 Right, good afternoon to everyone and welcome to our 51st installment of the Stop COVID Deaths webinar series. We are glad that you can join us today as we continue with the fifth season of our COVID-19 learning journey together. Two months from the March surge wherein the Philippines experienced an increase in COVID-19 infections in the country, mostly centered in the national capital region and adjacent provinces, we now call the NCR plus bubble. Medical capability and capacity have been strained to their limits, forcing most hospitals to turn away patients. Aside from the problem of bed or room availability, there was also a dilemma about multiple clusters of healthcare workers getting infected with COVID-19. What have you learned from the recent surge to help protect our health systems? Good morning, I am Dr. Albert Francis Domingo, a health system specialist and it is always a pleasure to pitch in as a co-host for this Stop COVID Deaths webinar. If you're looking for him, my colleague and classmate, Dr. Raymond Sarnento, okay Magalila, he's still here with us and you'll hear from him later in this regular Friday lunch date of hours. I always look forward to Fridays because I get to learn something new every week behind the scenes, but now I also get to share the hosting duties with a beloved mentor and a dear friend. Please welcome an adjunct faculty with the UP Manila National Telehealth Center and an internationally renowned public health communication expert, Dr. Susan Pineda Mercado. Hi, ma'am. Hello, Dr. Susie. Good morning. We might be having technical difficulties with Dr. Susie. We'll just checking on where she is. Yes, no? Just saying hello to all the participants now we're counting up to, we've reached the 1,000, reached the 1,000 mark, yeah, okay. So checking in. Hello, good morning, ma'am Susie. It looks like Ma'am Susie disconnected. All right. So while we're waiting for Ma'am Susie to come back, it's always wonderful to have everyone here. And today, we are going to talk about saving our systems, like controlling the surge for COVID-19. It's always been about what we see, that the hospital is full, that we are facing overcapacity. We might be wondering, how do we intervene? How do we help out? How do we try to fix the issues that are surrounding this? Why do we have direct directives that raise our bed counts, so to speak? So I just wanted to greet all those who have typed their messages here in the Zoom chat box. So hello to our, now we are at 1,060. All right, so we are seeing, I'm just randomly picking, when I saw the message, hello to Cecilia Joyce Bascara. Hello, hello to Belinda, Jubilo Santos, good morning, good afternoon, good afternoon to Irvin Llorente, to Ronaldine Joya. So our webinar can accommodate up to 3,000 participants. So please join us in Zoom, so you can fully experience this interactive program. We have a lot of platforms, we are at Zoom, we are also, there it is, ma'am Susie, hello ma'am Susie. Good morning, good afternoon. Hello, good afternoon, sorry about that Raymond. I mean, this happens, right? Sometimes you have a patient through flat lines, and so we have to do something about it. Okay, so good morning to all of you, sorry that you dropped my internet, I'd like to greet everyone who's watching us, joining us on the webinar right now. For those of you who are watching on the playback, YouTube or live streaming on YouTube and TV, TV, UP's Facebook page, good morning to all of you, we're so happy that you're here, and we're so happy that you're here every Friday with us, we've got a very exciting topic, it's good that we can talk about it, we can talk about the surge in the hospital, and we'll listen to the experience of the Philippine General Hospital, but we also have other guests, and our guest today is Raymond Sarmiento, he's so hot. So Raymond, we will talk about Raymond later, and I hope you're okay Albert, that I left you for a couple of minutes, so I just want to greet everybody. Okay Albert, over to you. Right, so thank you mom since you're welcome back, so everyone please join us for this very important and informative session, as we determine how to save our systems, what does it say, what is the health system here? How do we save our systems from the COVID-19 surge? This includes the role of technology such as, you can see that, the genetic sequencing, the variants of interest, variants of concern, later we can see that, and the telemedicine, it's like now, like last time, that the telephone order and the consultation is not just that, and the race against time to stop COVID deaths. So just to let everyone know the structure of this webinar, after the main presenter has given the presentation, we will be having a panel discussion, we have a lot of guests today, the reactors, and this will be followed by a Q&A session. You can use it, there's a button at the bottom of our Zoom, the Q&A button, for those of you who are on YouTube or Facebook, please type in a comment and our team will be monitoring those comments and relaying the questions. All right, so ma'am Susie, we have 1,170, and counting is still going up, from what I heard ma'am, in 2,800, almost 3,000 of our registrants. Yeah, and we always expect people to watch on the playback as well. So yeah, this is going to be, I think this is going to be a very good session, we're going to hear also about genomic sequencing, as Albert has mentioned, we're going to learn a little bit more about the variants, what do we know about them, and of course how do you keep yourselves safe? And I notice we have a lot of, so I think our other hospitals, Result Medical Center among Rodriguez, of course from PGH, a lot is connected, but we have people watching all the way from Basilan, from Kagayan, and many parts of the country, thank you so much for being with us. So Albert, let's talk about the, not least certificates, the people behind the scenes. Right, so the people behind the scenes, before we go into the next sections of our webinar, we just want to make sure that we are all prepared and ready, and let's thank those people behind the scenes. Thank you so much for our University of the Philippines system. So let's know that this webinar has been going on as number 51 on the webinar. So the University of the Philippines system, the UP Manila National Telehealth Center, the UP Information Technology Development Center, TV UP, the Internet Television Network of the University of the Philippines, the UP Philippine General Hospital, People Giving Hope, PGH, and everyone who has helped to make this learning series possible. A lot of the behind the scenes supporting us, ma'am. Right, so Albert knows that, it's like he's already with us, because he's already with us. I just wanted to say Albert, Albert was with me when we drafted the first concept paper for this webinar. And so it's great to have you here, Albert. Thank you. And later, you can design a little bit of a classmate, you'll have Raymond while you're here. Anyway, we have certificates of attendance. We're here, Albert. Yes, we have. So for our attendees, we have certificates of attendance. So there's also, to prevent the pre-pandemic, there's a certificate of participation. Of course, we're the first one. So we have E-certificates of attendance. For those who will stay on to watch, what's the passing grade? No, it's not passing grade. At least 50%. So please stay with us for at least half, half of the webinar duration, until 2 o'clock. So please take note that the name you input in your registration will be the name that will appear on the certificates of attendance. It's like a contact tracing. The name should be the one that you put in. Don't put other names in your contact tracing. All right. Yes, that's juicy. Okay, so let's go ahead now. And we'd like to, we're very honored to have our opening remark speaker, the Dean of the U.P. College of Medicine, Dr. Charlotte Chong. Again, welcome to our program, who's always with us. Welcome, Dean Charlotte. How are you today? Okay, thank you for inviting my friend, Dean. I'm back. You're so busy because the medical students are getting vaccinated. Is this true? Yes, there are about 94 of them now in Santa Ana Hospital. Some of them finished already. And so I would like to thank your men, Isco, and of course Director of Santa Ana, Dr. Grace Padilla, and our director, Dr. Ghapli Gaspi, for making it all happen for our students. Because they will return in June-July for their anatomy dissections especially the first year or LU-3. So we want them to be protected even before they come back for their bridging courses. Oh, Dean, maybe there are other medical schools here. Is this true for all medical students? They can now be vaccinated? Yes, if you can check out, Dr. Mir Nakobotahe actually released a memo that all medical students who will be doing face to face rotations or face-to-face classes can actually avail of vaccination and be included in the A priority list of the vaccination program of DOH. Okay, so I think Albert- So we need to get that memo and I'm sure try to make representations with your LGUs. Yeah, you know, our topic is really save our systems and Albert was pointing out that we really have to think about how are we going to produce more doctors? Albert, did you want to talk a little bit about that before we proceed? Yes, ma'am, actually, no. It's really good to find out that it's like A1 because medical students are the only difference in medical doctors is their license. But they are essentially at the bedside also. They're also facing the patients. And what is that? Maybe it's different for them. It's only one or two years. They'll be doctors. And not only the medical students, also the nursing students, the paramedical students, these are the future healthcare workers. By the way, today, if I'm not mistaken, it's Health Workers Day. It's being celebrated, ma'am. So, our vaccination campaign is really going in. So, I'd just like to emphasize what Dean Charlotte said, for our deans of other medical schools and also nursing and paramedical schools, all of those students, health students, are part now of the, I think, A1. They're considered to be A1s of vaccinations. So, please get them vaccinated already. Yes, ma'am Susie? Okay, great. Okay, so that's great. I mean, I think that when we get vaccinated, we'll be able to get vaccinated. Anyway, Dean Charlotte, please go ahead with your opening statement. Well, I'd like to welcome all our attendees to this 51st episode of Stop COVID Webinars. This is, of course, thanks to TVUP, Director G.G. Alfonso, VP Elena Perna, and of course, the WHO Health System expert now that we have as co-host is Dr. Albert Domingo, and of course, the adjunct faculty for NIH and envoy for global health, Dr. Susie Pineda. The title is SOS, and that means Save Our Systems from the COVID-19 surge. Over the past year, we have really looked at the multifaceted problems facing this pandemic. Worldwide, there are now about 155 million cases that have been reported, 92 million recovered, and 3.25 million have died. In our country alone, about 1.07 million have been infected, 993,000 recovered, and about 17,800 have died, including, of course, our esteemed faculty members here at the UP College of Medicine, our alumni, family, and even friends. Now, PGH is one of the three COVID referral centers declared by the DOH on March 20, 2020, and it opened as such 10 days later. So we saw a flurry of administrative changes, closing of wards, engineering controls to convert century-old pavilions to negative pressure areas. Innovations in computerizing our electronic medical records, providing gadgets like RxBox for telemetry, telekamustahan portals for our patients, more than 14,700 testing of healthcare workers have been performed in our 1,500-bed hospital that used to see 600,000 patients that now has a decreased capacity from 30% to 60% depending on surges at several time points during this pandemic. We've always considered the hospital as the last bastion for this war against this virus. PGH is where the fiercest among us do battle in the trenches. In a university hospital setting, our faculty continue to teach while infection prevention and control lies at the very core of having PGH remain open to serve the public. There have been struggles also for the college to ensure that we graduate a new crop of competent doctors, and hence we've been pushing hard for services for them, early vaccinations, for them to be able to join us and learn to be compassionate doctors. I recall emotional town hall meetings with the director to convince our future medical doctors, the interns and clerks to come back already for face-to-face rotations amidst their fears and trepidations, and we were ensuring them that we will take all the precautions to make PGH safe with PPE provisions, safety protocols in place that they should follow. 14 months in this pandemic clearly made us realize we could only survive this if we work together in uni. We buy in community effort, we all help out to make the trenches safe for our doctors in this field of battle, and what might not be discussed here today but should probably be also touched on is that local leaders, barangay captains, people's organizations, all help ensure that the communities outside of hospitals are safe. As our hospitals ran out of beds and our healthcare workers got sick and infected, our health systems almost were considered to be failing. Health permits all communities. Systems in the local and national levels have so many learnings from this pandemic. Science-based solutions mixed with cultural, economic, social, societal interventions will need more interplay. There is still a long road ahead of us with barely only 2.5% or so of our population vaccinated at the present time. But this afternoon, let us learn some more from our experts on how to deal with surges inside and outside the hospital complexes we healthcare workers work in. Our profound thanks to Professor Nina Berba for yet another presentation on our experience in PGH to Director Ghapli Gaspi, NTPC Director Dr. Raymond Sanriento, NIH Executive Director Dr. Eva De La Paz and of course East Avenue Medical Center Chief Dr. Alfonso Nunez whom I'm only meeting for the first time here in the Zoom meeting. Although I did perform the first cochlear implantation in East Avenue Medical Center about three years ago, I'm sure our conversations this afternoon will give new insights and better ways of dealing with COVID-19 in our country. Bangon, Filipinas. Over to you, Albert and Susie. Okay, thank you very much. That was Dean Charlotte Chong of the UP College of Medicine. And we're going to have you, Charlotte, come back later for our panel discussion. Thank you for a very inspiring message as always. Okay, Albert, let's go to our Mentimeter. Opinion poll. Yes, let's go to our Opinion poll now. So, Dr. Susie, I remember when we started the Opinion polls here in Zoom, but now because we have many watchers even on Facebook, on YouTube. So, let's use menti.com. So, bring out your devices, that's your phones, your computers. Let's go to the website at www.menti.com. Please use the code 75578216. Okay, 75578216. And this will allow you to answer the first question which is now displayed on screen. There, this is for the board exam. When is a symptomatic patient most infectious? When is a symptomatic patient most infectious? And the choices are A, upon exposure to confirmed COVID-19 case. B, day one of the appearance of symptoms. Or C, when you get the results of your COVID test. So, please try to answer. When is a symptomatic patient most infectious? This is an anonymous poll, no pressure. Just use the menti code you see there 75578216 on www.menti.com. While our viewers are answering the poll, acknowledge your well-represented audience. As I mentioned earlier, we see participants from all over the country, from Kagayan Valley Region 2, from Kalinga, Cordillera Administrative Region. We also have people from Sorsogon, from Kabikulan, Siniloan, Laguna, and Calabarsón. And all the way from Basilan, Zambuanga, Peninsula. So, we have a lot of participants that are joined from all over the country. So, based on our menti meter, there we go, let's see how many people are answering. So, we have the following responses. We have, wow, 236 responses. And the majority is answering 198. When is a symptomatic patient most infectious? On day one of the appearance of symptoms. So, let's see if that's correct. You will answer our speakers, our panelists. But before we go to that particular level of detail, so let's not forget that we have other questions. Wait for those to come out later. And this is the second poll question now. Why is it important to do genomic surveillance of emerging variants? Is it for us to do the genomic surveillance? And still the same menti code 75578216, our choices, A, it will help detect if a variant spreads more quickly in people. Don't believe immediately in the first response that a lot of people answered, but that's really the answer. B, it will help determine if a variant evades specific diagnostic tests. C, it will help detect if a variant causes more severe disease. D, it will help determine if a variant can evade vaccine-induced immunity. And those who are doing board exams answering letter E, all of the above. But there's also F, none of the above. So, please choose your answer. Why is it important to do genomic surveillance of emerging variants? And while everyone else is still answering, I can still see the numbers. Let us now acknowledge our international viewers. Mam Susi, we have from Ministry of Health, Bandar Seri Begawan in Brunei, from Taipei City in Taiwan, from Ho Chi Minh, Vietnam, from Simpang, Amphat, Malaysia, from Bandung, Indonesia, North Delhi, India, Dubai, United Arab Emirates, from Saudi Arabia in Riyadh, from Doha, Qatar, from Muscat, Oman, Salmiya, Kuwait, Islamabad, Pakistan, Pordenone, Italy, from Corona, California, United States, and the Niagara Falls in Ontario, Canada. It's very welcome all over the world and our participants, not just from the country, but also all over the world. We have members also of the medical and academic community, Municipal Health Office, Gata Ran in Kadaian, RHU Tanudan, in Kalinga, Ikapit Nisigmo Community-led Development, in Laguna, Metro Health Specialists Hospital, Incorporated the Sorsogon, and Basilan State College, not in Basilan, Zambuanga, Peninsula. Please join us. Welcome every Friday at 12 noon and again for our viewers on YouTube and Facebook, please feel free to answer in menti.com. The code is 7557-8216. Just comment if you have any questions. We will read that. So, Ma'am Susie, there are a lot of answers. Let's take a quick look at your responses all of the above, our respondents. Let's know if we have the right answers for our speaker. Over to you, Ma'am Susie. Okay, thank you very much, Albert. And yes, we'd like to welcome all all the international participants in the webinar. Sometimes we speak in Filipino. Well, a lot of the international participants are Penoise, but I understand we also have quite a bit of quite a bit of really people from health workers from other countries. So we really welcome you and just very happy to share what we know here in the Philippines with you and hope that we can also learn from you. So there's a Q&A box, there's a chat box. We try as much as possible to be interactive and and I think as we go along the webinar, please feel free to ask questions in Q&A. I said this the last time that while we may not be able to answer all your questions, the Q&A box helps us get an idea of what you're thinking and maybe we can ask our speakers to address that. So use that, use the chat box and be involved and be engaged with us. So we typically have a person on the street interview prepared by TV UP and Albert, do you want to cue that? Yes, let's see. Let's see, what is this person on the street interview? Let's watch this short video by TV UP's answering. Why are hospitals full because of COVID-19? In my opinion, this is the case of COVID-19 in hospitals because of the lack of knowledge of people regarding COVID-19. It's not inevitable for other people to get out of the hospital because they really need to find a way to live. That's another factor. There are so many variants. So many surges in communities and workplaces. Well, for me, it's the variants and then it's not all. I have the ability to earn money or buy food. So maybe because of the way people go out there's a possibility to get out of it. People became comfortable so maybe because of that, they became confident that we're okay because there's a vaccine that we're not okay anymore or that we won't be able to take care of. It's the same for us. We've been like this for a year. So of course, we've been like this for a long time. You need a lot of things. It's not just for work. But I want to see their families, their friends. There's a lot of things here. It's not just about home isolation. It's about medical management that hospitals can cater to. Other people are really critical. That's what doesn't give proper attention. That's why hospitals are full of COVID-19 cases. Other people who are infected or sick are also involved in many COVID-19 cases. The Filipino people are starting to get vaccinated. But we still need to be safer. Especially now. That's what we're going to do. So hopefully, it will get better even if there's a lot of cases. Let's think about the children of the generation today or let's do this for them. The fight will be over. I hope for us to start and for us to end. In the future, all people will be careful when it comes to their health. Maybe they will like the mask or the other people who are taking the vitamins. I fully believe in the vaccine. I really hope that the herd immunity I hope everybody here that they would encourage the Filipino people to get the vaccine. So we can all grow and get better. Okay. Sorry. Thank you very much. Thank you very much, TV UP. I think it's always very helpful to get a perspective of ordinary people what they think is happening. And our topic today save our systems and dealing with COVID surges inside hospitals is really a very good theme on Health Workers Day. Because the response of our health workers is really strong. So let's see how we can protect our health workers. There are still a lot of cases of COVID-19. So our special presenter for today is somebody who's not new. You've met her many times. She's the head of infection on hospital infection control at the Philippine General Hospital. Dr. Nina Burbot. Nina, welcome to the webinar. Hello, good afternoon. Oh, you're already there, Nina. Here. Waiting for my turn. Hello everybody. Okay. It's my game? Yeah, go ahead Nina and make your presentation. Go ahead. Okay. Good afternoon everybody. So let me there you go. All right. So save our systems from the COVID-19 surge. So these are my objectives to demonstrate how timely contact tracing may help manage outbreaks or surges and to describe some of the various tools that we can use to manage COVID-19. So this is my outline and I'd like to start just describing a little bit what we've been doing at the PGH. So this is our beloved PGH. It's been designated as a COVID referral center for over a year now and this is our office. This is what we call Hospital Infection Control Unit that's me over there and our staff and what we do. So if I were to describe what the top three best practices of PGH have been and our contribution to the COVID-19 response I would say that it's this. So side by side with what's recommended we tried to really use the science to have better engineering controls better administrative controls and the proper PPE. So your engineering controls we did it this way. So while many people would invest a lot of money on negative pressure settings what we tried to do was what we called controlled ventilation and it looked something like this. We had really big open words and we tried to achieve the we tried to achieve this the recommended 12 air exchanges by actually controlling the movement of air and using this full proof devices to make everything work. We also had this administrative controls that I think was also key to our good operations in the COVID-19 and finally the HECO based risk-based levels of PPE which tried to adapt with what was happening elsewhere and according to the levels of evidence. So how did we know we protected our staff? Because there is still a question of whether we could do a surge. So early on we actually did a hospital-wide COVID-19 testing the third month of operations and we saw here the really very extravagant unprecedented high participation of all staff members of the hospital. We have about 5,000 people in the hospital and 4,871 participated in this hospital-wide surveillance and you would see that at the end of it we noted that only 2% so only 2% have COVID-19. And that was really very remarkable and when we tried to disaggregate the numbers we saw that the numbers were actually better in some areas and even in the areas where doctors and nurses were working actually in the COVID wards they did very well. But this kind of approach was very very expensive it wouldn't be able we wouldn't be able to sustain it on the long term. And we felt that targeted testing was really better so that was what we did along the way and as Dean Chong was saying we actually encouraged targeted testing and we were very generous with the numbers of tests that we actually did whenever our healthcare workers would feel like they need to get a test or they were exposed we allowed them to have the PCR testing. So in this graph you would see that the tall light green graphs or bars represent the actual number of tests done and the little darker shades of the bars represented the ones that had positive tests. So along the way we actually really tried to monitor our healthcare workers and I think that's very very important anticipating whatever will happen with the COVID-19. So we had surveillance in the form of mass testing as I described earlier but along the way since we felt it was not economically sustainable we targeted only the COVID staff so that happened three months later after the June mass testing. So we had surveillance number two where we noted 4.2 percent infection rates and throughout the year there was this targeted testing on demand whenever they feel they needed. So in the end we had these numbers of infection rates that guided us as to how we would go about operating as a COVID referral center. So I think it's very important that our audience here have or the particularly managers of our different institutions and communities have some kind of an idea of what your epic curve is in your vicinity in your community in your institution. So we did something like this. We always plotted the number of infections on a per day basis and we actually had the definition of what's community acquired COVID that's community acquired or that came from the household or community or occupationally acquired that came from the hospital. So we were already there you see that the numbers have gone down around November, December, January, February. We were experiencing just very, very few cases and there were days that we actually didn't have infections anymore. So we were very, very comfortable and at that point we felt we're already almost one year into this. We needed to know exactly how people were doing who were infected how many were infected what were we doing were we doing everything correctly. So we thought of shifting gears from PCR testing to immunosurveillance or sero-surveillance. So we asked for volunteers from across the staff and tested them with anti SARS-CoV-2 antibody in the form of the IgG and in the end we categorized people to positive or negative. So here we realized that the positive but negative it doesn't end there it's not as simple as it seems because the negative ones sometimes they were one sick or never sick and the positive ones we think were sick but there were people who tested positive but actually were never sick or were never detected to have been sick with PCR tests. So in the end our sero-surveillance results came out like this. We wrote here all the possible permutations but nevertheless you could see that young non-reactive IgG didn't have antibody and was never sick. That means never really had COVID-19 in the last 11 months. That was 74 percent and we were very happy with this result. We felt reassured we felt affirmed that the operations were safe and there was in the last part of this table you would see there were persons who reported never having been sick but tested positive. So this we thought were the asymptomatic healthcare workers but they were not very many there were only eight percent of the total number of staff. So this is this is where we were you know back when I was surged at the context that I wanted to just establish we were comfortable we felt safe we felt proud that 74 percent of us remain COVID free and we felt this was a very good number we were just waiting for our vaccines and if we compare those numbers with other places in the world in the same setting and at the same period of the COVID-19 we felt that our numbers were comparable if not even lower. Okay So this is the surge here here then we experienced the emergence of the new surge and for you who is who are watching maybe the main question is how do you know it's an outbreak or a new surge? So we started to see change in our numbers as early as March 1 and at the time the DOH numbers were just that it seems like there was no premonition that a surge was coming and our epic curve looks something like this so comfortably we were showing our daily reports and it did say nothing much was happening until the there was some start of some traces that something was indeed happening and there was that surge so we needed to make the call so for you again who are watching it's very important when to make the call when to tell your staff or your colleagues or the people around you that hey alert alert we need to be more vigilant so we did that on March 4 and then it seems like we are running repeatedly there are alerts because things were not going down despite efforts so it started off how did we know there was something going on so in one department we had four cases in a span of just four days and then in a span of like just over a week we had eight cases and that triggered us to really investigate and call and quarantine 36 other people so that was a large number already and then because you know we don't work in silos we work together in the hospital we needed to look at what happened beyond that particular department A so we started to look at department B and here we saw that we needed to quarantine 91 people so together that was already over 100 people quarantined in a very brief period of time and in the hospital that really meant maybe crippling some very important essential operations and then we started seeing some other places in department C there was this webinar that happened face to face and then there was a lecture that turned out to be positive after the webinar and then had some infections there and needed we needed to quarantine other people and the same goes for department D where in people started to you know as we usually do gather around together and eat for a period of time so during that time at the first few days of this called coat and coat surge we figured out that me we thought that people were coming in to work despite symptoms because when we interviewed them they already manifested with some kind of symptoms related to COVID-19 days before their positive test and then they would go around the hospital maybe eat together with other colleagues and in fact more and more healthcare workers so we needed to stop this this particular process so we came out with future memos that said well do not come to work if you're sick or have been sick in the last three days and do not eat together so it's like it's like it's easy to say in memo but it's really really very hard to make people believe and comply okay and then we started to think hmm is there the presence of variants of concern already among us why is this happening so this is one of the things I'd like you all to take home from this particular lecture that when people come to work when they're sick it's very very it's really like heralding the possibility of more outbreaks because a person is most infectious so tina nongto during the mentimeter the person is most infectious just around the time before the symptom concept so and very high during the first days of illness and then it starts to decline within the seven days I'm very happy with your answers because it seems that you really knew about this infectiousness but when you start talking to patients and start talking to people who have been infected they start isolating themselves only after they hear about a positive PCR result so they've been infectious for a long time they've already infected many other people so that's something I'd like you to take home and I'd like you to share you with your family and friends and people in your workplaces and then the story in pjh continues so there were other departments that started to have more infections so we were really really very bothered when some people in the vaccination program developed COVID-19 also and then more offices and more departments and so we were wondering what was happening why was why were the number of cases really so explosive so we learned eventually that we were actually invaded in a way by the variants of concern so we had the South African variants many of them and then we also experienced within our needs a lot of people ending up with a UK variant some of them were patients and some were watchers but many were healthcare workers so we experienced not the variants first hand within our what we heard in the radio we actually experienced it in our hospital and we felt that the surge really was only partly the variants of concern but many also was related to many more things we needed to improve in our system so you said earlier it was a long time ago that's how we felt but it was very very important that we secure the PGH workforce because the last thing you'd really want to do was for this variants and the surge to overcome the operations from the COVID-19 we needed to like keep everybody safe despite the presence of the surge within us and make sure that we try to reduce the number of people infected it was like taking care of those people would take care of others we didn't want to close any of the wards and we didn't want to close our operations so it's important for you guys to understand that in this point in time we have a lot of time and a lot of time PPEs a lot of improvements engineering and administrative controls and with all of those layers in place healthcare workers probably do not get their COVID infections anymore from the wards so where did they get them so this review actually tell us what we've also been experiencing so transmissions occur outside the COVID wards they occur in our offices they occur when we eat they occur when we don't take care of ourselves and do not follow infection control prevention policies and it may happen while you are commuting from hospital to home in your with your families and in your communities so the last place that the healthcare workers might get their infections are actually in the hospital when they're wearing their whole PPEs but it's very important to secure the healthcare worker force because when they're when our healthcare workers when our frontliners are infected then they may continue to infect other healthcare workers and even patients so after the rapid rush of variants invading us we had to impose something like the martial law we had harsh rules imposed to stop the transmission so this is what we did we started to require a negative swab we had new rules in place we started to call back people we were very very strict with what people were doing when they were exposed we made sure they were quarantined we made every effort to really stop the transmission PCH employees who had household contacts knowing that they're very highly likely to be the next one infected we put them in quarantine already and we didn't allow them to work even if they were not yet infected so quarantined by virtue of high exposure and for those who had the variants we imposed that they had a negative swab before they returned to work so yeah so of course along the way a lot of people were angry at HIKU but that's something we needed to do we also looked at all the departments all the areas and when there were three or more consecutive positive COVID cases we asked them to close temporarily disinfect and make sure people were okay before we reopened so yeah that's what happened so those are all the new initiatives that we did to just make sure that we were working promptly on all the possibilities the most important of which was really to make people understand that when they're sick they need to stay at home and they need to reduce their social mobility also okay so that's what we again reminded everybody of the pandemic precautions and then we looked for the safety officers we reinforced we had this in place before but it seemed to be lacking so we had to find strict our people to make sure that all the regulations the new regulations were followed and we even the question is what are the meals what are the controls so even the meal times were managed we had to ask people to stagger their time that they ate we tried not to have people eat together we fixed the pantries we fixed the cafeteria and we tried to set up alternatives and then we actually didn't look into this before but because of the surge we had to look at them the call rooms and the lounges the offices we had to make improvements on them on top of everything else before we made sure they were transformed into well ventilated spaces there were spaces between beds and tables and we had to purchase additional HEPA filters so that's it so the risk communication had to be again reinforced we communicated communicated in English and in Filipino just that everybody made were made we made sure that everybody understood what we were trying to see but in the end this really glaringly really surged because for the month of March alone that already comprised almost 30% one third of the total infections we had for the whole year so that was really a lot of numbers and when we disaggregated the data we saw that many people actually did get the infections from community or household so in this particular graph they are represented as orange and as gray bars what does it mean from community? what did it mean? so when we asked people they would say they had a birthday party at home they attended the funeral they went on outing they actually went to commercial places like had the massage went to the parlor and things like that so we weren't really having reduced mobility we were actually moving around and that added to the positive cases what did we mean by the PPE breach? so in the graph they were represented as green bars so that means until the 11th to 12th month there were still some staff who didn't seem to understand the necessity of following all the guidelines or the health precautions so we had to again review and remind everybody about this and then what did it mean when from a co-worker? so this meant that they may have eaten together or during duties slept together or worked together without physical distancing so this is where the safety officers were needed the safety officers sort of hovered around departments and offices and made sure people were complying accordingly so here in the community when somebody gets sick you tell them to get isolated yourself or when others are exposed to this person you ask them to quarantine and sometimes that really doesn't add up to a lot of difficulties but when you're in the hospital when you start quarantining people who actually were just exposed to some positive persons then that adds up to a lot of people who need to be quarantined you pull them out of where they're supposed to work and you end up having very very few healthcare workers left to keep the operations of the hospital so here your yellow bar is represented here and that represents the total number of quarantined and we really in addition to trying to limit the number of people infected you also have to limit the number of people exposed and have to be quarantined because it really it causes so much disruption in your operation so if you have an operating room you might need to close that because you don't have enough nurses because they're all under quarantine so you would see here that in the month of March alone we had to quarantine 268 healthcare workers so a lot of them need to rest and leave okay so in all of this it's very very important to realize that contact tracing time timely done at the right timing is key to controlling whatever outbreaks you experience and it might be so complex so I just put it here you don't really need to read it just that you appreciate that they can be very complex and you really need to rely on what the well-trained staff of infection control or the contact tracing team in your communities will advise you there are high risk exposures so in the hospital these are exposures that happen because you're not wearing proper PPEs or you're not following exactly what's included in the pandemic precautions and all of this make you at risk for getting the COVID-19 okay so the algorithm can be very complex and it does require some knowledge and a lot of skills in communication so we'd like you to just ask your contact tracers to help you with this or your infection control committee in your hospitals but all of this the Martian law actually we had to do them only for a brief period of time two to three weeks and as soon as we felt that things were coming back to normal normalizing we were able to maybe nip the outbreak at the bud so we were by April 1 just one month after we called the first alert we were able to go back to previous programming so after the storm surge we went back to our previous policies where as before we asked everybody to be swabbed repeatedly after the storm surge we felt it's safe already we realized that the it wasn't necessary and that we didn't have surges beyond the places where the initial variants were seen so this is now our epigraph so you would see that in the last few days there have been days that we didn't have healthcare worker infections anymore and actually we were able to declare that despite the multiple PGH exposures to the variants we didn't really observe we were not able to observe that this cluster actually led to more and more of the other areas being involved so we're very happy what happened to the variants they recovered uneventfully but we felt that even before the results of the DOH so a message you don't have to wait for DOH to say now oh you have variants you don't wait for that early contact tracing at the point in time that you know about healthcare workers being infected whether variant sila or non variant you have to get them isolated immediately and we also did not see any additional generations of infected or high-risk contacts beyond the initial set of variants we saw so lessons learned I'll have to cite some of the other clusters we studied before confirmed by whole genome sequencing and this is all about looking and opting for safer choices so cluster one so this next set of slides describe our data on clusters so we found clusters before of infections and we thought and we tried those were the hypothesis we sent the samples to the Philippine Genome Center and they were very glad to help us and actually helped us describe the characteristics of the virus and we found indeed that they were interrelated the genome sequence were very very similar so this cluster started off with the one on the left-most side he interacted with the hospital he interacted with a lot of other people and their kind of work made them move around the hospital and what we found out it was very important that people wore correct PPE all the time because any kind of breach in PPEs would lead to infections like this that you can trace all over the hospital cluster two is about people who moved through or traveled through a car pool so car pools are sort of like a high-risk setting because people are together for long periods of time inside the closed space and when one person in that car pool gets infected he would inadvertently infect the other people in the car pool so that's something you have to think about if you're part of a car pool and practice more vigilantly your PPE use here you see that one of the people was part of a larger cluster so yeah and cluster three describes a cluster where in that person actually continued to go to work so there was just one index case who came to work even if he felt sick and actually infected everybody in that office so the message there is when you are sick you stay at home you don't put everybody at risk in your office and cluster four we needed to do this because they didn't want to believe us that it was the eating that it was the sharing of meals it was that sharing of space when you weren't wearing your masks that should be avoided so even if this different people came from different offices but spent some time during the day together eating that they got infected and the virus that they had were all the same and finally cluster five I want to show this to you because this is an example of a face-to-face interaction without full PPEs and even if you say well we only met for like five minutes we needed to do it nobody else could do it we had to have this meeting the message here is really no one is indispensable whatever you know whatever data you have whatever it is you need to do you can like just pass it on to another person especially if you are already feeling sick so symptomatic people even if they're just in the office or in the hospital for just briefly they can infect others and you would see here that everybody in that group in that meeting actually got infected so choose safer activities if you can talk virtually then do that and all of this were affirmed and confirmed by the PGC so this is where we are now I think we can safely say we were able to overcome the surge of March 2021 the graph in the bottom shows that we are back to usual hopefully it will stay that way but we're really really very very careful at this point in time and as of we actually over the last few weeks we have gone over the one year celebration we're not celebrating because of the surge but we're happy to say and we're grateful to everybody who helped us through this difficult year so my recommendations what works in PGH should work for all the other communities in our country but we all need to be guided by science we need to find solutions we need to implement by systems approach we need to be together in solidarity and always strategically use communication as part of your strategies these are my my teammates partners in crime so it's a bottom are the contact tracers in the HIKU that's mom Jeremy and mom Mary and mom Mary Lee who I'm very grateful to always and the COVID crisis theme on the left-overs so thank you very much for your attention wow thank you very much that's Dr. Nina Berba who is the head of the Infection Control Unit of the Philippine General Hospital and really demonstrating the extraordinary measures that have to be taken in a hospital in the time of the surge because it's like the surge will also reach the hospital from the community inter-hospital okay we're going to Nina while you're taking a little bit of a break take a look at the Q&A box lots of interesting questions there and the chat box also has some good some very good comments okay so I'm turning over to Raymond for our next reactor Raymond go ahead I mean Albert sorry Albert later Raymond don't get up but thank you so much thank you ma'am Susie and ma'am Nina Dr. Nina Berba from the Hospital Infection Control Unit of the Philippine General Hospital we mentioned that we will be hearing from Dr. Gerardo or Dr. Gap Legaspi of the Philippine General Hospital the director he is able to send a video for now due to another pressing concern he has to attend to so let's hear from the video of Dr. Gap Legaspi it's always a pleasure to hear Dr. Berba talk about new things in COVID-19 operations and also rehashing of lessons that we've learned and I think this current surge has proven that again basing our actions on good sciences what gets us through this pandemic we very well know that the increase in number of cases came at the time that we were turning around a year old as a COVID-19 Refail Center and we were about ready to celebrate that or commemorate that at least but the surge came and again we had to adjust and calibrate according to needs of the time so the COVID-19 Crisis Committee is composed of senior surgeons well on their way in life but almost all males but we all listen and we don't move unless Dr. Berba tells us to do so and this is one of those moments that we did and I'm happy that we have her in our team and to guide us on the next step so for this particular for this particular situation that on hand we again employ the personal reduction scheme as the first step and the initial step that we took was to send home our interns and clerks who were already spending around almost two months in the wards I'm not three months in the wards and of course they it was something that was difficult to for us to do but I think for the safety of these students we had to make the decision knowing that if they don't get infected from patients they probably will be infected from among themselves or some other personnel in the hospital and we don't want them unnecessarily exposed to that so that's a quite a number of them there are 180 interns and on the same number of clerks that were sent home for that particular period and of course the adjustment in the capacity to hold patients also was done prior to the search we were just operating one ward of around 35 for COVID charity patients and then a floor of around 30 beds for our COVID pay patients and around a few nine beds each for pediatric and obstetrics COVID cases and of course we still had our 18 bed ICU capability but with the search we were forced to open additional four wings and the personnel the personnel needed to run these things at least twice that of the regular ward so we were forced to close to close a few wards be close wards eight and six so that we can divert the personnel nursing most especially to the other open wards that we have the the reason for having more people more personnel including doctors in the wards was that I was very particular in the fact that our personnel should have protected time for resting so that you know after a year of course all of the anxiety and the stress would have taken its toll and and then again the search comes so I think it was only right for not knowing how long this search will run to schedule even the rest periods even more than they had in the previous surges that we had so we were fortunate to have augmentation of doctors and nurses as well and and you can the feeling of confidence and less anxiety was palpable in the wards when you make rounds so we were able to ramp up our bed capacity to around 250 and at a certain point in time we reached around 243 building the almost capacity of course the usual problems were there oxygen ports that were not functioning for a time we had a shortage of of high flow nasal cannula units and fortunately we're able to outsource this and add another 15 to our then 22 units available for our patients so this started us over until now I think we were needing less of this I think with the increasing number of patients the increasing need for medications is also felt not only by us but by the whole country probably especially the NCR hospitals because Remdesivir and Tocilisimab were running out in the beginning we're still able to even share our stocks with other hospitals because I think it's it's our duty to of course alleviate these conditions in people we can help outside the hospital but unfortunately we also ran out eventually and sourcing it was really a big challenge and it took a lot of wheeling and dealing to to be able to come up with the appropriate stocks for this but as we as we went along the supplies came and I think for Remdesivir we're waiting for our final delivery to come so the logistical requirements of of adding more people also to the COVID-19 wards necessitated more accommodations for them because our philosophy is that if they serve in the COVID-19 wards as much as possible we want them near the hospital so they don't have to travel much and lose time that could have been used for resting so we again employed the use of our facilities in the in UP Manila the colleges we got support from IETF and we were able to house at least additional hundred people going on duty in the COVID wards the this is probably one of the most challenging parts also the responding to the search is managing the transportation and that has cost us a lot of money to run but of course very much well what we pay for because the feedback from our staff is that it really gives them a sense of appreciation that's number one number two a sense of safety because they know everyone who's in the who's in the vehicle or in the shuttle more or less they know the status of health of these people with them and also of course the assurance that a vehicle will come and they'll be able to go to work so I think investing in the manpower in the shuttling of our employees is really a well worth the money that we pay for as we went along the operations the biggest problem I think that we met was increasing healthcare worker infection it was reflective of the community infection now it wasn't reflective of the infection increasing number of patients in the hospital COVID patients in the hospital so why because our data shows and I think Dr. Berba has shown that the occurrences of infection did not really emanate from one point in the hospital but where I conglomeration of different size of infections in different units of the hospital and traced back to their communities or their units only so I guess this is a reflection again of being probably one year into the COVID crisis people have started letting their guards down and and we were hit by a rash of infection which is at its worst around 15% of positive positivity of patients of people tested in a day so we had between 10 to 20 positive patients a day for around a week and a half so this is where I always mentioned that this is a point where we had to protect PGH from the community and that's we employed again the measures of safety officers being more strict reporting of illnesses online the allowing more access to the UP Health Service the manned by our family medicine doctors and eventually I I had to probably set it straight officially by issuing a memo that people found to be in breach of our health protocols we'll have to put in writing the explanation of how the event happened not only to remind them that it should not happen but of course for us to learn why it happened and maybe institute the necessary measures that that step of having them write it down is paying off now I think people are realizing that maybe it's really sometimes our human frailty that gets a better of us wanting to share a meal with other co-workers and even probably friends at home so these are just steps that we did just to remind us that the the battle is not over the enemy is still around us so having done all of that I think we were able to more or less contain the ravaging of our healthcare workers so to speak early on in the game and because largely to the systematic methods that our health infection control hospital infection control unit has instituted in that we also because of that realization that the work was getting bigger for our small team of infection control personnel we added we boosted the number of nurses in the team hoping to for them to be able to do their job better so I guess it boils down to responding to the search again in the ways that we have known them and adjusting accordingly to the current abilities and availability of resources we generally I think the even if the current surge seems to be more than what it was in the in last year's July and August the lessons that we have learned from being a COVID referral center in the last year has somehow allowed us to manage it more efficiently with less stress with less anxiety and but unfortunately I think we cannot claim that there are less deaths so because the the patients came in really sick sicker than they were before in the first surge and unfortunately the mortality rate has increased significantly also from I think we were doing a 12 percent early on in December in January even it has recent to around 20 percent during this search so despite all the efforts I think we just have to identify the areas where we can much improve delivery of care to our patients and hopefully outcome so a lot of the patients that came in were beyond help already being out there late in the course of their illness or maybe unable to find the proper institution to take them in so this will not be the last surge I think this will this will this is this current experience that we had made us even more prepared I think for a next one if ever it will come but hopefully it does not and the vaccination hopefully also will be able to decrease that and I'm happy to be here again with you this morning and share the lessons that you will learn in the Philippine General Hospital thank you very much and good morning to everyone okay thank you very much that was Dr. Ghapliga's PPGH director again giving us the whole view and really emphasizing how important it is to take care of our health workers during a surge and we're going to hear some more I'd like to introduce our next our next reactor is the Executive Director of the National Institutes of the Health Eva Kutionko-Delapas who is going to talk about the variants so we heard from Dr. Nina and from the cap about you know the risks transport behavior eating together and so on but let's look at the virus side so we've got Dr. Eva Delapas with us Eva welcome to the webinar please go ahead with your presentation thank you thank you Dr. Soussi Dr. Albert let me just share my screen so we always hear that we are fighting an unseen enemy in this pandemic I think sequencing somehow allows us to see that enemy through its genome and it gives us the opportunity to understand COVID-19 better what I'd like to share is how sequencing the virus helps the response to COVID-19 just like what Dr. Berba has mentioned in her excellent talk and also from a country perspective during the initial stages of the pandemic countries used sequencing to find out how many new cases of disease are imported or come from local transmission and global databases of virus genomes enabled researchers to compare genomes from country to country in this slide you will see the phylogenetic tree of SARS-CoV-2 in the Philippine Swap actually last year majority of the Philippine samples collected in March 2020 you can see here were observed to group into clades linked to the outbreak in the cruise ship MV Diamond Princess in Yokohama, Japan in early February later that month passengers and crew members of this cruise ship representing various nationalities including Filipinos were repatriated to their home country so our Filipino crew members were quarantined for 40 days at the Euclark city towards the end of March we did sequencing of some patients admitted to the PGH who had no travel history outside the country with some having no known interaction with a confirmed case confirmed positive case suggesting the possibility already by then of community transmission and shortly thereafter we had the hard lockdown from March to May and we surmised that the further spread of the virus from the MV Diamond Princess cluster of cases was stopped this phylogenetic tree also shows us the D614 G mutation in the months we struggled with increases of cases last year and here we see in January when we started the national genomic surveillance the arrival of the B.1.7 variant from the UK from our returning overseas Filipino and our borders were closed at that time and travel restrictions were imposed the second is a virus genome sequencing also allows estimation of epidemic growth rates transmissions and infections through mathematical modeling of how viruses evolved during the pandemic this is useful especially when cases are under reported because many people who are infected actually do not have symptoms this graph from Dr. John Wong of Epimetic showed the possible impact of then at the time last year B.1.7 no not last year sorry sorry January of this year the impact of the B.1.7 variant on active cases when the first case was reported in our country by our national surveillance if the variant becomes the dominant species after a month you can see in the graph after a month cases will increase by 28 times instead of just three times so that was the projection and from there planning scenarios could be derived from variant control and according to Dr. Wong if there will be a reduction in 80% at the end of the month after 30 days the country could have just a little more cases compared to having no variant and this is having no variant that's the baseline this is 80% reduction in the cases so the call was for efforts should be focused on reducing the baseline cases third widespread sampling and genome sequencing allows the reconstruction of virus spread in different places or groups of people this provides information about what is driving the spread of the virus both locally and nationally especially combined with information about where, how and when people travel internationally we will also be able to know whether these patients present with more severe disease this is the current to date data we have for the variants of concern so in the Philippines we have the B.1.7 as well as the B.1351 variants of concern which comprise 34% of the almost 6,000 sequences from RTPCR positive samples in the country of course you all know that we're not able to sample all we do purpose purpose sampling of cases from different regions of the country all the NCRC now have a variant of concern and 40% of the cases with a variant were from incoming international travelers using this data we were able to estimate rates between areas with and without the variants of concern you can see here in a steeper rise in areas with variants of concerns and you can also see that in areas where there's only one variant of concern like the B.1.7 or when there's only the B.1351 but together it will show a steeper rise and areas contiguous to these places with variants of concern here the orange one also shows increases in cases however slower areas without the variant have a plateauing trend this information was actually used to decide on the lockdown in the NCR bubble which we experienced about in the early part of April fourth unique genetic changes shared by all these infected in a single virus transmission chain can be identified using sequencing this can be used to distinguish whether two clusters of cases in the same area have arisen because one started infection in the other or because there were two distinct and independent chains of transmission with separate earlier origins valuable information from genome sequencing can actually enhance contact tracing efforts or track outbreaks in communities hospitals and other care settings and you've seen that in the example that Dr. Burba said in her lecture and one other good example of this is when genome sequencing shows there are five identical SARS-CoV-2 viruses within one workplace on the same day suggesting COVID-19 transmission going on in that workplace if there's no knowledge about the sequences we know there are five cases but we will not know if they were related and whether they constituted an outbreak it is possible that all five cases should could be different meaning they have separate sources and do not represent a cluster in this diagram we see that each node here represents cases where transmission could have been prevented had minimum public health standards being correctly practiced and if they were detected contact trace and isolated in a timely manner when this information came out there was an all out effort by our local government units to address these gaps so we really need the cooperation of everyone and lastly we all know by now that sequencing is important in detecting variants many genetic changes that occur in the genome of the virus will have no significant effect on the course or infection of disease or the impact of control measures however there are variants that concern us so and there are also variants of interest according to the WHO there are now three variants of interest and you must all be familiar to those by now and these are your B.1.7 originally identified in the UK the B.1351 identified in South Africa and the B.1 identified in Brazil so three variants of concern but about seven variants of interest so I put here another definition of a variant it's a variant of high consequence and according to the US CDC this has clear evidence that prevention measures or medical counter measures have significantly reduced effectiveness relative to previously circulating variants so I think I hope that this will never happen that we will have a variant of high consequence so I just want to emphasize there we don't have a variant of high consequence yet we do have three variants of concern and seven variants of interest just to end this short reaction this is the P.3 the variant first identified in the Philippines this shows geographic distribution of the viruses in March when we first reported this from 33 patients when there was a surge in Central Visayas on the right one can see that the emergent variant this one the red one forms a monophyletic phyletically separate from other known lineages globally so this is for your B.1.28 this is your B.1.7 this is your P.1 and this red one found in Central Visayas is your P.3 so what we can see is that local and global genomic surveillance systems operating in real time are key tools in the armamentarium of public health measures and our next big challenge is immunosurveillance which will look into the virus immunological indicators related to infection disease development and disease endpoints including the effects of therapeutics such as drugs and convalescent plasma as well as the effects of vaccination and how in general and how variants will affect vaccine efficacy and fortunately the department of science and technology Philippine council for health research and development is establishing the genesis program genomic and immunosurveillance system which is being proposed as an integrated organized framework of research areas on COVID-19 thank you thank you Paul okay thank you very much that was Eva Cotionco Executive Director of the National Institutes of Health and Eva there are lots of questions in the Q&A box and lots of questions in the chat box and I'm looking I can see that we're going to have a lot of questions on the panel so I'm going to turn over to Albert for one for our next reactor so I've been introducing my classmates so it's your turn so Nina I've been introducing so it's time to introduce your classmate go ahead Albert I'm telling millennials it's time to confuse them who is Albert and who is Raymond so by coming on the screen so one is the moderator and one is actually a panelist this afternoon I'd like to introduce it is my pleasure and my honor to introduce the next reactor a familiar face to all of our regular viewers definitely familiar to me for more than five years before we graduated from medical school and he does not need any formal introduction please welcome the director of the UP Manila National Institutes of Health National Telehealth Center and the recent TOYM awardee it's a good afternoon Dr. Raymond Francis Sarmiento over to you Raymond thank you for the kind introduction Dr. Albert the classmate and friend let me just share my screen and I will just give a brief reaction to really excellent presentations given by Dr. Nina Burba director Gaplegaswi and my boss NIH executive director Ebakucho Angkodela Paspo I will be talking about one of the tools that we had already we are still using in UP Manila we all started around April May of last year and we were trying to figure out how we could contribute in terms of being able to track symptoms through self-reported means and how we could leverage technology as part of it all of the reports that have been given really emphasized for the importance of data and where we are going to get it of course we need a good data capture system so what I will be presenting will be the UP Manila via NIHANA Employee Symptoms Tracking System we have already expanded it to include the other staff and also the students and it's something that really very much used in the campus of UP Manila the application runs on a web browser we use a a progressive web application in order for it to be used in the smartphone so that when you are visiting the URL the URL I will just repeat it HTTPS colon forward slash forward slash best that upm that ebu that ph eto po a mahanap po sa inyong well when you open your browser and you go to this link you'd be able to enter assuming that you have an account already and we because of our security and privacy policies in place we are making sure that those who are logging in have a up.edu.ph account para po makapaglogin but for the progressive web application part of it if once you have logged in assuming you do not clear your cash you'll be able to use it just like any other application that you have on your smartphone it will also give you notifications if you have notifications I'll talk more about the notifications and the alerts later in the next few slides the application works well in Google Chrome and Mozilla Firefox it obviously needs internet connection with no personal data being stored in the user's devices so what we have implemented is a role-based access with each of the levels and privileges being granted based on whether you're an employee staff or student or you are the head of that unit or in UP Manila because we have the vocal persons per college or per unit and then the head of the college and unit will be on level 3 and then obviously leadership the chancellor or the vice-chancellors will have to have level 4 visibility on everything from registration symptom encoding submission of symptoms and viewing of all of the data that has been presented this shows our employee monitoring form you will note that you'd be able to add a record there enter your temperature please note that we wanted to make sure that I don't have any bias when they enter the temperature you cannot enter a temperature reading that's in our PM field if your time is before 12 p.m. so it really encourages you it forces you to be able to input data in the morning and in the afternoon if you have symptoms you just click on the tick boxes here and if you have exposures to anyone who has COVID-19 what happens after you submit that is that there is an alert that is sent to your supervisor and then it also tracks whatever action that you did meaning have you reported to the Bayanihana operation center one five five two hundred have you reported or have you reported to the UP Manila health service or have you reported to your local clinic or primary health care clinic in because a lot of us are working at home and that's something that we wanted to make sure that there is an intervention and then click on it click on it if you don't click on it when you submit your data for the day and then for those who would want a print out especially for those who will be requiring a barangay certificate you need that you have well if there would be a need to print it out there is a functionality in the application that would allow you to print out anything that is recorded in that application for the reports generation depending on your level and assume and in this example I'm using the level four example that I can see everything since the very very first time that this application up until whatever time that you want it in terms of the filtering of the dates you'd be able to do that there are quick filters the point today yesterday last seven days and last 30 days and depending on whether you will just want to see a particular unit or a symptom that you need to select to do on reports are viewed as follows and I will be showing the latest pop for UP Manila so for the last 14 days I just took this earlier in the morning 6 a.m. in the morning 14 days even though it says 15 days I will venture into saying that it's just 14 days the ones that are the ones the ones being shown here are the number of users with symptoms per date and as assess by the college or office so the following UP Manila Colleges offices that have submitted the most number of reportable health status within the last 14 days the natural institutes of health that's the purple pink, purplish color like bell curves and then the light blue one a college of medicine and then we have the college college medical professions and we even are able to track assuming that you are using the application those that are in the school of health sciences because it's jurisdictionally it's under UP Manila therefore we are grateful that we are using the application in terms of system utilization for the last 14 days on those who have submitted their assessment regardless if they have symptoms or if they have no exposure or if they have no these are the units that have been submitting consistently to the best the college of medicine natural institutes of health the central administration Philippine general hospital in school of health sciences what that may take away message here because is that if you are able to identify based on how many users are really you must be guessing for the next I submit no you'll be you'll also be as a consequence be granted for a way to be able to understand in terms of the cases in that particular locality so expanding beyond the hospital and to the whole of UP Manila something to think about given the mobility the level of mobility of our individuals and staff and students in terms of policy we continually reiterate the use for utilization and compliance for as mentioned we started May June July and we have there have been multiple memos from the office of the chancellor to be able to have the individuals to do their self-reporting through the best application and then finally this is a a gif of the mobile version of best right currently we have more than 3,000 registered users in UP Manila community we want to be able to share this with other in terms of utilization with other constituent universities so that this is something that will be helpful especially with with the tracking of the symptoms for this okay thank you very much and we look forward to the panel thank you very much Thank you Dr. The best really best the best saying Dr. Antony Cordero patented expression that is the best the best. So we can see now how this is a really telemedicine. We are using technology to also protect our institutions from a surge rather. Yes ma'am Susie? Go ahead. Okay so we have our last reactor not but not the least we're very fortunate to have a hospital director, a huge hospital in Metro Manila, the East Avenue Medical Center. It's my honor to welcome Dr. Alfonso Nunez III Sito. Welcome to our webinar. Good afternoon Dr. Susie and Dr. Berba Dinchong. Thank you for having me here Dr. Delapas. Thank you for having me here. This is really just a reaction of what we have heard the past few minutes. I have no slides percent but listening to the lecture or the sharing of Dr. Berba and Dr. Legaspi so it's almost the same including the different controls mentioned by Dr. Berba, the issues about the health care workers and of course the story of Dr. Legaspi. It's like hearing what happened to East Avenue Medical Center last year until now. For Dr. Berba thank you very much Dr. for your very comprehensive and general sharing of what happened to PGH and indeed the controls you have mentioned really helped your institution evidently but there is one control that particularly in East Avenue Medical Center we had some difficulty which is the engineering control. East Avenue Medical Center is an old building. We never thought of this pandemic happening to us in this large scale and because of the old infrastructure we have several problems modifying our infrastructure. Unlike your hospital when you started surveillance very early in East Avenue Medical Center because we do not have the luxury of the molecular laboratory that time last year this is very hard to do the disease surveillance of our health care workers but we have learned this lesson last year and then we have established our own molecular laboratory and we foresee this molecular laboratory to expand in its scope not only testing infections but also we would like to venture into DNA detection and cancer detection as well. I would like to congratulate you because you are now in the zero surveillance phase and this is where we want us to be. This is a very good aspect what you are doing and very significant also what you have shared in terms of your health health care workers as to the nature of their infection and we have also done that in East Avenue Medical Center. We would like to know initially with the second surge if the infection of the health care workers was quite unique to us or was there what are the engineering controls and the protocols we need certain revisions on them but we found out that health care workers being infected is no different from the general population and we also have found out that health care workers exposed to COVID areas is no different from health care workers exposed to non-COVID areas so really there is some issue in transmission happening outside of the hospital or outside of the workplace and one aspect that we have identified is transmission during travel and to and from work because when the restrictions were loosened into GCQ that was when travel was quite open and we have some problems in transmission and we suspect the transmission is happening during travel and because of that East Avenue Medical Center invested heavily on accommodation and we have secured the services of at least four hotels we have also accommodation facilities hosted by our local government unit here in Castle City and we found this to be quite effective because the hotels we can easily control them we have safety teams posted in these hotels and on a day-to-day basis we can monitor the health status of our health care workers and one good practice also that we did in East Abbey Medical Centers is equipping and assigning safety officers in all offices be it clinical be it admin even the the motor pool janitorial offices they have assigned safety officers and we have equipped the safety officers regarding the competencies required to properly monitor health care workers or their fellow personnel within their office one difference between the PGH and East Abbey Medical Center because you are PGH has information on the variants but Kamesa East Abbey Medical Center we do not have the luxury of having these informations we have actually sent samples to the Philippine Genome Center and I guess no news is good news that's that's what they're telling me because if the facility does not report on a variant happening in East Abbey Medical Center then that's a good news to us well again hearing from the sharing of Dr. Legaspis like hearing East Abbey Medical Center's story and during the initial phase of the pandemic last year we started with just five hospital isolation beds and we thought that this is okay and we have our infection control protocols and we thought that this would serve us and to protect us based on our experiences with the H1N1 virus based on our experiences with the Middle East virus the Hong Kong virus as well in the Ebola we thought that this was okay but slowly the five beds we had to expand to 50 beds we had to expand to 120 beds and at the end of 2020 we were doing somewhere between 180 to 200 beds dedicated for COVID and we we step back a bit and to get a clearer picture of the general situation of East Abbey Medical Center at the time we noticed that our patients the main the main building we have converted the main building into COVID and non-COVID patients and this puts a lot of strain on our healthcare workers knowing that they are going to the same building working the same area with COVID and non-COVID patients for example the sixth floor is dedicated for COVID and the fifth floor and the third floor is dedicated for non-COVID the third floor is dedicated to COVID so it's a very very stressful environment so what we did in East Abbey Medical Center we had a newly constructed five-story building initially intended for wellness but management decided to convert this five-story building into a COVID hospital separate from East Avenue Medical Center main hospital so that we can safely and dedicatedly contain all COVID activities in the hospital now that hospital we have dedicated 275 beds to respond to COVID patients and in that building there is a dedicated emergency room a dedicated operating room dedicated delivery room a dedicated hemodialysis center and an ICU with a dedicated city scan x-ray and ultrasound so it is that all activities in that in that building are COVID activities and the main hospital of East Abbey Medical Center we can now slowly go back to non-COVID activities we have found this to be effective in terms of relieving the anxiety and fear of our healthcare workers and also some of our patients and other stakeholders interacting with the main hospital and just like the GH they we East Abbey Medical Center recognize the healthcare workers as the most precious resource uh this this time this is the most utilized and in East Abbey Medical Center this is the most protected and most cared of resource that we have right now and um um what we noticed what we noticed during this new surge our our healthcare workers anxiety level went down because they can continually uh they can contain schedule their activities in the new building um uh one one aspect with the healthcare workers that we have learned during the last year is that when you when anxiety goes into fear fear goes to confusion and confusion goes to anger and then everything breaks down a management is uh in in heated argument often with our healthcare workers and for this year we made sure that the anxiety does not transform into fear and if it goes into fear there is this uh active participation or active involvement of management to relieve the fear control the fear and to assure our healthcare workers that they are being taken care of we have uh still continue the accommodation of our hotels we have also increased our testing capability of our healthcare workers because we have established our own molecular laboratory we have been testing our healthcare workers at the rate of around 100 150 a day this is a far cry of what we are doing last year when we are at the mercy of molecular labs outside our institution and other with other hospitals as well um so uh maybe this is the short and long of what we are doing at East Abbey Medical Center and right now we have dedicated 275 beds to uh COVID and uh two months ago when we were hitting around close to 100 percent we are now doing around 61 percent utilization of our beds uh last month we were close to 200 healthcare workers that are active cases but now we are down to around 27 active cases right now and hopefully for the next few days uh these cases will uh will turn out to be uh recovered again uh again I would like to thank everybody everybody participating and thank you for uh listening to um my reaction and sharing of East Abbey Medical Center thank you very much okay thank you very much that was Dr. C. Tonunias the director of um East Abbey Medical Center again another very inspiring story of all the hard work that goes into keeping our health workers safe at the same time responding to a surge so congratulations Dr. C. Ton we were very happy that you made it and we really look forward to hearing more from you uh as we as we progress with the webinar series so maybe another time we can also invite you to talk about to talk about how your new building is going I think that's that's really uh that is really a very um inspiring story and something that we all look forward to hearing from uh more more about you want to hear more about that all right we're gonna call in the rest of the panel so Dean Charlotte Chong we're gonna have uh Nina Nina Berba um Eva uh Sito and Raymond and did I miss anybody okay so we're going to start off uh we start off with a couple of sort of discussion questions so Dean Charlotte are you here is Dean Chong here okay all right so um let me start with this question because I want to try to to tie together what we learned today okay so we heard about all the kind of infection control measures but I thought that and including Raymond's presentation on on an app right on on a digital platform to help monitor health workers but I wanted to ask and Sito pointed out to this a little bit right okay PGH is able to do genome testing and because of that we're able to identify and contact trace and be more quote unquote aggressive in terms of controlling uh the spread of a variant um in the absence of in the absence of that right because right now I think some hospitals have to submit but they don't have the full access so maybe my question is for Nina what is the proxy or what can we learn from this that can be applied in other hospitals like is there a certain profile of patients who are infected with the variant that based on symptoms uh suspension amen variant so um also the guidance that the Filipino center is giving us so um when patients when patients clinical courses are different like most aggressive um particularly younger individuals behaving as if they're more sick than what you expect them to be um we're tagged as possible variants and we really tried to get their uh nasopharyngeal swab samples made sure that they're uh on their way to PGC when they're overseas workers when they have linkage to overseas workers so relative to somebody who came back to the Philippines from countries that supposedly have this variants uh and when uh persons come in they've been documented to have been infected previously and then comes in again with a new infection and also I think despite being quote unquote fully vaccinated they'll be included in the list of people who should be kind of preferred customers for genome sequencing okay so short of that we've mentioned um for things uh symptoms symptoms and age uh possible exposure to to an OFW um reinfection reinfection that might be the subject of greater contact tracing because contact tracing has really been a problem in the country but from the point of view of the hospital if you have those kinds of patients that means you you put on high alert you put the community or the LGU on high alert Albert you had a question and I know this question is in the air so Albert go ahead and ask your question about transmission go ahead yes ma'am Susie so let's uh I will actually invite uh see uh Maria Regina Pacifico ma'am so um you can switch on your video but I'll just introduce a bit but you can ask a question you know she has a question about uh air conditioning and to put it into context there has been a change in advice so it started with this paper in the land set where 10 scientific reasons uh to consider that the the transmission of COVID-19 uh the virus of COVID-19 is now airborne because ma'am Regina Maria Regina Pacifico please uh join I understand you're in the panel yes please go ahead and ask your question thank you so much for your wonderful webinar very timely as to the work place to open uh air condition thank you ma'am and let's yeah who would want to answer ma'am Nina from one Regina to another Regina ma'am hi ma'am Regina so um there's a lot of questions about here so in hospitals because we know that there's a little bit of a little bit of a little bit of air borne aerosolized especially aerosol generating procedures now in workplaces um we need to like just quote-unquote improve ventilation you put in more fresh air so uh you ask you if you centralize your air conditioning you ask the engineers in the building to parang yunya increase entry of fresh air into the rooms tapos me way of exhausting parang hinihila mo yung used air within that uh confined space kasi sabi mo walang windows so uh engineers supposedly of buildings large areas commercial places know about this so they can manipulate the controls of your air conditioning system have a filter's good uh auxiliary equipment so uh that's what that's the uh uh parang nero ma'am ganung guide dun sa bibelin yo according to the specifications of the space of the particular equipment you will buy according to the size of your room thank you nina uh doc sito wants to say something sito go ahead yes ma'am uh for the those that question yun ang naging problema namin sa bagung building because when we were uh when we were constructing the the new building ang mindset namin to air conditioned building less ang windows including our operating room when we were renovating that yun mga malalaking windows ay niligita namin this is the east abbey medical centers at old hospital 1969 it was designed by the americans and fortunately yung main building ang ganda ng ventilation flow ang air flow napakag ganda but for the new building dito kami nagkaraon ng uh malaking challenge uh what we did was pinutas namin yung ibang mga windows mga glass windows we placed their exhaust fans we invested heavily on uh uh portable hepa filters medical grade and also on commercial filters for the offices karun din yung mindset namin on before the renovation yung mindset nang mga tao na uh mas mas air conditioned yung office liitan yung mga windows et cetera et cetera but ngayon kasi nage ibang na naman yung ano namin strategy and mindset and we have very much to consider ventilation talaga and um uh we are now in the process of procuring uh portable negative pressure devices yung bang plug and play devices that you can just uh you can just install uh externally sa isang area like the operating room the tr and the emergency room to create some negative pressure dito uh this we have not thought the past several years and ang investment namin dito really is almost none but now nagkaraon kami ng risk risk strategizing everything okay so the environmental measures are really very very important albert i think we have another live question yes and actually i was uh i was putting in the chat this uh next question naman from uh reisel asusana sir bago kaya yung mga question um we will give all of our uh five uh parang panelists here a chance to give their perspectives and parang when you hear the question kasi medjoh this is friends for yung mga tao the main tanong me me sir reisel no so we would like to hear in the sequence yung mga responses po uh first uh kaya doctor de la pas uh what what is your comment on uh sige nang sabi koning question sir kaya yung moning question bago kasi bing yung flow ano po yung tanong yes oh kata nung mga po uh diba um thank you so no so i i'd like to direct first lahat po tayo dada anand natin but first to dr eva maria kut yung kadila pas uh thank you a variant or b ones any bird ma'am yes b point one six one seven variant um di pa po si valid sila ay nag travel from india tapos dumating po dito sa philippinas at sila ay nag rtp cr positive pinaprioritize po namin sa philippine genome center ang pag sequence po ng swab sample nito mga mga uh patient um mga returning overseas philippinos sir risel sa ngayon po so wala pa po tayong documented case dito sa philippinas uh may um sandali lang po yan pag mabilis lang po namin nagawa yung sequencing nakarating na po yung mga sample sa amin mga gawang po mabibigay po namin ng kasagutan yun lang po at kong tayo po ay handa actually po um di ba po nakita yun anang um variant po naman kasi yung virus a pareho pa rin po ang kanyang way na pag transmit pareho din po yung pa rin po yung COVID-19 virus variant lang a push of the virus so yung po mga pinapag-ikting nating mga minimum public health standards yun pa rin po mga kailangan gawin yung apat-dapat yung air ventilation pag lalagay ng mask, face shield, physical distancing yun lang po. Thank you Dr. Albert. Thank you Dr. Eva and that's the segue actually I'd like to pass over to Dr. Nina Berba. Ma'am nung kayo ba ay mga naka pick up nung iba-ibang variant sa PGH? Nag iba ba yung practices nyo or the same practices na yung mga minimum public health standards? Pare-pareho halong hubayan kahit iba yung variant kasi yun tanong ni Sir Riesel is paano na toh kong sa kaling may bagong variant magi iba huba ITC. Dr. Nina Berba. The general principles are the same. Naging quote-un-quote I said marshalo kasi we needed to find out for ourselves kong we needed that that much of really being very strict with everything. Pero after a while we noted na walang difference the same level of infection control policies whether variant or non-variant be the same. So kahit hindi nyo malaman na kahit wala kayong news from the genome center na variant yung mga na submit nyo. Yung pagka-intense and pagka-strict ng compliance to everything we know should remain. Yeah Nina I was gonna ask follow-up question right? You did decide to do an exit swab on day 15 right? Were you speculating that maybe the infection of the variant last longer than the dominant strain? Yeah we were speculating that. Kasi yung umpisa so blang dami kasi talaga number of healthcare workers there were days na we had 20 new cases so you would think na nagkakahawahan talaga sila. So pero in the end the same findings that everybody else across the world learned before us na ganoon na. Let me clarify that kasi baka nakalito ko sa some of you. We don't do that anymore. We went back to the usual policy na hindi na kailangan mag swab. So as long as ma-finish yung 14 days of isolation for symptomatic individuals there is no need to swab anymore. We believe people become non-infectious anymore whether it's a variant or a non-variant. Parang mahirap isipin na si Nina Burbank in charge nang masyalo sa PGH. Okay so wait we'll take a little a little break on that and Albert do we want to go back to our mentimeter questions and then we'll go we're going to some more questions. Just a few more questions. Sure sure yes ma'am siga po. Let's let's have a look at the the mentimeter and remember tiren nung punating kanino no this is the first question. When is a symptomatic patient most infectious a upon exposure to confirm COVID-19 case be day one of the appearance of symptoms or see when you get the results of your COVID test. Dr. Burba anupo ang answer natin? Ang answer yung on the first day of symptoms. Ang totoong answer jyan I few hours before deba. Si nasabi ko panai pag melagnat ka today siguro kagabe infectious ka na pero reality wise parang parang parang madali lang maalala on the day you start getting your symptoms yun ka pinaka infectious so isolate ka naka agar even before you know it's really COVID but you feel you're sick and you were exposed previously to somebody who may have COVID. Isolate kana don't wait for the results of the test. Thank you. All right and and for the second question let's look at the second question from the mentimeter. Yan eto naman po why is it important so alam nino kong kanimin ng galing yung questions now why is it important to do genomic surveillance of emerging variants I'll just read the choices it will help detect if a variant spreads more quickly in people it will help determine if a variant evades specific diagnostic tests it will help detect if a variant causes more severe disease it will help determine if a variant can evade vaccine induced immunity all of the above or none of the above dr eva anupo ang ating answer for this question the correct answer is all of the above very good very good audience one in doubt answer all of the above joke all right so so coming from those two mentimeter questions I'd like to pass back so balik din sa question ni sir reisel kan yun o tungkol din sa b1617 variant or properly known as first discovered in india no so yun pung b1617 ang gusto kaya tanong kaya dr nunia so nakuento ni dr bourba na hindi naman talaga nag iba yun general principles pero shempre nakakatakot when it comes to a staff perspective sir from the perspective of east avenue nakuento niya sa lecture sa the reaction yun kanina yun big lang dumami yung rooms from just a few to ano ready naba ang east avenue kung sakaling mag-announce mommy ya sila dr kut yung kadila pas na o oga b1617 nga it could happen but are you ready po sa east avenue yep as far as east avenue medical school east avenue medical center is concerned and maybe sa lahat ng hospitals ang importante yun treatment management should be very assured sa mga paciente and actually we have done this east avenue medical center during the low periods started october november december we have prepared the hospital for any eventuality including the search we have invested or increase our mechanical ventilators from from 60 we increase it to 80 before last year we have no high flow nasal cannulas and during the october during the last quarter including january february we have invested heavily on high flow machines we have acquired or procured 45 high flow nasal machines and this made the difference sa surge ngayon eto ngayon yung ginagamit ng mga patients severe and critical to avoid intubation and mechanical ventilation which is an aerolizing aerosolizing procedure and can spread the the virus so sa amin as far as estabiles concerned hindi masyadong malaking factor kong anong variant yun ang sa amin we have to assure the patient that treatment in east avenue medical center is at par with the international community with the world health standards and what the department of health is saying in the guidelines so yun importante as far as health care workers is concerned with the new variants then we are confident that the protocols for the health care workers in terms of isolation testing and quarantine are well in place thanks to our reliable infection control committee okay thank you very much sito i was going to ask dean charlotte and maybe even reyman no um how are we how are we preparing so so the question was uh what if okay so what if we have uh what did you call it eva a variant of high variant of high high consequence high consequence okay so so first it's better to be prepared isn't it so i think i'm going to ask dean charlotte i mean in terms of our medical students and um how are we keeping our young professionals uh updated this is changing by the minute it isn't it it's like every day so how how are how are we doing that i was going to ask reyman also what can we do to what should i say of course people can google things no but there is also a need for direction because otherwise you know the internet is a wild wild west right so dean charlotte um because things can evolve and can go south really quickly how how should we be preparing our students for this well as you see they are constantly oriented as to the what's happening uh almost like uh we have regular town hall meetings where actually uh sometimes dr nina berba is actually asked to present to them so they know what's happening uh in the hospital and elsewhere so i think uh in terms of our students they're very um they're very keen on getting this information and uh they're very good at that in fact um they're digital natives but more than that is that uh the information that they get they usually verify so just last night i i got tons of questions regarding vaccination and uh what about if they already had another brand of vaccine so they're they're quite um curiosity driven and i'm happy to say that they're even involved in our research on covid so most uh some new knowledge coming out regarding covid are actually produced by our own students our md phc students our regular students who join research teams no and uh as we speak i've talked to the coordinator for the md phd uh i was telling her that uh maybe for the vaccination and the vaccine uh resiliency and capacity building of the philippines we'd like to have our md phc students to be part of the the different groups that we looked into different modalities of how we can really be vaccine resilient nice raymond you have questions okay so the application needs to be tweaked so that it will reflect the inherent units or organizationally that is inherent in that particular hospital or the particular unit nevertheless it's something that uh will will be more than happy to work with the other hospital so that that's uh that would be implemented and deployed um in their healthcare institutions as an aside there are multiple other um supplementary applications doctor sucy the department of health has this kira chatbot uh if you have any symptoms you could just essentially talk to a bot usually an internet bot uh so that it's a machine that uh based on the algorithm will tell you uh the likelihood or whatever uh steps that you will need to take aside from that so a lot of those things uh would be in the well since they are digital natives now they would be uh in like in direct messaging platforms like viber uh there are those that have been implemented in messenger or what's up a lot of these things uh have become avenues uh for information but it in in parallel the who has also emphasized to be able to verify all this information that's why infodemic management and infodemics uh have become such a staple word over the last year uh because we want to be able to with the preponderance of all the information that's out they will have to be able to share and uh confirm so Raymond can you just text them if you want to help them? okay okay so I think we're we're coming to a close a close of our program and we'd like to uh set up our evaluation question and while we're doing that we hope you can all just participate in this little survey we have just to give us some feedback on how you found the session the panelists etc um okay so let's go to our closing we're going to give a few moments for our speakers to just say their parting words I think um we we really need to uh save our our systems uh during a surge and I guess the question the question would be in your parting speech would be what what should what else do we need to do what else no so we're going to start with uh doc Sito go ahead as far as the hospital's concerned we have to improve our capability and capacity to respond to not only for COVID but other future emerging and reemerging infectious diseases maybe it is incumbent for government to look into uh quadrant setting of specific uh health care facilities that would cater to such cases in the future um if you notice there are certain quadrants like for example ncr there are certain quadrants in ncr that uh needs special attention because there are certain facilities that are not capable of addressing such such uh situations and pandemic and maybe the hospitals uh should rethink and maybe restrategize their future projects and activities that would focus for uh to provide certain uh resiliency in their agencies to cope with such uh pandemics and maybe third healthcare workers which uh I think personally I think this is the most precious uh most precious uh commodity right now on or resource uh not only in terms of providing them incentives but for the overall picture making the workplace more uh more conducive making it more uh incentivize them in terms of legislation and etc so I guess what I'm saying is um we we all have to work together government and non-government agencies including uh the private sector uh to really put everything together if so that if something happens again then we are much prepared we are much confident in addressing uh the situation thank you ma'am Susie thank you very much as Dr. Sito Nunez the uh medical chief or director of east avenue medical center um Raymond what else do we need to do thank you Dr. Susie so uh the technologies are we we really are very technologically savvy in terms of being able to leverage all of these uh digital platforms but technology is only as good as the business processes uh that that it follows all of the algorithms that the healthcare institutions implement so these applications these systems whether uh they are fancy or very user friendly or ultra functional will not really be that useful if it's not anchored in the business processes or the algorithms of that institution very very important that when you are trying to implement a technology aided program it's something that there is buy-in with each of the different uh stakeholder groups in that healthcare institution so that uh very very important because especially when it comes to this pandemic the compliance are you willing to give data or are you uh timely when you give data how accurate it is maybe you put it in your name Super Mario Brothers something something like that it's it's it's all of the little steps accumulate if you do it correctly and that's something that I think the whole panel shares thank you very much Raymond Eva um I think the message uh from the genomic surveillance side is the more the virus circulates the more opportunity it has to change and acquire new mutations and so it the most the important message is we need to keep the number of cases down by being responsible and doing our part in practicing the minimum public health standard so as not to give the virus the opportunity to become better at being a virus thank you thank you very much Nina I have three points the number one uh I think that's really the way to go for all of us to uh be better protected against the virus number two stay vigilant uh with uh complying to infection control we really need to stay vigilant with everything that we know so far and number three and being back on the next step is to really choose safe options so safer options for all of us in the future thank you that's it thank you very much Nina and um chance uh Dean uh Charlotte please SOS I think it's really just solidarity of everyone and the oneness in uh unity so everybody is in this boat together so vaccination safety protocols we all have to follow that and of course uh science we really see that science is very important in our fight against this pandemic and we're very happy that we have the expertise here and we have that spirit of collaboration and by any hand to get us through this pandemic thank you very much okay that was Dean Charlotte Chong of the U.P. College of Medicine all right so we are going to our closing remarks and of course we've got Chancellor Menchit Padilla to round this up for us Menchit welcome to the webinar and we're looking forward to your closing remarks okay so thank you so the webinar was opened by the Dean of the College of Medicine U.P. College of Medicine and Charlotte Chong and Dean Chong actually gave us a review of the past year of PGH PGH had to implement new engineering controls in a century old hospital the OPD had that the surfacing 600 000 patients had to close down and despite all of these PGH had to remain open the faculty had to continue teaching because in the means of the pandemic we have to graduate doctors nurses pharmacists and other health workers so the commitment of administration is to maintain safety protocols as we go back to school our main presenter was Dr. Nina Burba and allow me just to highlight a few points now she gave the top three best practices of PGH number one the use of science for better engineering and administrative controls and by engineering she meant controlled ventilation to ensure 12 air exchanges we could not afford to do the negative pressure for all of the wards the second was administrative controls they had a complex testing system to keep the wards safe and she she actually reiterated the part that instead of regular testing which was not economically efficient in a hospital with 4 000 employees they moved towards targeted testing and on demand when the healthcare worker felt they needed it and the third best practice was the risk-based HECO levels of PPE now there were two main reasons behind the surge one was the healthcare worker reporting back to work despite the symptoms and the second one was eating together and this was the result of their evaluation of the problem and as she said you know marshal law was declared but luckily it was short-lived the community so they followed Dr. Burba or else marshal law might extend so the lessons learned are actually captured from the various scenarios one is a healthcare worker who has initial symptoms and continues to report to work second is a healthcare working joining a carpool number three is a healthcare working eating with other healthcare workers during lunch but she had the same message for all the advice of Dr. Nina is to comply with all in capital letters all pandemic precautions all the time and she said avoid breaches in the PPE use and as she said you know they had to identify stricter safety officers to make sure that we never you know keep our guards down now she she ended by saying that you know whatever works in pga it should work for all so she actually gave four recommendations for letter s one is science use science for infection control two solution use innovative solutions systems approach three is solidarity we have to work together and fourth which i think is very important for pjh is the strategic risk communication we actually had four reactors so allow me to start with the two heads of a hospital so dr. Gappley gaspy started by saying that it is good science that helped pjh manage the search she actually shared urgent measures that had to be implemented as a result of the surge number one was the personal reductions scheme they sent home all the interns number two they had to increase the number of covid wards meaning closing down more regular wards to give way to covid patients and then increasing the personnel in the covid wards so that they have scheduled rest between in between their duties number three was the use of additional classrooms in ut manila for housing an additional 100 within the campus i think right now we're housing about 400 in the different colleges of ut manila number four the transportation was managed i think you know the the health workers appreciated the shuttle services because it meant avoiding exposure in public transportation and i think you know the the last one that he shared was that and this word if there was a surge in a department the department shared to explain why there was a surge so gap director gap gives credit to systematic methods instituted by heqo the hospital infection control unit of pjh led by dr burba um dr gap said this will not be the last surge so the only thing he can which we know now is that we know better our second director our second reactor was dr munius and he shared his experiences at the east abbey new medical center and they said the challenges are similar they had difficulty with the engineering control they also had the old hospital they also experienced the surge and like pjh they had to in they had to increase the number of beds for covid but luckily they had the new building and this new building instead of being a wellness center they have converted to a covid hospital which now is 275 beds so he said that separating the patients the hospital for the covid patients and the hospital for the regular patients is the anxiety among the health care workers but one thing they realized is that the health care workers were exposed to had the same level of exposure to covid areas and also from outside the hospital and of course they gave credit to the hotels who continued to support them and i'm not i'm really happy that they've set up a molecular lab because i really believe that you know being as a geneticist that all hospitals should really have a molecular lab in the midst of their diagnostic test something that's worth sharing he said it is the active and conscious management of anxiety of the health care workers that they gave priority because anxiety leads to fear fear leads to frustration and frustration leads to anger and he said so long as you keep your health workers free from anxiety then everybody will be happy in the hospital our next reactor is dr eva and the where he she explained the the value of the genomic surveillance and so just just as a summary number one it gave us a history where it all started we know that it came from envy diamond princess number two you know estimates epidemic growth we think modeling is is is not important it is important for government because that is the plan for the next step the third is they are able to verify where the virus is spreading so where are the variants traveling and as a matter of fact this information was used in the very recent lockdown that we had here in ncr glass the fourth is it identifies the transmission chain so you know it tracks the outbreaks it tracks it supports the contact tracing we're able to identify whether there is a cluster and of course the last is they're able to identify new variants so every time we have a new variant that's announced in the world we know that we have the facility to be able to do that our last reactor was dr raymond and i'm really happy that he actually did this for u p manila it's a u p manila best it's an employer systems tracking system um which actually um unemployed is actually expected to log in to this system before they go to work and um there's a level of reporting and i can tell you that when a dean is sick and if that were if the dean is reporting i know when she has fever because that ends up with me the um just maybe just just a few words from our group from from dr sito i what i gathered from him is that he said address resilient strategies to prepare for future pandemics from dr raymond technology has to be anchored in the business processes dr eva said do not give the virus a chance to move around and get better from dr nina be vaccinated be vigilant choose safe options let me end with what dean charlotte said also in the opening dean charlotte said to survive covid-19 we need solidarity we have to work together not only within the health system but also with the local leaders and ngos using science-based solutions with the cultural backdrop of the philipines thank you and back to you sissy thank you very much that's uh menchit padiria the chancellor of up manila and um i i have my own quote from yoda and albert una hitadito diva sabi nya sabi ni yoda the star wars fear leads to anger anger leads to hate and hate leads to suffering and most of the time the cause of our fear is the lack of information so next week we have some of your favorites our topic is going to be frequently asked questions on covid-19 vaccination and we're gonna have eric tayag so this team that you wanted to have before the part two no so eric tayag we have uh dr anna onlim and ted her bosa so vaccination i think you still have questions from the chat box from the q and i i can see you're asking you got one shot of astra what are you going to do next uh are you going to take this putnik vaccine how long until you can get the vaccine so we will refocus on vaccination next week so uh don't forget to join us over to you albert thank you doc suzino meisa pang yoda kote sabi nga ni master yoda do or do not there is no try yeah and so we just really need to do as we did with this webinar and thank you so much to all of our panelists i'll just quickly read the results of the poll no all of our i would say all because 93 percent strongly agree and seven percent agree almost consistently ganun silak ng questions everyone agrees uh thousand respondents that the panelists demonstrated thorough knowledge of the topic the panelists were well prepared and organized the panelists spoke clearly and audibly the panelists used appropriate language with technical medical jargon adequately explained and the panelists contributed to new perspectives and knowledge on managing various key covid 19 issues as always it's been a pleasure to fill in for for dr reymond sermento as he was one of the reactors this afternoon and with that being said i'd like to thank everyone this formally closes our webinar for this week dr reymond sermento will be back with you next week it's a date together we can stop covid deaths stay safe stay healthy and stay connected the enemy remains unseen i'll keep your hand in mine let's say a prayer one more time i know you're long for home but i am here you're not alone let's stay with you until the coast is clear the other Spain before my the other side i'm looking to myself do i have strength to carry on my god need you here to keep me strong i'm here to hold the line i'll keep my word until my time is hold on to the word he gave this time will come to pass because their salvation makes a last you'll carry you to see the breaker the others pain before my fears the others mouths before my tear but right behind the mask i'm looking to myself and i do i have strength to carry on my god how long was this gone need you here to keep me strong i'm here to hold the line i'll keep my the others mouths before my tear but right behind the mask i'm looking to myself and ask do i have strength to carry on my god i'll be here to keep me strong i'm the same before my tears pushing on the side of tears these things through another day