2020 and Beyond: Reflections and Outlook at a Time of a Global Pandemic


By Dr. Arnel Z. Rivera, Chief Response, Recovery and Rehabilitation Division Health Emergency Management Bureau, Department of Health, Philippines

Reflections

More than twelve months ago, we learnt about a new virus said to be originating from Wuhan, China. As the virus spread, an increasing number of death cases due to an atypical pneumonia were recorded in the same region. The high index of clinical suspicion led to think that the illness was spreading rapidly among the population and was especially deadly for the most vulnerable persons, including elderly, or adults with certain underlying health conditions and weakened immune systems. Most countries first reacted by closing their borders to land, sea and air travelers. Lockdowns and/or quarantine measures were implemented worldwide and an unbridled competition for Personnel Protective Equipment started. Infection prevention and control standards were set and implemented; laws were enacted, guidelines and other directives were issued to support the response to the newly named COVID-19. Heads of state discussed various strategies and actions to address the challenge posed by this new pandemic.

The Philippines did the same. Looking at the latest data, the country still has a high number of cases still being reported and monitored.

To top it off, the Philippines, which on average faces 20 typhoons every year, was affected by several weather disturbances (typhoons Goni (Rolly) and Vamco (Ulysses) and especially in three regions, namely Metro Manila (NCR), Bicol (Region 5) and Cagayan Valley (Region 2). Although they could have been anticipated, the consequences of these events were significant both for the environment and the economy and contributed to the government’s distress in dealing with the COVID-19 crisis. People living in the affected area had to be displaced and a plan was needed for the evacuation, relief, recovery and rehabilitation of the population. This challenge did not help the country already struggling to replenish its resources and to respond to the ongoing pandemic. First responders dealing with the COVID-19 crisis were particularly concerned. There were hesitations as victims of the typhoons were worried of being exposed to the virus. Some refused to evacuate and preferred to stay home despite the warnings; anticipating the effects of these weather disturbances and based on lessons learned from past experiences

Deployment of Emergency Response Teams

Health response teams were mobilized days after the impact of the typhoon to increase the human resources needed in the affected regions. The team composition was organized into sub-clusters: Medical and Public Health, Water, Sanitation & Hygiene (WASH), Nutrition and Mental Health and Psychosocial support. The following process was followed before deployment:

1. Pre-deployment briefing: situation report, mission objective, team composition and transportation. 2. Obtain details of the point of contact in the affected area 3. Logistics Support: medicines and medical supplies, transport vehicles and funding for operational expenses. 4. Safety measures: a. Review of infection prevention and control measures to observe while on mission. b. Pre-departure RT-PCR testing of all team members (only those with negative test were allowed to be deployed). c. Distribution of face masks (surgical and N95 masks), face shields, disposable gloves and sanitizers.

Post-deployment

After their deployment, the team underwent mandatory quarantine and RT-PCR testing. The teams returned to work upon release of negative RT-PCR test results. An after action review (AAR) was carried out, challenges were identified and appropriate measures were implemented in response.

2020 and Beyond

2020 has come to an end but COVD-19 still remains a challenge and threat to the world. A high number of cases are still reported. The end of the Christmas season was marked by a surge of COVID-19 cases. Many realized the need to enact new laws to strengthen response and recovery efforts in 2021 and beyond. Vaccines are on their way and will be available for mass immunization in the Philippines in the second quarter of 2021.

“An effective communication between the National IHR Focal Points and the WHO IHR Contact Point is an essential component of IHR implementation and facilitates timely risk assessment, decision-making and response.”

Preparing for 2021: the International Health Regulation (IHR) Exercise Crystal

"The Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III) is the regional framework for action to advance implementation of the International Health Regulations (IHR) (2005) for health security.

In December 2020, the Department of Health of the Philippines participated in the WHO-led “IHR Crystal Exercise 2020”.

The International Health Regulation (IHR) Exercise Crystal is an annual functional exercise to test the communication and assessment of the National IHR Focal Points (NFPs) from the WHO Western Pacific Region.

An effective communication between the National IHR Focal Points and the WHO IHR Contact Point is an essential component of IHR implementation and facilitates timely risk assessment, decision-making and response.

IHR event communication includes public health event reporting, verification, notification, information-sharing and risk assessment. It may also involve official communications required to determine if an event constitutes a public health emergency of international concern (PHEIC), and the associated emergency response under the IHR (2005)." *

The objectives of the exercise were the following: 1. To validate the accessibility of IHR NFPs and the WHO IHR contact point using registered contact details. 2. To practice and test IHR NFPs’ assessment of public health events using the decision-making instruments contained in Annex 2 of the IHR (2005) and its notification process; including posting to the IHR Event Information Site (EIS). 3. To facilitate cross-sectoral communication between IHR NFPs and their national department counterpart on public health event assessment and response. 4. To improve the understanding and familiarization of staff across member states, areas, territories and WHO with the IHR NFP system. 5. To use a structured scenario to explore key issues and identify strengths and areas needing improvement. 6. To test the communication capabilities of Emergency Operations Centers (EOCs) of the WHO Regional Office for the Western Pacific and IHR NFPs, including telephone, email and video conferencing. The IHR Crystal Exercise 2020 gathered the Department of Health’s (DOH) bureaus and offices identified to respond to an Adverse Event Following Immunization (AEFI). An AEFI is defined as any untoward medical occurrence which follows immunization and does not necessarily have a causal relationship with the usage of the vaccine. The adverse event may be any un-favorable or unintended sign, abnormal laboratory finding, symptom or disease.

Lessons learned

The main findings during the post activity evaluation were related to the use of technology as major means of communication and reporting, although not all the participants were acquainted with some of the equipment used.

The exercise also highlighted the need for action points to be followed as a roadmap when responding to a public health event (e.g. manual, process flow chart, and checklist).

It also drew attention to the need to review, enhance and improve operational and tactical actions in response to such an event. The use of multi-agency and whole-of-society approach having proven to be effective.

“The people’s perception and understanding of the government’s decision plays a major role in changing their practices.”

Tomorrow’s Development

The use of vaccines has shown promising results against COVID-19. Several pharmaceutical companies have applied and some are in the process of applying for the Emergency Utilization Authority (EUA) from the Philippines through the national Food and Drug Administration (FDA). In the meantime the DOH has created a Vaccine Sub-Task Group, in charge of planning the different stages of the vaccination program. The start of the vaccination program was tentatively scheduled in February 2021 and health care workers and frontline service providers will be prioritized to receive it. An estimated 100 million doses will be made available to the Philippines according to the latest reports. Most people believe that this will help overcome and win the war against COVID-19 and the legislations are on their way to support the fight against this pandemic.

Continuing Challenges

People’s behavior plays a crucial role in the success of the fight against COVID-19. There are laws to follow, standards for infection prevention and control measures to respect. What is crucial is for people to comply as much as possible with the implemented guidelines and regulations. The people’s perception and understanding of the government’s decision plays a major role in changing their practices. The Philippine government’s effort to protect its citizens has been assertive and untiring. This effort will continue in 2021 and beyond.

Conclusion

Although I cannot predict when the current COVID-19 crisis will end or when the next pandemic will arise, I hope this article highlighted the lessons learned by the Philippines when responding to this international threat. Only by sharing our experience will we be able to help each other to respond to this current crisis and be better prepared to any pandemics we may face in the future.

“If We Work Together We Can Do Things Better”
Dr. Arnel Z. Rivera, Chief Response, Recovery and Rehabilitation Division Health Emergency Management Bureau, Department of Health, Philippines
*IHR Exercise Crystal 2020 Briefing for NFPs ; WHO-WPRO

Dr. Arnel Z. Rivera presently serves as the Chief of the Response , Recovery and Rehabilitation Division of the Health Emergency Management Bureau of the Department of Health, Philippines. He is also the Focal Point for CBRNe concerns of the Bureau. During his long career in the Philippine Government, Dr. Rivera has held many key positions. His last position was Finance and Administrative Division Chief of the Bureau of Quarantine. He also formerly held the position of Department Chair of the Emergency Department Services of the Tondo Medical Center and was also a TWG Member of the Committee on Biological, Chemical and Radio-nuclear Warfare, Department of Health.