What the two-week ‘timeout’ meant

The entire country, including the national government, paid attention to the call of 160 organizations representing healthcare professionals and workers. They sounded the alarm that we are losing the fight against COVID-19 and called for a two-week timeout from relaxed quarantine rules in the face of the rapid rise in COVID-19 cases. Their unified message was about the need to rethink the strategies to win the war against COVID-19.

The position of the medical community and other allied healthcare professionals was so compelling that President Rodrigo Duterte declared a two-week return to modified enhanced community quarantine (MECQ) in mega Manila, from Aug. 4 to 18. Now that the timeout is over, the question on everybody’s mind is: Has it really worked?

Contrary to popular perception, the MECQ was not just about giving time for our healthcare professionals to rest and recuperate. In actuality, the two-week timeout practically meant more work for these front-liners as they had to participate in numerous meetings with both the government and the private sector in order to make concrete recommendations on how to effectively address the pandemic.

When they called for a return to stricter quarantine rules for two weeks, the Health Professionals Alliance Against COVID-19 (HPAAC), a group of more than 160 organizations of doctors, nurses, midwives, dentists, pharmacists, therapists, barangay health workers, municipal and provincial health officers, flagged seven major issues. The seven issues are: hospital overload; inefficient case finding and isolation; inefficient contact tracing and quarantine; workplace outbreaks; inadequate and unsafe transport options; difficult public compliance to safety protocols; and worsening inequities.

It is worth noting that the HPAAC has been invited to various meetings with both the government and private sectors to address the above concerns. In a press conference on Aug. 18, the alliance informed the public about the outcome of the different meetings with different government agencies. These bodies dealing with COVID-19 issues that the HPAAC met with include the Inter-Agency Task Force (IATF), the National Task Force (NTF), the Departments of Health (DoH), Transportation (DoTr), Finance (DoF), Information and Communications Technology (DICT), Labor and Employment (DoLE), Trade and Industry (DTI), and the Metro Manila Development Authority (MMDA), among others. In these meetings, which are still continuing, the voice of the health alliance representing more than 80,000 doctors and more than a million allied healthcare professionals, has been heard. New strategies for dealing with COVID-19 have been agreed upon or are being seriously considered.

Indeed, some significant reforms have been secured during the two-week timeout. Of course, being part of the conversation is different from being the ones calling the shots. But the signs are encouraging.

The DoH launched the One Hospital Command Center on Aug. 6, during the MECQ. This addresses the issue of health facilities being overwhelmed by the rapid influx of patients. Through this program, people are provided with a hotline to call and to help them navigate through available health facilities based on their needs. The HPAAC welcomes this development at the same time that it recommends the expansion of this program whereby people can navigate and access the services of laboratories, clinics, and most especially, local government units (LGUs) or barangays. The HPAAC calls this proposal the One COVID Referral Network. This, the coalition has emphasized, is consistent with strengthening the primary care system.

Further, the DTI and the DoLE issued the Joint Memorandum Circular No. 20-04 series of 2020 on Aug. 8 which clarifies that rapid antibody tests (RATs) are neither recommended nor required for asymptomatic employees returning to work. The country’s medical societies have advised against the use of RATs as a requirement to return to work because of the high false negative rates they produce. The false negative as well as false positive cases give a false sense of security and contribute to the spread of the virus. Used in the wrong way, RATs cause unintended harm in the workplace and in the community. Still, a lot of work must be done when it comes to implementation on the ground. At present, some companies and LGUs still use RATs as part of their policies.

On the challenges relating to technology, a most difficult issue is dealing with the influx of information coming from multiple sources. Given the thousands of available technologies, the policymaker or decision-maker grapples with the question of how to choose the most effective, most efficient, intervention. In this regard, the HPAAC has asked the government to look no further than the Universal Health Care Law (RA 11223). One important provision in that law is the creation of the Health Technology Assessment Council (HTAC). The mandate of this group of experts is to assess all available health technology in terms of safety, equity, and cost-effectiveness. Simply put, it provides inputs and recommendations on whether or not the government should invest in a particular health technology. The HTA process is crucial especially in a pandemic like COVID-19 where evidence is evolving on a daily basis. The HPAAC fully supports the integration of the HTA process in all government decisions related to the pandemic response to promote evidence-based policymaking.

The HPAAC maintains that HTAC must be protected and be well funded so decisions on health technology are based on evidence and science, not on the lobby of vested interests. In this regard, a boost for the HTAC is the supplemental budget of P10 million as part of the Bayanihan II bill that both Houses of Congress approved.

Also on technology, the HPAAC has articulated the public clamor for internet connectivity, especially internet access for far-flung areas or geographically poor areas. Better connectivity is needed for health responses such as referrals, telemedicine, and contact tracing. Liberalizing the use of satellite technology through an Executive Order will make this happen. Different government agencies have expressed support for this proposal.

With regard to public transportation issues, the DoTr is now setting up interim bike lanes in response to the needs of the health workers and other essential workers. These bike lanes will connect major roads, residential areas, and high-volume commuter areas to major medical facilities in Manila and Quezon City. Bike lanes will also be put in place covering the whole stretch of the EDSA Corridor, from Monumento to Pasay. This will allow more options for active transport and relieve pressure on public transport.

Another important gain on public transport is the policy of contracting the service of public utility vehicles (PUVs) that will allow safe, adequate, and sustainable transport options for all. The Bayanihan II bill has allocated a significant sum of funding for service contracting.

The HPAAC and government have likewise put into motion plans regarding other serious concerns. These issues include enforcement of workplace safety guidelines, augmentation of social support for those whose livelihood are affected by the pandemic, and improvement of strategic communications towards improving public compliance to safety protocols.

The HPAAC explains that its recommendations are not solely theirs. These recommendations are products of months of consultations with various stakeholders across the country and also the product of meetings with executive agencies in the past weeks. The success of these reforms will depend not only on the health professionals and the government, but on every single Filipino.

One lesson that the two-week timeout has shown is this: The medical frontliners are a credible social force, and they can undertake effective collective action together with the rest of society. As the doctors put it, kapit-bisig, sama-sama, tulong-tulong (arm-in-arm, all together, helping each other).

Mabuhay ang ating mga mahal na medical frontliners! (Long live our beloved medical frontliners!).

Arjay Mercado is the head of the Universal Health Care and Sin Tax program of Action for Economic Reforms (AER). Filomeno S. Sta. Ana III is the AER coordinator.