 Good morning. Good afternoon. Good evening, everyone. Nasalman po kayo sa Parti ng Mundo. Welcome to our 78th installment of the Stop COVID-19 webinar series brought to you by the University of the Philippines. As you know, we are still in the 7th season po, pero malapit na rin po in fast approaching ang ating new season. So we hope that that's something that you'll also be looking forward to. We are very, very lucky that each and every one of you continue to join us week-in and week-out and for those who are joining us for the very first time and who have just discovered us for today, welcome po and I'm sure sana po magustuhan po ninyo ang ating mga topics for these webinars. As new spikes in cases are seen in the United Kingdom and in Singapore and this despite the high levels of vaccination, our attention is drawn to how we can survive the continuing ups and downs brought about by the COVID-19 pandemic. Sa center po ng ating pong response, nandito po ang ating mga healthcare facilities o ang ating mga hospital and throughout the pandemic, persons with other illnesses that are not related to COVID-19 suffered from delays in consultation, sa pala ang pagpapagamot, sa kaya ang pagpapagopera. Merong po mga talagang mahabang listahan kung paano po na pwersa ng pandemya po para po tayo lahat ay makapag-re-think kung paano po ang gagawin po natin long term, paano po ba natin mas-servisiohan ng mas-maigay ang ating mga pasyente lalo na po yung mga may infections po without compromising or sacrificing other types of medical care na nabibigay po natin bilang hospital bago po yung pandemya. At ito rin po ay desperately needed by our other patients. So if you want to learn the latest on COVID-19 design interventions straight from the most credible experts, please stay tuned nang Dr. Raymond Francis Sarmiento, director of the National Telehealth Center, National Institutes of Health University of the Philippines Manila. Always a pleasure to be with all of you during a regular Friday lunch date and I always look forward to Fridays because as you know, I get to share hosting duties with a special envoy of the president for Global Health Initiatives, our adjunct research faculty at the National Telehealth Center, Dr. Susie Pineda Mercado. Dr. Susie. Hi Raymond, good afternoon. Magandang hapon po sa inon lahat saan man kayo naro and I hope you're doing well. I think nobody knows what's going to happen with this pandemic. Parang yung ibang bansa nagbukas na, tapos ngayon naggibit na naman. So magandang ay yung mga hospital natin, meron silang plan. At meron silang mga pagbabagong ginagawa para tumuloy man itong COVID-19, sana naman hindi, pero kung tumuloy man yung COVID-19, handa tayo. So today we will talk about hospital design. And I know that there are a lot of you who are watching from the hospitals because you've got great, great speakers. And this is an opportunity for us to think about, how do we organize the space where we're working, kung saan tayo nag-anon na nag-bebegin ng service yong. So abangan yung po ang maganda kong pag-usapan natin nga. Over to you, Raymond. Thank you so much, Dr. Susie. And for those, gaya po nang sabi ko, for those who are joining us for the very first time, we usually have a very brief video prepared by TVUP. Ito po ito ninyatag po nating mga interviews or person-on-the-street interviews po natin. For our interview video for today, we have as well as several respondents po ang mga katanoang ito. Ano po ang intindin ninyo sa green design? Ano po sa tingin ninyo ang kailangan? Para tayo po ang lahat ay maging pandemic ready. Ito po ay in addition na po sa ating minimum public health standards. Ano po ba ang mga effecton ng mga disenyo ng mga gusali sa ating kalusugan para maging pandemic ready? So please watch this. Ano natin para maging pandemic ready talaga yung pondon. Tabad ready lang yung pondo sa may mga... naka-ready na tayo na mga facility o konkretong plano kung sa kaling kung anong pandemiyaman yung ladapok. On a personal level, siguro, dapat pinagahandaan natin by getting enough sleep, exercising, eating nutritious food, ganon. Pero on a societal level, siguro, dapat may have systems in place para maging pandemic ready. Personal health natin. We must always strive to stay healthy, to stay fit, ayusin yung mga kinakain natin lalo na sa office workers. Ginagamit yung mga eco-friendly na mga matarianes katulad lang yung mga kahoy o yung mga local limit. Merong approach sa construction na sustainability or eco-friendly na materials na ginagamit kasi kino-consider na yung mga taong gagamit dapat say from hazardous effects ng construction. Pag-design ng ating mga buildings o pag-design ng mga structures natin with the thought of lessing or carbon footprint in constructing and yung how to design buildings para makatulong sa ating environment patirin sa health ng mga tao. Na sa office naka o na sa mall o kahit saan, important na maganda yung circulation ng air yung maaliwalas makakainaka kasi siyempre tong COVID dapat hindi ka nakakonfine sa isang space kasi babilis makawa. Bukit ng mga gagamitin, dapat yung mga construction natin mga itatayo ay prepaid na rin saan na saan mga kwarto for isolation na ready yung mga provision para sa electrical o kung anong gagamitin dun. A big difference in space planning more on technologies na makatulong sa ating of less contact and better ventilation of air and sunlight sa ating mga buildings Wala naman din natin, alam kung kailin yung dadating yung pandemic yung siguro yun na lang din kung may dadating na gantopakalasing ng pandemic sumunod sumunod sa mga instruction, sa mga guidelines yung mga protective measure natin para mga protecta natin sa ready natin. Okay, thank you very much TV UP it's always very interesting to see what persons on the street are thinking na katoan, kasi pinagusapan nila yung ventilation dapat meron tayong open space mas maraming sunlight ito ay siguro isang layunin ng mga architecto natin namin, meron tayong architect is going to talk about green design, kasi hindi lang naman yung COVID pati yung pandemia pero yung pandemic pati hindi lang yung COVID pati na rin yung climate change pero hindi lang yung yung design later we will talk about the PGH one word concept ipipresent yan at pag-usapan yan pero hindi lang yung physical space kasama din yan, yung network papan nahikipagug na yung isang hospital sa mga secondary and primary facilities and I know you're all very interested in this kasi as frontliners laging na sa isip natin yan yung referral yung systema so maganda ngayon mga pag-usapan natin at natutuan naman ako yung ating persons on the street and na iisip na rin nila yung na iisip na nila so tama-tama lang okay over to you Raymond Thank you so much Doctor Susie very interesting ang ating inputs lalala mo from the youth sector ang mga nagspan sa ating person on the street interviews just reminder po that our webinar is able to accommodate a maximum of 3,000 participants we are now numbering a little less 700 in the zoom but we all know mayarabi po sa inyo ang nag-join po kasama sa atin sa YouTube channel na TV UP patin na rin po sa Facebook pages ng stop COVID deaths ng University of the Philippines at na TV UP so sana po kung maari po kayong makadwog join po sa atin lalo sa zoom for you to be able to get the full experience please join as soon as possible and for you if you could also hikayatin ang inyong mga kaibigan kamag-anak mga katabaho na mag-join po sa ating webinar for today very very interesting po ang ating topic at ang ating mga experts in our panel they will be sharing nuggets of wisdom in preparation or at least for making the healthcare facilities pandemic ready I would like to enjoy everyone of you to also put in sa ating Q&A boxes and maybe if you are outside of zoom sa YouTube chat po o siya sa Facebook po sa may comment section if you have any questions that you want to ask if you have prepared beforehand please go ahead and enter them and then finally meron po tayong fan quiz ito po sa zoom poll or sa menti meter for those who are not able to join us in the zoom please go open your internet browsers and please type www.menti.com and enter the code 17231665 that's 17231665 for you to be able to join in our fan quiz for those who are asking certification of attendance will be given to those who have at least watched 50% of the webinar duration po ito po ak ichura ng e-certificate na maibibigay po natin we have distributed for the last 76 webinars I think there are still those that we are still distributing for webinar 77 so we hope that those who still have not received at least for webinar 76 pa baba ay masabiyan po kami lala po sa ming mga e-mail their staff that counter checks po sa ating database yung inyong mga requests for certificates over to you Dr. Suzy thank you very much Raymond and I just wanted to greet RJ who said that this is 30th 30th webinar no, nakakatuan naman to kapati natin yung mga who also watching us outside of the country but I'd like to greet all those who are watching from Manila Doctors' Hospital it seems like we have a number from Manila Doctors' Hospital we've got a number from Southern Philippines Medical Center SPMC in Davao and nico ma-name lahat nung mamaya inaname ni Raymond pero we're just so happy that you're here kasi kung hindi sa inyo wala kami rito and it's great to be with you on a Friday okay, so Raymond time to go to the opening remarks ikaw bang opening palagay kong opening ayon na yes, thank you Dr. Suzy abit before I start with just a brief opening remarks I just wanted to let the audience know that we are following our standard panel discussion format which means we have a main speaker who will be presenting followed by a set of reactions from our two other experts from the panel this will be followed by a Q&A session and questions will be entertained kung saan mat mo kayo mag-enter sa Zoom sa Facebook sa YouTube may mga pipiliin din po mga katawnoongan po doon kung kayo man po kung kayo po ay na sa Zoom at pili po kayo na magre-request po kami na mag-coby po kayo ng video or maybe join us in the panel for you to be able to ask your questions live to any of our three panelists we hope you'll be able to grant us this request so maraming salamat po for this webinar we will be talking about really how hospital design is a critical element to making sure that well the institution in this case the healthcare facility is ready for any outbreak any pandemic tatama po dito as mentioned po sa aking introduction tayo po ay nakapagsurvive na po na mga ups and downs brought about by the COVID-19 pandemic pero and pagusapan na rin po natin sa mga past webinars how hospitals have been really restructuring re-designing their spaces pero ano po ba yung mga specifics po noon ano po ba how does one hospital effectively organize its space lalo na po sa mga lugar na limited po ang mga resources have sparse resources to achieve its mission pano po ba lumalabas ang inherent creativity innovations new ideas and how all of those that are sabihin na natin being considered as sort of new age or innovative ideas really become part of the mainstream protocol for hospitals as mentioned by Dr. Susie we will be exploring particularly for the Philippine General Hospital the one word concept to be able to contain the COVID-19 disease as well as enabling also other services to continue so our design not merely architectural in nature but has an emphasis on linking up pano po ba yung mga services na pwedeeng ma-provide sa isang hospital gaya po ng Philippine General Hospital ay maigipo na party po ito na isang tina-tawag na service delivery network so that all of the services for that particular patient is accessible so please stay tuned and we hope more and more of those who have registered will be able to join us for today's webinar over to you Dr. Susie okay thank you very much Raymond for setting the tone for our discussion today aside from PGH we will be listening to the director of Saint Luke's Medical Center in Global Saint Luke's Global and we have an architect from Green Architects Philippines who will be speaking to us about design okay so without further ado amabayon o may mentor mo na tayo I think we have a fun poll mo na Dr. Susie okay na throw off ako don't kasi kung na no problem Dr. Susie bago tayo mag bago natin puntaan ng ating main presenter we have a fun quiz for you or game Raymond ikaw na yan okay we have two questions po as mentioned these questions po really hindi po siya require pero we hope you'll be able to to join us for this fun quiz just to be able to gauge ano po ang alam punin nyo and then afterwards ano po ba ang nututunan punin nyo sa ating webinar for our very first question in today's webinar what should hospitals do to prepare for pandemics option A have effective and accessible leadership option B constant review and revision of infection control and prevention protocols option C restructuring of the healthcare worker staff option D infrastructure re-design and restructuring or option E lahat po nang nabangit so we are seeing in the zoom po less than two well more than 250 na po ang nag response sa ating zoom and then for our men team mayro na pong 73 respondents po so we hope mas manami po po ang mag-join sa ating fun quiz we also like to greet those who are joining us locally from the United Architects of the Philippines in Quezon City from the Climate Change Commission in San Miguel in Manila Palawan State University Student Nurses Association in Puerto Princesa in Palawan Alba y Doctor's Hospital Legaspis City Albae the National Economic and Development Authority Region 6 office in Ilo Ilo City and the local government unit of General Santos City in South Cotabato for question number two our question states ano ano po ba ang mga health facilities na pwedein makatugon sa crisis ng pandemya multiple choice po ito option A, hospital option B, health center option C, quarantine facilities option D, sa bahay option E, hotel option F, on occupied buildings and then lastly all of the above so patuyo nyo lang pong sagutan mag-join po kaya sa ating fan quiz we also like to greet those joining us internationally all the way from Chonin Hospital in Taipei, Taiwan nguyan tayo ho poly clinic in Vietnam from Penang Malaysia from Lunici Alley University of Bleda to Algeria from Dubai United Arab Emirates the University of Haile in Saudi Arabia University of Fiji Lautaka Fiji Morningside Nursing and Rehab Center Bronx, New York and then finally from Zurich, Switzerland so maraming-maraming salamat po we all know it's admit of a sacrifice sa iba po ang inyong time zone at we hope this is something that will be useful for you in your work and really in your administrative roles po so we won't be closing this fun poll and just yet as we move on to the introduction of our main speaker ang cute Raymond no, na cute ang talaga ako dyan saan ok so maraming salamat sa lahat po ang mga nakikining and I think you know sometimes we talk about mga crisis kung meron problema pero ito naman dapat pinagahandaan natin pinagahandaan natin kung ano man ang mangyari sabi nga natin kung ka lang tumatatapos so as mabuti na yung handa tayo mabuti na yung meron tayo pero tayong kung baga vision di ba na kung sa kasakaling magtagal pa ito alam natin kung ano nga gamin natin ok so ngayon it's my honor my privilege to introduce our speaker paborito nyo siya alam po and he's been on the on the webinar many times already and we're just very grateful na meron siyang pangkakataon na pinawinlakan tayo na mag-present mag-share ng pgh1 ward concept or system and we're our country is very fortunate that we have somebody in the Philippine General Hospital who's leading the Philippine General Hospital who's very stable very reliable and very credible and alam natin na ano yung di na tutulog to yung sa pang di na tutulog pero kahit di na tutulog to memoriado niya lahat nangyari dyan sa PGH let's welcome Dr. Ghapli Gaspi Dr. Herardo Legaspi the director of the GPGH hospital Gap, hello Dr. Suzy Raymond, good afternoon I'm happy to be here again na mimi-miss ko na kaya yung excited na kung pasamak ko matagal-tagal na rin yung pang-apad kong pa-appearance gan alam na amin busy kaya para anong talaga iniipon namin kung talaga nang talaga so gap welcome we are really very happy to hear about what you're doing what your vision is anong pag-ahanda ang ginagawa natin and just wanted to let you know that there are many hospitals that are watching right now so I think parang maganda may learning tayo Sige Gap, go ahead Thank you very much if I may share my screen ang gano'n haput po sa yun lahat ang dalawang party po itong aking discussion ngayong hapun isa ito ko sa experientian ng PGH sa mga improsaktura sa hospital na naging challenge sa aming lahat nang nagumpisa ang pandemic dahil wala naman po nagbalak na magkapandemi at maghanda doon the last one we had I think was in 1928 to sa huge typoid outbreaker in Manila but after that was the war that was the worst that happened so we have been fortunate to have been supported by a lot of agencies and I would just like to probably thank everyone at this point for that and as we hopefully reel away from the heavy load of COVID we start going back and look at the lessons that we've learned and I thought in preparation for the future from here on it will be good to look back as we have already done with our procedures our medications our protocols is now to a real a hard factor a concrete factor in handling a hospital responding to the pandemic which is the infrastructure ang PGH 514 years old na tayo siya na 1910 at ang design niya parang dinisend niya para sa isang tropical county matataas ang kisami halos 15 feet po malalaki ang mga bintana pero at puro natural ventilation but through the years the demands of patient care have made it really congested even if it was big but fortunately the corridors remain with high ceiling so when we closed to be a COVID referral center in march of 20 almost one year and 20 20 months ago no one year and eight months ago marami po nangyari na gusto natin balik ang ngayong hapon para matutunan at magamit ang kaalaman ito para mas maganda ang ating pag-responde kung meron man sa susuruda pandemya o kaya ating pagalaga sa mga paciente sa kasaluku yung pandemya pwede pa tayong gumawa ng mga adjustments sa ating mga kinalalagyan kami po yung nakakita na na mahigit pa itun libung paciente at sa ngayon po ay bumababang numero nang galing po ito sa 336 na pinakamatahas at ngayong po yung na sa kahapun ay 96 sa mga COVID patients dito ang aming pung healthcare workers ay itang karun ng positive test in 1823 at lagi po namin sinasabi ironically ang pinakakonting infection ay dun sa mga directo nagtatrabah ako sa COVID-19 may dahilan po dito sila marahil ang pinakamayinhat dahil alam nilang directo silang mahawak ng mga paciente may COVID at ang idea nama infect sila ilaging sariva sa kanilang isip at sila ilaging nagbabantay sa sarili nila o kaya lang baka dahil na ang aming mga COVID-19 sa mga Modified Awards based on ventilation and health protocols sa SWED baka mas mababanga ang chance na mga kuha ng infection doon at ito yung napatunayan si Dr. Berba ay gumawa na mga swab test hindi na mga paciente kung di mga surfaces sa aming COVID-19 at wala pung tumubu na virus kung di sa toilet seat sa Kubeta kailangan, ito pa nabukit ay ang mga pangin nangmang mga nangalapang ay mga nangalapang kaya may mga kailangan nangalapang ay mga mga olu ay mga mga mga mga mga ay mga hindi ay mga mga ay mga mga mga mga scientifically and manually at that our COVID crisis team may being mainly surgeons led by Dr. Ocampo, our infection control unit led by Dr. Berbano. The manpower management was staggering. At one point we were housing 1,800 employees in 15 hotels, 10 schools and religious dormitories and Dr. Rodin Dofitas, aimly handled the different personalities, the different needs and the different personal crisis that we went through handling manpower. Now director of St. Luke's Medical City and Global City handled very efficiently and methodically our logistics. I think by now we should have spent around 2 billion pesos for the whole COVID operations and getting the supplies, for food donations, our PPEs was Dr. Serrano's job and of course making sure that the constructions needed were done properly. So in those constructions, going back to them as I was preparing for this lecture, I thought basic principles involving different areas of need for infrastructure could be better discussed in actual details of these constructions. So I think looking back, if a hospital is going to respond to a pandemic like COVID-19, special attention or more attention should be given to ventilation, use of space and making sure that more open space is available should be considered, granting also the small areas at hospitals are built in now because of the cost of land where they are built. And of course the isolation of patients and healthcare workers has been a big reality that we had to take care of and with much difficulty also at the start. And in the long course of COVID-19 infection has been with us, we realize also that we can just, that we eventually make the hospital our home, second home, and that we have to have refuge areas for our healthcare workers that will hopefully dissipate the anxiety, the stress, the fatigue or maybe the longingness of home even if they're in the hospital. And all of these changes should be scalable meaning you can increase them at a given notice and you can decrease them when the time comes that more other services needed to be mobilized. So I'll just concentrate probably our experience in these four areas and start with the most important is ventilation. As I said, PGH is a non-air conditioned facility with high ceiling and big windows. So we had seven days to prepare the ventilation of the wards. So I think our friends who knew the owners of factories of exhaust fans knocked on the doors of these owners and asked to supply us with almost 250 exhaust fans that we needed for the wards. Architect Dan Lee Chawko and Amani Minyan came with engineers to help us study the airflow design that will allow us to optimize the direction and the wind flow, velocity that passes through the wards, these big wards. And our friends from DMCI, Hillmarks Construction and of course our engineering personnel here all put together their effort to install these fans in less than a week's time. So the principle behind that is what we call natural airflow, wind directed natural airflow wherein we blow in wind air to one side causing a negative pressure effect that pushes it to the other side or upwards, which we facilitate with electric fans. So these are the various illustrations that we kept to illustrate the flow of air away from patients and away from healthcare workers in different areas of the hospital. So the unidirectional natural airflow was facilitated by installing these fans that sucked in air from the outside fresh air and then eventually blew it out with the fans on the other side that will blow off the air to an empty garden in the middle. So if I may demonstrate that, so to facilitate air from the front of the pavilion we put installed large fans to blow in the air from the front. And then different exhaust fans to facilitate the flow from outside into the wards here. And exhaust fans that facilitated blowing it to the inner garden inside, which gave us a unidirectional flow of air into the garden. So we estimated that we should using air wind veins that the air exchange around 6 to 8 exchanges per hour. So these are the exhaust fans mounted on the windows of the wards sucking in here and pushing out here. This is the positive fan going out into the garden there. So for us to know if we are effective, we put these slips of tissue paper to always check that the flow of air is towards the garden area. So it shows that and from outside we were blowing fans also as indicated by this strip of tissue paper giving us an idea that almost all the time wind flow to the wards is adequately provided. So we have used this system since March of last year. It's still operational till now. And we're happy to note as I said that the infection rate in the COVID-19 ward is 0.3% as estimated by our HIKU coming from patients to our personnel. So the other factor that we need to put employee in planning for the future responses to pandemic is open space. I think this has been a big problem of all hospitals when they found themselves overwhelmed with patients, not only patients but equipment, supplies, food donations. And there's no place to put them and it became a problem for those running the operations and wastage and spoilage at that. So I think we've been PGHs fortunate enough to have a lot of this space and we were able to mobilize, utilize them to our big advantage. We had spaces in front on the sides at the back and inside the hospital itself. And one of them is a team that we built right before the pandemic opened August of 2019. It was supposed to be a gathering place, a happening place and in fact was inaugurated with the UPC for the orchestra playing there during our Foundation Day. But it turned out to be again a jump off point for a lot of operations from launching our bike, parking our bikes early on in the pandemic for our healthcare workers, accepting the hundreds of thousands of PPEs that we had to stock to give every month and donations from elsewhere, everywhere coming in including beds. We have to prepare for deployment to the work. So a big area is always needed for a big operation and this is a well protected area from the sun and from rain also. So I guess in planning the future we should not overlook that need. Of course it also turned out handy when we decided to have a Christmas celebration at the peak of the pandemic in December of December last year and even hosted the homecoming of Class 1995. So this also of course allowed us to have some camaraderie and cordial activities even for a night. And one of the biggest use for our open space which is the atrium is a vaccination program. So we were able to accommodate at a given time 400 to 500 people because of the size of the facility. So a third need that we had to do was to isolate patients and our healthcare workers and it was really makeshift at the start. I think everyone did this plastic and wood in closure. I'm happy to tell you now that this is all aluminum and glass with sturdy air conditioning and ventilation systems. As a response to a long term need for COVID to be isolated to be built a 42 bed 11 ICU capable in isolation ward which is now ideal in ventilation since we're going to build a new one anyway for negative pressure direction, negative pressure ventilation where in the air is filtered and also you'll be treated as it leaves the exhaust on the roof. So we decided to put up an isolation complex in preparation for that time or in COVID can be our COVID patients. Numbering may be 42 or less as we have experienced in the past. It was possible to be put in an area separate from the main pavilions making the pavilions COVID free. So we very well know how much the presence of COVID patients disrupts flow and processes inside an area. So I think it's a good move on our part to be able to build this isolation complex and it was another effort that was by any hand in nature being jointly funded by private government and government agencies. So the idea there is that we have separate isolations, each one with an independent ventilation. So no air mixes between the compartments, ICU here with a more oxygen and gas piping lines. But I think one important factor here is that you have an air pocket completely separate from the corridors and the wards where in patients, healthcare workers or doctors needing to evaluate patients can do so through windows in the walls of this air pocket without donning PPEs. So we're going even a step further. The new respirators you're buying and they have arrived I think can now be remotely controlled from this station. So we learned that through our wards with the glass partitions that you can actually also effectively manage patients through windows and through remote communication. So this is the interior of that COVID ward. We made sure also that the design was homey so that patients are more comfortable inside. And I'd like to thank Dr. Serana for giving us the beds in this facility all 40 of them. We also installed CCTVs to allow us more visibility of patients when they are already inside and adhere to DOH corridor measurements of two meters. So through this window, we can actually see all of these patients in the ICU. So you can imagine how doctors can communicate through an intercom and give orders based on what they see through the window. We can also see the other wards in the three compartment wards and if you notice there's a window here that allows us to see to the next compartment. So if you look from here, you can actually see to the next compartment some of the patients inside that. So visibility was increased. I think that's one part that lessens the need for our doctors, healthcare workers to go inside and use PPE. So as I said, finally we were able to have an ideal negative pressure system. And you can see the direction of the steam here from this steam producer, steam maker going inside away from this ward. So there's extra protection for the healthcare workers as they walk in the wards because all the air carrying the virus are directed towards the ward and away from the corridor. So the next one is something that we also realize again in hindsight when we went back to our healthcare workers and studied what factors affected them and a lot of them were affected by the fact that they couldn't go home. There was no capability to relax because malls were closed and other areas. So we thought we somehow dissipate some of the anxiety by refurbishing our gardens inside the hospital and allowing them areas where they can partake of some of their indulgences and we put up a coffee shop right in the middle of the hospital. So this is not something we've had in PGH in the past and I think the realization that our healthcare workers needed to be taken care of better led us to this intervention also. Providing refuge areas will also require providing accommodation, good accommodations. And we are now in the process of renovating the nurses home. We have started with this smaller one. This is how it looked like before the pandemic. And during the whole time of the pandemic we started our renovation. It looks like this now restored to its 1911 specifications and the rooms are wider, brighter and busier. So as I said, I think we should start providing refuge for our healthcare workers even inside the hospital. In addition to that, structures are not enough. Just as additional, this is not infrastructure anymore but I guess it's really more of the human touch that you put to all of these refuge areas that will make the caring for them more complete. From all the way from reminding them to moisturize after wearing their N95s to psychosocial care and of course the spiritual and emotional support from our chaplains. So in short, this is just a summary of I think major areas of infrastructure intervention that will help us in the future design a better place to take care of our patients and our healthcare workers. And we have done just that in the middle of the pandemic while we were planning for this 15 story multi-specialty building with the clinical or patient areas in the top four floors. And the outpatient and laboratory, parking, dialysis center, the burn unit in the bottom floors. We realized that we could actually use this as a model to be a pandemic ready building. So in the final design, two shafts of elevators were planned instead of one. The major one, which is seen here as gray, running from the ground floor up all the way up to the top floors of the clinical area in regular times. But on a pandemic mode, we close off the areas that are not clinical, that do not hold patients like the outpatient department or the dialysis area or the child protection unit area and shift on elevator separate from the main one to bring the patients up into the clinical areas into the patient area. So in effect, you are isolating your other areas for continued use so that you can, at the same time, allowing the use of what may be for the pandemic patients. This in particular case may be COVID patients, but separated in transport in an elevator designed specifically to isolate them from the rest of the hospital. So I think this will be an important feature of hospitals in the future so that we don't disrupt all the services. Maybe we will disrupt the wards and the rooms for patients by displacing those that really use them. But at least we maintain and continue services in other areas by isolating the area. So I think that's about it for the infrastructure and just to wrap it up in a bold attempt to make a proposal for hospital organizers and hospital administrators, maybe even the government, that I think learning from this pandemic, we realize that no, you can never really do it alone. That's the worst thing that we can think of in a pandemic like this. So this has been a proposal designed during the attempt for a service delivery network of NCR hospitals which we thought could be looked back into and see if we can use it for the current COVID crisis. So what the pandemic has done is it has impaired access to care. This is the whole hospital. If you were mandated to have 30% to 50% of power ward beds to COVID and unfortunately, those 30% to 50% affected the rest of the 70% more severely that you cannot aptly use the 70% anymore. So in effect, services to other COVID cases really suffered. And as an example of that, when we started doing surgery in June of 2020 in Ura surgery and we were going back to our brain tumor patients, we found that almost 20% of them have died already because of tumor progression or disease progression. So it has limited our ability to do what we do best, giving the other highly specialized care. So maybe if we just get out of the old model of what is going on now, this patient with COVID goes to hospitals that hopefully will take them in and that's why it is very common to hear when they get to us, they've been to 20 hospitals. One patient even saying 40 hospitals all the way from Laguna. So without an organized delivery network, it was a patient in an ambulance brought to any hospital that eventually will take him in. And unfortunately sometimes, just too late, maybe for that patient already on the road too long. So with an SDN service delivery network, the agreed functions of all these hospitals will expand the ability for a patient to have more entitlements to the services of this network of hospitals. But the function or the ability of these hospitals to give service will depend a lot on the general joint management of these hospitals and will require a command center, a command center that will dictate who moves to what hospital at what time during the time of need of the patient. So this is the command center is now the main connection of all the hospitals who in this model do not talk to each other. But as we have experienced in this crisis when the NCR hospitals were organized into a loose referral system, it really worked for us and I thought it would be good to make that a formal tie-up and of course only the government can do that. So another important factor in making a service delivery network function is common financing. So all of these hospitals should know or should be assured that they'll get paid for whatever services they render by whoever patient that goes there. Doesn't have to be a patient from their local government unit as long as the network agrees that any patient that gets into their network gets a service that is common to all of that. So the concept is born out of the ability of hospitals to commit what type and how many beds they can to a common pool of beds that will be used specifically for a particular disease and in our case COVID. So imagine if those hospitals have committed their beds, you virtually have a big collection of or conglomeration of bed units that the command center can use to place patients or transfer them from one facility to the other. And the commitment is up to that point that the hospital can provide without compromising the rest of the services. It is easy to understand how patients who open their doors to patients get overwhelmed because it goes around that that hospital is taking in patients and eventually they get overwhelmed by the looch of patients that come in. But in a command center basis type of referral, no one moves without being given the go signal and they only move to these blue slots provided for by the hospital. So that is having like a virtual hospital with an assured number of beds. So this is another representation of that when you actually take the committed number of beds per hospital and you group them together virtually and you can actually now assure patients that they have a bed to go to within the members of that service or the other way that we can do it also is have an actual hospital. One of these hospitals probably will be closed down completely and taking all these green spots as the main mega hospital taking in COVID patients, relieving these other hospitals of COVID patients allowing them to serve the non-COVID ones. So what will the COVID main COVID hospital get from this? Of course, because these hospitals have allotted this number of beds for that for COVID services, they are now obligated to send this compliment of support whether manpower including resources, respirators, hypo nasal cannulas, to support those beds that are going to be absorbed by this hospital. So you don't abandon this hospital to look for resources on its own. You actually provide from each hospital the appropriate support of the beds you would have had reserved for COVID and transferred to a mega hospital. And to bring it any further, we know that a lot of hospitals have training programs so this other hospital should be ready to take in the trainees of this designated mega COVID hospital. We cannot let and on a rotation basis just like in a war we have conscripts that we train regularly to be able to handle COVID patients and we have that now called EPIC, emerging practices and innovative care in COVID which we have a regular online education for non-IM residents and fellows. So you're able to prepare our doctors and nurses to be sent to this hospital on a rotation basis so that you relieve also the workers of this hospital of chronically being exposed to COVID and the fatigue that comes with it. So that's the one more concept that we have been working on and hopefully further make it more make it have a finer teacher, more specific in nature and we're working on that but the important thing is that all of these participants in the network are willing to pool their resources their logistics and their training. So what is imperative if you take this model if you go this way is the command center and the Johns Hopkins command center has shown how effectively this intervention can improve the efficiency of a network. Of course field health should be able to assure us that we're going to get paid for the services we rendered and also what important and probably the key to making this work especially the referral system is the constant streaming of data from all these hospitals so the command center this common hospital that they'll build so that the command center has accurate data of sending patients to and from the COVID referral centers or even the virtual beds that we will able to that we will put together in an SDN code. So the responsibilities of each hospital involving the service delivery network is that they constantly communicate with each other and that they allow patients already in that delivery network access to their hospitals or their services whether COVID or non-COVID to ensure that there's continuity of service. Of course this cannot be done in a national scale I think it's best done in small district levels or maybe even eventually if it's perfected into a regional level. So the hospitals involving the SDN should be able to access full fund they have additional revenue stream because there are more patients that will come to them in an organized manner and of course the ability of the patients to access care the wide the full range of care even in COVID times is preserved and I think that is the most important point of all. So with that I'd like to end my talk and maybe as an ending again remind you of the lessons we've learned to this COVID that for us to get through this let us fight our fear let us believe in good science let us not put our guard down at any time and let us take care of each other and maybe we'll be really resilient to anything that comes our way. Thank you very much and good afternoon to everyone. Wow thank you very much Gap I think if we could we'd have a standing ovation I think that's really brilliant visionary anything the idea of every hospital having some ability to have a highly controlled infection control unit and if that can be done in every province you can imagine we wouldn't have all these suffering people na balik di nilalamsan sila pupunta So napahoosay talaga oh my gosh Gap na iiakko, nakikimigosin na iiakko while other people are complaining and saying this and that here you are with a solution yun maganda ay di ba parang roll up our sleeves let's have a solution and I think this really is a very what should I say it's a very viable plan it can be done eh Hindi it's impossible Pwede nga gawin to, kailangan lang may will at kagagawin susupportan talaga ng anong ng government. Ayan ako thank you Gap so much thank you so much for that presentation Sana ma, rinig na mga kinauhulan itong presentation mo at magkaroon na na let's do this we can do this we can do it. Did you have something to say? Introducing the next one Thank you so much director Gap really he enlightened us using the systems approach po on how hospital could be prepared and get ready for like a pandemic and being able to provide services also not just for COVID-19 but for other services also an emphasis po on primary care level solutions yung service delivery network nabanggit naman po so very very thankful to director Gap for providing us with a brief overview I especially enjoyed yung pung mention na preserve yung old nurses home nung circa 1911 pa po siya so thank you so much for doing that so now we will move on to our reactions from our two other experts we will have the medical director of the St. Luke's Medical Center in Global City sa tagig po ito pleasure to have with us today Dr. Dennis P. Serano Dr. Dennis Hi good afternoon thank you very much for having me if I can share my screen go ahead sir so that was a very nice presentation by Dr. Gap Dr. Gap is still my boss in PGH and we continue to still collaborate and co-operate in responding to this pandemic so I hope you can see my slides yes sir please go ahead just a brief caption I think the message yung message na gusto mong iparating this pandemic does not discriminate whether you are a public or government hospital or a private hospital and the response challenges and the problems and the responses that we had to come up with at St. Luke's Medical Center at Global City were pretty much similar to what we have encountered in PGH fortunately this time last year I was still working under Dr. Gap Legasti at the director's office in PGH and we were looking for all sorts of things foremost among them were N95 masks that were at that time and of course the ventilators the hypo nasal cannulas and that sort of that was sort of the same thing that was happening in many of the private hospitals in Manila so let me just give you a short story of how we shared during the pandemic grappling with the pandemic then transitioning to the new normal as we sort of call what we are embarking on now and then probably I'll just end with some thoughts and wish list for Attorney Luisa for redesigning for the future unlike PGH which is more than 100 years old St. Luke's Medical Center Global City is a little over 10 years old when the pandemic hit we were one hospital building if you do not count the medical arts building which is not actually house patient so our building that house patient was just really one building it is a 500 bed hospital located in the Central District of Tagig being there we had limited open spaces and that's where I missed the open spaces of the Philippine General Hospital while the Philippine General Hospital had a lot of freeware I think one of the really challenges that modern buildings have is the centralized heating ventilation and air conditioning and that was one of the main concerns when the pandemic hit finally one of also one of the things that we had to grapple with was our small ER space and I will show that to you in a bit so those were the those were the challenges that we had this is the emergency room of St. Luke's Global City at the height of the pandemic really the emergency room can hold around 30 patients it was really designed as a private emergency room it was not going to be a pandemic or a public emergency room it can hold up to 10 critical care patients and 22 moderate to severely ill patients but of course as you well know we had I think between 2020 and 2021 four waves of surges and in every search we had patients overflowing and I think one of the more common announcements that people look out for was the announcement that the ER of St. Luke's is closed for COVID and that was sort of the trigger for all of the other hospitals private hospitals to also declare that their ERs were closed for COVID so what did we do what we had to do was in St. Luke's Global we had to convert our driveway for triage but also for sometimes for taking care of patients and we had to dedicate nursing staff and doctors to patients who were overflowing in the ER in our driveway and it was only till recently probably just a couple of weeks ago that we actually closed the driveway and converted it back to a driveway and we reclaimed the driveway from the ER and what we had to do was in separating COVID from non-COVID we had to move our clean ER away from our ER we actually put the clean ER in our ultrasound area located a little bit away from the ER but still had the same access at the ground floor so we had to make do with separation of the clean and dirty ERs that was a bit tasking for us because the flow of patients from COVID to non-COVID was a challenge also so there was not enough beds we wanted to transfer patients to other facilities but other facilities also were full so the one hospital concept of director Gapri is a welcome solution and I think that we really need to partner with you in terms of that because we can really network better for patients to be transferred not only was the ER a problem we also were filling up our wards and our ICUs let me start with the ICU our ICU allotment initially was 20 ICU beds but of course especially during the last Delta surge convert even our PQ to a COVID ICU and we were running more than 350 patients ICU patients at one time the ER was also semi-converted to an ICU because we could not admit critical patients from the ER because there was no ICU beds to admit them on top of the COVID ICU we still had our regular ICU patients and those were also allot in as far as the COVID wards were concerned our mandate from DOH was to convert at least 30% of our total bed allocation and St. Luke's is a 500 bed hospital the total bed allocation of 530% of that was around 160 beds 20% during the non-surge areas total of 109 beds we all had to close 3 units 3 floors and because of concerns for ventilation and air flow we decided to put all of our COVID general nursing units in the south wing floors and at maximum occupancy that was 3 south wing floors and those south wing floors were converted inside to have isolation ventilation on separate air ducts in order to comply with air flow so that really was an engineering challenge for us fortunately now we were now able to convert back those floors to general nursing units and with the lowering of the COVID cases nationally we are now down to one COVID floor and at any one time we are ready for any surge to convert back these wards to COVID wards the operating rooms was also a problem as you very well know the main operating room of St. Luke's Global city is just in one floor and we could not separate we could not mix COVID cases in that main operating room complex for rooms for outpatient surgery that were negative that had negative flow and we converted that to our dedicated COVID OR and we did that at the beginning of the pandemic up to now that outpatient surgery OR still serves as our dedicated COVID OR and we moved our outpatient surgeries now to the main operating room finally one of the bigger challenges that we had to face was thinking human traffic flow and we have 15 floors in St. Luke's and all of these floors are accessed by the same elevator system and we have nine general elevators for our patients but rethinking COVID traffic for these areas we had to designate one to two elevators for COVID patients and healthcare workers so that was separated and also for that we had to separate flow in the corridors for these patients who needed diagnostics in other parts of the hospital if they needed CT scans they had to be brought down if they needed MRIs they had to be brought down so this was also separated we separated CT scan machines for COVID just in order to be able to have a semblance of separation of human traffic flow in the hospital at the peak of the surge in March our occupancy rate for the general nursing unit was 129% and we were cohorting patients who were family members who were relatives to the same rooms our ICU beds was around 135% and that is because we were running ICU in the emergency room and that went on for several months at one point we had more ICU cases or critical patients in the emergency room than what we had in our labor ICU COVID area so that was how we grappled with the allocation of spaces for the patients but we also realized that in responding to the pandemic we also had to take care of our health care workers and during the height of the surge and the pandemic many of our health care workers were unable to go home we had to give them accommodations they were given free food in these accommodations for those who opted to go home a shuttle service was provided and that shuttle these were not cheap we provided pre-transportation in and around the whole of Metro Manila and this amounted to more than a million pesos of expenses per month not to mention the expenses for the accommodation of the health care workers but at the time of the pandemic the health management of St. Luke's through all the proverbial profit and loss statement or the profit and loss sheet out the window we were not concerned with the profit and loss on a monthly basis essentially it was the response of the pandemic that became the priority one of the things that we also learned pretty much also applied in PH was we had to rely on a lot of remote monitoring for patients in the COVID areas telemedicine remote CCTV monitoring to lower down direct patient contact and then at the same time ensure that our patients were being monitored properly our patients were getting the care that they needed finally as we transition and as we emerge out of the pandemic this was in between waves sometime July of 2020 we realized that we had to reopen the parts of the hospital that needed to take care of the patients that were non-COVID and one of the things that we felt that needed really needed emphasis was in order to convince patients to come back and to get their medical care for the non-COVID concerns we had to convince them that the hospital was safe to come back to little did we realize that in order for patients to be convinced what we had to do first that we had to convince our own doctors that it was already safe to go back and hold clinic so we retrofitted many of the routes in the medical arts building in order to ensure that there was good traffic flow for people the fans that Dr. Legaspi mentioned in wards 1 and 3 were also considered for the individual for the individual medical arts building clinics this was also the time that many people were sold out on getting the HEPA filters and the air filters and I remember this because even in PGH all of the units were asking for HEPA filters for individual rooms so we needed to convince everyone that it was safe to come back what did we do we had to convert or we had to change many of our open limited open spaces but they're not actually open because they're still under central air conditioning to triage areas and to waiting areas and in order to limit traffic of patients going up to the medical arts building clinics and we devised a way to queue patients down in the areas we employed strict scheduling of patients so that there will not be a pool of patients ang conglomerating in the common areas of the hospital finally this is just a wish list for architect Luisa who's going to talk after me we had there's a lot of literature out there for redesigning hospitals for the future looking at versatility, looking at wellness, supporting well-being of the healthcare workers as Dr. Gap emphasized clean air and surfaces the emphasis on isolation, containment and separation of patients finally flow flow not just of health of patients but also for healthcare workers and also for flow of everything else supplies and services and finally digital and physical transformation but for me I think this is something that we need to rethink for many of our hospitals that we're going to retrofit is that we have to be versatile and surge ready because we'll never know when there's going to be another surge we have to incorporate flexible spaces that can serve both as refuge but also can be utilized once there is a pandemic and can be a surge a surge area for the pandemic response we need to rethink how we can isolate contain and separate our individual wards and our individual areas and how we can do that efficiently pass and at the same time may do it so allow the rest of the hospital to function normally for the non-pandemic patients we have to realize that business goes on as usual for the rest of the hospital so I think this is a wish list finally engineering innovations we've heard a lot about air flow there's a lot of innovations now for HBAC for heating ventilation and air conditioning for the new hospitals we have to rethink about human traffic flow and maybe allowing more for open air access sites and I hope that as we embark on redesigning our Philippine hospitals we can ensure this will all be considered because really this pandemic is here to stay with us I think that's my last slide thank you very much and congratulations to Dr. Gap and I look forward to hearing architect Louisa's input on this new changes okay thank you very much Dr. Denis Serano another very good presentation showing what's up it's like there's nothing to do and even for a hospital like St. Luke's which is perceived to have a lot of resources and so on you could also be overwhelmed by just so many people coming in so we really appreciate sharing your thoughts on the private sector and looking forward to having you in our panel discussion may I have to say something no thank you it's been a while since I've seen Dr. Serano's face he used to be one of our preceptors during med school so thank you sir we will now move on to our third and final panelist for today not exactly from the medical sector but really an expert in her field because I want to introduce because when I met our speaker I was just so blown away by her ano rin to hen rin may genius may pangkajenous nilang may pangkajenous genius sa architecture para masob natin problema ng pandemic we always say this lahat ng talino kailangan natin na ito nga ang mga nga sa laboratories but in this case because of the problem of ventilation the problem of crowding you really need people who work on design and really know how to fix spaces so I met our speaker some years back and I was just over some of the work that she's done I said my goodness ito yung mga kailangan natin mga idea para hindi lang para sa pandemya pero hindi sa mga bahat para sa lindul, para sa lahat ng klasing sakuna because we are one of the most disaster-prone countries in the whole world and in terms of climate recently there was a German watch it said we were number four at risk for climate change and it's true pagumulan, bumabaha pag nagdadraot, wala sila lahat ng albi kultura natin we really have to be forward-looking, have a vision but we really need to work with our architects and it's my honor and my privilege to introduce someone to be my friend and I'm actually glad that she's here because I wanted her to meet Gap and to meet Dennis also and put something together so I'd like to welcome Dr. Louis Louis Daya Garcia who is one of the multi-awarded green architects of the Philippines Louis, welcome Hello, good afternoon Dr. Suzy, I am Tickled Pink by your introduction Maraming salamat Also, if I may I'd like to commend also Dr. Gap for his presentation He was talking about flexibility of spaces about versatility naman si Dr. Legaspi and when they were presenting I felt like para ko nakikinig din sa mga architects so it's very clear to me that you were able to discuss these things with many experts and I would like to also patlo lang nagsabi nito si Dr. Suzy, si Dr. Gap siya kasi Dr. Legaspi na si Dr. Serano sinabi nilang lahat na we all need everyone for us to be able to make this work so wala kasing one expert can solve all of these so the same thing with design so hindi po eding isal lang yung aayuse natin and then makakalimutan natin yung iba and so with that I'd like to present to you that my reaction so, kontin kwento lang so this was me three weeks ago in a hospital I'm sure you have done this attire so many days of your lives for the past year but it was a novel for me because I was the companion of my mom I will tell you a story that's not documented this is a documented wala tong scientific basis kwento ko lang many of my kin relatives, cousins, et cetera were affected by covid sabay-sabay kami halas lahat and during this time this photo was taken kasama ko yung mom ko sa hospital and my brother was also in the hospital ang magkaibang hospital sila kasi depending ako anong napasuka namin in this hospital allowed ang companion my mom is 86 years old and she was able to get out of that hospital right away she had a companion kasama ako so meron siyang sort of emotional support at all that whereas my brother who's a lot younger it took him like three weeks in the hospital ang pagal ng kanyang recovery ang anxiety niya iba yung level as compared to my mom pareas naman silang covid with that compared ko yung practice ko in that experience I have to have a scientific backing for that but if we are to talk about green buildings I'd like to believe na meron siyang connection so let's go to covid-19 and their quality we know for a fact that covid is a respiratory disease and that our lungs are affected by the air that we breathe so CDC has already confirmed that covid is air born and therefore inhaling air that's contaminated with a virus can make us sick so ang intention dito is how do we dilute the air particles or the virus particles para hindi natin masagap lahat kasi pag maliit yung amount mas makawanti yung effect sa atin mas marami of course mas marami yung sakit na makukuhan natin again it all depends on our immune system this is similar to if we are conscious about the water that we are drinking the food that we are eating yung cleanliness we also have to make sure especially at this time that the air that we breathe is of quality of good quality so you know this you've seen a lot of photos of this this is a photo of the philippines shere madre on the right and on the left is pre-covid so you'll readily see the kind of air pre-covid so going to building nismano we have to understand that there's a thing called sick building syndrome and the ones presented here are the minor ailments I would say in many studies, in many reports in many researches nakalagay doon that sick building syndrome could even cause deaths for example nalang yung the use of asbestos nati usong-usong pag-amit ng asbestos at tinatanggal na yan ngayon because nagkosya ng maraming cancer sa maraming building occupants and not only that, sick building syndrome is not just physical manifestation it affects our mental and psychological health so marami din studies because you're all doctors you'll be able to see yung mga risks of suicide and depression yung sila sa condo nila mag-isa sila o sa building nila wala sila lugar na lalabasan and so with all of these things no I am privileged to be able to draft a policy on climate smart buildings and beyond green building designs which are all focused on the environment and how we can protect the environment how we can be sustainable in the environment ang focus of climate smart buildings is about humans, about people it has to evolve kasi nakakalimutan natin para sa tao naman ng buildings talaga we have to remember that pre-COVID period people are inside buildings 90% of the time so we go to the office, we go to mass we go to the church, we're staying at home we go to the theaters and therefore the air that we breathe in these interspaces matter to our health to our lung health and also nung after pinakita ko sa foto na after ng COVID ngayong COVID nakarun tayo na mga lock-downs and all that 99-100% we are inside buildings and that really is we should be alerted at that condition so in the climate smart buildings kanina nagbigay si doctor serano na kanyang wish list this is some sort of a plan, a design consideration in climate smart buildings all buildings will have to be holistic so pinag-usapan dito hindi lang physical building design we have to talk about health about the vulnerabilities of the people inside it papano natin siya i-design how do these windows or the roof or the gardens or how do the materials affect the building occupants any mga vulnerability sato flexible ba ito kanina pinag-usapan natin flexibility and we also have to take advantage of technology that we have now and remember in the hospitals may mga wifi na ngayon and we were able to talk to the nurses and to our family members using just our computers or our phones so environmental development is also a big aspect in this because every time we build something every time we develop something progress, construction all that we make an impact we have negative impacts to the environment and therefore our government is very important in this whole discussion hindi lang to pang architecto or pang doctor lahat ng stakeholders kailangan kasama natin dito sinabi ng tatlo natin doctors ahead of me kanina now we need everybody on board to be able to have a solution to this and so climate smart buildings is all about integrated sustainable building ecology you're talking of ecology and science in buildings may ecology din aneyong relationship natin with each other or how do the organisms present visible or invisible affect us in that indoor environment and so before we even go indoors we have to understand ano ba yung nangyari sa site for us to be able to understand how we're going to papani yung goals natin papano natin siya ita target now we have to understand the site but the last when we build new buildings it's very critical for us to find out ano ba yung demographics bakit but we have to understand that bakit ko lang yung mga bedrooms natin or mga awards natin tapos yung mga tao na may sakit ang dami-dama we cannot attend to that because we have to number one upgrade the number of of our rooms alam na natin yung progress dumadami population natin and therefore yung quantity ng mga bedrooms natin we also have to be addressed so marami pang ibalik the site we want to maximize the air because karina impotati impotati ang ventilation and therefore yung wind pattern will have to be simulated may mga computer style to be able for us to be able to identify ganokalakas or ganokakonte ang gusto natin air na iplay palabas or papasok without mechanical intervention so many things that we can discuss now ito yung kanin ang wish list the doctor Serano so I'm sure you were able to discuss this with your architects I've been in touch with Erup one of the top top engineers engineering firms in the world this is how they are designing pandemic resilient healthcare design and it's comparable to the climate smart buildings that we are currently drafting in the Philippines no so meron ang versatility nyo pa ninyo natin pinaguusapan multi-purpose areas ang kailangan natin na datin say pantry gagawin natin siya ng staff unit et cetera has to be surge ready so how do we multiply our rooms for us to be able to bring bring in the patients for example kanina marami examples yung mga garages yung mga parking spaces ginawan natin triage and all that and we also have to support well-being now this one is where the architects can come in because the five senses will have to be addressed just as well-being na ito we're talking of the technicalities of HVAC systems, air conditioning systems we were talking about ventilation and all that but what about our psychological needs do we want to really be in a hospital at this time and at this time na pandemia kukulong ka ay isolate ka anong makikita mo do you even have a garden do you even have a refuge so parang paano ka I was kaya kanina I mentioned about my brother and my mom kasi yung well-being nila totally mga iba when actually they're just in the same room and so we have to have our clean air and surfaces antibacterial ba yung materials natin we have to make sure that our materials are easy to clean less horizontal features I'll show you later the kinds of if I still have the time kailangan less horizontal features para pagdapo ng dust hindi masyado maraming dusting da dapo if possible have vertical yung mga spaces so all the nooks and crannies na nilalagay natin as decorations in hospitals let's get away with those now there are actually three basic considerations when we design whether it's a new building or a a building for retrofit so we have three transmission kailangan natin isipin ano ang pwede natin features when we when we design health spaces surface because it means surface contamination droplet contamination and airborne and as we know COVID is airborne so itong lahat ginagawan itong nang design solutions in an architectural perspective many many things marami examples this one is just an example of the award na yung flexibility nangyayere so from a non-COVID is the one on the left non-COVID or non-surge hospital hallway to a surge unit so ang nakikita natin dito na trend is nagkakaran ng anti-room or a foyer it's a room before you enter a room initially in the past ang mga houses or ang mga buildings palaging may dyan so we call them now lobbies before you even enter a building or a house may anti-room muna so they wait for that so ang trend ngayo ng mga isolation rooms is to have that anti-room so that ang patient will be totally isolated so of course I will not be exploring or expanding on HVAC system but those are very very critical ventilation is critical the number or the quantity ang air change rates per hour is very critical negative pressure is critical so because nga sinasabi natin this is airborne we have to take care of our lungs everything that we breathe should be clean to the highest degree if I may say that and so this is an example of a room puwede kasi siyang pang retrofit pag-limited ang space of course we'll do away with this we need spaces for anti-room and then we'll just upgrade with ventilation so may mga pros and cons for ventilation upgrades and we have many studies on that it's very technical just something that I would like to share with you this is the before and after of your ducting system air conditioning systems ito ng mga commercial establishments the one on the left side was before occupancy construction pa lang yung pinag-usapan natin ano and a lot of commercial establishments kung hindi nga apply ng green certification they just move in so yung occupants occupants come in for as long as meron na silang building occupancy but if you look at the ducting system ganito yung ityura so you know day in day out and then so many so many days well past years hindi na lilinas yung alikabok durin construction is the same air that we are breathing when we are occupying the buildings so what more kapag na sa hospital tayo ang ducting system natin ay hindi masyadong lilinas again the key is we have to clean even the surfaces that are invisible are hidden to us so this are techniques on how to do how to differentiate negative air flow and direct exhaust kind of technical but it was already mentioned earlier and you know we have to also go beyond our building standards na ang building standards natin normally in hospitals ganito lang o good for for a wheelchair and then meron taot but we have to expand that na so pinabusapan din kanina yung mga one-way flow and that's also very critical so if we can expand our hallways we do that as well again air flow na if you look at the history of healthcare facilities in the past palagi silang merong atrium not just healthcare facilities but most buildings most structures in tropical countries meron siyang air flow kasi that's a very critical in tropical areas or in non tropical regions also so you'll see here two kinds of passage where wind passage na yung isais yung longitude na the other one is naka atrium type and PGH you know I'm really happy because it's an old building a good example of an old building na meron siya talaga ng atrium where you can put your garden and because plants can filter the air it's one way of you know natural filtration earlier I discussed about not putting too many horizontal ledges and this is one of the major booboos that I've been seeing just to again tell you a little story I have this client years ago na lahat silang umpamilya nila meron silang asthma and they were saying lahido nila so meron sila yung neighbor nila na kapitbahi nila na relatives nila may asthma din silang lahat and so I told them ano yung mga pwede nilang tanggalin kasi baka na petrigger na asthma and so everything was synunod naman nila to the dot and then when I visited the site visit ako one culprit was the covelighting uso-uso in the 80s I'm not sure if you're familiar with covelighting pero para siyang yung pocket where you hide your light para medyo dramatic yung effect may diffused light ka but if when I went there and saw how how it was andaming niyang mga insect droppings andaming dead insects may mga rodents na mamahay dun lahat so especially in hospitals this is something that's very basic I'm still saying this in a lot of structures hospital and not ni mga covelighting para nilang there are many technologies now technological upgrades lighting upgrades that you can do and get away with this dust accumulating respiratory risk feature architectural feature and I'd like to also mention that we cannot forget that climate change is caused by carbon emissions carbon emissions is through the burning of fossil fuels ginagamit natin sa koreyente natin so we have to ask ourselves in the medical field na napapagaling tayo ng patients napapapasok tayo ng patients because we want to give them a care but what about those who are not coming in as patients how do you care for them we have to think about the the energy that we are burning because carbon emissions napindansa air and which cause climate change and we know that climate change could be climate change is actually bigger than COVID and if we are now panicking because of COVID the ibadayin pang omohay na and we have to also think about climate change because it will really change our lives it is already changing our lives and you know you're flooding and all that remember that walang vaccine sa climate change hindi tayo pwedein mag-lockdown because may climate change climate change would mean wala tayong pagkain because you know drought wala tayong pagkain because baha yung economy natin bagsak and all wala tayong kuriante communication et cetera and we are very unhealthy because of you know pollution and all that so many many layers of problems of climate change and so we have to attend to that and if I may may wish list of doctor serano let's also include the 17 SDGs or the 17 Sustainable Development Goals of the United Nations so these can all incorporated in in any building I would say in any structure or in any office and so to simplify everything that we have been hearing we have come up with three simple terms to remember in climate smart buildings it's called a triple S approach we have to design for survivability and if this is in your mind pa paano ka mga ka survive with this lockdown and all dapat may tubig ka so how do you design for water na may water all the time pa paano pag nagsaray yung utility mo may tubig ka pa rin ba so you have to be self sufficient as well many of us experience this na ka lockdown tayo wala tayong ayuda so where do you get your food so this things so ka ilangan in old buildings we have been promoting this many many years ago and this is something that you can find in green building certifications but for humans to survive in lockdowns and in pandemics we have to think of self-sufficiency how do you make them self sufficient and again sustainability will be a part of any green building design or any green intervention regeneration of sustainable features How do you replenish water? How do you replenish food, et cetera, et cetera? How do you even have corriente when there's no power in the utility? So, because energy is the main culprit of climate change in most projects, palagang yan yung na-uuna i-design. So the target is to really reduce. The projects that I'm going to show yung mabilis lang toh, will be from small projects to big projects to communities, meaning what I want to tell you is there is no limit or there are no limitations when we're talking of green design. So from a small house, we can reduce energy by 80%, water consumption by 50%. So this is a very sustainable house, this one an award, because it's very self-sufficient and this was designed 12 years ago. And nung nagkaroon ng pandemic, hindi nila lakailang mag-air condin, lakailang lumabas, merong silang pagkain makukuka, merong fish, merong fruit-bearing plants and trees and all that. I am telling you this concept because the concepts here, the features, architectural features here are also present in the other big projects that we have been doing. May mga rainwater collection system ito again, iba-ibang solutions, magnitude of the solutions depending on the scale of the project. Now this one is a mid-scale project, this is Bagong Senado, and again the reduction is 70%, 50%. But right now we are discussing if we can go net zero, meaning zero energy coming from bad fuels, from dirty fuels. So we want to do clean energy here, and you'll see we were able to reduce the energy through intelligent systems by applying lang yung parang cover, parang payong, we call it the building envelope. So how do you address that? Now another project is the Metropolitan Theater. I included this because PGH is an old building, same as Metropolitan Theater, but we were able to make green interventions, reduce energy, make the air cleaner, et cetera, through simulations, computer simulations and a lot of experimentations also. And we have daylighting studies medyodumilim na dito sa area na ito, but what I'm really proud of is, of course I'm really proud of the cost na reduce namin na no, but what I'm really proud of is this one. So this is we, at ultrasound ito, you are doctors and you know me mo ultrasound kayo na in buildings meron min kaming ultrasound. And we were able to find the cause of mildew, of molds, of fungi in the air, in the theater, because may bahap sa ilalem. And technology now is very, I'm very happy with technology now, and so you combine it with your practicality and with your green concepts. It's win-win situation for everyone. And again, this is another old building, but not so old na. It's an institution and just to show you yung mga daylighting, daylighting harvesting. You know the reason why I want to point out the importance of daylight harvesting is because alam naman natin lahat that sunlight is a natural sanitizer. And it reduces right away. Yung mga airborne germs and the bacteria natin. Not everything can be addressed by sunlight na, but if we can have that, it can also affect our hormones na. Kusama to this is sick building syndrome research, it can regulate our melatonin, regulate everything. You know the doctors here, I do not even want to expound on that, but really green building should be able to regulate your hormones as well. If you apply itong mga daylight harvesting and all that. And I mentioned earlier nung nagkita nga kami ni Dr. Suzy. Ito yung isong project na pinagusapan namin because this was clearly pre-COVID na na. This was in 2018 na, Dr. Suzy. And again, this is a manifestation of how we should be designing spaces na. So it's not just about technical or technology or about just ventilation alone or lighting alone. We also have to think about triple S na sustainability and self-sufficiency and survivability. And so this are some photos of some projects na. With the features, architectural engineering features and with the green features. And pinagusapan yung flexibility. You know how flexible this project is na, itin kanin ang bahay. We were able to make something out of it na. So you were talking about staff housing. How fast could you build staff housing na? So pa paano kumbig lang nakarun ulit ng surge? And wala ka yung nursing station katulad nung sa PGH na. If we have available lots, this can readily be installed na. These are modular housing units na. And then if you develop that any further, pa di rin siyang maging isang lying in clinic or a small clinic pinagusapan natin na merong, you know, atrium or airflow and all that. It's very flexible na similar to your concept of administration in hospitals. Your buildings also will have to be flexible enough. So just to give you an example of how biophilic design or regenerative sustainability is in other countries. This is an example of a hospital in Singapore. This is the Kutepwatt Hospital. Yung meron silang water view, but this is actually man-made. Dito na ko-collect yung rain water nila. Reused waste water. They created like a lagoon out of it. And then they made sure yung mga patients will have a good view of the man-made lake. Actually green feature nila na. So maraming ways on how to do it na. This is an example of biophilic. And it's the same hospital na nung nagkaron ng pandemic. Yung triage nila was really just outside. So bago pumaso at ma-infect yung loob ng building na dito na sila sa labas. So it was flexible in that way. Datte parang outdoor spaces lang siya, lobby and all. Naging effective siya na nagkaron ng pandemic. And again, the importance of atrium. This is a new building, but again because Singapore is another tropical country. So ventilation is very critical. So more examples of biophilic design. Again, this is, it was presented earlier. It's a sensado ng komunidad alays sa Pilipino. It's an example of how we should be designing really for emergency spaces. So you can thrive in this. It's a multi-purpose facility. Hindi siya magiging white elephant because pwede siya maging training grounds. So pag walang pandemic or pag walang anything, it could be turned into something else. So may social impact because you'll be teaching the community how they can survive during pandemics. May mga yung lobbies nila open or hallways are all open for ventilation. Again, clean energy and the concept of building envelope to pull the spaces inside. And food production is critical. And this is something that not everybody is talking about, yung pervious pavers. The reason why we lack water in a country na andami natin tubig to yung umoulan is because we are closing off our grounds for the rainwater to penetrate din sa ating aquifer, din sa natural aquifer. But if you can create pavers yung imisnahi concrete, magawin mo siyang pervious and bring back the natural rainwater to where it should be, din malelesin natin yung pagbabat ng ating lupa, nagbumababaan yung ating lupa in. Kasi nabumabagsak yung ating water aquifer. And so we should also be designing for resiliency as mentioned earlier. We are the fourth most vulnerable country in the whole world. We've experienced this, typhoon and all. So pa panong gagawin natin? Kung halimbawa, bumabagyo at may pandemian na naman yung baha, hindi makakupunta dun yung mga tao. So how do we design for that? Importante, we work with urban planners and then we must be able to situate or locate our health facilities in places na madaling makapot. And kung baha, dapat meron tayong ready, helicopters and all that. Kasi some people are saying bakit napakasocial ng ating mga units na to dahil meron pang helipad. It's very critical because we have to design based on our needs. Papano kung binahanga yung ating lugar, dapat nakakarating din yung ating mga paciente. And as mentioned earlier, it has to be accessible by water. We should not also be designing only for buildings, but we have to design for the community as well. Location of your health facilities, very critical yan. Identifying the existing buildings or the old buildings that can work or that can be used as health facility. Ginagawa natin yan ngayon, yung mga hotels natin. Bago natin din sa hospital, dapat meron tayong care about that. And I have seen, you have seen, I'm sure, how COVID vaccinations are being done. So we had some interviews with some LGUs and a lot of them are doing those spaces, na na elbow room lam, kaya sinasabi ng DOH siya ka na World Health Organization na dapat 6 feet or more than a meter ang distancing, social distancing. Pero hindi na papatupad because ang nags-a-space plan ito should be professional. Ang nangayari dito, ang nags-a-space plan are members of LGU na hindi sila, they're not familiar with a regulated space planning or how do they even do that? Kailangan may mga traffic, one-way flow, et cetera. And we have to help them. So this was drafted together with the United Architects of the Philippines, itong COVID vaccination center planning guidelines. And so net zero again, we are discussing about this. This is how we should be designing in the future. We have a 2030-2050 target. Kasama tayo sa COP, kakatapos lang ng COP natin. May pangako tayo, may commitment ang Pilipinas na by 2030-2050, meron tayong pinatarget na energy. We have to work with our government. Climate Change Commission is working their best to give us inputs and we have to ask them anubay yung goal natin, ano ang target energy output na kailangan natin para maging mas-efficient tayo. So we'll be able to reach that target because we have to address climate change. And so with that in mind, we have to be designing our buildings, our cities, and everything else towards future zero carbon. And just to end, a few things lang, we have to understand that COVID-19 is a much lesser problem compared to climate change. Nagkaran tayo ng recession and we know that this is a very, very big problem to us, to everyone. Latay apetado. And so if we can at least change our mindset, nagpalit tayo kasi lang mga systems natin from office work, nagkarun tayong work from home, so many things, nag-adjust tayo, nag-adapt tayo. If we can do that because we're seeing COVID as an immediate death situation, immediate life risk. Whereas yung climate change, medyo matagali kasi ang COVID kasi sa buong mundo nangyayari, everything is happening all at the same time. Pero ang climate change pagbumagyo sa Takloban, hindi naman bumagyo sa Metro Manila or hindi naman bumagyo sa U.S. or sa Europe. So hindi natin siya masyadong nafifil. So for some people, climate change is still a concept. Parang hindi makapos masyadong. But we have to remember that if everyone, if all of us can prepare for climate change the way that we are preparing for COVID, then I'm sure we'll be able to handle things very, very well. So we have to remember again that climate change, the mode of transmission of climate change is through the air. And we have to protect ourselves. We have masks and all. And I'm glad that it was mentioned that integration of experts has been expressed in many instances. So transdisciplinary approach is something that we can use in addressing the pandemic. So with that, the message really is very clear for everyone. Binamit narinto ng lahat one, the word one, one word, and then we unify because really we must be working as one. We have to unify and we have to create solutions. Hindi pwedeng, if I may say this, ginagami kasi ito sa construction. Excuse me for this word, but I just recently talked to my engineer and said kasi na papataasan ng ihit. So siin yung masikat, ganyan. So hindi dapat ganon. So we work together and we can do this if we work as one. So that's all. Dr. Suzy, back to you, Dr. Raymond. Thank you. Thank you very much. That's architect Luida. Luida, thank you so much. You can see in the chat how much your talk has been appreciated and we are all feeling very enlightened by your insights. So maraming salamat. Maraming maraming salamat. Okay. So we are close to the top of the hour and let's do our public service announcement and I'm going to ask our panelists to all open their videos. I don't know other cameras. I don't know if we have time for questions, but TVUP over to the PSA. Mama, bayad po. Naku, anak. Tabi mo na yan para masukriyan ko ang mga sacrificio ng sanatawmbayan. Mapagbigay po kayo. May kita ko ang mahal na mahal ninyo ang inyong pamilya. Tamaka. Kaya nag-alala na ako. Paano ba matapos ng pandemiyang to? Para matapos, umpisahan na ninyo. Magpabakuna na kayo. Paal ko kayo. Magpapabakuna ako. Thank you so much, TVUP. The COVID Communication Public Service Announcement is one of the many outputs of the UP Research Entitled, Communicating COVID-19 in post-quarantine Philippines. It's headed by the UP Vice President for Public Affairs, Dr. Elena Perna and funded by the Department of Science and Technology, PCHRD and the Department of Health through the AHEAD HSPR project. Dr. Susie? Yeah, Raymond. I think we have time for only one question. So it's your choice, Raymond, what the question is. Well, this one question, which is I'm also interested po, and I don't know if any of our speakers will be able to answer this. But is there any incentive from any international group or from the government for healthcare facilities and hospitals to go green any certification that they will need to undergo so that they're certified to be as a green healthcare facility po. Well, if I may answer, Dr. Raymond. Go ahead. So nima green building certifications ngayon and these are almost kabustuhan ng administration ng hospital, no? So wala pang masyadong rewards ngayon, very content if mayro na, no? But ang lagi namin sinasabi dito, ang panalo dito yung tao, no? So if we are to do a green buildings, it has to be because not just of the patients, but because of the staff as well. Alam naman natin, yung kakulangan natin ngayon ng medical workforce, di ba? So if we can, if we can give them a good place or, you know, pa marirating natin din sila. So, meron na rin ng yung green building certifications ang tao sa kanya ay well, no? It's focused really on the health of the building occupants. Okay. Unfortunately, we don't have time for discussion. I think we need a part two sabi, no? We're gonna, anyway. So let's see. We're going to give our speakers a few minutes to just formulate their parting words while Raymond is going to answer the poll and then do the evaluation. Raymond, go for it. Thank you, Dr. Suzie, as our panelists are collecting themselves for their final messages to the audience, we'll go through the two quizzes from the pond poll. First question, what should hospitals do to prepare for the pandemic? 91% of the respondents of the 787 respondents chose all of the above. That's the correct answer po. Kailangan po natin lahat, effective and accessible leadership, constant review and revision of infection control and prevention protocols, healthcare worker restructuring, infrastructure redesign and restructuring. For the second question, ano-ano po ang mga health facilities na pwedeng makatugon sa crisis ng pandemya? Again, ang, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay, ay First question, the panelists demonstrated thorough knowledge of the topic. Number two, the panelists were well-prepared and 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. We will not be closing the evaluation poll just yet as we move on to our final messages. Okay, so we just need a very short few sentences from you for our frontliners who have been with us today. And what are your parting words? So we'll start with you. Oh, okay. Hold on. Oh, there, okay. Well, the country is still battling COVID, no? Alam naman natin yan lahat, severely. And we have a lot of limitations in pandemic preparedness. And I'm really glad that this is happening because we are helping our community, our brothers and sisters to be prepared for the pandemic, no? But we have to speed our efforts, no? And we have to also make sure that if we're talking about COVID, for preparing for COVID, we also have to be prepared for climate change. Kasi pagdating ng malalaking pandemia ulit because of climate change-related pandemics, it's going to be very, very difficult. And so again, as I mentioned kanina, battling COVID has required each of us to do our part. We changed our habits, nagkarontayon ng disinfecting of hands. We adjusted our lifestyles. So, you know, we made many personal sacrifices. And if we can do this in our homes because our homes can also be health facilities. And para hindi natin makklag, no, yung hospital system, we have to do this and we have to take apart our part, especially tayo. We are influencers here, if I must say, because we are being heard, no? So if you can tell everyone to tamayon, mag-vaxin tayo and we have to plan our building facilities very well, then matutulungan natin lahat directly or indirectly sa pandemics na ito. Okay, thank you very much, architect Louis. Okay, let's go to Dennis. Dr. Dennis, please. Thanks, Susie. We've learned a lot over the past two years of this pandemic and we still continue to learn everything. So I just enjoy everyone to keep on listening to the experts, follow the advice of our experts and let's just cooperate in order to end this pandemic once and for all. Thank you very much, Dennis. Gap. Oh, ulit-ulit yung sinasabi. I just like to repeat again the four lessons that I have personally learned from this pandemic. Fight the fear, believe in good science, never let your guard down, and let's take care of each other. Thank you very much, Susie. Thank you very much, Dr. Gap. Please ask for the Philippine General Hospital. Okay, so just to close, I'm not going to give a long summary. I just wanted to say that today we spent some time thinking about what we're going to do in the future. And PGH has shown us their plans, which look very feasible to address disruption of services for non-COVID patients, the anxiety of health workers, confusion about patients where to go, and the need to just overall improve our health facilities. So they've shown how engineering innovations and design can be applied now. So in the future hindi tayo magkahagan ito. Dennis Serrano, obviously it looks, also talked about all the issues, especially around traffic inside hospitals. How do you use? How do you change? How do you retrofit? How do you become flexible and adaptive? And so I think the main message was that it's not just the public hospitals, but even private hospitals that are well resourced have to deal with this. And of course, Louie walked us through design, smart design, climate, sort of climate resilient architecture. And I would say that, and I've seen this in some of the literature that whatever we're doing for COVID is actually good for climate change. So we have to, the same response that we have for COVID is the response we're going to have to have for climate change. And just on a little note, right, we are supposed to work together so that surface temperature of the earth will not go beyond 1.5 degrees Celsius. Well, in July 2021, it was already 1.6 degrees Celsius. So yung sino sabing, hindi kami nananakot when we're saying that there's something more that's coming, but this is based on the science. So it was a great, I think a great webinar for me. I felt that I learned a lot and I'm very inspired by our speakers and I'd just like to thank you and our audience for being with us today. So over to you, Raymond. Thank you, Dr. Suzie. For those who are asking, we will be collecting all of the questions that we have in the Q&A and also in the chat. And we will be relaying them to our experts and then aggregating all of the answers and posting them later on. I would like to take this opportunity to thank our really excellent panel of experts for today, not every day that we're able to be graced with their expertise and their presence and really be able to learn from the nuggets of wisdom that they have shared not just from the health sector but from a more holistic perspective using the systems approach. Very, very important to note that teamwork is critical. A collaborative approach is necessary for us to be able to get out of this pandemic. So maraming-maraming salamat po. Director Gaplegaspi of the Philippine General Hospital. Director Denis Soranoff of the St. Luke's Medical Center. And architect Louis Diagarcia of the Green Architects. Maraming-maraming salamat po. You will see in the chat how you're well-received and well-loved and they really are very much receptive to all of the knowledge that you have imparted. Maraming-maraming salamat din po sa lahat po nang ating nakidalo sa ating webinar for today. I'd also like to take this opportunity to thank the very hardworking team behind the Stop COVID-19 Webinar Series without each and every one of you will not be able to provide this quality content week in and week out po. So maraming-maraming salamat po sa inyong lahat. And finally, all Stop COVID-19 Webinars 77 na po, no? And will be 78 right after this webinar or archive for viewing at the TV-UP YouTube channel. So please feel free to watch them on the playback. Kaya anuman po ito. We will be especially highly recommending this webinar just because it's something that encompasses not just the work but also in your home if you're looking into incorporating any of the recommendations by our experts. So this formally closes our webinar for this week. Next week po, maganda po ang ating paguwasapan. It's not something that we have been talking about probably more consistently and more often than how we should be doing it. But we are really looking forward at least for our experts to join us for next week and this will be about COVID-19 testing. We look forward to your company again next week. Same time, same channel po from 12 noon to 2 pm. Every Friday, let's make this our regular Friday lunch date. Lahat po, nang inyong mga kasamahan, saan na po ay makajoy na po sa ating Zoom webinar lala po yung mga nag-watch party po either in Facebook at sa YouTube po. Saan na po makapasok na po sa Zoom for next week. Maraming-maraming salama po. Makita-kita po tayo ulit. It's a day. Okay, thank you very much Raymond. Next week, as Raymond said, it's about COVID testing. Ano bang mga bago sa COVID testing? Magpapatesk ka ba kung na-vaccinate ka na? Merong ka bang merong bang testing na dapat gawin pag atapos mabakunahan ano ba yung antigen test? We will talk about all things related to new forms of testing and we'll see you next week. So together, we can stop COVID deaths. So keep safe, keep healthy, and see you online. The enemy remains unseen. I'll keep your hand in mine. Let's say a prayer one more time. I know you long for home, but I am here, you're not alone. 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 and ask, do I have strength to carry on? Oh God, how long must this go on? And leave you here to keep me strong. I'm here to hold the line. I'll keep my hands His name to read. Just hold on to the word. 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 and ask, do I have strength to carry on? Oh God, how long must this go on? And leave you here to keep me strong. I'm here to hold the line. I'll keep my hands until my hands die. From my fears, the other's lives before my tears. But right behind the mask, I look into myself and ask, do I have strength to carry on? Leave you here to keep me strong. The other's pain before my tears. Pushing on the spite of tears. These things through another day.