 Good morning, good afternoon, good evening to everyone who's joining us, nasanman po kayo ng Parte ng Mundo. Welcome to our 67th episode of the Stop COVID-Dets webinar series brought to you by the University of the Philippines. We are glad that you're able to join us today as we continue to spread the word in terms of our credible online community that brings you more timely and informative topics on COVID-19 as we all together learn in this journey of well really of our online community and as the Philippines ramps up on the vaccination program there have been reports of fully vaccinated individuals testing positive for COVID-19 and people are of course concerned bakit po bako nagkakasakit pa or bakakasakit pa ng COVID-19 ang mga breakthrough infections po bang mga ito ay talaga po bang rare occurrences katulag po ng mga sinasabi po sa media and made salient and prominent po sa mga social media accounts. I'm Dr. Raymond Francis Sarmiento from the National Telehealth Center, National Institutes of Health, University of the Philippines, Manila. Always a pleasure to be with all of you during our regular Friday lunch date and as always I look forward to sharing hosting duties of our webinar with our adjunct research faculty, our partner in this webinar for a very long time already and also the President's Special Envoy for Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie. Hi Raymond, good afternoon. Magandang happen po sa inyo dahat. I see we have so many people watching from all over the country nabati ko po mga nakikinig sa SPMC, sa Palawan, our Metro Manila Hospitals. Welcome everyone, I hope you're all doing well. And I know na this breakthrough infections are really top of mind na Raymond. So welcome to our participants. In Zoom, those of you who are watching on Facebook and those of you who are watching on YouTube and on the playback. So we've got a great set of speakers today. Marami po tayong matututunan ngayon. Alamin po natin ano itong mga breakthrough infections na ito. Tapat ba tayong matakot? Ano bang dapat ang sabihin natin bilang mga front line workers pag meron nagtatanong sa atin o nagsosabi at pa kami magpapabak mo na many infect din. Ano bang sagot natin tama? So marami tayong pag-usapan ngayon. We've got great speakers and we're going to start Raymond with our person on the street. So it's always good to find out how people think about this topic. Raymond over to you. Thank you Dr. Susie for our person on the introduce and as well also for those for the benefit of those who are joining us for the very first time. The person on the street interviews put our discussion in context through the delivery of a short video created by TVUP and for our interview video for today. The question will be, meron ba kayong nabalitaan na-baconado na pero nag-positive pa rin sa COVID-19? So sa tinginin nyo bakit kaya siya nahawaan pa ng COVID-19? TVUP? Meron ako nabalitaan na-baconado na pero nag-positive pa rin sa COVID-19. Pero office meets sa ng mother ko. Nangyari is tapos na yung fully vaccinated na siya pero nagkaroon pa rin sa nang symptoms mas kaya pinaswab siya nung municipal doctor namin. So do nag-positive sa RTPC. Yung mga family member ko mga vaccinated na pero nag-COVID pa sila. Atik ko na buntis na hindi pa vaccinated. Biglang lumabas na yung symptoms. Ang kasama ng ati ko, yung dalawang anak niya, tsaka yung mother ko, tsaka yung father ko. Parang after two days, nangkaroon na rin sila ng symptoms. Actually ako mismo, recenty ako na-baconahan tapos walang dalawang lingo na-insectin ako ng COVID-19. Tapos oriented naman tayo na vulnerable yung unang mga araw. Larin yung unang mga lingo bakit tapos ng vacuna. Pero I had to attend ang activity nung araw na yun. Actually yung mama ko rin ko nag-kainos siya. Nag-COVID, nag-positive na sa COVID yung mama ko. Sa tingin ko dito bakit, kung angayong bakit nagkaroon parang nang re-infect ng kaisakonado na. Eh, lahat naman ng bako na hindi naman sa restaurant na na hindi ka na may infect. Ang mangyayari lang kasi dito, magiging mild lang yung tama sa yun ng virus. Pinapabagal yung pagdame at pinapahina yung effect ng COVID-19, or pinapa, liet yung posibilidad na halimbawa ng severe cases and death. Para sa aking talaga, wag talaga mapakumpantik ay hit na may vaccine na. Yung COVID talaga, nandyan talaga sa kaligid lang di mo masabi ka mag-anak sa kamag-anak mo, talaga minsan maikita ay yan. Parang nangyari sa amin. O, may nai-kita kung hoop na pwede yung maibalik sa dati, o dahandahan ng bumalik sa dati yung galao ng pawa tao, galao na. Lalo na galao ng industri at triconomonia. Para din matapos, kailangan magpag-vaccine din lahat para hindi ganun ka lalala yung punayat tamaan man ng COVID. Hindi ganun ka lalala, mild lang. Nining-niwala ako sa experience natin sa COVID-19 pandemic dun sa naging napakalawak na bayanihan ng mamamayan na may pag-asa naman. So marami tayong madodron na lessons dito sa hinap nating pandemic. At hopefully, ma-apply natin yung mga lessons na yun sa mga susunod. Alimbawa yung pag-strenten ng ating healthcare system na foundation talaga sana natin para maharap yung ganito mga crises. Thank you very much, TV UP. It's always good to get a sense of how people see it. And I think, Raymond, if we look in the chat box, we have a lot of disclosures. Marami tayong, well, most of our audience are health workers and they're reporting here that they have been vaccinated but have had an infection. So I encourage our audience, all of our participants, to ask your questions on the Q&A box. We've got some experts here who can answer your questions. And I hope you'll have more time to pick up questions later on. But I can see a lot are saying itong situation nilab ahonado sila pero may break. But I hope you're fine. I hope you're all okay. And, yeah, Raymond, you wanted to... Are we doing a Mentimeter? Raymond, we are, no? Yes, we are, Dr. Susie. Thank you. Thank you, TV UP. So for those who are joining us, yung mga nagwawatch party po via the Facebook pages of the University of Philippines stop COVID deaths and TV UP. As well as those joining us in the YouTube.com channel of TV UP. Please also participate in our Menti poll which is our opinion and fun poll po. Open your internet browsers and enter www.menti.com. And when you are prompted, please use the code 6632-2726. That's 6632-2726 for you to be able to participate in our opinion poll. For those who are joining us in the Zoom na bring near 2,500 attendees. Please wait for the Zoom poll to be flashed on your screens. Both the questions po na na sa Zoom poll and na sa Menti will also be as well essentially be the same po. So for those who are also well slowly coming in, we want you to be able to encourage those of your family members, relatives, coworkers that the webinar is able to accommodate up to 3,000 participants. That's the maximum number of participants. So please join us in the Zoom so you can fully experience this interactive program. And for those who are also greeting us, maraming-maraming salamat po. We'll try to recognize you later on and for those who are asking. For ano po bang ityura na mga certificates natin, nakatanggap na po ba yung iba at hindi po ako nakatanggap. Please email us at stopcovidets at up.edu.ph. The appearance of the certificate po is flashed on the screens and will be issued to those who have at least attended 50% of the webinar duration. Over to you, Dr. Susie. Okay, thank you very much, Raymond. And I know some of you are waiting for that phone please. So we'll have that in a moment. But let's go straight to the meat of our presentation. We've got a very familiar face and voice for you to do the introduction or the welcome remarks for today. And kilala nyo po siya, one of your favorites. He is a epidemiologist public health expert. And so I'd like to welcome the director of the DOH, Kay Mitz, Knowledge Management and Information Technology Service, none other than Dr. Eric Dayag. Eric, welcome to the webinar. Thank you so much. Magandao maga, magandanghapon, magandang gabisa yung dahat. Thank you so much, Susie. Thank you so much, Raymond. Eric, tagaw na. Eric, tagaw na. Anong, you know, I can imagine you're extremely busy. Okay, so you want to tell us what you do to relax? Ah, what I do to relax. Work makes me relax. Paran paradox ano? Paran paradox siya tayo. Anong pang-relax nyo? I mean, especially, you know, I know that the Department of Health is going through a difficult time now, but what do you do? Thank you, ma'am. I stick to a routine. Maga ko na tutulog. I make sure I have six to eight hours of sleep. Okay, I wake up very early around three or four a.m. That's the only time I read my e-mails so that it doesn't stress me the rest of the day. Okay, and the food should be something that is satisfying. May hirig akong makinig ng music. Okay, before nang wala pa yung pandemic, what helps me relax is actually listening to the music at pagbabasan ng libro. Okay, at on Sundays, yung pagsymba ko, Susie, helps me relax. Pero ngayon, matatawang na talagang stressful sa maniwala ka o hindi. For example, dalawang earphone ko kasi yung isa may hearing sa Congress regarding information system. Alam ni Doc Raymond yan. So dalawang bosses ang napapakinggang ko yung bosses ko ngayon. At bosses ng mga congressman ko natin ngayon. What makes me relax is nakafocus ako so that everything is in place. Hindi ka kasi Susie madhi relax kung you are not organized. Right. So thank you very much, Eric, for those tips. I think that's very helpful for all our listeners. Somebody was texting me and asking if you have already created a delta dance. Meron ko yan. Meron ko yan. I can text lang sa argument. Okay. Okay. Go ahead, Eric. Alam mo, marami nang tataanong sa Department of Health. I miss mo nang tataanong bakit nakalockdown tayo, lalo na dito sa Metro Manila ay patulit pa rin ang pagkalat at pagdagdag ng mga kaso at mga namamatay. Unang-unang po may kinalaman to ito sa viral. Alam naman natin ang Delta variant ay lubang nakakahawa po. At siyan ay napanodyo na sa ibang webisode po ng regular na webinar na ito ng TV UP, stop deaths ng COVID. Pangalawa po may kinalaman sa social mixing, sa pagkat tayo mga Pilipino ay ugali na natin talagang hindi mag-isa at may mga kasamahan to tayo na. Pagkat tayo natin ay makita manlamang at sa kuwantin pagkakamali nga ay marit tayo mahawa. Anong pagkakamali, pag hindi po tayo sumunod sa mga health protocol katulad ng pagsod ng MAS, umiwa sa indoor muna, lalo na kung hindi magandaong defilation. At pang apat hindi pa po lubus na marami o sapat na mga nababakunahan. Ngayong araw, inyong po matutong hayan, ang malat patagal nyo nang pinatanong, bakit yung mga nabakunahan ay nakakarumparin ng COVID infection? At ano ba tong breakthrough infection? Paano natin matatawag na isan tao ay merong breakthrough infection? Ito bang breakthrough infection, ibig sabihin niyan ay vaccine failure o pumalpak ang bakunang binigay sa atin? O baka naman may mga bakuna lang, hindi lang manlat ng bakuna, ang madalas nagkakarun ng breakthrough infection, so tama ba para isipin natin na ganyan niyan? At ito gusto rin natin malaman, gano ba ka rami tong breakthrough infection? Marami ba to o baka kontin lang naman? At siyempre tatanong natin umuubra pa ba yung bakuna at may rungang breakthrough infection? Anong dahilang bakit nakakaran ng breakthrough infection? Tamang-tama po ang mga kasama po natin si Dr. Reina. Okay, Berba ang ating resource speaker sasaman po tayo mamaya ni Dr. Benilda Galvez, attorney Marie-Antonette Velasco na ipapakilala po ng formal may amaya lamang. Inasan po namin na kayo ay hindi po ahali sa pagkat mamimis nyo po ang mga kaalaman at paglilinaw na gagawin namin lahat sa araw na ito. Marami salamat, patulipo tayong manod at makinig. So okay, Raymond mag-mementi meter ka na, magpapani please ka na. Yes, let's go. Dr. Susie, TV UP may we have it on the screen. The questions po from menti.com. We are also flashing on the screens of those who are joining us in the Zoom, dun po sa Zoom poll po natin. So please log in, we have nearly 1,700 attendees po dito po sa ano, sa ating Zoom webinar so hopefully all of them or at least 90% will be able to participate. We have two questions for today. The first question, a breakthrough infection is when one test positive for COVID-19 after becoming fully vaccinated kapag nakalipas na ang option A, one week, option B, two weeks, option C, three weeks and option D, four weeks. So may kita po natin, may medyo kalat-kalat po pero may isa poong choice na napili po ang ating attendees na talagang they gravitate towards that choice. And then for our second question, so please ano lang po input your answers for those who are participating as part of our Zoom poll and menti meter poll po. For our second question, it reads, fully vaccinated person may still get COVID-19 but breakthrough cases that lead to hospitalization and death are low. Ito po ba ay true or ito po ba ay false? So yun po yung mga kailangan po natin masaisep and that's also one of the things that our experts in our webinar for today will be talking about. We'd like to greet those who are joining us all the way from James L. Gordon Memorial Hospital in Olongkapo, from RHU Milaor in Kamaruyna Sur, from Lambuna Municipal Health Office in Ilo Ilo, from the City Health Insurance Office in Kagayan, D. Oro, from Butuan Pwere Culture Center No. 394 in Butuan City, Agusan Del Norte, internationally also being joined here with us in this webinar. The faculty of medicine, Dipo Negalon University in Jakarta, Indonesia, Nagasaki University in Japan, the National Center for Global Health and Medicine in Shinjuku, Tokyo, the Institute of Biomedical Sciences, Academia Sinica in Taipei, Ministry of Health in Kuwait, Fanga, Thailand, Oman College of Health Sciences in Oman, Prince Mansour Military Hospital Taif Saudi Arabia, Alhana Modern Medical Center, Dubai, Neptune New Jersey, the University of Fijian, Laotoka, Opal Healthcare, Meadows Springs, Australia, Bagupu Ion, Nagiging regular na Thunbridge Wells in Kent, England, Lunichie Alley University of Lida to Algeria, and St. Catherine's Ontario, Canada. We are seeing that there is, I think this might be our most responded to, participated in, because we are seeing more, well, almost 1,500 combination na po na na sa Zoom poll at na sa Mentimeter ng mga sumagot. So, for those who are joining in this opinion in the Mentimeter to Zoom poll, maraming, maraming salamat po. We will tackle both questions later on towards the end of the webinar. Dr. Susie? Yeah, thank you very much, Raymond, and thank you everyone for participating in the fun quiz. We're here to learn. We're here to be good examples of the right information, and I know you're very eager to listen to our next speaker. As we have been talking about from the introduction, we know that all of the vaccines are effective. All of them are effective, but we also know that it doesn't mean that you can't get infected, you can get an infection. And so I think we want to know more about why is it some people get infected? How do they get infected? Are there people who are vaccinated who actually have severe disease? What are the risk factors? And I can see, Raymond, that in the Q&A box we've got lots of questions there, so I encourage our guests to answer them to the extent that they can, but now we're going to listen to our expert and you know her, you've met her, and she always comes us down because she's very calm. So I'd like to welcome the head of the Hospital Infection Control Unit of the University of the Philippines, Philippine General Hospital Dr. Nina Berba. Nina, welcome. Hello, everybody. Magandang hapon po sa inyong lahat. I'm always very glad to be here and be invited. So pisahan na natin ang aking lecture today. Okay, so we'll be talking about breakthrough infections, but kaagad in the title page palang I'd like you all to remember na vaccines reduce risk for severe breakthrough infections. So I'm sure we are all on the same page that the COVID pandemic has affected every aspect of our lives and actually the number of confirmed cases and the number of lives taken by this virus is really, really phenomenal. So what I'll do is I'll just get some very important landmark documents from the United States, from UK, from Israel, from Indonesia, and from the Philippines. Inisip ko how I will talk about breakthrough infections kasi parang andami-dami information. So that's what I'll do. So to review parang the USA is number one, di ba sa number of total confirmed cases. And the United Kingdom also has a lot over 6 million confirmed cases. For both of them they have been using mostly Pfizer and Moderna vaccines. Israel also Pfizer vaccines with just a little bit over 1 million confirmed cases as of yesterday. So I wanted to look at what the experience was of Indonesia who used a different set of vaccines, Sinovac primarily, and of course zooming into our experience in the Philippines. So what are breakthrough infections? So it's a mentimeter na, tinanong ni Raymond kanina. So to clarify para our definitions are just standardized, CDC would say that a vaccine breakthrough infection is defined as the detection of the virus for this particular COVID-19. It's the SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person at least 14 days after they have completed all recommended doses of an EUA approved COVID-19 vaccine. So ang sagot, tamang sagot din sa mentimeter question ay 2 weeks. Now, so going to the experience in the US, I think this particular paper that came out very recently this month actually on breakthrough infections actually happened in Massachusetts outbreak. So it narrated what happened, what led to all of the breakthrough infections. So di ba when they started to be able to rapidly give a lot of vaccines to many of its citizens, the United States actually brought down a little bit the degree of restrictions that they had. So they allowed people to go outside already without masks and have some kind of public events in different parts of the country. So in Massachusetts, there was an outbreak that was documented from July 3 to 17. Very brief lang to 2 weeks tapas kinalangan na nila i-control kasi they detected them already following multiple large public events in a county in Massachusetts. So that particular county already had a vaccination coverage of 69% very close to the 70% herd immunity that we are all aspirating for, but nevertheless they saw 469 COVID-19 cases. Even from that pool of COVID-19 cases, 74% were actually fully vaccinated cases. So it really brought a lot of concern for many of the people in the Massachusetts area. And when they looked at they studied sampling of 133 patients who were able to submit their respiratory secretions for whole genome sequencing, they found out that 90% were already because of the Delta variant. So apparently we already see what are the ingredients for this breakthrough infections. So very early on the Massachusetts Department of Health was able to quickly detect and follow through the events that seemed to show that there was really a rise, a rapid rise in the number of cases. So parang nag-open sila, nag-invite sila ng mga public events na yung mga race, horses, yan yun nangyari sa Massachusetts. And quickly they were able to stop all of these events in an effort to control the ongoing outbreak. They found out that most of the cases were male, 87%, and the median age was 42. And the distribution of this were because yung mga public events nila invited mostly males and mostly this group of middle-aged people. The vaccines that were received were mostly Pfizer, Moderna, and Yansen as indicated here. And 79% reported signs and symptoms, mostly cough, headaches, or throat, myalgia, and fever. They said that most of these were mild. Only four of all of these cases had to be hospitalized. So mababa-mababa yung hospitalization rate which was only 1.2% and no deaths were reported. But because of this, they also tried to compare the city values. City value is a number we use in infectious disease. When we're trying to see just how infectious or communicable certain samples are. And usually the lower the city values are, the lower that means it only takes a few cycles for the machine to detect. The virus in the sample. So ibig sabay mas madami na siyang virus. The viral burden is heavier when the city values are low. So you would see here that it didn't seem to matter kung unvaccinated or vaccinated yung individuals. So the infectiousness looked the same. So what happened? Because of that very important outbreak in the subsequent paper that came out from describing the experience, the CDC now recommends that bak na sila sa wearing of the mask. So CDC started to recommend that even if you are fully vaccinated, if you are indoor in public settings, you should wear masks. And that reverberated throughout the country. And yun nga, there are more and more concern about this particular breakthrough infections. And we should really all continue to update ourselves. So maraming, maraming information mostly in news items, but there's also a good resource from the CDC MMWR to keep ourselves updated. Okay. Let's go naman to the UK, the United Kingdom experience. This is the paper I thought would help us understand better what's happening with the breakthrough infection. So this are effectiveness against the Delta variants. So this is a description of symptomatic disease. The design of their study was a test negative design. And the people who did this study were associated with the public health. Yung parang equivalent ng Department of Health natin. And you would see in this graph, they try to map out the vaccine effectiveness for the alpha and the delta variant after the first dose and the second dose. And you would see na may malaking difference. So if we just receive the first dose, the protection is only around 30% to at most 50%. But it rises very significantly. If we finish the recommended number of dosing. So although it doesn't match breakthrough infections. So don't get this heartened if you get an infection in between the doses. Because that really happens because our level of protection is not yet full if we only stop at the first dose. We really should make every attempt to finish the recommended number of doses. So here after the second dose, you would see that both for alpha and delta variants, the vaccines that this group of population received were effective up to 89, 79 to 89%. So the conclusion of this experience from UK is that there's high levels of vaccine effectiveness against symptomatic disease with the delta variant. So if further population receive the Pfizer or the Astra COVID-19 vaccines and that there's reduced effectiveness if we only receive the first dose. So if you know of other people who might stop at the first dose or get disappointed because they got an infection after just the first dose, it's not a problem to go and finish the second dose or the number of recommended doses. Pwede naman tayo sa Israel. So Israel, I really tried to look for this information about what they experience as breakthrough infections because Israel actually is the number one in terms of coverage for COVID-19 vaccines. The report here narrates to us the experience of the largest medical center in Israel, which is the Shiba Medical Center. At the time they did this study, the vaccination coverage was already 91% for their hospital and this took place over 14 weeks from January to April of this year. So very, very fresh information. So they wanted to see and identify every breakthrough infection, including asymptomatic infections among their healthcare workers and it was a matched case control analysis. So what did they see? Ganong kalaki yung medical center nila, they had 11,453 healthcare workers. They were doing PCR tests whenever the healthcare worker would have been exposed or would have any symptom. And among this, they only saw 39 breakthrough cases or 2.6%. And the characteristics of the healthcare workers who developed this breakthrough infections were mostly nurses, people who were coming in and out of the wards like the maintenance workers, some allied health professionals and physicians. The average age was 42 years old and there was some increase in the incidence among women. The median interval from the second vaccine dose was 39 days and only one person was infected who had immunosuppression. Saan kaya nakuha yung infection? You would usually ask, where did the healthcare worker get the infection? So the Israel group described the breakthrough infection origins mostly from unvaccinated persons around the healthcare workers who were already fully vaccinated. So 57% got it from an unvaccinated household member like children or other household members who were still unvaccinated. And 30% got them from unvaccinated fellow, yung colleagues, fellow healthcare workers for patients. And they were able to track seven healthcare workers who were linked to a patient who had the alpha variant at the time kasi alpha variant yung predominant in Israel. And again, when they described the severity of the symptoms, 67% were mild and the rest were asymptomatic. So very, very mild, kung meron man, mild mostly, non-required hospitalization. And the most common symptoms were aporespiratory congestion, mayalga, loss of smell or taste, and 21% reported fevers or ribers. What happened to them? So it said that after the 14 days, some still had residual symptoms. One-fifth actually reported having the long COVID-19 symptoms, so prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea or mayalga. One-fourth of those who had the infection actually had to take a leave of more than 10 days longer than the isolation period that we recommend. And there was one worker who was not able to return despite six weeks of leave. So ang conclusion nila was, oh, the variants of concern, as I said, mostly were alpha variant because at that time, 94.5% of the Israeli samples had the alpha variant. So ang conclusion nila was the Pfizer vaccine for them was extremely effective and they actually called, kasi 2.6% in this particular healthcare worker population, the breakthrough infections were rare in incidents, but of course they sort of give us a challenging situation because many are mild or asymptomatic and may pose a risk for vulnerable populations in a medical health facility. Okay, now going to, siyempen tatanungin nyo, ay paano naman yung sa hindi gumagamit ng Pfizer or the other they call it first world country vaccines? If you look at the more recent news items from Israel, they've been identifying that breakthrough infections may be more severe in sicker patients, in older patients, in patients with the comorbidities. So that's something to keep in mind and that's something to make us again always more vigilant for our vulnerable populations. Ito na talaga, kumpunta na tayo sa Indonesia. So we've been hearing this since around the end of May to early June how Indonesia was like just swamped with so many cases of COVID-19 and we heard about why hundreds and hundreds of vaccinated healthcare workers actually came down with the breakthrough infections. So actually, or maybe I didn't find them but I tried to look for them, there was only one case report so far and how it was that Sinovac recipients would anyway end up with breakthrough infections. And this letter to the editor published in this particular journal tried to tell us that when they measured the antibody responses of this particular infected healthcare worker, there was a decline in the antibody response at the time that she had the SARS infection, SARS-CoV infection. So in conclusion for that Indonesian paper, the possible factors for breakthrough infections included maybe lack of immune response from different kinds of populations receiving the vaccines and occurrence of variants of concern in the country. Ayyan, putan na tayo sa Philippines na. So Philippines so far I really have only healthcare worker data from the Philippine General Hospital. This is our epidemiologic curve of what's been happening lahato healthcare workers through the 18 months that we've been fighting the COVID-19 as a referral center. So meron kami talagang naging surge very recently when the August month came about. And this is the number of healthcare worker breakthrough infections we've had so far and that amounts to about 71% of all the COVID infections we've had with healthcare workers. This one we did last night. We completed this data collection and infographic last night. This is not healthcare worker. These are our current patients in PGH. And in the first set of dots, we were trying to represent persons who were fully vaccinated, sila yung green, partially vaccinated, they are represented here as yellow dots and the unvaccinated as red dots. And you would see na yung green did not proceed to the intubated, critically ill intubated COVID cases. Meron din COVID critical, pero as far as we know, as of this morning, they are sort of okay and hanging in there. The ones that really become very very sick are the unvaccinated or the partially vaccinated individuals who proceed to being critically guarded and intubated. So segue lang ako to saying that our information here in the Philippines is not yet complete enough for large completed studies kasi ginagawa pa lang natin sila. So we've started to organize ourselves to have this vaccine effectiveness or Philippine VE project. There's a lot of people who will be part of this all over the country and we're going to look at how the vaccines may be the key to end the COVID-19 pandemic. So ang titing na namin would be a real world vaccine effectiveness data. We will be collecting them in the next 12 months and the project will be trying to estimate effectiveness of the COVID-19 vaccines amidst all of the different vaccines we've been using in the Philippines. We're already on our third month by September to October. So siguro kong imbitahin nyo ako liat makakabigay nako ng more complete data on this. And the project design is a prospective cohort of 12 sites. More or less this VE project will look at two arms. There will be antibody testing or immunosurveillance. This is not to say na people should go around getting their antibody levels. This is, we recommend this only as part of our research or a clinical study. And the other arm would be looking at COVID-19 surveillance. Exactly si no ba yung symptomatic at si no yung nagkakaroon ng asymptomatic infection. So for PGH we've started to do the antibody test but again under a clinical study setting and looking at the incidence of COVID-19 hospitalization and death among PGH healthcare workers between vaccinated versus unvaccinated individuals. This is already my second to the last slide but I hope through all of the slides I've been able to show you through the experiences of the USA, the UK, Israel, Indonesia and a little bit from the healthcare workers in PGH that COVID-19 vaccines are effective but many factors really come into play and that make us more prone to breakthrough infections including host factors like comorbidities or immune responses, situation factors like exposures, use of protection and virus factors like the presence of variants of concern and of course the properties of the vaccines that we use. Okay. That's it. So kasama ang sambayan ng Pilipino laban sa COVID-19 pandemic. Thank you very much for listening to me. Thank you very much. That's Dr. Nina Burba, the head of the International Program of the Philippine General Hospital ng HUSAY talaga ni Nina. Parang napakalinaw, napakalinaw at napakaklaro ng pag-explain niya ng situation. In fact, it's really good to see what's also happening in other parts of the world and also great to hear na meron tayong mga sariling pag-aaral dito. So abangan namin niya na yung results ng prospective study nyo. Okay. Everyone, let's go to our next speaker. Thank you, Dr. Susie and thank you for the comprehensive presentation. Surely mamaya sa Q&A, Dr. Nina, marami pumakatanungan for you. So abangan po natin yan. We look forward to our panel discussion later on. But first, we have a couple of reactors bringing different perspectives po to the table. Our next speaker is a retired manager of the pulmenari critical care and sleep medicine department of the lung center of the Philippines. Please welcome to the webinar si Dr. Benny, Dr. Benil da Galves po. Dr. Ra Galves. Mam, you're on mute po. Good day to everyone. Thank you for inviting me in this special edition of webinar which is special topic of concern which is breakthrough infections. Well, Dr. Berba has presented adequately about breakthrough infections and has given their data at QPPGH regarding breakthrough infections. Now, I was tasked to give some raw data on our experience among healthcare personnel at the lung center of the Philippines. The lung center of the Philippines is a designated COVID referral center especially for moderate to severe and critical cases. Since the start of vaccine rollout in the Philippines, we were among the first who were given the first batch of vaccines last March, first or second week of March. And we have completed our vaccination around May for the AstraZeneca and earlier for the Sinovac. May I have my first slide please? Thank you. So, since March up to August 2021, we have already completed two doses of 1029. So, one dose, second dose to be given at 157 personnel. And 22 for whatever reason still refuse to have their COVID vaccination. So, currently we can say that our fully vaccinated personnel would be around 85.2%. However, once the 157 have completed their full vaccination, second dose, we can increase that to 98.2%. Now, when will the second dose be given? We're expecting the second dose to be given by around the first or second week of September. So, please take note that we gave vaccination not only to our healthcare workers but to all personnel meaning to say those in admin offices, janitorial, and even our security personnel. So, they are included in this LCP personnel vaccination program. So, how do we fare with our breakthrough infections? Next slide please? Okay. This is the road data with breakthrough infections among our healthcare personnel. So, as I mentioned, we completed our second dose of vaccinations around May. So, if there will be breakthrough infections that will be as defined two weeks after the second dose has been given. So, this is our data from June 1, 2021, up to the recent August 22, 2021. Please take note this is from June, July, and August. As you can see from the slide, we have, among the vaccinated, we have eight versus the three in the non-vaccinated for June. For July, we have 11 in the vaccinated group and three in the non-vaccinated group. However, in August, there seems to be a surge among the vaccinated 46 and non-vaccinated 13. I would surmise that the surge in August coincides with the surge of cases in the community. So, for these three months, at least up to August 22, we have a total of 65 among the 1029 personnel who were vaccinated, giving us a rate of 6.3%. In contrast, in the non-vaccinated, we have a 19 total of 19, giving us an infection rate of 10.6%. Take note that, still, the breakthrough infections, there are more infections, rather, in terms of personnel among the non-vaccinated personnel. Next slide, please. Okay. Now, majority of our cases in June and July were all mild, mild symptoms or asymptomatic. There were no moderate or severe or critical cases in June or July. However, during August 1 to 22, we were able to, I have a one severe case in the vaccinated group. This one severe vaccinated group who completed his vaccination is a 58-year-old non-healthcare worker. It's worse in the engineering department, but has hypertension and is obese. Versus those in the non-vaccinated, we have one severe case who is a 50-year-old but has since recovered. Now, the present case of one critical in the non-vaccinated group. So, for a percentage in the severe or critical breakthrough infections, we have 0.01% in the vaccinated group. Whereas the incidence of infection in the non-vaccinated group is 1.12%. So, where do we go from here? We will try to increase further our vaccination rate from the 85% current to the targeted 98%. Once we have the one dose personnel 157 personnel who are due to have their second dose completed by September. So, just like in the literature, I think the variant of concern specifically delta possibly drove the increase in our breakthrough infections despite being vaccinated, particularly during this August. So, this, however, this should not discourage people from getting the infection. Still, it protects patients from getting severe or critical or even landing in the hospital. At least, it protects you from going to have deaths. So, this is my last slide. I hope I was able to give you a brief overview of the status of breakthrough infections at least for the last three months at the Lang Center of the Philippines. Thank you for your attention. Okay, thank you very much, Dr. Galves. Many Galves of the Lang Center of the Philippines for sharing that information. And I think we are very, very, very fortunate to have you here to share that and we do hope to be able to get more information from the other hospitals as we progress. Okay, so we go to our next reactor. And ang sabihin natin dito sa webinar. Natang talino, kailangan po natin para maagapan natin tong COVID-19, hindi po kwedin. Puro tayo lang dito sa health sector. Napakalaga po na, lahat po tayo nag-isip ng solution. And recently, there was news that 95% of the tourism sector in the National Capital Region has been vaccinated. So we thought we were going to invite someone who could talk about that. And she's not a doctor, but she has been working in the health sector. I've known her for the longest time. Even when she was a law student, she was part of the team of Secretary Flavier. She's a lawyer and she is currently the chief operating officer of the Tourism Promotion Board of the Department of Tourism. But she has handled many, many different positions in government. She's well-known to all our civil servants because she was the head of the SAS Board. And I've seen her grow and rise and become a leader in Philippine government. And we are just so happy. Ramon ka ano ang time-award din nito, ha? So I'd like to welcome Attorney Antonette Velasco-Alionist. Tonette, welcome to the webinar. Truly my pleasure, Dr. Susy, Mam Susy, my former boss, my mentor. And Dr. Raymond magtakilala kami because I chaired the screening committee for his batch. Hi! Maraming salamat sa interbaksyon mo, Mam Susy. On Friday, sa mga kasama natin sa webinar, nining nervous ako kanina, sabi ko bakit ako nasali dito? Parang mga experts ang nan dito, atang mga datos, ang mga statistics. Parang naligaw ako dito. So kahit naliligaw ako, may connection tayo pagdating sa usapin ng bakuna. So kung nasan man po kayong gawin ang Pilipinas, may mga nasa ibang parte ng mundo pa na nan dito. Maraming salamat for joining because it's important that we continue to share information, get ourselves updated. And as I share my slide, I'll walk you through some of this and why I'm probably here for the tourism sector. So vaccination, masabi nidok ako, may mga breakthrough infections. Pero alam ninyo, kailangan din namin ng breakthrough para mag-break yung barriers to tourism recovery. And vaccination actually, fortunately, is considered as one of the key game changers. Binabago niya yung laroon ang pano magbubukas ang turismo sa ibad ibang parte ng mundo. Syempre, sarado pa pula. May mga matatapang na mga na-u-uang nagbubukas pero nakikitapuh natin sa karanasan natin para tayong close open, close open magbubukas, may koon-o-o mga pakete, tapos may search ulit magsasara pero siguro na itinatanong nyo. Bakit pa kasi kayo ganyan, baka nakakakontribute pa kayo dun sa mga infections sa transmissions. Pero malaki po ang contribution kasi na ng turism sa ekonomia sa ating bansa alone. Nakot 12.7% po na ating gross domestic product, contribution ng turismo. 5.7 million workers ang nasa turismo. Last year, 4.8% of them kung hindi po na wala ng trabaho, all together ay nabawasan ng oras ng pagtatrabaho at ngayon ay kasama sa mga naghanap ng kabuhayan para maitawid ang pangangailangan ng pamilya. So ganyan po kaya ng kahalagahan ng turismo. Kaya kami, siguro na dito ngayon as I speak actually, si Secretary Borna Puyat na sa Shargao ngayon balikan siya precisely to roll out vaccination for our tourism frontliners dahil as I mentioned, vaccination is really key to opening the doors to tourism recovery. Across the world, last month ng July, nakita natin may apot mabansana, mas innovative at siguro mas matapang at may mga excess siyong vaccines, nag-offer ng mga pakete sa U.S. na una yung New York, yung picture na yan sa Kaliwa, yan po yung sa Times Square, may mga ano sila don't tent. Pag ikaw ay dumating na turista, babakunahan kanila, ginaaya sila ng Alaska, sa Arizona, Louisiana, Texas, and even Florida. At sa Maldives naman, yan meron pa silang package. Visit, vaccinate, vacation package ko di ba? Kasi pinaplano nila pagbatin ng next summer dahil sila i-summer destination, maka-engdanyo sila ng mas marami pang turista kasi saansad ang ekonomiya nila. Dito po sa riyo natin sa Southeast Asia, ang Bali sa Indonesia dahil heavily reliant po ang Bali sa International Tourism. Ay, nag-bukos din ng pakete, although hindi pa ito fully rolled out dahil nagkaroon sila nito, breakthrough infections, yung latest search, and the latest news is that President Widodo will be the one to make an announcement as to when they finally roll out this Bali package. And of course, Russia, with its own sputnik gamalay vaccines, has been quite strong also in offering packages for tourists. Although ang isapang barrier nila din, of course, ay yung mga entry or visa requirements. So makakikita natin may apot na bansang ngunguna dito sa usapin ng pangdikit ng turismo at vaccination. Although alam din naman natin, like the UNWTO and certain organizations did not receive this positively dahil sinasabi nila na parang, siyempre may mga moral or ethical questions dahil, manami pang parte ng mundo na wala ng access of vaccines at sanay, mauna natin ibigayon desa dun sa mga, ganitong agi, ang mga activities or agikay na magpromote lang ng tourism. So the road to recovery of tourism globally faces certain barriers and top of that would be the travel restrictions that we still face and that's largely influenced by how governments or countries are able or not able to control the cases. So it's really we get the information out in terms of our cases on a day-to-day basis how we're able to respond to this through capacitating our public health systems and of course the economic environment of the country is also a factor for concern. Dito, when we zoom in sa Pilipinas, ang effecto po ng pandemi ay malaki, ang ating foreign visitor arrival bumagsak by 82% last year alone, at ang ating tourism resits ang mga ginagastos ng mga tourists na contribution nga sa ekonomiya natin, bumagsaktin po yan by 81.96%. That's why I said, affectado po talaga ang mga kasama natin mga gagawa, lahat po yan ang mga bankero, ang mga gumagawa ng souvenir, ang mga nagtitinda, ang mga nga negosyo. Ang sotong t-shirt ngayong negosyo, ito ng isang tour operator na sinosupportahan natin kasi para makapulay-tulay lang sila na mga cope naman din sa mga challenges. So ito ang challenges, these are the buyers to recovery. But looking ahead for us, our travel sentiment survey, we ran two surveys last year with the AIM. The trends point to number one, domestic tourism will lead our recovery and that's an advantage for the Philippines unlike other countries that are fully on international tourists. Actually po tayo, secreto natin sa Philippines natin natin na lang. Yung 10% of the 12.7% na contribution sa GDP, yun po ay domestic tourism. So in 2019, that translates to 110 million domestic trips. Kaya gusto rin natin mainggan yung mga kababayan, magsigahin ng muli, matulungan natin yung mga destination makapagbukas ulit at crucial po yun yung pangalawang factor na increased digitalization at paggamit ng social media. So ngayon virtual tours to entice people to visit the destination site virtually muna. But we're also capacitating the sector para magkaroon ang contactless booking, contactless payments, lahat po ng mga paggamit ng technology para maging safer yung travel and tourism ginaagawa natin. At sabi ni Doc Susick kanina sa umpisa, well top of mind concern, hindi lang po ng general population, more so for tourists, ay health and safety ng ating mga destination, ng ating mga workers at patipun yan ang pagbabakuna. Kung kaya si Secretary Berna, dinawa niya po talagang priority advocacy na ma-vaccinate lahat ng mga mga gagawa sa tourism. Beginning with my own office, the tourism promotions board. Lahat po kami ay fully vaccinated as of last month, July. Patlo na lang ang hindi nababakunahin dahat ito naman ayon namin pilitin kasi may history of severe allergies at so wala nga clearances from the doctors. But otherwise, there is no hesitancy, lahat kami gusto ang mga bakunahan dahil, lahat po ng jahin namin hindi namin pinalalabas ang mga hindi fully vaccinated. Mayroon din po kaming mga frontliners, parang mga medical workers, hindi lang sila na sa hospital, sila ay na sa hotels that are being used as quarantine facilities or isolation hotels. Karamihan po ng mga infections among tourism workers nung yayari doon sa mga hotel, which cater to mga returning overseas Filipinos during the quarantine period na in case may not positive. O yung ating mga returning overseas Filipino workers dahil nga po yung karamihan ng hotel na na ikayat namin mag-shift mo na hindamin time na maging quarantine hotels ay binpo sila nagtatrabaho. Out of target na 32,467 workers for these facilities serving as isolation and quarantine hotels, Kuntin na lang po, less than 20% na lang, 17.98% as of August 20, ang hindi pabakunado. And then for all the other hotels kaman, across the country, ito po yung siyempre nag-compet kami sa access, medyo na sa 33% pa lang ang pagbabakuna pero yan po ang kadahilanan kung bakit, kung may ikot secretary Berna, particularly for the priority areas, ito po yung priority areas. NCR dahil tayo po ang gateway, ito naman talaga karamihan din ang gagaling ng mga tourists ang bumibisita sa ibad-ibang daco ng palit ng Filipinas. And that's the NCR plus 8. So there are 8 provinces or areas that are priority tourism destinations. Most people frequent them Baguio, Pampanggap, of course Palawan. There's Coronel Nido Puerto Princesa in San Vicente also. And then of course Boracay at Bohol Siargao. In fact Boracay po number one sa listahan ating domestic tourism destination since it reopened in October last year. And for that tayo po kami nagbigay ng support pa sa Malaya clan para may subsidy tayo, yung mga workers po dung tinipest regularly sa RTPCR at magbigay na rin po kami nag-roll out ng subsidy for tourists coming from NCR to visit the other destination. So the way forward really compels us to carefully navigate, mindfully navigate the way to the better normal for travel interests. And that requires these factors of doing or share of responsibility to get vaccinated, Observing the minimum health protocols of wearing mask, face shield, the hygiene for the hand washing and of course observance of the distancing note, especially if you are in a crowded place. And for tourism and travel, we support and encourage LGUs to really require as one of the protocols yung test, a negative RTPCR test before travel, not even anti-gen because we still want to follow the gold standards. So this is actually the second to the last of my slide. The last one is an AVP that we developed last year but just by way of, in a fun way, contributing to heightened awareness and consciousness on the observance of our health protocol. So I hope you enjoy the, you enjoy, I'm sorry, let me go back, pag mamadali naman ng aking video. Thank you very much to Kora Susi and I'll be happy to join the panel later for some questions. Okay, thank you very much. I'm sure you all enjoyed it. And okay Raymond do no? Parang sabi ko, ang mula sila, tayo eh. Ano to talagang, kaya sabi na din lahat ng talino ng ating bansa ay kailangan ating gamitin. Donet, you can see all the, what should I say, all the positive comments on the chat box. I think they found it really very, very interesting and we're looking forward to more discussion as we open the panel. Okay Raymond, over to you. Thank you. Thank you so, thank you so much Atornito Net and also Dr. Susi. Nag-singpo ako dun sa anang, sa video actually for that and that's something that we really thank the tourism promotion board pa for sharing with us about the learnings and also their plans and what they have done as part of the vaccination program and really how to protect all of us moving forward. So thank you for that Atornito Net. So at this point may we ask our panelists to please switch on your videos po so we can begin our panel discussion calling po director Tayag of DOH also Dr. Nina Burban, Dr. Benny Galvez. Atornito Net already has her video on. And before that, very, very quick lang po no, quick break for our special public service announcement which we have been doing for the past few weeks. Over to you TV UP. Oba. Dail mahal ko kayo magpapapakuna ko. Okay. Thank you so much TV UP. The COVID communication. Kagikita talaga akong sa PSA na yan. Talaga hindi gasin talaga sila. So ala po, the COVID communication public service announcement is one of the many outputs of the UP research entitled communicating COVID-19 in post quarantine Philippines. It's headed by our vice president for public affairs, Dr. Nanny Perna and funded by the DOSD Philippine Council for Health Research Development and the Department of Health as part of the AHEAD program. Over to you Dr. Susie. Okay Raymond, I think let's start with the Mentimeter. I think Nina answered the questions but let's just go through that quickly. Yes. Yeah, go ahead. Thank you. There we go. Dr. Nina, this will just be a reiteration po no? Pero for the benefit of those who are in our Zoom po who are numbering, well past 2000 na po tayo and for those who are joining us in other channels. What's the answer to this question? A breakthrough infection is when one test positive for COVID-19 after becoming fully vaccinated pag atapos ng one week, two weeks, three weeks, four weeks. Two weeks. Two weeks. Two weeks. Thank you so much mam Nina. And then through or false? Thank you. Through or false? Fully vaccinated individuals may still get COVID-19 but breakthrough cases that lead to hospitalization and death are low. Is that through or false mam? Through. Okay, thank you so much Dr. Burba. Okay, let's get the ball rolling Dr. Susie. Okay, so I think I'm looking at three when I box and I think we have 70 questions. But let me just start off by asking everyone about, well I think this webinar is good because I think what we're saying is that yes you can get a breakthrough infection but no you don't have to be so afraid of it. Nina has talked about mild symptoms. I think so has many values of the lung center. But I guess the thing is people have a kind of expectation that if you get vaccinated you can't get infected. So maybe I'm going to start with Eric na this is now in the realm of risk communication when we start communicating. How can we counteract the idea that the vaccination completely protects you? We talk about people who are resistant. But if you get vaccinated you can get infected. So I'll start with Eric. Eric how do we change that it's a wrong expectation? Parang gano nandeng pa, parang mali ang expectation. Sige Eric, ikaw. Okay. Unang-unang Susie, marami salamat sa lahat nakasama ko ngayon sa panel. Unang-unang Susie walang bakuna na 100% effective. Pero hindi ibig sabihin na walang 100% effective ay hindi tayo magpapabakuna sa pagkat na patunayan na hindi pa ang dumating ang pandemic sa atin ay malaking halaga po ang premium na binibigin natin sa vacuna sa pagkatang marami ng pagbababa sa mga namamat ay sa mga nakakahawang sakit. At nai-radicate na natin smallpox at nga yung malapit ng ma-radicate ang polio. Pangalawa sinasabi po natin na ang ating katawan ay gumagawa ng antibody, ispag tayo nabigyan ng vacuna. So barit, kailang may tindihan natin na hindi dal sa vacuna kundi sa ating immune system. So kaya tanong gawin natin ang vacuna niya, hindi lang COVID-19, yung ibang vacuna ay talagang 2 weeks matapos yung complete schedule ng vaccine at magkakarantayon ng antibodies. Anong ibig sabihin yan? Sa mga panahon na hindi pa tayo protectado o pinaliliwan ng kuhusay nyo. Wok ay magpapaselpig ng 2nd dose na sa pagkat 14 days after pa po ang protection. So anong mga araw between the 1st dose and 2nd dose, kung hindi tayong nangingat, hindi tayong nagmasa, gukasang kamay, physical distancing ay mahawa po tayo. Ngayon itong breakthrough infections ay expected po it's not something na parang tinago po ng mga experts. Sa pagkat sa ibang mga vacuna rin ay nangyari po yan. Ngayon kailangan yung pumahintindihan. Kung kayo po ay nagkaroon ng COVID, bago pa yung 2 weeks after na may protection kayo, ibig sabihin yan na unahan po kayong mahawaan, bago pa kayo nagkaroon ng protection. Ngayon, after 2 weeks at mahawa po kayo, ibig sabihin yan ay isa kayo sa mga sumusunod. Una, maaring mahina po ang ating immune system kaya hindi masyadong maganda ang antibodies na nakudos. Pangalawa, baka naman sa katagalan, kasi hindi lang kung hindi nabanta yan na, katagalan yung bakunang natanggap natin, bumabagsak na rin yung immunity na makukuasa kanya. At pangatlo itong mga variants hindi lang Delta at yung mga lalabaspan. So may krinsalita Susie, ini-expect natin yung breakthrough infections, pero hindi lahat magkakaroon yan. At yung bakuna ay makakaprotect sa ating sa severe COVID at kung magkakasakit, nakita naman yung mga datos ay isang situation na hindi tayo dapat magalala. Thank you Susie. Thank you Eric. Nina, can you comment on that? On how do we change the mindset na ok lang toh? It's okay. Part of your expectation talaga yung nag-go through the effort of pila sa online, pila paulit sa vaccination center. Parang naturally, we expect na on na ako hindi na saan ako ever magkakapovid 19. So tama po kayo dapat very clear natin except yung expectations. What we're really trying to do is to reduce yung risk na hindi tayo ka ilangan ma-admit, hindi tayo ka ilang maging critical, hindi tayo ka ilang mga ilangan na oxygen should we come down with COVID-19. Karang ganoon dapat yung mindset natin. At malaking bagay nung kasi nakakatakot talaga ma-hospital at mga ilangan. Yung pagdinedescribe po sa aking nga mga patiente yung air hunger nila, parang nakakatakot. Parang nakakatakot yung sensation po na yan. So I think even if we feel we're healthy, wala tayong comorbidities, yung fact na we are taking away or at least significantly reducing the risk na mapunda tayo sa situation na yung malaking bagay na po yan. Thank you very much. Can I add? This is experiential and also related to recent sa marketing. So una, important thing we get the correct influencers. Kasi there's so much information out there that cost people to fear the side effects of the vaccine. May very own driver. Kung July ko lang na-discubre, hindi pa wala siya vaccinated. Puyo, bakit na nagpabaksinit, nag-palista na tayo lahat? Kasi pumang sabi, magiging zombie daw ako. Diba, talaga ang gusto ko kasalanong ko yung sabi ko. Ang dami-dami ko nako convinced, tapos yung sarili ko nagmamane ko. Nakakala niya magiging zombie siya. So noong nagpabakuna ako nung as early as April at mag-post ako sa Facebook, sa social media. A lot of my colleagues in government reached out to me sa message, enjoy private messages, sabi nila, kapatid. Anong nangyari bakit nang pag-vakuna, wala ka bang side effects? Bakit, bakit nila? Kasi ayaw talaga namin, pero nung nakita ka namin, nagpabakuna ka na, sabi namin. Matalino naman ang babayin to, siguro hindi siya susuong danang hindi niya alam yung mga risks and benefits. So it's important that we get influencers out there to give information, correct information. And as bakt, siguro bakt Eric, kailangan mo talaga ang gumawa ng Delta Dance. Kasi yung kaalaman, kailangan natin labanan mo. Ah, noong sir Eric ako din, I vote. Okay. Sige, pre-premier natin dito sa TV UP, thank you so much for that. Kagagagay natin. Kagagay natin. Kagagay natin. And just to close for the tourism sector, ang dami sa aking, kasi nag-wiki-chattin ako sa mga stakeholders, tinatak, tinanong nila ako nung CEO, vaccinated ka na ba? Sabi ko yes, with Sinovac. So nung sinabi ko yun, ba? Wala na sige na sila choosie. Dati kasi mga choosie, hindi po ba? May mga ganawang agam-agam. At mong nagpabaksinit sisek Berna at sisek Berna, Sinovac din. O ayan, ang problema namin ngayon, makahanap talaga ng supply para makover lahat dahil yung mga tagaturismo, gusto talaga nilalahat, magpabaksinit. So gawin nyo kami. Magpaparticipate kami na imam dun sa study nyo dun sa cohort nyo na. Efectiveness. Okay Reymond, go ahead. Reymond, andaming questions sa chance sa Q&A. Ano ba umihinal jatang? Ang pinaka actually, ang pinakam ano po, I'm trying to figure out if we will be calling someone from the audience. But the very first question that we have has to do, first question meaning the most upvoted, has to do with boosters po. So I think it's coming from the fact that if there are breakthrough infections among the vaccinated, how about those that have not yet been vaccinated or hindi eligible mababaksinit po yung ating mga kabataan, yung katanungan, is it already time that we talk about booster shots for the frontliners? How about prioritizing children 12 years old? So yung po, and also I think the question is coming from Pfizer being given the go signal to be able to be used for 12 to 17. So yung po ang question po from other audience. Maybe either Dr. Burba or Dr. Galvez, let's hear from Dr. Burba po. So booster, booster mo na yung pag-isakang ko. Actually nagsig ako talaga sa experts panel ng vaccine, yung vaccines experts panel natin at sabi talaga ni Professor Gloriani. Parang hindi pa panahon ngayon magpapakunan ng booster. Diba sabit kasi when you look at the immune system and how it responds to vaccines, may tamang panahon to ay and pagka yung booster dose mo is too soon after your second dose. Parang walang effect sya. So they're still trying to decide when that will be but it's not yet right now. She was saying something like, siguro po mga at the least six months or around one year ngayon ina-anticipate nila yung mga recommendations but that will still be depending on how things would be going. So yun, pagkatosun yung too close from the second dose parang walang benefit giving the booster dose of whatever brand of vaccine. Okay. Pwede ba magkaloab? Question, Doc Raymond. Sige po ang mamponet. Go ahead po. Doctor Nina kasi diba, parang pag-inisit mo common sense yung mga breakthrough infections dahil may bagong variants. At yung mga bakunan natin ngayon, do not cover these new variants kasi di ba nag-mutate mga yung virus. So di po ba parang logical nga na bakit sa pag magpapabuster kung ang mukukunin mo naman booster shot ay yung parehong vaccine na hindi po nag-cover nung mga variants na mutated. So ay di hindi po ba ideal na talagang dapat ang booster nga ay it will also be vaccines na man po cover na nung variants na mga bago. Tama po ba yun? Anong po yun ang mga stakeholders po eh? Well kasi ma, meron pa rin ano eh. Like the data I showed you for the, from the UK, parang very strong yung evidence nila na yung current vaccines natin ngayon particularly ang gilamit nila po doon ay Astra chakay yung Pfizer works well for the alpha and the delta variants even the variants. Of course baka dumating yung panahon in the future na mag-evolve yung ating SARS-CoV-2 into a variant that the vaccines won't, the current vaccines won't be able to cover. That's really a possibility. Pero kung makikita nyo sa pipeline yung mga nga apply sa FBA dami-dami po ang makabagong vaccines that are undergoing phase 3 trials, 2 and 3 trials. So we look forward to having more platforms that will become available for the, to fight the future variants po in the, for tomorrow, always keep us once the head of this very difficult virus po. Mam Nina, we have the original person who asked it, Ruperto Angel Navarro. Maybe we could ask him to provide more context doon po sa pinanggalingan ng kanyang katanungan, Dr. Berba. Classmate kami, si Bongan. Ay, ay, ay, ay sigaip po. Go ahead, sir. Hello, Nina, yes. Classmate niya. Anyway, no, I was asking that question because ang Pfizer kasi ang coverage na 16 and above diba. So there's this move that, you know, in this country, I'm not saying that you're supposed to follow the U.S. model, but you know what I mean. Pfizer has already said that, you know, they're ready for product registration. Is there a change in, in the coverage with Pfizer na from 16 before, nga yung pwede na hanggang 12 years old, before we ever consider giving vaccine doses to our children, you know. The reason I'm asking is because, you know, I know children don't get worse with the, with the COVID infection. But given our current status, ECQ and ECQ, et cetera, et cetera, hindi makalabas ang matatanda, hindi rin makalabas ang mga bata. So nangyayari ang nawutusan yung mga midel, yung adolescent, yung hindi halatang nakanda, hindi rin halatang bata. So sila yung mga lumalabas ng bahay, sila yung nakikistalamuha sa neighborhood, posibling sila kasi vectors of transmission, sila yung nagdadala papasok sa bahay. And you know, I mean, nobody's ever thought about that, but that's the reality on the ground. Baka mamaya, they're the vectors of transmission and that's why we're having this surge, despite ECQ and NECQ. That's all. Okay, so. Can I answer that question from Doc Bong? Go, go, Eric, go. Okay. Bong, unang-una, vaccination alone cannot stem the spread of the coronavirus. Okay. So kung lahat ng ating asa ilalagay sa bakuna, that will be a mistake. It should be bakuna and all the other things we're doing now. Okay, kasama yung mga granular lockdown. Pangalawa, inuunang muna natin yung most vulnerable population. Kaya nga inuunan natin yung front-line health workers katulad mo, katulad namin. Pangalawa yung mandatanda, kasi pagsilan ng hospital, sobrang yung complication. Malaman, sila yung mamamatay. Pangatlo yung may underlying medical conditions. At ngayun niya, essential worker, kasi we worry about the economy. Yung mga bata kaya na delay yan, kasi nang unang ginawato mga bakuna, walang pag-aaral sa mga bata. At nga yung meron ng evidencia, so nakapilan na yan, pero kailangan maunang muna yung most vulnerable. So tama ka sa pagkat pag tayo na bakunahan na, eh, sino ba ang mahawa, doy mga bata na, kaya kailangan, nakandaan na rin tayo. Kaya nga inuunanan na nito mga vaccine manufacturers na ipakita na yung mga studies sila na pwede sa bata. Sa China nga three years and a bad day, ginagalit na yung bakuna nilaton. Yung Pfizer nga 12 years old palang. Ang kaibahan ng pool approval ng FDA, pwede yung commercially available na siya. At sa U.S. parang naihimiga nila dung kung meron tayong bakunang fully approved na week and Monday. So alimbawa, hindi kayo pwede yung pumasok kung hindi kayo bakunado. Yung nang kaibahan kung emergency use listing ng kaya hindi natin masabi kung tama yung decision ng US FDA pero yung nang nangyayari sa U.S. ngayon. Yung booster, nirerekominda naman sa America yung sa mga immunocompromised. Okay? Sa pagkat, kahit na dalawa yung dose, merong evidentian na, hindi pa rin maganda yung antibodies. Kaya, makakaroon ng booster. Atama si attorney Toonette, bakit yung ginagamit natin bakunang ngayon, yung nang gagamitin mo sa booster? Ehingtaid mo na yung mas matibay na bakuna. Yung nang gamitin natin booster. Kaya wag ko kayo magmadali, kasi nababalitaan namin, bakunado na pumipila pauliti. Okay? So, mo hindi pa rin magdokon. Thank you, Suzie. Thank you. Raymond, we have another another question. Another question, Dr. Suzie. This one comes from our long time, like really one of the first ones who has been attending our webinar series. Dr. Joseph Tortona. Yes. Go ahead, sir. Yes. I would like to greet every good day. And especially Dr. Henry Ketayag, Batchmate? UERM? Batchmate. Thank you. Wako naman na ng classmates at classmates? O lang video si Joseph. O lang video ko. Mam si Rai ang busted niyo kamera ko sa laptop ko eh. Matagal na. O do lang. Okay game. I think it got busted because of my face also. So Mike, my question is I've been fully vaccinated since April 5. No? We'd sign a back. And if ever I get a positive RT-PCR test, doesn't mean that I'm a carrier. Or if ever I do have a positive RT-PCR, how many times should I get tested for RT-PCR to make sure that I'm already... I do not harbor the bodies anymore. Okay good question. Maybe we're going to ask Dr. Galvez to also answer. Hindi ko siya sumasagot eh. Dr. Ara, please go ahead. Okay. Even if you're not fully vaccinated, yung patient na nagkakovid, okay, we don't routinely use yung test-based strategy. More ang nere-recomend ay yung symptom. Ang tanong nagkasymptoms ko ba kayo? Kasi kung wala kayong symptoms at nag-RT-PCR kayo positive, ang routine is isolation for 10 days. Yung test-based meaning to say repeat RT-PCR, that's recommended for those who are immunocompromised, who may be harboring or magiging mas prolong ang positivity sa RT-PCR. Even if you are already magaling na and you test positive, it doesn't mean na buhay pa or active yung virus. Because an RT-PCR is so sensitive na even the dead virus, the genetic material which is tested sa RT-PCR will still be positive. Sa mga studies, it could be depending on your immune system, possibly positive ka pa rin sa RT-PCR up to 3 months. But it doesn't mean to say that you are active at COVID infection. So may mga cases kami na after 2 months, positive pa rin and then later on nagiging negative. So iba-iba ko kung kailan magiging negative. That's why at present we do not recommend using a repeat RT-PCR testing or swag test to say na recovered ka na. This is adopted internationally and even here nationally by the DOH. I hope I answered your question. So April ka, April, May, June, June. August na po kayon. Malamang negative na kayo sa RT-PCR. Hindi natin masasabi. But the short answer is we do not recommend a routine RT-PCR test after a COVID infection. We use the test-based strategy in certain population of patients like the immunocompromise, yung mga HIV. We expect na mas matagal na nandoon yung genetic material ng virus. By the way may us also. Let's remind ourselves that vaccine alone is not a magic bullet. We have as of now vaccine and our health protocols. So physical distancing, hand washing, good ventilation. Perhaps until we reach na fully vaccinated na ang majority of our population. There's a saying, we can only be all safe when everyone is safe. May nagsabi na nandoon. We can only be safe until it's time that all of us are safe. So as of now, let's try to reach vaccination, increase our vaccination rate. Hopefully to achieve nationwide herd immunity. And with herd immunity, hopefully mababawas yung circulating virus. So in that sense, we will not give the virus a chance to mutate. So parang cycle yun eh. Thank you Benny, Susie. Susie, ang sasabihin ko may implications k'y mamto net. Kasi iton, nagsong ko yung pinakita kanina yung breaking through the barriers. Ganito po yun. May mga classmates, may mga condition kung saan routinely inuulit yung RTPCR or antigen test. Pinaliwan na kanina ni Dr. Berba Breakthrough. Pasitib ka sa test, pasitib ka sa RTPCR or antigen. Hindi pwede nagsyntoms ka lang sasabihin mo breakthrough, mag-pates ka. So ang ibigpun sabihin ito, ang ibigpun sabihin ito ay ito yung mga situasyong kaya yung kailangan uuliti niyan. One, kung merong research na kinagawa na kung saan gusto natin malaman kailangan nakakarun ng breakthrough na 14 days after nang mabakunahan. So yun ng research question mo. Ginawa niyang sa ibang bansa, so ling-ling-go yung mga nabakunahan 14 days after kinukunan ng ling-ling-go. Kasi may mga asymptomatic, pwede nga wala kang symptomatic. In the real world dito sa atin, pwede nga iadap yan na Dr. Berba sa hospital nila at Dr. Galvrez na kung saan yung mga vacunandong health workers ay i-follow-up ng random day kung sino yung nagkarun ng positive test at pwede rin yung pag-aralan nina mamtunet kasi andami na sa kanilang tourism workers na mga vacunahan. Congratulations, that's a big effort. Hindi lahat po nang ayan siya nakakagawa ng matas na vaccine coverage for the workers. Pero magandang malaman kasi ko asymptomatic ka. Ang reported ng breakthrough infections nalala sa mga asymptomatic at kahit na yung mga nag-asymptomas ay ayodin mag-patesa ayun na nilang malaman. So dapat may procedures tayo na may recomenda sa kanila. Lalo-lalo na sa tourism natin para na sa ganun. Mag-asos mag-patesa kailangan maingat tayo kung ano yung procedure. Sana nakatulong kami sa yung classmate at ang huling payo ko sayo. Kahit na tayo vacunado lahat, we can get infected at any time. May be not now, may be months from now at pinalewa na kung nakambakit nag-rewaying yung ating immunity at pangalawa yung mga variants at mo yung darating pang variants. Sana hindi. At yung ating behavior, pagdayo ay na expose. Syempre mahawa tayo kahit vacunado. Pero alam nyo naman na mas-protectado ang vacunado kesa hindi pa nagpapabakuna. Thank you, Susie. Thank you. Thank you very much. I was going to have a follow-up question for Nina. Our audience are mainly health workers. As I said, if you go back on the chat, you'll see na maraming nagkaroon ng infection. I guess in the general population, as Eric was saying, people won't get tested. But for the health workers, it's very important for us to know. What are we doing in PGH in terms of testing of the health workers? How regular should this be? Would you have any recommendations also for the tourism sector in terms of testing? Kasi the more we have vaccinated people, then the more we'll have people who might have asymptomatic COVID. But you don't want them to ay mong makahawasil ng iba. So what are we doing in PGH? In PGH, we're very liberal with the testing. So meron kaming mga testing indications for any symptoms. Actually, si Dr. Raymond gumawasyon ng app naantawag best. Everybody's saying... Ano nga ba ibig-sabihin, Dr. Raymond, ng best? Baya nihan na employee symptom tracking system. Wow! So ano na nga replace niyan for more than a year since the pandemic started. So lahat po na mga employees ng UP Manila, kailangan parang they go through this best every morning para madiside nila kung papasok sila or hindi. Kasi kung may symptoms, yun nga po, we really recommend na magpatest po sila. Tapos, the other indication for testing would be if they're part of a contact tracing. So some people, very active po kasi yung contact tracing. So immediately, pag kami nalamang nag-positive, dintratrack na lahat ng mga contacts. And if you're a parang high risk, met na talag po kaming high risk exposure. That means either yung healthcare worker walang mas na dapat, hindi na naman nangyayari o kaya parang nagagalit kami pang mga high risk exposure or yung patient or yung index case walang mask. At nagsama sila for kahit a very brief period of time, medingan ng close space, high risk exposures po yun. Dapat napupulout po sila at nat-attest po sila. Kung asymptomatic... Dr. Susi? Okay, go ahead. Oh, sorry. Well, just to share, kasi it might help the other sectors. For the tourism sector, the Department of Tourism has issued guidelines and we engage our stakeholders like for hotels. Meron talag kaming protocols. Yung sinasabi ni Dr. Eric na, there's continuous monitoring of the symptoms also. And once may magkasimpom, automatic na-isolate sila. Merong quarantine facility na-dedicate. Kaya kung na-noticed ninyo kahit magkakaroon ng mga a few cases here and there, eh hindi naman siya na out of control. So we're able to manage that. So importante talaga na may proceso, may protocols na sinusundan sa baba at yung sabi ni Dr. Eric. Medyo mahalang RTPCR. So fortunately for the tourism promotions board when I got there last year, merong kaming special contingency fund. And I was able to deploy that last year. For the first time in five years, last year lang magamit. And we use that to actually help the different local government units to reach some destinations, lalo na yung mga like Boracay, Bohol. Para hindi naman sila, as you said, Dr. Eric, medyo mahal, medyo. So we're able to, and we're thankful to DOH for setting price caps kasi at least it somehow helps regulate the expenses on that side. So yun po, Dr. Susie and Dr. Mina impotante talaga yung pagmonitor at kadalasan ang fear kasi niladok nina pag mag-isolate walang sweldo. So as much as possible, we try to make provisions for those. Kahit dyan sa mga regular matting daily wage earners sa Metro Manila, yan naman po ang katatohananan, medyo nakakaawa na. Hindi sila magbidisklose kasi marami sa mga kasamahanating, ordinari yung mangdagawa, no work, no pay. So kailangan po yata yung safety nets natin para matulungan sila sa ganung paraan, mandun din. May mga LGUs na medyo mas masigasin dyan. So hopefully mag-encourage po yung iba. Salamat po. Thank you very much, Tonette. Nina, I picked up a question on the Q&A. Well, I saw several which were, let's see, they got vaccinated once and then tested positive or became symptomatic. So how long after can they get the second shot? Kasi sabi mo kanina, wag silang magbidiskourage, they should go ahead and get that second shot. So if they test positive, they developed symptoms and therefore got tested, how long after should they get the second shot? So yan nga, mereng yung since the natural history kasi SARS-CoV-2 COVID infections, palang naturally after 10 days for mild to moderate COVID, hindi na tayo infectious. Expectedly gumagaling na tayo. At the end of that 10 days when we're feeling well enough tapas nakakuhan na tayo na slot sa online registration, then go ahead and get yourselves vaccinated. Safe na po yun. Many of the, no-on-on po nung palang kulang-nakulang yung vaccines at palang pre-na-prioritize natin yung mga iba-ibang more vulnerable people. We were saying you have at least you have up to 3 months. So many people remember that 3 months kasi, supos hindi, pag nag-COVID ka, manong ka more or less maybe a reliable amount of antibodies against any new SARS-CoV for about 3 months. Pero ngayon, since mas medyo mas madami na tayong vaccines, allowed na tayo to, kama po ba, baka iba'y sasabi ko. For Eric, allowed. Ganito yun. There's a compulsory 14 days isolation. Dapat makompleto mo yun. So that's one condition. Okay. Number two, napat naka-recover ka na significance sa illness mo. Then at any time, ang pabakunan susi. So example, nagpabakunan ako first dose na yun. Tapos ang second dose ko, 28 days later, depende sa brand. On the 20th day, nagkarunan ako ng infection, may symptoms, na confirmed sa test. So 20 plus 40 ng isolation ko. So on the 15th day, naka-recover na ako, wala na-configure, hindi na ako nila pang huminga, hindi naman ako na hospital. So pwede na akong pa inject ng second dose. Ngayon kung na hospital ka hinahabangan, mga 21 days, lado na consiveo critical. Thank you. So ask the doctor. Ask your doctor. Yes, yes. It's okay. Pero ang importante, napat, nag-isolate ka muna. Kasi ekin at imagine, pupunta ka sa bakunasenter, hahawaan mo lahat, dahil lang sa gusto mo mabakunahan. Okay. Dapat matapos yung isolation period mo. Yes. Hindi ka na makakawa sa iban ko. Okay, great. Ita susi pa na yung ano? Ita susi kami kasi sa TPB, ang panong naman na maka-impliado ko kasi, annually we give pneumonia and the regular flu shots. So doc Eric, pwede pa rin, pwede din. Oh, yun. Recomended yun. Dati ratin, nag-intay muna ng 14 days in between, whether na una yung regular vaccine, so COVID-19 vaccine. Not because bawal, but because kung magkakaran ng side effect, hindi natin malalama kung kanino sa flu vaccine ba yan sa COVID. Correct. Pero ngayon, may isa lang exemption dyan. Pag nakagat kayo ng so at baka magkarebis kayo. Okay. Hindi na pag-uusap, ano unayin yung rabis vaccine. Pwede naman magpabakunan ng COVID vaccine anytime, hindi na kailang maghintay ng 14 days. Thank you. Alam mo, Eric. Ang katonet. Parang, I'm trying to study and understand, as a community, putting on my communications hat, trying to understand why some people think that a flu and a pneumonia shot is a substitute for the vaccine. And what I've understood, so Nina, correct me if I'm wrong here also, parang what I think people are thinking is if they get the pneumonia shot, kahit magkakovid sila, they won't get pneumonia. Because it's called a pneumonia. A pneumonia vaccine. Diba? Parang ganunin na ina, kasi sabi ko, parang bakit niniisip na, bakit niniisip ng tao na magpapafluo pneumonia shot na lang ako imbis na vaccine against COVID. And I think it's because they think the word pneumonia, which of course refers to pneumonia, right, the virus, is that they won't get severe COVID if they get these two shots. So Nina, can you explain that a little bit para our health workers can explain it? Of course we want, dalo na the seniors to get the pneumonia and the flu shot, but it is not a substitute for the vaccine. So go ahead Nina. I think it goes back to the hesitation for new vaccines, I think. Yung pneumonia shot kasi atyaka influenza shots. They've been here with us for a long period of time. There's vast experience on that. So people are, parang kung pipilihan ako ng isang klaseng pupunta ko sa doctor ko to get shots. Bakit ito na yung gagawin ko? Kasi I've done it before, walang nangyaris. I think yun yung reason for the preference. Pero yun nga po, very important to explain to your patients na yung kinokover ng COVID vaccine is a totally new virus. We don't have previous vaccines that will protect us from this new SARS-CoV-2 virus. So magandang to go ahead and get that shot, the two shots or the recommended number of shots for COVID-19. Pero on top of that, get your usual yearly influenza shots and the pneumonia shots for senior citizens every five years or the lifetime yung depended on the brand. Okay, thanks Nina. Raymond, we're reaching the top of the hour and I think what we'll do is we'll go to the evaluation for today which will give our panelists a minute or two to think about your parting words. So you've got lots of health workers out there more than 2,000 on the Zoom. I think probably 1,000 more on Facebook and YouTube. So we're going to give you a few minutes to think about your last parting messages for them but Raymond, let's go with our evaluation. Thank you for the well, riveting discussion po and part of our work also is to be able to do evaluate the learnings and the attendees. We still have a little over 2,000 attendees here in the Zoom as mentioned, there might be more outside of the Zoom po so maraming-maraming salamat. We encourage everyone in the Zoom to at least participate in this assessment poll which has five questions po. First question, the panelists demonstrated thorough knowledge of the topic. So it's a Likert scale, strongly agree, agree, disagree and strongly disagree. For the second question, the panelists were well-prepared and organized. Third question, the panelists spoke clearly and audibly. The fourth question, panelists used appropriate language with technical medical jargon adequately explained. And number five, the panelists contributed to new perspectives and knowledge on managing various key COVID-19 health issues. So we hope that the couple of minutes were enough for our experts po to compose their final messages po to everyone who's in to this webinar. Okay, thank you. Thank you, Raymond. Okay, we'll start with Donet. Donet, what is your parting message? Well, I started on a note of gratitude for the opportunity to have this conversation with you, kahit feeling ko e saling po sa ako dito. Parang ako lang yung albulario lahat po yung mga doctor pero maraming salamat po sa pagtakataon and marining ko sa abili Bak Edsel, 12 pandemics end. So we look forward to that common sense knowledge na good things end and so do pandemics but it's important that while looking at that we continue to prepare for it and part of the readiness is of course ensuring that we also revive this pandemic so that it's more fun in the Philippines is something that we can carry for the country as a campaign and as we say it's always more fun to do with you guys so we hope to welcome you back to our destinations and in the meantime wag natin kakalimutan through this pandemic importanting pala kasi ang immune system at ang ating pananong palataya sa Panginoon I'm sure that the divine providence will always be there to keep us safe, protected and thrive through this adversity Maraming salamat po and God bless. Thank you very much Let's turn it to Net Velasco of the Tourism Promotions Board of the Department of Tourism Let's go to Dr. Benny Galvis of the Lang Center of the Philippines Okay So the bottom line is let's all have vaccination majority of our population so we can attain the needed herd immunity but as I said previously vaccine and we still practice the standard health protocol to protect ourselves okay Although breakthrough infections is there a reality it protects you from getting severe COVID infection and prevents you from landing either in the hospital or in the morgue so majority of breakthrough infections are mild or asymptomatic Thank you for this invitation Thank you very much Dr. Galvis Let's go to Nina Go ahead Nina Okay So Thank you very much for being here I think the fact that all of you have joined us today means na palang meron tayong mga katanungan nagahanap tayong mga kasagutan So we're in this journey together Sana'y bitahinulit ako nagpaparinig ako baka din ako kami sa aming results of the studies that we're trying to complete para sa ganun mas maintindihan pa natin at eventually this pandemic should end soon Thank you very much po Thank you very much It's Nina Burba the head of the Infection Control Unit of the Philippine General Hospital We go to Eric Tai of the Department of Health Thank you Susie Maraming salamat sa mga kasama ko rito Ke Mamtunet Doc Benny and Doctora Burba Susie Raymond sa mga hindi pa po na babakunahan ang breakthrough infection sa hindi po dahang daylan kung bakit hindi po kayo magpapabakuna magpapabakuna po kayo para may protection kayo at ang mahal nyo sa buhay at parang sa ganun ng ating mong bansa ay makausad na po at doon naman sa mga nabakunahan po wag kayong campante na kayo ay protektado na sa pagkat itong ang breakthrough infections ay maali pa rin mangyari subali titong tandaan nyo kung magkakaran ng breakthrough infections pwede ngamuti nyan sa bahay and it can be managed sa inyong punglahat sana po ay panatiliin po nakumukawa kayo ng tamang information sa pagkat pag nakawa nyo ay fake news nako na kayo nabakunahan mali pa yung information tapos isi-share mo ay hindi po maganda pungyan kaya po ang sabi namin po sa inyo kontin siya ga gumagawalat ng paraan ng ating pamalaan na tumating na yung mga bakun ng kailangan natin at para kaya mantunet may personal po akong message kami sa Department of Health ay sasabi ko sa mga kasamahang ko na makipagugnai pa sa inyo sa pagkatang turismo ay malaking bahaki hindi lamang ng ating hanap buhay kundi ng ating mayamang kultura Maraming salamat. Okay, thank you. Thank you. Thank you so much. Alright, so on behalf of the organizers I'd like to thank all of our panelists today you can see in the chat box everyone's clapping and thank you hearts and whatever it is I think we had a really great discussion today and I think it's very clear that we have to really push for vaccination vaccination will protect you all the vaccines are effective against all of the variants right now if you've been if you got vaccinated and you have once and then you have an infection then just finish your quarantine and get vaccinated again I think our healthcare workers as exemplified also by what Dr. Galvis talked about Nina talked about really have to be extra take extra care kasi kayong exposed and yet we know that most of the time this is going to be mild and it's going to be maybe asymptomatic so let's just hang in there continue to do what we need to do and of course I think I love Donets presentation because I think this is what we need right I hope it comes to a point where we can all do local traveling and local local tourism because for our mental health it is so important to be out there to get the sun to be just to enjoy ourselves kasi napakatagal na rin ang pandemi so malaki ang pasasalamat natin sa Department of Tourism na nagdibigay sila ng Iwanag nagdibigay sila ng pag-asa at parang parang something to look forward to iba pang dingbab nakita ko nga sa chat waga tapos ng video tonete ay nagsisabi gusto na nilang mag-yahe wonderful that's our spirit right that should be our spirit parang tising muna natin ang gaganda tita susi ang gaganda ng mga destinations natin ngayon kasi they also took a pause from the pandemic during the pandemic there you go there you go so ang luma alabasta ang mga ibon ang mga ista this is really good so I'd like to thank you for being with us today I just want to remind everyone also know that the risk of more serious COVID really is because of comorbidities so it's so important for all of us particularly health workers to stay healthy and remember I asked Eric at the beginning what we do to relax you all need to relax you all need to find something that keeps you sane na okay lang kayo you wake up in the morning and you're not feeling low you feel like you're there you're gonna fight you're gonna do this for our country, for our people so you have to take care of yourselves because the mental health of our health workers is of primary importance take care of yourselves no one is going to do that for you you have to take care of yourselves you have to see to it that your blood pressure doesn't go up you have to eat healthy food para hindi kayo magkasahit kasi that's one of the things we're seeing in this pandemic that actually people are are more prone to severe illness when they start out start out from a point where they're not healthy so exercise sleep early don't smoke don't drink I don't know be happy and when it's time we will all go to the tourist destinations of the DOT okay so Raymond I'm going to am I going to queue the queue the next week okay next week yas segue to the next to next week's topic na Dr. Suzy nga wala ako doon eh sorry ya kasi pinag-posing ako yung pili nagkuwento ako o sige next week na ko again don't miss it we're going to have a very exciting discussion we are going to talk about the Delta variant in different parts of the world and we know that there are many people watching this webinar many Filipino health workers watching from Raymond's always announcing where they're coming from from Russia from the Middle East from Taiwan from Japan most of the people who are watching us are coming from different parts of the world and we are going to have a couple of speakers international speakers who are going to talk about the Delta variant and the surges that are happening outside of the Philippines sometimes we think ah tako talagang dito lang talagang problema no it's all over the world so we want to hear more about that and to the extent that we can we would like all our overseas Filipino workers who are watching to make your own to watch parties to participate in our little discussions next week because we want to also hear from you how you are doing wherever you are you're still part of the country and kasama kayo sa talino na kailangan natin gamitin para mapuksa natin itong pandemya okay Raymond over to you Thank you so much Doctor Susie before we conclude our program po let's first acknowledge the following there we go the University U.P. Menil National Telehealth Center U.P. ITDC TV UP the Internet Television Network of the University of Philippines the Philippine General Hospital and the U.P. College of Medicine Maraming-maraming salamat po for making this learning series possible without each and every one of you each one very hard working and their own right po talaga really contributing to making sure that we have quality and credible webinar content po each and every week and then finally all of our stop COVID-19 webinar episodes they are archived for viewing in the YouTube channel of TV UP so you just go to www.youtube.com and then look for the TV UP channel so this formally closes our webinar for the week sana po marami po kayong natutunan and based on our assessment po marami po talaga nag-agree greater than 90% for all of our questions po maraming-maraming salamat po sa lahat po na nag-participate 1500 more na 1500 responded sa ating evaluation po thank you so much hopefully we'll be able to see you again next week from Friday po from 12 noon to 2 PM it's a date together we can stop COVID deaths so keep safe keep healthy and see you online let's say a prayer one more time I know you long for home but I am here you're not alone I'll stay with you until the coast is clear the other Spain before my fears the other lives before my tears but right behind the mask I look into myself and ask do I have strength to carry on oh God, how long is this going on and need you here to keep me strong I'm here to hold the line oh keep my until my time his name to read is hold on to the word he gave this time we'll come to pass because this salvation makes a last you carry you to see the breaker day the other Spain before my fears the other lives before my tears but right behind the mask I look into myself and ask do I have strength to carry on oh God, how long is this going on and need you here to keep me strong I'm here to hold the line oh keep my until my time my fears the other lives before my tears but right behind the mask I look into myself and ask do I have strength to carry on oh God, how long is this going on and need you here to keep me strong I'm here to hold the line oh keep my until my time his name to read is hold on to the word he gave this time we'll come to pass because this salvation makes a last