po for question number four a COVID variant of concern could option A testing accuracy option B affect effectiveness of vaccine option C affect effectiveness of treatment and option B all of the above so perhaps we'll ask Deputy Executive Director Roldistura PGC or Dr. Juber to chime in should I go first? go ahead sir for the first question in terms of I think the first option is on diagnostics, right? So as I mentioned a while ago the current RTPCR designs that are actually available in the country are multi-gene targets. If the RTPCR test that you are using are not just testing the spike protein target but also the other gene targets it would still be able to pick up the variant unless in the future that the other gene targets are also affected in terms of mutations in the future so in terms of treatment that was the second choice right treatment in terms of treatment the standard the standard option two is effectiveness of the vaccine does it affect effectiveness of the vaccine? studies have shown that the vaccines are still effective for all of these variants but in terms of this South African strain there is a reduced effectivity that will harvest the A4A4K mutations but overall if you look at the vaccine efficacy it's still high enough to be effective on a programmatic level and which means if you think about it the answer would still be yes and the third one is on treatment am I right? short memory span in terms of treatment the standards for therapy in terms of COVID has no difference in terms you are treating the variant or the non-variant of concern mutations and the degree of response will ever be different because as mentioned by Dr. Juberto Bididicto because of its enhanced receptor compatibility in the spike protein there is a tendency for the virus to attach more which means you will have higher viral burden which means higher inflammatory responses which means the need for more aggressive intervention may be needed in that case but ultimately we really really need a good drug that can effectively treat this patient in the outpatient but it doesn't happen still at the moment and hopefully we get good antivirals that can actually be given as an outpatient regimen because most of the treatment are very decautomous you want to control them but they need to be treated inside the hospital but in terms of programmatic control it would be nice if it is something that you can take like a pill in the outpatients further reducing the verological burden we are not there yet in terms of treatment but in terms of how to treat them in the hospital there is standard to the pediatric regimen that has evolved over time as new data on how we approach this treatment as we go along was that the last choice and all of the above and all of the above I think it's all of the above thank you pa sir Raul and then finally our last question a COVID variant of concern can be option A, detected through study of DNA, option B, detected through symptoms of the patient option C, detected through epidemiologic studies on locality and then last na namampong option all of the above okay first kasi di ba sinabi po natin that the SARS-CoV-2 is not an RNA so it's detection of an RNA and nakikita sana po tumangangos si Dr. Jubert pero ang sagut po do sa pangalawa hindi po nakikita ang variant of concern through clinical symptoms tama po Dr. Jubert at number three ang hulet Dr. Raymond detected through epidemiologic studies on the locality yes that probably is the best answer thank you unless may sasabihin po si Dr. Raul at si Dr. Jubert just to add on to Dr. Eva's comment so I agree it's not a an RNA virus for the second question is it will only give us a clue in terms of out of the ordinary getting more severe cases than before that can be one clue but again it will be picked up by choice number three which is the epidemiological studies and in this type of jamayabang natayin ng konte pagsinabi na nating epidemiological studies that includes clinical and genomic epidemiology in terms of monitoring this virus as part of the biosurveillance program so the answer would be the comprehensive epidemiological study on choice number three thank you thank you very much and thank you Raymond for we go to our two members of the audience who are going to ask questions I mean VP Sintes here VP Sintes you are seeing the fruit of your investments and support for the Philippine Genome Center what what do you think will be further needed to enable this group to expand and to do more I guess first thing is we need more we need to support our researchers in the Philippine Genome Center I guess we need more items for them and that's what we've been asking that the DBM for because they're mostly contractual so we want continuity in the Philippine Genome Center and that's one we still need resources even as we have a lot of support from the DOSD and from other agencies we need a lot more resources so again strategically well the Philippine Genome Center is more than just working on COVID it's working in other areas as well but I think for this particular situation we need to fully support it as the Philippine Genome Center and not just because it's a UP a UP unit so this is I mean the Philippine Genome Center is really a national institution and I think again I'll just say it again that the response of COVID is not just taking care of patients or even vaccinating we have to know who the enemy is, where it is paano siya nang babago siya ako anong balang aandarasakanya so malaking bahagi yung and I know the audience is sharing that they're saying it in the chat box that this is very important scientific work that's being done in the Philippines that we should all be very very proud of. Raymond I'm going to turn over to you to introduce our audience participants okay so first things first we'll get someone very very close to Dr. Susie's heart is currently working with the Philippine Red Cross maybe we can call on Dr. Art to give his ask his question po go ahead Hi Dr. Susie can you hear me yes Dr. Raymond Dr. Cynthia and all the panelists congratulations you're really doing a very big service to the country at TVUP I'm sure everybody knows that the Philippine Red Cross is at in the ticket of testing and response dito and in the advent of this new variants in a few days time or a few weeks time the country is contemplating on opening up slowly so for the Philippine Red Cross kanga the question is with these variants is there a threshold number of cases or what are our considerations or what are the circumstances for us to even conclude that there is already a community transmission of the new COVID variants to say the last time I heard na there is no sufficient evidence to say that there's already community transmission despite of the different reports of the cases with the new variants so what are our considerations for even considering that there is already community transmission with these new variants in the context of us considering na mag-open up tayo slowly we are a little apprehensive there thank you back to you ma'am back to you doc go ahead go ahead ma'am Eva marami salamat po sa inyopong katanungan many of you will know community transmission is when there is no clear source of origin of the infection already in a new community so that means we can no longer identify who became infected after being exposed to someone who interacted with people from other infected communities however sa ngayon po ang amin poong mensahe kasama po na department of health at kasama po technical working group of the variants na mention po namin to kanina sa media presser there's no strong evidence yet that there is ongoing community transmission we need to prove that large number of cases in different clusters and with no known linkage para po for us to say that there is community transmission which means we will need better representation from all regions and populations please remember po I mentioned kanina nags-type lang po tayo ng ating genomic surveillance po first week of January at may yung data po na sinabi ko 1,222 sequences that have been generated that was first week of January to the second week of February and now we're doing another set for sequencing sinabi ko din po kanina na we will also focus on areas where there is a surge of cases like region 7 mayroon po tayong special focus so sa ngayon po ang amin po ang amin po binibigay na ay hindi pa po tayong nakaka-establish ng community transmission okay thank you very much Eva Rima we have another question yes and our second query comes from all the way from Beacoll University po Joseph Martin Paet who is from the research and development division of Beacoll University sir Joseph okay I think oh he got disconnected so we'll probably march forward Dr. Suzy okay so Rima if you have a voted question we can take one more question and then we'll have to start wrapping up go ahead okay the first voted question has already been answered the second one was asked by Dr. Art so the third one I'll just choose the one from Mary Catherine and she asks the panel what could be the possible reasons for the mutations happening to the COVID-19 virus just to reiterate to everyone okay anyone can answer I can answer the question the mutations for RNA viruses it actually happens when the virus is actually replicating and during the processes of replications there are some mistakes in the copying of the viruses and when the mistakes are happening sometimes it doesn't create the global effect of the virus but at certain time during the mutational process it might be able to shift into something that is significant like what we are seeing now is significance meaning a change in the functionality a change in how it's actually transmit in terms of attachment that will make it more invasive into the cells so this happens during the virus is actually replicating and that's one characteristic of RNA viruses that are a bit scary in the process but they really mutate thousands of times each time nang hindi lang significant yung mutation to have an overall effect to the virus but in certain situations like what you are observing now still in the future as long as the virus are continuously transmitting in the community so important may tigil natin ang pag-report yung transmision niya kasi habang dumada, habang nag-reproduce siya lalo siyang pabago-bago okay so we are now going into an evaluation of our webinar for today so if you want to launch our evaluation questions okay thank you so much so for those who are again joining us for the very first time we often have this panel discussion assessment just to be able to assess well how much you have learned from this webinar through our panelists it's a five question assessment number one the panelists demonstrated total knowledge of the topic the panelists were well prepared and all organized number three the panelists spoke clearly and audibly number four the panelists used appropriate language with technical medical jargons adequately explained and number five the panelists contributed to new perspectives and knowledge on managing various key COVID-19 health issues so please key in I am seeing only 41% of those who are in attendance over to you Dr. Suzy okay so we are going to give all of our panelists a few moments to just give their parting words a few words to summarize take home messages for all just we are going to start with VP Sintia Bautista who played a very big role in setting up the Philippine Genome Center now wala ba si VP Sintia? a commute okay please unmute ma'am Sintia I think she may be having internet connection okay so we'll go to Eva go ahead the more the virus circulates the more opportunity it has to change and acquire new mutations so pag mas marami po tayo mga kaso ng COVID-19 sa bansa mas marami po opportunity nidad upo magkaroon ng mutation ang virus bagamat may mga mutations na walang effecto meron din po maaring makapag-bigay ng mga katangi sa virus na mas malakas itong makatanghawa so ang bidang solution po dito ay patuloy po natin pababain ang mga kaso sa pamamagitan ng pagsunod sa minimum public health measures na pinapatupad po ng Department of Health at ng gobierno ito po it's a matter of personal responsibility so kailangan po tayo magtulong-tulong lahat po tayo para po labanan ang pandemiyang ito marami salamat po thank you very much, Raul para sa pandemiyang ito na very important nakailangan talaga natin sali ang siyensa sa paggagawa ng decision para sa ating bayan at ang isa sa gustong tumulong para sa pangkontrol ng COVID virus problem na hindi ko sa Pilipinas and rest assured that the research team will always try our best to give our best forward in providing scientific information that are needed for control of the virus in the country salamat po. Thank you Raul, Jubert. Yes, good afternoon once more. So I'm 11 months already in the front lines. So gusto ko po talaga makita yung day na hindi nakailangan ng isang consultant na nag-around sa ICU on an everyday basis. So hopefully as what was mentioned this virus is trying to outwit us at every turn. So let science speak. I think that's the best way to move forward. We need a multi-layered approach as far as the fight against this virus is concerned. So as of now really there's optimism there compared po nung nag-start tayo dito sa pandemic. So we really just have to continue of what we do best with what we have, with what we know. Thank you. Thank you very much. Well said, Jubert, manaming salamat. I don't know if VP is interested as back. Back. Sorry about that. I just want to correct. I'm not the one who started the PGC. Actually I knew of its conception in the very early part. But the ones who actually struggled to put it together whole history and I think Chancellor Menchit is going to end is part of that history. But basically we are the university is committed to supporting the Philippine Genome Center and also committed to making the Pin Genome Center. Even if UP is its host. But the second one is I'm very happy. Thank you to all of the organizers. Thank you to TBUP. Thank you to all of you here because this is public education. The problem with vaccination I think we have to say this more often that you have to have vaccination because there are a lot of all sorts of stories coming up and even a lot of things coming up and I think our role and we should have more of us is actually educating the public and we are very grateful to those who are with us. But beyond us the public is much bigger the public that you have to have you want to have herd immunity for is a bigger public beyond this group. So even working at that level of mass communication is important. But thank you to all of you for doing this. Thank you very much. Thank you to the Vice President Cynthia Bautista, Vice President for Academic Affairs of the University of the Philippines. And so we are now going to have our synthesis by none other than Chancellor of UP Manila Menchit Padilla. Menchit, please go ahead. Magandang hapon po sa inyong lahat. Okay. Well, we started our webinar today with the Vice President Dr. Cynthia Banzan Bautista who is actually has the office where the Philippine Genome Center is housed. So, of course, we thank her for the continuing support that she has given to PGC. She gave a brief history of the Philippine Genome Center and she said that in 2011 the UP Board of Regents approved the establishment of the Philippine Genome Center in response to a scenario when the borders are going to be closed in the event of a pandemic and that pandemic is what we're having right now. So the PGC is a UP system research and advanced research center for genomics and bioinformatics with the mission of increasing the capacity of the Philippines. So it's really for increasing the capacity inside making sure that we have young ones who will take care of the future. So with initial grants from BUSD, PGC received also grants from CHED the Philippine California Research Institute initiative and it was that grant that actually expanded the core sequencing facility and we're all actually using that for facility right now for COVID. Now in the past 10 years PGC has provided a solid track record to prepare for this pandemic and now PGC joins NIH, RITM and DUH in the biosurveillance of COVID in our country. Now PGC being the biggest sequencing facility in the country was actually the first to flag the UK variant. PGC also actually is a COVID laboratory since April 2020 and I think one thing that many people do not know is that PGC together with the National Institute of Biology and Biotechnology or NIMBB of UP Diliman the NIH of PGC PGC rather PGC Visayas and PGC Mindanao they actually conduct hands-on training for those hospitals who want to set up the COVID laboratory so actually PGC is not only in Luzon but now in Visayas and Mindanao and they have actually taken the major role of training the hospitals who want to set it up. At Luzon, Bautista said that this COVID pandemic we affirmed the role of UP as a research and public service university and indeed PGC has brought the faculty even within UP in different fields together but I think what is important to tell our audience now is that although UP is hosting PGC it has shared its resources with students and researchers from many universities from all over the country. At the center is Dr. Eva Cochang is the Executive Director of the National Institutes of Health of UP Manila and likewise the Program Director for the Program on Health in the Filipino Center she actually started her talk by saying that information must be accurate and to avoid confusion we have to make sure that there are substantial studies on the things that we actually tell the public. She actually gave a to bring down the level of discussion to delay. Thank you Dr. Eva. I will just give the highlights of her talk. I encourage everybody to go back to the recording at the YouTube so let me give you the highlights of her presentation. She said that genomic sequencing actually allowed the development of diagnostics and treatment at modalities for COVID. Indeed genomics and bioinformatics are now very important tools and very fortunate that we have that now in the Philippines through the Philippine Genome Center. She shared with the group that the PGC actually processes 750 samples a week. The PGC has been designated by DOH to actually take charge of the biosurveillance in the country. She moved on by saying that there are many mutations but most mutations are not useful. There are combinations of mutations with clinical treatment. She said that every patient who contracts the disease is an opportunity to change or mutate. Every time they enter a new patient the body of the new patient the virus gets better at combinations of mutations with clinical impact. But what is important now is that we understand what are the mutations that are here in the Philippines and then which ones will have clinical impact within our setting. It was interesting when she showed the map just to show the different mutations and I want you when you go back to the recording I want you to take a look at the map with all of the dots to show that different countries of different mutations and this is actually what we are monitoring in the process of surveillance. She also gave us an example on what happens. You may have a beginning dot with a different color. I think that's the simplest way she actually presented it. When they change colors they may have a different mutation and it's really when this is spread that's really the one that's affecting the whole world right now, not even the Philippines. So I want you to go back to that graph that picture with the dots and look at the phylogenetic tree because that's something that we should remember when we're trying to understand COVID. She talked about the different variants. I'm not going to talk about that but just to highlight one point that came out during the question when she said that when you talk about a variant it is a group of coronavirus that share the same inherited set of distinctive signature mutations. Pagmutation it's just one or two letters and they're different and we did have another session I think early in January just talking about the difference between mutations and variants and I urge the community the audience not to go back to that session because it will help you understand when you hear the word variant and you hear the word mutation. The key messages of Dr. Eva a national genomic surveillance using the whole genome sequencing can investigate the outbreak dynamics and assist in the design of diagnostic assays, drugs and vaccines. In other words, this was not discussed but allow me to say this because of genomics now we were able to get the sequencing of the COVID virus and that was actually shared to the rest of the world and that is the reason why different companies now started working on their diagnostic kits and they also started working on the vaccines. It is the era of genomics that made a difference. So number two, she said that the whole genome sequencing is also used for monitoring changes and efficacy of treatment. So in other words, hindi na pwedein sabihin mo gamut mo treatment A, treatment B we've got to look at the genomics part now because they can actually affect also the way we're handling the patients. Number three, she said that mutations, recombination of mutations leading to new variants may provide the virus with selective advantage. Sinabi niya matatalino ang virus basal lumipat sa ibang katawan pwede siya magpalit at mas magaling siya can be more transmissible and have a difficulty on the ability to evade the host immune response and the last thing she said that we need a better understanding of the violence of concern for our country. We try to understand the rest of the world but what is important is that we understand what's happening in our country. She had a you know because we have the Philippine Genome Center now and we have a better understanding she said that you know we we can be better prepared for the next pandemic and that's what we're doing now we're not only trying to resolve COVID we're actually trying to make sure we're doing our best to make sure that when there's another pandemic that happens we know what to do and again she said at the very end keep the numbers down so that we're using the public health measures because by this way the COVID virus can be contained and then you know then it will the total picture of controlling the COVID pandemic. Key words that she left prevent, detect, isolate, treat and reintegrate. We had two reactors and the first reactor is Dr. Raul Dustura who is actually the director of the National Training Center and Biosecurity and maybe just to inform the group that this particular center we didn't mention it but I wanted to let you know that Dr. Dustura leads a team who takes care of partly training all the people running the laboratories in the country because you have to understand the issues of biosecurity even before you set up a lab and they have trained actually thousands at this point so here are the messages of Dr. Dustura again he highlighted importance of biosurveillance and that is when you talk about biosurveillance for COVID it is the movement of the virus and it's really I'm glad that he mentioned that we do contribute to the international data bank now because the virus moves around the world and if you do not give our data then when there is a vaccine or treatment that will be discovered then we will not be included in the formula so it is very important that science is deep in the Philippines so that we can make a contribution to the general picture of COVID the second message he gave is that there really is a need for a day-to-day observation to even say that the variant is affecting clinical outcome so when we hear the news and it's based on something that happened last week we don't even know whether it's already true right now because Dr. Dustura said this is a day-to-day activity that's happening among the scientists as well as the clinicians the third message he gave us on the issue of diagnostic kits he said that because there was a question about now that we have the variant are the diagnostic tests still working he said on the diagnostic kits Dr. Dustura said that have multiple gene targets have better chances than those with a single gene target so just maybe just to let you know that if you go and read the kits it will tell you which gene targets they're attacking she's saying that if they're targeting more than one then you're better off the fourth one is on preventing mutations this is reinforcing again what Dr. Eva said the only way is if you want to stop the prevention of the virus going to we have to stop preventing the virus to go into another person by doing the minimum health standards and that will actually is a major factor for the control of COVID the fifth message really was he was saying that he talked about herd immunity but let me just mention this part our main goal right now really is how fast how efficient can we have this vaccine in what short of time can we cover a big a big number of people so that we can achieve the herd immunity that we're talking about so it's no longer it's not a mapapabakuna ka pero ako hindi because right now COVID is global and the effort is to be simultaneous he said that this has to be a collaborative effort and he ends again by saying that the vaccine is the best but what we have right now really will be to do the minimum health standards because that's equally good in spreading the disease in the country our next reactor is Dr. Jubert our pulmonologist and of course he talked about treatment and I think we have many in the audience wanting to understand whether is it the same signs and symptoms and it's interesting this is the first time I'm hearing this Dr. Jubert he said that what they've noticed is that for those with with a variant they have the symptoms would include the persistent calf the tiredness the increased muscle fatigue but there was no loss of taste and smell and he said you know somehow this is good because since there's persistent calf they actually go to the doctor much earlier and I like that part Dr. Jubert that because they have the persistent calf now that the diagnosis made much much faster so the question did it affect treatment well Dr. Jubert said we're doing exactly the same thing he had a detailed discussion of the the treatment that they're offering and as a matter of fact he actually gave some information about new data that has come out but I do want to just mention one point when he said you know because there's a question about the convalescent plasma he said that he may be it may be less effective right now because of the mechanisms of the mutation but maybe it's just too early to know because all of this is being studied right now um the monoclonal antibodies may have some promise but as he said if you notice everybody saying we've got to study this even before we go to before making conclusions about the effectivity of one so we do he ends again by saying that um minimum standards say proper hygiene, the mask the distancing and he said if you want to keep the cases down we have to take care of the variants too and then sharing the information about PGH I think is also important because he said the cases are going down but what he is seeing now is that the elderly and those who go more bits will never left the house but it's because there was a visitor in the house and I think it's a very good message for the community that just because you meet a person you're going to visit because you may be breathing the virus now during the open forum I had to add this although it was not part of their talk it was asked by Dr. Suzie on their take about the vaccination and so let me just mention a few things that they highlighted um from Dr. Eva she said a big proportion needs to be vaccinated to achieve the herd immunity it is our responsibility okay from Dr. Raul he said that over time vaccination is the best mechanism to abort the pandemic it will not completely protect it can modify to a milder version we are better of now because of genomic surveillance the vaccine companies if we are watching the vaccine companies are also watching these studies because they can actually adjust and modify the vaccine so that it becomes a better one for COVID and this is the statement of Raul it is a moral obligation of the members of the community to actually get the vaccine to get the vaccine so he said over all the vaccines will work with the variants kung nakutayang matapot sinabi ni Dr. Distura it will work from Dr. Juber on the issue of vaccine he warned us even if you get the vaccine yes you still need to wear the mask do the distancing can I still transmit yes because it's not 100% protective he said what is clear is that regardless of the brand there is a purpose for the vaccine kung nakutayang matapot on the final words of our presenter and speakers once again Dr. Eva said the more the virus circulates the more opportunities for mutations from Dr. Raul include the science in the solution and the PGC since Dr. Eva and Dr. Raul are part of and of course vice president or part of the PGC PGC is willing to her to help the country from Dr. Juber the approach has to be multi-layered the approach to the fight is multi-layered it cannot just be one approach he said use science for the solution and I'm glad that he used the word optimism Dr. Juber he said there is optimism we just have to do the best he said with what we have right now and finally from vice president about this he said UP is committed to make sure that the Philippine Genome Center role in the big picture in the country in addition to what science is doing I think one of the big roles of UP now because UP is also part of UP is to make sure that public education becomes a major part of what we will do for the next couple of months so let me give my final my final thank you having been part of the genome center this time I'd like to say thank you to UP for establishing the Philippine Genome Center the country is now a major beneficiary of this initiative indeed there are more challenges ahead but without the support of the management of UP we will not be here to serve the country mayan ni salamat sa inyong lang back to you Dr. Susie and Raymond thank you very much that's Chancellor Menchie Padila always gives us a great synthesis and summary and so we coming to a close soon I'd like to thank all of you our audience if it was not for you we wouldn't be here just looking at your comments in the chat box na kata ba I think for all our speakers for the Philippine Genome Center we're all in this together and I think we had a very fruitful and productive session today but next week very interesting I remember someone said last time why are you talking about the vaccines without an allergologist okay so next week we're going to have a session that is co-hosted by the Philippine Society of Allergy Asthma in immunology and many of you know that they had a statement that has circulated and we're going to have an in-depth discussion the title of our session next week is may mga allergy ako COVID-19 vaccine safe ba okay so that naalala ko daming mga tanong so invite your friends if you're teaching invite your classes to come you're in the hospital some of you are writing invite your office mates it's worth it to sit down an hour and a half, two hours and understand what this looks like from the perspective of the immunologist, allergologist and the specialist in asthma so that's next Friday and we're going to have a little bit of a different format we have invited multi awarded and very popular journalist Karen Davila to be part of the reactor she's not going to moderate the webinar she's going to be a reactor and of course i'd like to thank all of you who participated in asking questions so ba raming salamat ko sa inyong lat thank you doctors you see and thank you for the beautiful synthesis and summary of the events for this webinar marami na po chance makitakita ko tayo ulit na next week and this really is the one wherein we will probably talking about allergies and for those especially for those who have been asking pwede mo ako matusukan ko merong poong asthma merong po ako skin allergy all of those things we hope you'll be able to still join us for next week's webinar but for this webinar this formally closes our webinar for the week and we look forward to your company next friday february 26 same time same channel 12 noon it's a date together let's stop covid next so keep safe keep healthy and see you online the enemy remains unseen i'll keep your hand in mind let's say a prayer one more time i know you long for home but i am here you're not alone i'll stay with you until the coast is clear the other's pain before my fears the other's lives before my tears but right behind the mask i look into myself at mask do i have strength to carry on my god our lord when things go wrong and leave you here to keep me strong i'm here to hold the line i'll keep my word until my time 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 a last you carry you to see the break of day the other's pain before my fears the other's lives before my tears but right behind the mask i look into myself at mask do i have strength to carry on my god our lord when things go wrong i'll stay with you until the coast is clear the other's pain before my tears but right behind the mask i look into myself at mask do i have strength to carry on my god our lord when things go wrong and leave you here to keep me strong i'll stay with you until my time pushing on the spine cares these things through another day