 Welcome to the 47th installment of the Stop COVID Deaths webinar series brought to you by the University of the Philippines. Magandang hapon po sa lahat at puna saanman po kayo sa Sulok ng mundo. I'm Dr. Raymond Francis Sarmiento, Director of the National Telehealth Center, National Institutes of Health, University of the Philippines, Manila. Today is aro ng kagitigyan wherein we commemorate po the fall of Bataan and also the sacrifice of all of our heroes po sa aro na ito. First and foremost that comes to mind ngayon po sa ating pandemic ay ang ating frontline healthcare workers and a part of that also is to try to understand ano po ba ang nangyari ngayon at ano po ba ang mga pwedeng mangyare sa mga susunod pa po mga buwan. As always po, I'm very happy and proud and honored to share hosting duties with our adjunct research faculty at the National Telehealth Center and also the Special Envoy of the President for Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie. Hi Raymond, maganday aro po sinon lahat na ang mga mahikinig. Those of you who are watching us on YouTube, on Facebook and on the playback. Raymond, how many webinars na? Sabi mo 40 what? 47. 47. Okay, we have been together for 47 weeks and I know a lot of you are having great difficulties. It's a difficult time now. I think from the beginning of the pandemic, we have not seen this level of transmission of SARS-CoV-2 and we wish we had a crystal ball to kind of see what could happen in the future, but as we always say, laban lang tayo tiba. We're here together, we're here to support you and I just like to thank all of you who have regularly been listening and joining this webinar series where we try to bring you the very best of our health professionals and as Raymond said, we truly appreciate what everyone is doing. We know how difficult it is for you, the doctors, the nurses who are watching the staff, the pharmacists. Napakahirap talaga ng situasyon ngayong, but we don't lose hope. We are here, we're gonna slug it out and we are going to succeed. So we're not gonna give up hope, we're going to continue to do what we need to do and tulongan tayo, let's help each other. So today, we've got very, very good speakers who will enlighten us, who will tell us about trends, who will tell us about variants and treatment and all of these things that we need to focus on. There's a lot of noise out there para daming misinformation, but when you're with us, you know that you've got credible speakers who will really prepare before they come here to talk to you. So welcome to the webinar. So Raymond, here we are. I think, okay, so before, Raymond has some announcement, but before that, actually I do have an announcement from TV UP. So let's go to our special announcement for everyone. Okay, so congratulations to R.D. Lopez, who wrote, you know, that music that we play at the end of the webinar is an original. And bakikita ninyong parang merong guide doon sa ending na parang gumaganon siya. Yung anakasin niya front line na nilong. He wrote this song, I will hold the line, I'll hold the line. And it just won an award. Go further change maker award in the Henry Ford Awards for this song. So we are so grateful to R.D. for allowing us to use this song and it's become our battle cry. We're going to hold the line. And we're very proud and honored that you have received this award. So congratulations, R.D. Okay, over to you, Raymond. Thank you, Dr. Suzy. And congratulations po alet kayser R.D. Lopez for that Henry Ford Award. We're very well-deserved po at parami salamat po sa pagpapahiram ng inyong kanta para sa ating webinar series po. We are now numbering a little over 1,200 participants in this Zoom webinar. Pero dun po sa mga gusto pa po ang sumale, please invite them, please encourage them to log into the Zoom webinar. For those who are malakihan po ang pagpapano'od, we are being livestream po in three Facebook pages. That's the UPC's Tempo na Facebook page, that's the PBUP Facebook page, and the Stop COVID-19 Facebook page. Yun po ay dag-dag po sa ating YouTube na livestreaming din po and all of our recordings, all of our 46 previous webinars patin na rin po ito, kagakapos po nito, you could watch it in the playback dun po sa TV UP channel po nila sa YouTube. I'd also like to thank this, take this opportunity po para pasalamatan ang very hardworking team behind the Stop COVID-19 webinar series. Without each and everyone of you out there po, hindi po mapapangyarihan itong ating learning series na ito and we hope that we could sustain this sama-sama po tayo as we try to learn more and more about this virus and how to, well essentially get through this pandemic po. Over to you, Dr. Suzie. Okay, thank you very much Raymond. I think what we're going to do now is we are going to launch our poll, so you remember we always have a poll which is, you know, we want you to have some take away messages and so we're going to launch the poll. Of course, the poll will ask about where you're watching from and so on. So I'm handing over to Raymond for this part. Raymond, go ahead. Thank you, Dr. Suzie. As always po, we want to be able to get sort of the demographics for all of our participants dito po sa Stop COVID-19 webinar series. Ang unang-unang katanungan po, palagay, ay saan po ninyo ito pinapanood what place are you viewing this webinar from? The options po are, well the regional options are as follows, Metro Manila, Northern and Southern Luzon, Central Luzon, East Visayas, West Visayas, Central Visayas, Northern and Eastern Mindanao, Western and Central Mindanao, Southern Mindanao and outside of the Philippines. Alam naman po natin lahat na marami po at meron po nga nanonod po sa atin abroad at salabas po ng bansa. For those who are in the webinar po, I'd like to take this opportunity to greet our attendees who registered and have logged in all the way from Lamut Ifugao in Cordellera, Amnistotin region, from the West Visayas State University in Ilocillo City, the Northern Samar Provincial Hospital in Katharman, Eastern Visayas, and the South Davao Medical Specialist Hospital in Padada, Davao Del Sur, as well as the Surigao Doctors Hospital in Surigao City in Karada. Internationally, we also have attendees po, at least those who have registered from the Institute of Biomedical Sciences, Academia Sinica in Taipei, Taiwan, from Universitas Advent Indonesia and West Bandung Indonesia, ITM University Gwalior in Betaya, India. Those from Singapore, Hong Kong, Ho Chi Minh City in Vietnam, Sunggai Petani, Malaysia, Riyad, Saudi Arabia, and Najran, Dubai, United Arab Emirates, Muscat Oman, from Bonifatius Hospital Lingen, Germany, medyo ano po, no pun intended, do the name, Troy, Michigan, United States, Farmington Hills, Michigan, Geneva, Illinois, Lexington, Kentucky, Niagara Falls, Ontario, Melbourne, Australia, Canberra, Australia, New South Wales, Australia, Auckland, New Zealand, American Samoa, and this is the very first time we are also being joined by someone from Diego Garcia in the British Indian Ocean Territory. So, maraming salamat po sa inyong pakikinig, panonood, at pag-participate dito sa ating webinar. Number two po, question is what is your line of work? Most of our participants, those who have logged in are from the medical and nursing sectors po, they have comprised nearly 60% of all of our attendees, hopefully you'll be able to key in your answers and then we move on to our questions po. Question number three, it states, how much more transmissible is the B117 variant? Ito po yung unang nadiscubre sa United Kingdom po, na variant. Magano po ba siya nakakahawa transmissible po? 26%? 56% or 76%? Those are our options or choices. Number four, the economy can only recover if the public health crisis is contained. Only only have two choices, either true or false. And number five, our last question, which variant of concern ang unapong nadiscubre, first discovered in the Philippines, B117, P3 or B1351. So, for those who are still trying to key in, I'm seeing a whole lot more of our 1,400 plus attendees participating. Paking input lang po ito and may I ask TVU people to flash on the screen yung pung ating certificate. Ano po ba akikyura ng ating certificate? There you go. For those who are asking, so ang sequence po kasi ng ating webinar, it's usually someone, we have our opening remarks speaker, we have all of our main discussant or discussants, or reactors, and then we go into a Q&A panel discussion. If you have spent at least half of the webinar duration dito po sa ating zoom, you will be eligible to receive this certificate and also a copy of the presentations po of our speaker. So hopefully you'd be able to stay on at a very least po 50% pero sana po the entire duration of our zoom webinar. For those who are asking, we have already distributed all the certificates for the past 46 webinars. So if you feel that you should have received one at tingdi po kayo naka-received, please let us know through stopcovid debts at up.edu.ph. Over to you, Dr. Suzy. Thank you very much, Raymond, for that. And for all of you for participating in our survey, we're going to get some answers to those questions. Okay, so right now, I'd like to welcome our guest who's going to give opening remarks. You know, recently, we have been inviting people who are not medical doctors, you had Maharlag Mayay the other day who's actually a geologist. Today we have an expert in economics and a professor of the UP School of Economics. I'd like to welcome Professor Tobe Melissa Monson. Hi, Tobe, welcome. Hi, excuse me. Hi, everyone. Thank you for inviting. I'm not exactly an expert. I'm an economist. You're an expert. Okay, you know, Tobe and I go back a long, long, long, long, long way. Long. Many lives ago. Many lives ago. And I think it's very interesting. We were working together on disasters when we were in our late 20s. Is this correct? Yeah. Okay, so let's take about five years ago, right? In a tubo and stuff, in a tubo and all that. Yeah, so we were working together on disasters. And she was working with Caritas Manila. I was working with the Kapakomahalco Foundation. And I remember we went to flooded areas in eastern summer. Yeah, northern summer, Katharman. Yeah, so we were together on the ground in some of those times when people were stuck on top of roofs. And we couldn't pass through roads because of landslides, because of the earthquake and so on. But I can't imagine, Tobe, that we would be working together again now because of this unthinkable disaster that we're in. I mean, you know, at least in the past, those were kind of localized, right? Whether related, local. We could, we could, there were kind of parts of the country are spared so that help can be given to very local areas. But now, but I think you're going to talk about this, that the Philippines is not, I mean that the COVID situation is not uniform around the country. I'm not going to pre-emput you're going to talk about. But anyway, thank you for joining us. And, you know, guys, Tobe has been publishing some articles on the economic side of COVID-19. And she's been talking about health and economics. And I think we should not let this opportunity pass that our country does not put in the proper investments in public health. So sabihin natin dito sa webinar, lahat ng talino ng Pilipinas, kailangan natin gamitin, hindi lang yung talino ng mga nasa health sector, pero pati sa ibang mga larangan, kasi ang solution dito ay maraming, maraming ibang sector talaga, ang kailangan magsama-sama at gumawa talaga ng plano para hindi na maulit ito. Anyway, enough of that. But welcome, Tobe, and please give your opening remarks. Go ahead. Thank you. Okay, good afternoon, everyone. This is taken from a publication we did have sometime in November last year, myself and a colleague. Okay, at the onset of the COVID-19 crisis, it was thought that strong macroeconomic fundamentals would carry the day for the country. We were coming from about a decade of high and robust growth. Our credit ratings were at their highest ever. Our fourth quarter GDP growth in 2019 was second only to China in the ASEAN 3. That's three. Thus in mid-March, but March 16, 2020. Tobe, tobe, hold it. Do you have a presentation? No, no slides. Okay. No, no, no. Go ahead. I was wondering if you had slides. I was wondering if you had slides. Sorry to interrupt. Okay, go ahead. Sorry. Okay, so in mid-March last year, economic managers reassured us that economic fundamentals are on our side and that even under the worst possible scenario, the Philippines will grow in 2020 and in the medium term by about 6%. So this is when the lockdown happened. So that's like the famous last words, right? This is clearly not happened. By the second quarter of 2020, we had a contraction of about 16%, which is our lowest quarterly growth in four decades since 1981 and the second lowest in the ASEAN plus three. We were also predicted to have the worst projected economic growth outcome in 2020, of the sharpest reversal from country performance in 2019 among my neighbors. So the question was why? Why despite strong economic fundamentals did the country do so poorly? Our managers largely blamed or accounted for this by describing the strict community quarantine imposed in March 2020 that was extended until the third quarter. However, this is a somewhat circuitous argument because the lockdown precisely suspended economic activity. It restricted mobility of people. We couldn't go out. People couldn't work, et cetera in order to hold the pandemic at bay and buy time for the health system to organize itself. In other words, the lockdown did not cause the economy to contract. Rather, the economy was contracted. Activity was suspended as a response to the virus. Rather than blame the lockdown per se, a colleague and I had a different thesis. We noted that the Philippines version of the lockdown seemed to be the longest and most stringent in the ASEAN plus three region. Other countries, Vietnam and even Singapore, South Korea or China did not use such an extreme measure nor use lockdowns for prolonged periods. And so we posed the hypothesis. Rather than the timing, intensity or length of a country's lockdown per se, do the different capacities to detect and respond to the COVID-19 outbreak. Account significantly for the different economic outcomes among countries in the region. Sadly, we found the answer was yes. Implementing a cross-country model, we found that stronger national capacities to detect and respond to emerging outbreaks are associated with better short-term economic outcomes. For the Philippines, better prepared laboratory systems coming into the crisis could have saved up to 3.6 percentage points in lost GDP growth forecasted in 2020. What does this mean? This is equivalent to about 700 billion pesos. So if we had just done our homework when everyone was doing that homework in the early 2000s and if we had listened to our own experts that we had to be better prepared for emerging outbreaks, perhaps we would not have suffered such a contraction in the economy. We also found evidence that the traditional channels via government spending to increase output and stabilize the economy are overshadowed by the importance of having specific core capacities precisely to detect and decisively respond to the COVID-19 pandemic. Put another way, if COVID-19 is not first well-contained, then government spending aimed at other things may not matter for economic recovery and could even make things worse. The implication is clear. Health system capacity must be prioritized over and above other types of spending, including build-build-build spending. Unfortunately, the budget for 2021 does not quite reflect this. If I'm not mistaken, the 2021 budget decreases the budget of the DOH and other related items by about 25% that may not be as accurate as before and increases allocations to DPWH and DOHDR for infrastructure spending. And now we see NCR again in an ECQ but this time without allocations for any sort of ayuda to households. In other words, we're back at the relief stage and we don't even have that. We don't even have recovery budget, much less relief budget. What is our challenge today? We need to convince officials and stakeholders who are concerned for the economy and for economic recovery to focus on capacitating public health systems and get out of this bowl. This is a big ask because they're just not accustomed to thinking in that way. But it would help to identify more precisely what capacities to invest in as a matter of priority, in what sequence and where and at what level of the public health system, national, provincial, city, municipal, clearly the crisis has proceeded at different speeds and intensities across the archipelago and so it may not make economic sense for all regions or cities to invest in the same capacities at the same time in the same sequence everywhere. In other words, a one-size-fits-all solution doesn't make sense. So given budget and time constraints for instance, should all provinces and cities be investing in a vaccination rollout now? Would it be more efficient and effective for instance for some regions and provinces to focus on developing better contact tracing infrastructure precisely to avoid what has happened in NCR? I hope this webinar can help us answer these questions. Thank you. Okay. Thank you very much. That's Professor Tobi Monsaud of the School of Economics of the University of the Philippines. And we're going to keep Tobi, you can stay, right? So Tobi will be with us in the panel and we have a Q&A box over there which, you know, you can put in questions there. And we're actually going to ask our panelists to answer questions that come up. So thank you so much, Tobi, for that framing. I think in this webinar, we usually talk about more of the medical and the health and the public health side of stuff and occasionally we have had speakers like you we had Professor Perna also speak at some time on the economics of it and I think in the future we have to do more of it. So thank you so much for those opening remarks. All right. So we have a we have a person on the street set of interviews that TVP prepares for us on the topic and our topic is you know, COVID takang ano ba'n topic natin? The entire topic is what are the scenarios for the next 12 months? And I think we are all it's a good thing to be forward looking so that we don't we don't get mired in the difficult situation we are in right now. So TVP has done some interviews. So TVP please take the platform. More than a year na yung kaso ng COVID natin at hindi siya bumababa siya ay pataas palagay ko ang kailangan natin kami ngayon ay magtulungan natalaga ang government at saka ang mga mamayang Pilipino. You know, give it to science actually what is happening now is science, data analytics Dapat imantin the health protocols such as social physical distancing frequent washing of hands, face shields, face masks. Huwag masyadong dumabas kasi ayon natin may expose natin din yung sorgilin natin yung family natin. It is not really so important never go out na lang. Kasi ito ang satingin ko ay balaking contribution to prevent or to minimize the increasing the increase of the virus the spread of virus. Maging truthful lang tayo when kapag alam natin may sintomas tayong nararamdaman na related na pwedeeng related sa COVID-19 kailangan gawin ng bawat isa ang responsibilidad nila para malabanan itong pandemic na ito itong COVID-19. The people and the government the national government ang taosa na may realize sa of then kailangan tumulong para ma-realize ng government ang kanilang objectives. DOH should really do their jobs wag yung para ka mga namumuno iba-iba yung pinapalabas vaccination should be sped up. Ilangan nilang iimprove ang kanilang procedures iimprove ang kanilang protocols iimprove ang kineng testing and treating sa mga taong infected ng virus. Hindi matigas ang ulog ng mga taong sila ay pagod na halimbawa sa level ng mga taong mahirap talagang mag-stay sa bahay nakakabagod na yan lalo pa sa mga taong na maykulam sa kanilay kakabuhay nakakapagod yan. Ako later on hopeful ako na dadating tayo sa point na yung COVID-19 ano na yan kaya na natin siyang i-manage kung anong mga natutuna natin sa pandemiyang ito mababago nito kung pa ano natin siya alaban sa mga susunod panahon. Thank you very much TVP and those who participated in those short interviews. We're going to the main part of our program which is we have our main presenter. Our topic is COVID-19 what are the scenarios for the next 12 months to introduce someone who is actually has actually been working very quietly behind the scenes throughout this whole pandemic but his work has been so powerful and he's an epidemiologist he's currently professor of the Atameo School of Medicine and Public Health and he's the co-founder and senior technical advisor of Epimetrics. So Dr. John Wong is a expert in many government panels when it comes to epidemiology and even in the assessment of medications or drugs that are used in the country. So I'm very pleased to welcome John welcome to the webinar. Thank you Susie for that kind introduction. O sige John Ano, kamusta na ba? Kamusta na tayo? There's a short version and then a long version that I'll present later. Okay my short version is how are you doing? I mean are you even able to sleep with all the work that you have to do all the analytics that you have to do? Since last year I found that may quality of sleep fluctuates up and down with the level of quarantine. So you mean more quarantine more sleep? Ganon ba? No, more quarantine less sleep. I think Raymond that's a common thing. Parang well for those of us who are working in public health and our frontliners there's rest but it's not really rest. So anyway John go ahead with your presentation everyone's waiting for you. Okay, thank you. I'll share my screen. Can you see my screen? Yes, sir. Go ahead. Okay. So I'll talk about pandemic alternative futures for for the Philippines in terms of the pandemic. So this is how I'm going to structure my talk now. Where are we now? How did we get here? Where do we want to go and how do we get there? So just briefly because I think everybody knows what's happening. So here we are now. It's more than twice the August peak that we had last year. And it seems to be peaking but we had to wait with a few more days before we say that it's good news. But I also want you to I want to draw your attention also to the pre-peak period. After the August peak we sort of plateaued during this period. It was lower than the August peak. But it never never really got down below maybe 500 cases. And we we were sort of happy with this with this low level of cases. So just remember this. I'll talk about I'll come back with later. And this is the the curve for our cases. So as cases have gone up that's also started to go up. Hasn't reached the peak of last year but it's past 75% which is a significant line. Okay, so how do we get here? This is a search which started in February. So one way to understand the pandemic is to look at it as a system. So if we look at it holistically we know what states what health states people are in and how do they flow from one health state to another. So for example we can divide the Philippine population into five or six compartments or buckets. So most of the population is here. We're susceptible. We're not sick. People who have to go out in spite of the quarantine have to travel. Have to go to the workplace. They will be exposed because they're mixing with people from other family bubbles. Most of these people will not be infected but some will be infected and then become infectious. So these people some will be high risks. Some will be admitted to hospitals. Most will recover but also some will die. So if you look at this system diagram of the pandemic it becomes easier to understand how we got to where we are. So for example susceptible can become exposed. So if we want to reduce that we have to reduce exposure. So we have to do things that reduce the transmission rate. This is something that we cannot influence. It's the incubation period. This is a characteristic of the disease. But this is where we can influence things. How do we increase recovery rate? How do we reduce the death rate? If you look at the other direction the more active cases we have the more susceptible people can be exposed. But there's also a silver lining. There's another bucket or compartment which is immunization which we have now. So one objective would be to dream the susceptibles so that more you immunize and then fewer become exposed. Let's talk nice about R. I think a lot of you have read about this in the papers or the basic reproduction number which is a number which measures transmission. So we see this in the papers every day. Or the time-dependent reproduction number. But more important than the number because the number is actually just an estimate. It fluctuates up or down. But it doesn't tell you give us much information. What is more actionable is to understand what contributes to reproduction or transmission. So it's the transmission rate of the virus. It's how many people we have contact with let's say in a week and if we're infected how long we are in the community infecting other people infecting our household or infecting people in the workplace before we're isolated. So these are the things which have contributed to the increase in reproduction number. The variants low compliance to the non-pharmaceutical interventions we had a couple of super spreader events starting last December. There's increased mobility because of the opening of the economy and poor indoor ventilation. We began to understand that aerosol transmission is a significant driver of infections. In fact it was in the newspaper today that CDC finally reversed itself and said that for my transmission or transmission through objects it's not a significant or a major driver of transmission. And then this one the duration of infectiousness is influenced by if we're sick if we're symptomatic how long before we go for testing and then how long before we're isolated in quarantine and how long it takes contact tracers to trace other contacts and have them quarantined. All of these can either increase or decrease the duration of infectiousness. So let's look at this. Let's start with variants. So this is just a simple analysis comparing cities with the variants and those without the variants. This was early early March data from early March. So at that time some metromagnetic cities had variants the others did that. So of the patients with variants their symptom onset date median median date was around here mid-february in cities with B117 variant also known as the UK variant although we shouldn't be using country names those with the B117 variant at the fastest outbreak this is incidence rate the number of cases per day they had the fastest rise since mid-february those with B135 or with both variants had the second to the fastest increase in infections whereas those that did not have variants had the lowest increase so we know that variants did contribute a little to the search. But we also notice here that even cities without variants had a search so we know that there are also other factors involved let's look at those other factors so this is effectiveness of face coverings now face shields and face mask so face mask have an effectiveness of about 70% if you have good compliance to it the effectiveness in the population is about that much also 65-70% face shields also have the same level of effectiveness if used properly however unfortunately our compliance to the variant facial is very low about 30% so at the population level the effectiveness is also very low so the combined population of effectiveness of this is about maybe 69% the target of view which is for 90% of the population to be wearing face mask and face shields so if you're able to achieve that we can actually increase the effectiveness of this non-pharmaceutical interventions to 80% and 80% is quite a high level of protection it's actually even higher than some of the vaccines so as you're waiting for your turn for vaccination just these two things can protect you to the same degree let's look at super spreader events so these are graphs of google mobility trends if you own an android phone google is tracking your movement from place to place and it can tell as at the population level the amount of time people spend in certain areas to look back at Christmas Eve there was an increase in time spent in groceries and also in retail and recreation this includes restaurants later later in the in the next month for the translation event there was also an increase in mobility for groceries and also for retail and recreation but also in parks and transport stations in contrast we didn't see the same mobility or rate of people going out for Chinese New Year and Valentine's Day so this increased mobility contributed to cases so this is for Christmas Eve so this was Christmas Eve and we know that mobility increased when we looked five to fourteen days later there was an increase in the production number so we know that there was a post-holiday search about for translation the increased mobility did not result in an increase in reproduction number and I think this is because this was mostly an outdoor activity so even if there was crowding the spread was mitigated by the open space how about the duration of infectious test how did that contribute to the search so from last year's data when people get symptoms they usually wait three days before they go to the health center to see their doctor and get tested and it takes two days another two days to get their lab results the current protocol is that when they're already symptomatic but before the test results come out they're already asked to quarantine so this is probably the more significant period but we know that the infectious period of COVID is two days before symptoms and five days before symptoms so we know that in these three days they're infecting their colleagues at work or their household members and there's also some evidence that a quarantine is also a bit leaky not everyone stays in quarantine or is quarantined early or if contact tracing is not completed soon enough you also have these people who are out in the open while they're possibly infectious what about testing if we're able to do enough testing we can isolate and quarantine people earlier and shorten the duration of infectious testing this is our positive cases we have now in our positivity rate is about 20% so what that means is that to achieve a 5% positivity rate which is the standard set by the WHO signifying good control of the outbreak we need to be doing 200,000 cases 200,000 tests instead so we need to do five times more than what we're doing now so if we can find them we can isolate or quarantine them where are the clusters coming from now most of them are still community clusters people found in the household or spreading it in the household but for this February search we've seen that the number of workplace infections are also increasing so this was December to January for hospitals government offices and workplaces so in general all workplaces and then by March this had doubled or quadrupled so workplace clusters are also contributing significantly so that's how that's probably how the search occur it's not the virus alone it's multifactorial and each of these factors nanday identified contributed to this so where do we go from here or where do we go from here first short term in the short term what will the eCQ accomplish again if we use the August search as a benchmark the number of cases will peak 10 days into the lockdown so yesterday was the 10th day so in the next few days we should watch carefully what's going to happen in the next few days however hospitalizations will peak two weeks later because it will take time for people to recover and be discharged from hospitals and there's already a wave of cases coming even if the cases come down here there's already a wave of cases that need to be admitted so in the short term that's what we're going to expect in the next two or three weeks how about in the long term what goals should we set for ourselves if this were baseline so this was January and this is where we are now the variant because it increases transmissibility by about 56% so if it becomes a dominant strain right now we don't know yet whether it's a dominant strain because we haven't done enough sampling we've done a lot of testing of the genome or the virus but the sampling has been uneven but if it becomes a dominant strain this is where we will be after it becomes a dominant strain so we can probably set targets the rationale is that once the eCQ is able to bring the number of cases down to the pre research baseline we shouldn't be complacent at 500 or 1000 cases a day we should continue to drive them down and set successive goals so that our baseline cases will be lower and if they are lower even with the variant we will not have the search that we are experiencing now so that can be a long term goal so how do we get there again it's useful to it's useful to look at the go back to the system model and look at this right away we are able to identify several intervention points how do we decrease death rate how do we reduce the number of active cases reduce transmission or speed up the pace of vaccination from the equation for R again we find several ways that we can do to reduce the reduction number or reduce transmission improving compliance to the minimum of public health standards improving indoor ventilation so doles recently released guidelines for improving ventilation in red places but it will take time for businesses to install these so this is individual behavior this is where the public community and business sector can contribute but this is for a government to do since people are delaying health seeking there should be active case finding like what they did in derabi in India they did community community this is not mass testing but this is bringing the laboratories to the communities where we have a lot of cases it's difficult to do contact tracing at this scale of the pandemic but we have to prepare that capacity so that when the cases come down we're able to do it better and prevent another surge and we have to be able to measure how efficient are we in isolation and quarantine so if you look at the pandemic as a system there's this systems one of the founders of systems thinking he said that there are about 9 to 12 ways we can intervene in a system to bring it into balance so I'll go through some of them I've color coded them in terms of effectiveness so these are actually they're numbered in reverse order of effectiveness so these are the most effective so let's start with the bottom three so one way to influence systems is to manipulate constants, parameters and numbers so these are providing subsidies taxes or setting standards so for example we can set performance targets for isolation and quarantine efficiency meaning what percent of your positive cases or your symptomatic patients do you isolate in 24 hours but the reason that this is we use indicators in the public sector and private sector but one of the least effective ways to influence systems is numbers alone do that change behavior you need other interventions second thing you can do is to change the structure of materials, stocks and flows for example building new roads changing the transport networks so if you remember a while ago the exposed lead to infections but if you improve indoor ventilation not all of the exposed will become infected some will become exposed but not infected so that's one way of changing the structure of the model however facilities take time to revise and improve installing new filters new fans will take time third we can try to weaken or strengthen negative feedback loops for example one loop that's driving the pandemic as I pointed out a while ago more active cases increase transmission because more susceptible are becoming exposed to these infectious cases so a negative loop that can counteract this growth in cases is to increase and maintain public health capacity to test trace and isolate however negative feedback loops because they are usually backup loops backup or reserve capacity when they're not in use or when they're not needed like when we had fewer cases when we had up to two last year they're frequently dismantled when they're not used such that when we need it again they're no longer there for us to use so these are some of the things that indoor ventilation can accomplish so sometimes simply opening windows indoors improves ventilation or installing fans but it will take time for the standards to be disseminated across business sectors you can also improve air conditioning by installing this high quality filters Merl 13 and we have evidence that ventilation actually works in this case of a gym where a trainer head was positive for COVID but none of the gym clients were infected because they had prevented by improving ventilation and using a carbon dioxide monitor to monitor ventilation so these monitors are actually available you can buy them online so we also have to multiply by five times the number of tests that we're doing but this also presumes that we're able to find these cases so active case finding is also necessary so while we're in lockdown we have to ramp up again our contact tracing ability so last December we discontinued the contracts of most of the contact a lot of the contact tracers that were nationally hired because we ran out on money to pay for them so we started the year with decreased contact tracing ability and then I encourage you to read this article from Rappler it's a very interesting and very detailed story of how when the search started we lost control of the number of cases because we were not able to quiet up trace, isolate and quarantine and reduce the duration of infectiousness the second set this moderate effectiveness so another way to intervene is to reduce the positive feedback so a positive feedback loop is as I said more infectious cases more transmission leading to more infectious cases and it continues to drive itself so the way to break that is to reduce the infectious cases by isolating them again, it's difficult to do now but what's a better intervention is to reduce the number of cases or the number of exposed people that are feeding this positive loop so you reduce exposure of the susceptibles so that it doesn't feed the positive feedback to them anymore another way to intervene is to provide more information in a effective way or efficient way of doing it because improving information does not cost a lot so for example what we've tried to do is to provide some badang guy level maps that are visible to the public unfortunately that website owned by the DOH is not very much used public is not very well aware of it they could see the level of the outbreak in their badang guy it can change their behavior in terms of not just staying at home but also wearing masks and being more careful so this requires data to be open and it requires innovation so we're approaching the more effective interventions in a powerful way is to reset or change the rules of the system providing incentives, punishments or constraints for example as we mentioned a while ago we don't have a single epidemic or outbreak we don't have a national outbreak what we have are different outbreaks at different phases or levels some are at the peak or accelerating some are slowing down and some are just have gone through a search and are waiting for the next one so we need to provide incentives disincentives for each LGU to rate them in terms of their performance for outbreak control but also to provide incentives for them if they perform poorly so right now although we do track the levels of the epidemic in each LGU because of LGU autonomy there are no rules or consequences for different levels of performance so accountability is very important so this is from which faster website it's called the faster website FATSSER so when you sign in or when you register you can actually zoom down to your own barangay and you can show this so for example red are barangays with high level of transmission but also surrounded by other barangays so these are hotspots and then you also have barangays with no cases but also barangays don't have a lot of cases but they're also surrounded by barangays with high levels of cases so if you're resident of this barangay and you have this information it can change your behavior so as I said this is the framework that we use is de-escalate LGUs in terms of disability of their outbreak or epidemic before we allow LGUs to de-escalate we make sure that they have sufficient public health capacity and their case transmission is already at very low levels before they are allowed to pass through a gate and assume a lower level of community quality status but this is voluntary there are no rules that will first of all even require LGUs to submit their data much less consequences if they don't meet their standards and then the last set of leverage points this power to which evolve or self-organize in short, this is the ability to innovate so for example after more than a year of the pandemic people have been experiencing pandemic fatigue they've been lost in compliance they forget it's more difficult to get yourself to do yourself to do it but design thinking is a process where we can rethink or reinvent the way we communicate these messages or we motivate people to adhere to these public health standards but what's necessary is in the decision making process we have to incorporate more diversity not just a whole of government but a whole of society approach we need other sectors to be involved in decision making we also need to allow experimentation and innovation to come up with better, fresher ideas so we're not stuck in what we're doing now so again one of the more effective ways is rethinking what are the goals of the system control the control the outbreak say the economy it's sort of strange also that some people think that we have to balance health with the economy as if they're opposing opposing forces but actually public health or good public health also translate into a bit better economy we're not conflicting forces one of the former economic advisors in the Obama administration said this very early in the pandemic the number one rule of virus economics is that you have to stop the virus before you can do anything about economics and then finally the most effective way of changing or intervening in the system is to change your paradigm so once you change the paradigm everything downstream changes goals, structures, rules incentives so we need to be looking upstream and looking at the factors which may not directly cost a pandemic but made it much worse than comparable countries so inequity, housing, transport working conditions so for example under ECQ some people have been allowed to work because they're frontline essential workers but these are usually lower income workers also and then they have to take public transport which is also unsafe they live in crowded housing so social distancing is not really something that they can do and they report to workplaces that may not have good safety protocols so we need to address not just the social determinants of health but also the political and commercial determinants of health so this is a study done on OECD countries it shows how how the economy and public health are related so these are four countries that did a hammer and dance approach but what's noticeable is that as death started to go down they already opened up the economy without waiting for it to come down at two very very low levels so this was a premature opening of the economy so death stayed low for a while the economy improved but since they never really eliminated the viruses it was still there they had a second, third or as in the US now, a fourth surge and by the end of the year their economy had negative growth versus four other again developed countries that tried to or aimed for elimination and not just mitigation so again they locked down except maybe in Japan and Japan is an outlier so this is a country that has the culture of wearing masks even before the pandemic so they actually had the safety protocols pre-installed but what these four countries had in common was they drove the cases or the deaths very very low before they opened up and all of these countries ended the year with positive growth except for Japan but not as bad as for the other countries so good public health also translate into good economics so again it matters what is the goal of our system so this is the rate so if we look at the vaccination program which is the sixth compartment in our pandemic system model this is the rate at which we are vaccinating after a year we could probably get up to about 10 million this is the goal that government has set herd immunity which is about 70% of the population but herd immunity is unrealistic goal for several reasons the duration of immunity given by the vaccines is unknown some variants have already escaped the protection of vaccines a lot of the vaccines have decreased protection against the variants and the efficacy numbers that are reported for vaccines is really efficacy against being susceptible to the virus and effectiveness against progression of the disease and the good at preventing mild and they're even better at preventing severe disease and death but we still don't know whether the vaccines are affected in preventing onward transmission meaning preventing transmission from the vaccine recipient to people who are not vaccinated so because of that herd immunity may not be realistic at this moment so what we should be aiming for is prevention of deaths and prevention of severe disease which is what we know that vaccination can do and we also know that variants are affecting the younger population now so even the younger population can be at risk for death so we need to aim for 100% vaccination or full vaccination so this is the rate at which we should be doing it so again this is an example of how setting or resetting the goals of the system will affect how the system operates and then this is diagram or a framework of how we can look at COVID-19 in terms of its upstream causes this is just one part social determinants but you can see that these are things these are weaknesses that we have before the pandemic and these are things that we need to fix at the same time that we're trying to control the outbreak or eliminate the virus and this is my last slide so we have seen that the problems are systemic so it requires system solutions and not solutions that are done in isolation from each other thank you thank you very much John I'm sure our audience truly appreciates all all the things that you have said and presented and the number of participants has been increasing over the past few minutes I think na babalita na nagsasalita si John Wong so John thank you so much there are a lot of questions in the chat box so I encourage you to continue to put your questions in there and we're going to ask our research persons to try to answer them while they're not talking or they have a break and we have two reactors to this presentation I'm going to turn over to Raymond to introduce our next speaker thank you thank you for that excellent presentation as always Dr. Jan I miss going to your house so I hope we can get together soon thereafter anyway we'll go on to our reactors but before that let me give a quick shout out to the UP College of Medicine Dean Dean Charlotte Chong is in the call also as well as the director for the UP Manila Community Health Development Program and all the members po UP Manila CHDP together with director Anthony Meronimo Cordero Maraming salamat po sa pano nood anyway may we call on a very first speaker who will talk about medical perspective po no she is an infectious disease specialist trained in the United States po no and is currently a clinical associate professor at the UP Philippine General Hospital may we call on Dr. Sybel Lara Abad Dr. Sybel please go ahead with your reaction ma'am hello thank you so much for the invitation today and let me just share my screen can you see my screen yes go ahead alright so thank you so much for having me today and I have the job of trying to digest Dr. Wong's excellent talk but I was asked to focus mainly on the variants and why we should be concerned about these variants given everything that Dr. Wong talked about so some reflection points that I had to digest as a physician and as a Filipino member of society as Dr. Wong has mentioned the B1 variant has shown an increased capacity to transmit the virus and because there's a lot of transmission so it's the nature of viruses to mutate to go forth and prosper to multiply other variants are sure to follow so we have to do something about that before we come up with a super variant and we'll talk about that in a bit the increased rates of transmission and the surge so to speak of our COVID is really overwhelming it's overwhelmed the physicians and the hospitals and it's been very heartbreaking because we've had to turn down patients we know our own families or relatives because the hospitals are full and so kind of the flip side to that as mentioned by Dr. Wong what can we do to solve that as individuals perhaps there has been inconsistency or laxity in the following protocols if you were here at the first part of this webinar there were people on the streets saying pagod na sila following all these protocols because it's been a year and that is totally understandable and for some it's actually not doable we always ask people to physically distance but sometimes there's just no space to do the distancing so we have to correct this and as Dr. Wong mentioned it has to be a systems change and then finally as a clinician and as a doctor I'm always thinking with the emergence of these variants and will our vaccines work and this has been also alluded to by Dr. Wong so let's try to answer some of these reflection points just so everybody's on the same page the variants also have some definitions so there's a variant of interest there's a variant of concern and a variant of high consequence so simply put a variant of interest is simply a variant that has changed enough that it is associated with perhaps reduction in neutralizing antibodies perhaps reducing the efficacy of treatments but this is kind of just anecdotal evidence not just an association it's not yet proven so there are actually many variants of interest at the moment but we want to focus our attention on the variants of concern because these variants have shown evidence already that there is increase in transmissibility such as the B1 variant with an increase of more than 50% in terms of transmission it can cause more severe disease such as increased hospitalizations or deaths so this is what we are concerned about as the label suggests but there is also a variant of high consequence and thankfully we do not have yet any variant that meets this criteria we will be in grave danger the whole world if we have a variant of high consequence because this will show that the current preventive measures are no longer effective so at the moment again we do not have yet any variant of high consequence so let's focus on the variants of concern now there are actually three variants of concern the B1 variant which was first discovered in the UK that Dr. Wong discussed there is a B351 variant out of South Africa and there is a P1 variant out of Brazil and these smaller notations here are the number of people in the Philippines known to carry this variant already this is as of March 20 so these variants are here and so as shown by Dr. Wong this is in part responsible for part of the surge but as you saw in the graphs earlier there is also a surge in eras without the variant so there must be other things we are doing wrong or not correctly so what can we do at the numbers of society we can do little things that will amount to big things so perhaps we cannot do a system change by ourselves but we can do these little things it just means going back to the basics so hand hygiene, physical distancing frequent disinfection wearing our mask and our shields properly and now we have a fifth dimension so hindi na sya apat-dapat lima na sya so someone has to think of a catchy phrase of vaccination in addition to this armamentarium and the way you think about these methods is you want to think about them in layers so the more layers you have the more we protect ourselves and others so that we don't transmit the virus forward so the way to think about it is to think about in terms of the Swiss cheese model of prevention I always show this picture when I do lay for because they seem to get it and now I show this picture so this is the Swiss cheese slices so there are holes and you want to plug as many holes as you can so when you have many layers you can plug all these holes so the virus will not come across and infect this person to the right but note here and I want to emphasize this as well there are personal responsibilities in a pandemic and this is what we're all doing already and this is what we're all tired of doing but we have to hang tight so you don't think only of yourself you think of your neighbor you think of the people around you so you have to follow or we all have to follow quarantine and isolation protocols we can't escape or jump ship and escape quarantine for example we have to abide and be tested or be contact trace and then finally we added on this layer here in the last slice of cheese is vaccines and we'll talk about that in a second now here in the middle if you notice there is a mouse munching at the cheese so this is who you call the misinformation mouse and Dr. Susan Pineda mentioned that there is a lot of noise and this is all coming from the misinformation mouse so I think I want to also emphasize that people should follow the science just as Dr. Wong presented there's really a lot of science behind COVID-19 and we should stop listening to these rats so I'll just call them a rat and then we'll talk about misinformation mice so we have to be very careful and be discerning in terms of the things we forward on Viber or the things we forward on Facebook is it true, is it fake or is it a half truth so we have to contribute as well in terms of trying not to forward misinformation pieces so what else can we do to slow transmission and this in my mind is how I envision the virus mutating or the variants transmission is in the order of thousands per day or even millions sometimes depending on the virus so the more it multiplies again the more chances it can form a variant which are these in different colors so what you want to do is you want to slow down transmission so that you can prevent emergence of these variants and you can do it just by doing things that we're doing already so hand hygiene, wearing your PPEs your mask and your shield properly so here's my two cents on vaccinations so vaccines still work and again as mentioned it will decrease the number or the end of the susceptible population and it will also modify illness so what we want to happen is we want to get vaccinated so that if we get COVID-19 we will not get severe illness we will just get mild COVID-19 a very mild cold for example or a flu like illness so we can just the hospitals for example and in terms of vaccination we also want to think about prioritization which we're already doing we're vaccinating the healthcare workers first the frontliners and then the seniors who are at risk of very severe COVID-19 so there is some speed or there's some urgency to getting vaccinated and there's also equity because I think we have to think about it in terms of the whole facility so everybody will eventually eventually be vaccinated because we want to avoid what I like to think of as a vaccination gradient again this is kind of the picture in my mind so if we have two areas with COVID-19 for example and they both have a lot of viral transmission but area one is a bit more successful than area two in stopping the transmission of virus so let's say they've been able to curb or flatten their surge eventually because the economy will open up or because of the loss of physics or the loss of science there's actually diffusion or osmosis or travel of people from area two to area one so because area two is not very successful in curbing the virus then eventually area one will again be re-infected and perhaps even be infected with the emergence of a super variant or a variant of high consequence so if you want to avoid at this point so kind of some take-home thoughts for you to think about in the next few months or the next few days even with the variants our current minimum health protocol still works so please try and hang in there and wear your masks and wear your shields and remember to layer up so if you have to go out because you know you have to a job to do, you have to feed your family then just wear your mask and wear your shield the more layers you do the more likely you are to stop the transmission of the virus and the less likely you are to be infected yourself in terms of urgency to vaccinate we have to vaccinate a lot as Dr. Wang showed you in the graph but we have to do it the right way because we want to also avoid the emergence of a super variant or a variant of high consequence and as everybody put in the chat box I also like this line now there's also virus economics that we control the economy and I think that's my last slide I just want everybody to be safe and if we are safe only if everyone else is safe thank you very much thank you very much that was Dr. Sibel Lara Abad again another excellent presentation thank you so much for that very clear on the variants and I'm sure I can already see in the chat box a lot of questions so I'm going to ask our doctors to continue to try to answer on the Q&A in the Q&A box okay so we're going now to another reactor and just a little bit of a backstory when we started this last April so our webinar series started last April the person who helped put together the first set of speakers for the stop COVID death webinar death's webinar is Dr. Aileen the Big Wang we talked a bit about who do we put in the webinar first if we want to have clarity on clinical management of COVID remember at that time we didn't know we had very little information but PGH plunged into research right away and was as they were going along modifying protocols and so on and in this webinar we did talk about for the first time cytokine storms proning using not ventilating to intubating too early and so on and so forth and the person who worked on getting those speakers in the early days was none other than Dr. Aileen the Big Wang so we're very happy to welcome her back she's professor of medicine at the University of the Philippines one of the leading pulmonologists in the country Aileen, welcome thank you very much Susie sige, so teka mo na before you start Aileen give us an idea of what the situation is like right now at the Philippines General House allow me to include that reaction cause Susie later sige, okay sige, so again thank you for this kind invitation again Susie and Raymond and the stop COVID team and I would like to share this first infographic of Bindike Simons PGH group namin it's been a year since this horror started and we still haven't awaken from this nightmare and indeed yung mga anon natin frontliners rose to the occasion and I think over and beyond what is expected of them over and beyond their call of duty and as mentioned by Susie she invited me to speak at the very first stop COVID webinar and can yung imagine number 47 na kayong ayon and Susie actually asked me to talk about conducting research during this pandemic how visible it is and I think from the beginning we already saw the importance and the need for unassailable indisputable evidence so that it can help us in caring for our patients and at that outset we already talked about how we can possibly conduct research and I think we are fortunate we have scientists like John who talagang ignores the strong opinions and strong emotions and just sift through all the noise and just gives us he analyzes he looks at what figures and numbers and trends that do not lie so that we know what we can do so I was asked to give my reaction one to my researcher and two as a clinician pulmonologist and ito yung how I feel about John's talk first each of his slide I think gave akarin yung brutal outlook hindi ko alam kung paano ko yung English yan sorry so I think he opened their eyes to the sobering reality of our current situation and formerly at least for me I really couldn't see the forest for the trees so if you look at all the social media and all the news parang nakakatakot all these things but we don't really know what's happening and I think yung yung nagawani John for today and I also found solace despite being confronted by the results of his big data analysis in that we did see the big picture and now at least we know now how to move forward and to quote Aristotle or probably miscoat him knowing ourselves is the beginning of all wisdom and I have another favorite adage this time from George Santayana those who cannot remember the past I condemn to repeat it and we're right there right one step forward two steps backwards so what do we do next for the next year so how do we stop this so I thought that John's presentation was factual it was pretty compelling to me he was informative you can really tell that the presentation was well thought out and there was extensive prior preparation and I think the most important thing as I've mentioned he provided clarity amizu this chaos of all the background noise and misinformation going around and pero hindi lang negative or hindi lang dooms day scenario he did propose solutions for science based he emphasized the need for systems change and I think for us even for the laymen we need to think along this way and if there's one take home message for me it's that we need to trust science and hard statistics which brings me, allow me to make another last adage pasabi from Adam Smith science is the great antidote to the poison of enthusiasm let's talk science just to share with you and I thank Nina Berba for sharing these slides with me she's the head of our Hico control so PGH just to show you what happened or what's happening in our hospital mimics what happened in the community just what John presented so in PGH in March 66% of our healthcare workers got their infections not from the hospital but from the community or household and as you can see from all of these and ano yung definition of activities from community naghanda po kami sa bahay yung sang visita may COVID pala nag attend ako ng birthday party nagpunta ko sa lamay, nag outing kami nagpamasahi ako, nag beauty parlor kumain sa labas nag shopping sa mall, nagpunta ng palenki ng pinapakwarentin ako community spread and if you will actually see how it affects our work in PGH those infected co-workers who still work and expose others they produce the greatest disruption to our operations so yung call talaga isolate yourself I remember Nina sharing one infographic for every healthcare worker was infected na-infect niya mga four to five others so what's happening in PGH the same as in the community microcosm within the macrocosm so as a clinician and as a researcher what evidence convinces us to prescribe a new drug for our patients so let me share with you one study that came out early in the pandemic March last year 80 admitted patients with COVID-19 they were given drugs A and B and look nice results negative na viral load clearance by day 7 93% by day 8 and 97.5% showed clinical improvement with the mean hospital stay of 5% and only one death that makes it 1% really nice results right so this was actually one of those studies that were released in March talking about the beauty or the effectiveness quote-unquote hydroxychloroquine this time combined with acetromycin and these and similar studies moved politicians like Donald Trump to really try to to brazo the arms of CDC to put hydroxychloroquine there in the guidelines and actually in our clinical pathways we actually put it there as well but many once later the huge recovery trial came out this UK multi center it's a randomized control trial obviously you've noticed that the original one did not have a control arm so these were huge numbers comparing hydroxychloroquine with usual care and what did this study find so Hindi 1% the deaths within 28 days 27% much much higher for the hydroxychloroquine group and although it did not show overall a difference in the usual care but what they found the patients given hydroxychloroquine were less likely to be discharged from the hospital alive and if they were not intubated at baseline they had a higher frequency of invasive mechanical ventilation and eventual deaths and there was some concern about some excess of cardiac deaths so this was published at high impact peer reviewed journal New England Journal of Medicine so take note of the difference between a cohort study with no control and a randomized control trial then let's look at the natural history of COVID so as of yesterday 23 million active cases 99.6% of them have a milder disease and I would like to quote WHO country representative Rabindra Abea Singh and as seen by the natural history ng COVID for those patients of recovered actually more than 95% of them recovered without specific treatment so if you give that patient a certain drug that's maingay now you'd think that that drug actually cured them Doctor Abea Singh said this is not science this is not evidence so in God we trust all others must show data but what kind of data do clinicians trust and I know that there are laymen in the group so let me just share with you how we oops sorry how we look at evidence based medicine we actually have what we call a hierarchy of research design levels of scientific evidence at the very bottom are the animal and laboratory studies which we call mechanistic studies and then next testimonials series of cases good outcome or poor outcome and expert opinions and then the observational studies case control retrospective studies prospective studies and at the top of the pyramid they're not as many but they're the most important are the robust, well-conducted randomized control trials and the pooling of those results of those RCTs which we call meta-analysis only RCTs can actually or have the ability to control bias and therefore will have more valid results and can truly demonstrate costs and effects in humans individually. So this is how we look at it and ang problema na all that noise and all those misinformation going on and let me quote again Dr. Abeya Singh here the fight against the infodemic has been even more difficult than the fight against the pandemic so just to show you how it is in my village one of our residents actually is a Facebook group namin comparing mRNA vaccine with a controversial drug I'm not going to mention what it is pero yung proof niya for effectivity it's proven to kill COVID in laboratory experiments positive trends from retroactive studies and widespread anecdotal evidence on effectivity and if you remember from my pyramids are way way at the bottom of our levels of evidence although yung resident acknowledge that there are conclusive data or still lack of data from well controlled prospective human studies pero since highly effective against parasites you can give it and in case you have that you hit two birds with one stone patay si COVID patay din si parasite but this is the problem that we have now we need to address this by Sybel actually given all those beautiful steps how we can do this try not to share fake news or have truth news so how is it like in the in UP manila what are we doing in our group so in April of last year I presented the proposals or the studies that we were planning to do and what is the scenario for the next 12 months I would expect to be able to share already the results of these studies so these are all sponsored by PCHRD and what you can actually look at from our study group we tried to see all the salient disease aspect so that we'll be able to understand the disease further and we will know what works so as you can see we looked at epidemiology clinical profiles, outcomes, predictors of mortality lab based studies and then very important disease transmission and infection control I put in yellow the project leaders for each of these studies and then we were also looking at impact of COVID-19 families and patients me small I included here the rapid living reviews of our very own NIH Institute of Clinical Epidemiology in coordination with the Philippines Society of Microbiology and Infectious Disease so there and then we're doing predictive models we're trying to validate them and also addressing ethical issues so the ethical guidelines on COVID-19 crisis level has actually been published already by Dr. Lenny Fernandez and finally the most important studies looking at diagnostics, the utility of the various biomarkers to detect cytokine storm at predicting hospital mortality also coagulation parameters and the randomized control trials, those important studies in our very own population so hopefully by end of next year we'll have an answer for you on convalescent plasma therapy Ayavito silisma, virgin coconut oil we are part of the WHO solidarity trial and we've actually already published the interim results last year and Nina Bear was doing the avigan trials as a country investigator for this I did not include here the vaccine studies were also involved in them and finally among the studies as we speak we're actually also developing the program from for what comes after COVID so we're looking at long long or long haul COVID or what we should now call the WASPASC and to try to understand and address this and plan for it to help our patients and finally I think this is my last slide in the hospital what are we doing so in March, April we formed clinical pathways to try and to make standardized how we manage our patients at the PGH and in April of this year or early this year rather we actually updated this continually throughout the past year and you'll expect that in the next 12 months we'll still do this depending on what new data appears so what you will see here in the clinical pathway we've put here those that have been shown to work by solidarity and all the other trials including steroids or dexamethasone for the more severe patients enoxaparin or anti-coagulation at the torx and then umbram desivir for a certain group of patients so usually those patients who are moderate to severe in character and then all the other all the other interventions chemo-perfusion you will see here and Tosilisumab so studies also now coming from the recovery trial showing that Tosilisumab will be effective for patients with high inflammatory markers like CERP so that is what we've been doing at the PGH and you'll expect that we'll still be doing that and finally as a last slide we've had some doomsday scenario pero may both of confidence naman and let me quote one of my favorite ideas aside from Cibel of course Dr. Edsel how good are Filipino doctors and healthcare workers during the COVID-19 pandemic world class better than world class our death rate of 1.8% is lower in many countries so out of the top 30 countries with the highest number we actually have the second lowest so at least some hope and some confidence with our front-liners and I think that's my last slide thank you very much Susie, back to you thank you very much for another excellent presentation and you'll see in the chat box Aileen, all of the masalamat also for John and for Cibel okay, we're going to call everybody back now Toby Cibel, John and Aileen and I understand that being Charlotte strong of the UP College of Medicine Charlotte, you're most welcome to join the panel if you can so we're going to now go into our panel discussion but before we go into the panel Raymond is going to inform our panelists of who the audience is so Raymond, please go ahead thank you Dr. Susie and thank you to mom Aileen I particularly like the suspense but I was actually trying to wait for the naming of the controversial drug but baka next week nyan natin yan may entay mam na for our poll we have five questions we'll start with the demographics 54% of those who inputed their locations are located in Metro Manila next up are those from Northern and Southern Luzon and also Central Luzon 1% comprising of attendees from outside of the Philippines as always majority ngayon po 56% of those who are attending our webinar are from the medical and nursing sector so yun po ang karamihan ng ating mga nanonod although meron po dito po sa others ako po ay very much excited to tease that out we have three questions we'll probably try to answer this later na lang po Dr. Suzy will go to the panel discussion before we try to answer these questions okay thanks a lot Raymond for our panel discussion I thought what I'd like to do is because Toby started us off on economic side and how the investments in public health are actually good for the economy Toby to have a reaction and maybe to ask a question to our panelists so I hope I'm not putting you on the spot Toby I'm sure there are questions that come out of what you heard so Toby let me turn over to you no I'm happy I'm happy I heard the same thing from John he calls it virus economics for me it's really quite simple right it's not about controlling the outbreak versus growing the economy or even in a sequence it's not the first is a necessary condition for the second dun lang kasimple and I think we're seeing that now because we're going back and forth and back and forth on all these things I think the questions I had actually to John and the rest were things like this for example with respect to John because I'm thinking about okay so what does this mean operationally right what are we talking about and I got many messages from John and from an economic viewpoint we are into we need to prioritize because of budget and time constraints we cannot just say vaccinate all we cannot do that right and so it's not helpful to policy to say things like that but for me it's like I'm happy you said something about testing and you need the point that our testing must be 5 times more than what we're doing now that's really important to me however I'll also still ask because the debate in April last year was are we talking about diagnostic testing or surveillance testing because that was the big debate DOH did not want to do surveillance which is what we thought as economists in fact the dynamics of the pandemic of the virus not so much for clinical or diagnostic purposes and honestly I think that's what we're missing now we don't have that because we never did it so it's important that we define what you mean by 5 times more so it could be a combination I'm happy also that you're saying contact tracing mainly because what's happening in NCR is not happening in other places and like I said before I do believe obviously that NCR needs to get its act together and roll out but with the national government but that as a priority may not be the same as somewhere in the Visayas so the question to everyone I think from a regional viewpoint or provincial viewpoint one more peso, where would you put it would you put it in vaccinations would you put it somewhere else that's the economic question for me and I think that if the DOH for instance now and I'm not quite clear how they're allocating vaccines I'm not typically that's what they did before divide by N everyone gets something even if the level of priority is so different across the country and now if you're saying you want to vaccinate a good percentage in order to optimize that measure the instrument is vaccinations where would you put that would you distribute it across the country from an economic viewpoint that doesn't make sense and so I think you need to do that and from the public health people it would help if you say this is the general rule but you know you have to apply some sort of cost effectiveness or efficiency analysis to see what where when and when right that's my anon and I think the stuff that John was talking about and others it's like yes systems thinking but systems thinking itself must be unbundled some is short term, some is medium, some is long term whenever you make recommendations not only do you disaggregate by geography because we are just we are different epidemics happening all over the place but also short, long medium and long term so that we don't get overwhelmed so from what I understand from Suzy and our previous discussion maybe an NCR is vaccinations in congested urban areas how can you even isolate so maybe that thing in NCR is so different from I don't know the rest of Cebu province and so forth so if we can have that then economists can help can help parse that there was a comment in the chat box about how do you deal with the no work, no pay because of pandemic my only answer is well government has to provide Ayuda if there's going to be a government imposed lockdown such that people cannot work they have to come in the other question was can we print money to give printing money guys is a phrase we use it's one way to raise funds from the banko central viewpoint technical thing with that you don't just print money and then give it away though but I think the issue here is our economic managers don't seem to get and I'm sorry if anyone's in the room don't seem to get that yes we prepared for a rainy day we were strong before the pandemic so now you borrow to the hilt your country is suffering what are you doing trying to monitor that you use you leverage those fundamentals to borrow to the hilt so that the country does not die and households do not die and in from an economist viewpoint remember for as long as you use the borrowed money wisely then it will all pay back later on the issue is if you don't use that borrowed money wisely then you won't get the returns later on you know that's what we need to do right I agree that if we are in a lockdown stage we should be talking about recovery it's relief and then you set up for recovery the way everyone's been talking about thank you thanks Toby John you want to respond to that yeah I feel like I was in my master of thesis defense John I want your slides I just answered it's a lot of questions but maybe I've answered for some of them the testing I mentioned was diagnostic testing so these are people who are symptomatic who need to be tested so that the decision can be to isolate or quarantine because we also don't want to indiscriminately isolate people even though they're negative but I agree that surveillance testing is also necessary because one study by the CDC said that in the US for every person that was tested positive they missed about 4.5 other people I think here in the Philippines it would be much larger but we might be closer to herd immunity than we actually think because of those undiagnosed people in regards to vaccination I also did the modeling that Toby mentioned what if we just focus on NCR because that's where most of the cases are and most of the deaths are and I didn't look at the economic side but just from epidemiologic side we actually do save more deaths focusing just on NCR but the problem is we're supply constrained also so if we had unlimited supply we could do that and save I don't remember how many lives I didn't say but I also looked at the timing of the delivery of the vaccines we won't be getting it in time to be able to do it at that scale and I agree with you the in-systems approach has to be both prioritized in terms of person, place and also time just to if there's a supply constraint across the country if there's a supply constraint so you have to sequence it and it's not only and I understand about seniors but I remember Susie bringing this up you're talking about this earlier right after seniors we should really think about the working age population it's like if you really wanted to do that shouldn't that be next my point with the NCR which you share is a supply constraint so the more you have to prioritize who gets it first and that's all thanks the government does have prioritization and they did prioritize saving lives first but also persons with comorbidity on the average 1.5x the risk of death and then the next to go would be frontline essential workers this group have a lower risk of death but a higher risk of infection because they're the people out there so I think that's thank you is it seniors across the country or is it at least geographically sequence right now it's across the country yeah well that's what I mean I'm being very cold it may come out very cold but the risk honestly the risk of someone who's not senior may be higher in NCR than someone who's senior outside that's my point that's that's what I mean that the national if we cannot just apply national analysis we gotta go down we don't have enough money we don't have enough supply and we don't have time that's a resource allocation issue when I did that exercise my experience was that it's not just an epidemiologic or economic issue it's also ethical because you're already deciding who's lives to save first when you prioritize NCR some lives will be lost also in other regions needs a wider discussion across a group of stakeholders no I agree John but you just said in your slide that masks and shields can give you almost equal protection I'm just saying I'm not suggesting that someone is saved first because as you said there are other measures that could maybe approximate the vaccination so as you it was in your slide so I'm wondering if given the spill overs and given everything else some hard choices have to be made but that doesn't mean that you're condemning someone to die it just means that in the meantime in other places can we make sure that masks are available for seniors in rural areas that's all we're saying can you use that first while the supply comes on stream yeah I think and that's why we entitled this webinar what to expect in the next 12 months an ideal world we would like everything everyone to have access to everything ideally but that's not that's not the situation in fact as we ask our clinicians as we ask both Aileen and Sybil because they're seeing it on the front line to describe to us a little bit what they're seeing and what they think the effect is going to be on the system because I get it that we actually know what the trends are so John has given that to us talking about what the consequences are of not shifting our prioritization or going more more localized but I think from the point of view of the front line which I'm going to ask Aileen now and ask Sybil where earlier we were talking about nurses are leaving hospitals or patients are dying in the emergency room so may let me turn over to Aileen and maybe to Sybil because there's a short term the long term and the ideal that we want to do but there's this right now we are in a crisis so what are you seeing and how do you think we're going to mitigate that so let's go to Aileen first allow me to ask Sybil first because she's a frontliner she's right there okay Sybil yes pa so in the front line it's really it's a war zone the ERs look like a mess there's too many people in the ER inside and outside of the ER this is both in the private and the public health setting so PGH looks the same as the medical city in terms of volume of people and parang the way they're just waiting outside medyo pareho na yon parang wala ng distinction between private and public hospital parang just to paint the picture and it's the recent surge has really stressed the capacity of all hospitals now in the NTR the big hospitals to accommodate the sicker patient so it's been very stressful because it's parang hitting closer and closer to home parang 7 degrees of separation now it's closer and closer to home I know relatives now colleagues na we're admitting them or not being able to admit them is even more stressful because they call you and you try to look for a bed for them and almost certainly di tayo successful so that's very stressful and may pila na siya in mga hospital, for example right now I'm in the PGH ICU it's just virtual rounds but we have to triage people lined up for the ICU just to get in the ICU but it's full and so a lot of them unfortunately either get too sick or die outside of the ICU or wherever they are in the ER or in the pila so that's how it is gunon din po sa private hospital people are spending five days in the ER where they should just be spending hours there and some of them die in the ER while waiting for their room and from a patient perspective tayo hindihan ko po kasi we receive calls nagalit-nagalit na yung paciente ang mumur na nakikawento din yan sa amin as frontliners but I understand that because if you have a loved one you want to get into a hospital makagalit ka na sa lahat but parang wala kaming choice kasi wala din kaming staff walang room walang sulok walang sulok where we can place your loved one or our own loved ones so ang hirap-hirap ko talaga so yung solution we're always about trying to find solutions so part of the solutions we're trying to hopefully some people are talking to the government and other LGUs kung puwede bang i-step down na yung mga maybe recovering patients maybe they can just step down to a facility somewhere para mag-open up yung rooms something like that some have even maybe said open up field tents for those who can do that and also home care umabot na po tayo sa home care where people who have the means or people who have at least some people to take care of them or help them consult na lang and then we'll try to help them at home parang ganun lang siya, it's that bad these sicker people who should be admitted we're trying to help at home so this is how it looks like in the field it's really quite a mess so we really need all the help we can get ma'am Aileen Aileen what do you think where are we going in addition to what Sebel has mentioned we'll need to consider also with all those increased number of cases the worry particularly among as great care people the lack of medications important medications that are starting to run out and I think we're still fortunate in PGH we have a very proactive supportive leadership who see these things and at least we're more better prepared in PGH but I've seen small hospitals on the side of Metro Manila not even having the basic needs and something for me which was a shock they should have had at least a year to prepare for this and you find out they don't even have high flow nasal cannula et cetera so at least for the next 12 months this has to be addressed the problems of the variants I don't think is going to go away we can try I think the most important still is to kill the source of those viruses so we really need to isolate the hosts it's still very important I think the priority should be in contact tracing and community isolation I think we should have those hospitals like in China those huge hospitals if we can set those up at least to relieve the tertiary hospital so that we can really just take care of the moderate to severe patients what's my additional take on what Sivel has mentioned John also said that nagpick ngayon and you will see a peak in hospital hospitalizations in two weeks so what do we need to do to prepare for that I don't know who wants to answer that John maybe you should answer that question what what's being put in place for this we already know, we already anticipating a huge number of hospitalizations and we've got 3,000 people who are listening to us right now from all over the country what kind of preparations need to be put in place whether it's in Metro Manila or the outskirts of Metro Manila so Si, I think let's also ask the benefits of the lockdown okay do we start seeing it now? na kilesis ka ngayon John eh, sige and where is that peak? is that NCR? sorry sige so if this current search follows the pattern of the previous search and just looking at NCR the peak should have been yesterday 10 days after the lockdown and then hospitalization will peak 2 weeks after after yesterday 2 weeks after the peak of the cases with regards to Susie's question of I think you phrase it correctly na how do we prepare for the next search because I think it's already too late to to do anything about the way the hospital system has been overwhelmed na we should have prepared for this search during the interim between August and now one of the things we realize is that we'll be measuring beds and ventilators na but now we realize that ethical workers are actually a scarcer resource na they're more difficult to increase in number and they're more difficult to replace especially now that they're also hospital clusters that's that's all I can say na na I wish you had better news okay Rima did you want to ask a question or did we have a question from the audience well we have ma Maria Cecilia Polido coming in from our live audience ma may we ask you to unmute and ask your question po it's the most upvoted question in the Q&A I don't think we can hear you ma yeah we can hear you now go ahead good afternoon my question is our government is also pointing out that otherwise are the main reasons but I believe that we citizens are not given the means and measures to cope against a massive community transmission there is poor mass transportation ventilation and capacity no safety net for our daily wage earners and our administration what do we do what do we ask our administration to increase the compliance to health standards and be trustful in reporting possible contacts without being stigmatized that's all thank you very much who wants to answer the question John Mr. John I've heard him answer this question before John part of your thesis defends John do I get another diploma after this definitely I've answered some of the questions so I disagree that poor compliance is the main factor it's one of many factors variants poor contact tracing isolation quarantine and I don't think it's the main factor second I also believe that lockdowns with equity meaning it shouldn't just be a lockdown but there should be economic relief also for people who need it the question of your last question of how do we improve compliance I think this is where we need more more innovation more design thinking processes initially initially it worked people were afraid people were cooperative but as it dragged on their other concerns became a stronger factor in influencing their compliance so I don't have a good answer for that but I think more or introduce more design thinking processes in the decision making but we have more answers for this but one easy maybe not easy but one way we can do it is the more effective masks are the surgical masks and N95, KF94 but if we can if government can pay for that at least for people who cannot afford it that's one way to increase the protection regularly thank you I think that I agree with John first of all you cannot ask people to stay home without providing subsidies of some sort in cash or in kind I mean sorry it just it makes no sense the risk of getting the risk of infection is much smaller than the the fear of is much smaller than the fear of going hungry or something so you have to provide so it's not possible to have a lock it should not be done that a lockdown is imposed without that and if they do without a UDAR of some sort and if they do that but there's some I don't know flaky decision making going on it's like I think one of the officials early in the lockdown last year remember he said hindi okay magutom ng isang one kaya ng Filipino yun set something like that and so it was ridiculous so we can't have that second I know what you're talking about you're saying that how can we comply with non-pharmaceutical instructions like social distancing if they do not provide if mass transportation is not adequate so yes okay you have you allow work now but if they're all crowded in buses or whatever there's not enough they have to line up line up for hours to get there then you know that's why we have to another surge so the answer to that is straightforward then there must be some sort of public intervention with respect to providing more buses or subsidizing private the private sector to mobilize vehicles for that matter it's anoy you must solve the problem directly because if you go around in circles you may not get there now if they cannot do that it's effectively partial lockdown for people who can't get to work and so you go back to the household subsidies so I think maybe we can't do anything about this surge but certainly can we now figure out the next surge if we already know that this surge we had infrastructure was bad health workers were in short supply etc then what what is it doing now all those quarantine facilities that were built can they be remobilized or repurposed for I don't know intensive care something is there a program better than the contact tracing program that you can really mobilize people who may be out of work now and repurpose them to be some sort of supplement health worker in some capacity you know what I'm saying in other words you I don't know it repurpose some parts of your labor force that are now finding themselves without work because the tourism industry is dead and so forth can they be somehow used to help relieve system you have to think out of the box yeah I know I'm not supposed to do this and I rarely do it but I'd like to answer the question because Toby is very provocative I mean I think to help compliance one of the things the government should do is should make testing all testing free if all testing is free then people will know they will know if they have to stay home not stay home they will do their own contact tracing short of having an improved contact tracing system if you do one thing you make all testing free and actually testing is not that expensive it's expensive because it's in the hands of the commercial sector but if you find a way to test everybody to make testing available to everyone people will go for testing they're going to do that the other thing is John is correct when you make masks and shields free make that available for everybody and the third one of course is every time you lockdown you should receive something in your bank or your PayPal or whatever it is there is no reason to not give people money during a lockdown because if you tell people to stay home and they have no money just to stay home they're not pasaway they're hungry they have no food and Toby just reminds me of many years back like we were saying distribution of relief food is very expensive kasi yung logistics na laki but if you just put cash you give people direct cash they will comply I don't think I'm not thinking that their heads are really high no they need to be capacitated so I'm sorry I'm giving an opinion but testing should be 100% free and I don't know people are going to get mad at me and we have money for that feel health has a whole whatever stack of money that they are not okay let's not go into that but the amount of the matter is I gotta get started on that I know that but I guess our point is we can do it yes on the cash I agree with you I think there are certain circumstances where I think in the beginning of the lockdown last year where the supply chains themselves were disrupted and therefore when you have cash and no supply that could be a situation where it should be in kind so there are certain circumstances maybe that's not the case anymore anyway rather than putting money to building highways or something give people cash okay we are past the top of the hour sorry everybody they got excited we are getting emotional we have some we want to answer the questions to the opinion poll so Raymond let's go to that and then we are going to close I know we could talk about this for a long time but we want to honor everybody's time and Raymond let's go to the questions and let's ask our guests to answer them thank you Dr. Suzie for the first question actually it's the third question in the poll how much more transmissible is the B117 variant is it 26% 56% or 76% Dr. John 56 56% thank you sir no or may have missed it because sir that's something that people will appreciate thank you sir number four is for professor Tobi Munso the economy can only recover if the public health crisis is contained through our falls ma'am true absolutely okay and then finally so this is how it goes po as we may have to hear it from the expert themselves okay okay then the fifth question would be which variant of concern was first discovered in the Philippines let me call Dr. Siebel for that it's the B1 the UK variant was first discovered here but the one that from here or the new variant here is the P3 variant but the first variant in general is the B1 variant thank you may we call on all of our panelists back and then let's probably ask for their final reminders or messages po address to our attendees yeah Raymond, I think are we doing the evaluation also Raymond I'm seeing it on myself while they are going through their messages po may we ask also our attendees to please fill out or key in your answers for the panel discussion assessment there are five questions but in the interest of time just in a nutshell it's mostly about how much you have learned and how it was delivered to you with regards to the topic what are the scenarios for the next 12 months for COVID-19 here in the Philippines over to you Dr. Siebel thanks Raymond okay so we're about to close but we'd like to ask everyone to just give a very short message and I think the question we want to ask is what's your advice what's your advice to all these doctors nurses who are listening to us right now what's your advice for the next year for this coming year so we'll start with Aileen I think coming from all the lectures that we heard today let us try not to make gatong yung disinformation and misinformation and I think let's leverage yung social media by advocacy groups about proper use of masks what kind of masks are effective and how do you clean face shields et cetera and yung mga friends natin let's try to get drives how to give free masks and free face shields to our less fortunate co-citizens thank you very much Aileen very very positive message and something that we can all do okay so Sibyl yes thank you again for inviting me here and to all the fellow healthcare workers the doctors the nurses especially so today is parang fortuitous today is aro nang kagitinan so kayo pung lahat ay magiting ang heroes we probably don't say it enough to all of you especially the nurses who have stayed and who are still with us throughout this pandemic manaming salamat po and just hang in there I'm with you in the front lines so we'll just take it day to day we can do this this will end so hang in there thanks John I think the first thing to do is continue protecting yourselves kasi there are a lot more clusters now in hospitals so get your vaccine if you haven't yet I think only half of the health workers have gone to take the vaccine and then second try to observe you in health protocols kasi a lot of the clusters also come from I mean health workers coming back to eat together again but I think maybe the more important message is we need to get our political leaders to do more and to do better and I think health workers have a lot of social and political capital that they can use but have not yet maximized I think we need to all speak up and get government to listen thank you very much Toby same as everyone else all I can say is please keep safe we need you, thank you I wish we did a better job in terms of resource allocation and prioritizing and I hope we can do and I hope we can push so that moving forward investments are in the public health system led by you will really will really be made in anything else so I think from an economic viewpoint it's economic managers I think that have to come around in that sense as well sorry but we'll keep on trying we'll keep trying thank you very much Toby okay so we have a closing statement and a bit of a summary coming from our Executive Vice President for UP Ted Robosa Ted, over to you thank you very much Suzy you guys always amazed me it's the 47th episode of this and the first one was a blockbuster and each one continues to be a blockbuster on top of the other one and for all the people that are here in this webinar you know these guys that work for this they prepare a lot they think about this they choose who to bring in and every week, every Friday I am impressed with the level of information that you have been able to deliver today is no different and today is more auspicious and Saibel already talked about it it's something that happened on April 9th 1942 that was 79 years ago and what happened then there were 78,000 soldiers that were fighting for this country 66,000 of them were Filipinos 12,000 of them were Americans and they were fighting and the Filipinos what did the Filipinos say no, we're not going to surrender ba? Bayang Magilio, hanggang mamatay and they were ready to fight to the death the Filipinos wanted to fight to the death but the Americans couldn't take the number of deaths that could happen so the Americans decided that they surrender and they indeed surrendered and we commemorate that day of surrender but that surrender saved many lives although what followed was a death march the lieutenant general of the Japanese invading force Lieutenant General Homa Masaharu he didn't know what to do with 78,000 prisoners and people that were weak or sick or tried to escape were killed or bayoneted and it's amazing how many people died 600 American soldiers died on that death march and 5,000 Filipinos died almost the same as the number of deaths probably we have here in COVID but the interesting thing is eventually they were able to execute this lieutenant general for war crimes I'm not saying we should execute our government officials but definitely there is a lesson to be learned here Filipinos never give up Filipinos always keep fighting to the death and I'd like to thank all the speakers led by our economist our epidemiologist our infectious disease specialist our evidence based medicine pulmonologist who described everything to us Professor Toby Monson I will counter by saying my rebuttal as a health professional well the economist never invested in our health system we've been fighting for a higher investments in health system and we as doctors I worked in PGH for many years as head of an ER that is very similar to the situation most ERs are actually having today and we tried to work it out with the bigger budget that we have I think what's important a lot of what she said I agree capacitate the health system the way to fight this pandemic is really to capacitate the health system and I heard this as well from Professor Perna he said health and economics we shouldn't be afraid to spend for health care and we should invest we shouldn't spend for it it is not an expenditure health is an investment and it is not an expenditure John Wong it is not about data and epidemiology he has been guiding the IATF with his epimetrics group and without his analytics of all the data he probably will be in the pancitan but I think all his analytics are on point and describes exactly where we are and he contributed three things he said where are we how did we get here and where are we going and what are the contributions like me in the national task force I give plenty of advice but I don't know if the advice always falls to debtiers and here some of the advice that I say has been actually echoed by our experts here in this particular period so thank you John Wong for those nice contributions about how to really fight an epidemic and we value that we value your comment you need systems thinking to solve a systems problem and it's not so different from what our economists actually said then there's tribal who's in the front lines in the critical care and infectious disease front lines and talked about how it is really out there and I can commensurate with her I'm glad I'm not doing any more clinical practice because I'd be shouting my head off in an emergency department that was exactly how she described but she described several things that are important to me the Swiss cheese model that solutions to us must be layered and that we must continue to have all those layers in place to protect us and that misinformation and science are very important and she coined the term that's very that caught on the virus economics I think that's something that needs to be written about Eileen in the end impressed me with her quotes I didn't realize Eileen was a wise woman with all these quotes started with a carinyo or brutal that she didn't know how to translate looking at the forest instead of the trees she looked at the solace at the big picture that Jan Wong was able to show and quotes like knowing yourself is the beginning of true knowledge quotes like science is the great antidote to the poison of enthusiasm and what's the other one of enthusiasm and superstition superstition correct and she demolished a current conversation some politicians want to give away a current drug and she demolished the evidence for why these politicians are so passionate about that and she said in God with trust we need data in the end I'll talk and say my favorite quote because people were throwing on their favorite quote my favorite quote when I was studying abroad was I studied disaster medicine and what was told to me was that we are in the information age we are swimming in oceans of data and the data needs to be organized to become information so that it can flow to rivers of information so that the rivers of information can be used in lakes of knowledge where we get our droplets of wisdom thank you very much for joining us this afternoon manaming salamat thank you very much it's Dr. Ted Derbosa the executive vice president of the University of the Philippines and also a special advisor to the national task force for COVID-19 so next week, next Friday we have an exciting discussion and the topic is facts and fiction and we actually might talk about some drugs that we are not mentioning right now because we feel like if we talk about it we give it more it's like you're giving more attention to it but we will talk about facts and fiction and so we're going to address misinformation and we're going to have Dr. Isa Alejandria who again is the president of PISMID the Philippine Society for Microbiology and Infectious Disease and we're going to have a couple of infectious disease specialists hopefully we also have somebody from the Department of Health and I've seen this in the chat should we invite some from the department okay we will but I can't announce yet who because I might get into trouble again by announcing I don't know if confirm yet but we do have somebody invited from the department huh? you're going to ask it's confirmed we will have Beverly Ho from the Department of Health okay so Raymond over to you thank you and thank you for what a way to wrap it up sabi nga po na isa sa ating mga attendees at ABP Ted I will not give my quote because we are over time but we'd like to thank everyone who is watching us in the live streaming links YouTube, Facebook who are still with us here in the zoom webinar for those who would want to again retest their knowledge and try to understand we are sharing the poll results as you are seeing here and the answers to the questions as relayed by our experts so again next week facts and fiction on COVID-19 prevention and treatment hope we could see you or let the next week for Friday 12 noon to 2pm it's a date okay together let us stop COVID-19 so keep safe, keep healthy and see you online the other Spain but for my fears the other lives but for my tears but right behind the mask I look into myself and ask do I have strength to carry on oh God our Lord what's this going on and leave you here to keep me strong I'm here to hold the line my word until my time I came to realize it's fine to be afraid just hold on to the word he gave this time will come to pass cause this salvation makes it last you'll carry you to see the break of day the others pain but for my fears the others lies but for my tears but right behind the mask I look into myself and ask do I have strength to carry on oh God our Lord what's this going on and leave you here to keep me strong I'm here to hold the line keep my word until my time my fears but right behind the mask I look into myself and ask do I have strength to carry on but God our Lord leave you here to keep me strong I'm here to hold the line my word until my time