DOH revises how virus cases are categorized

MANILA, Philippines — The Department of Health (DOH) has modified the classification of people on whether they have been afflicted with the new coronavirus disease (COVID-19) to ensure a more “uniformed reporting” of cases across the country ahead of the extension of the enhanced community quarantine on Luzon next week.

Health Secretary Francisco Duque III said that due to evidence of local and community transmission of SARS-CoV-2, the virus that causes the acute respiratory ailment, there was a need to reclassify the cases to ensure early detection and laboratory confirmation, especially among high-risk and vulnerable populations.

“The country is also challenged on how to cope with the sudden surge of confirmed cases and must identify measures to ensure that the health system will capably respond to this emergency to reduce the number of serious and critically ill cases and fatalities while maintaining essential and other routine health services,” Duque said in Administrative Order No. 2020-0013.

His order was signed on Thursday but was released to the media on Saturday.

As of Saturday, the total confirmed cases in the country rose to 4,428 with an additional 233. The death toll spiked yet again as 26 new fatalities were recorded, bringing the current count to 247. The total number of recovered patients is 157 with the recovery of 17 more.

PUIs, PUMs dropped

Under the new classification, the DOH will no longer use the labels “patients under investigation (PUIs)” and “persons under monitoring (PUMs)” as COVID-19 patients will now be categorized as either suspect, probable or confirmed cases.

PUMs or those who have had exposure to a known positive case or had gone abroad recently but are asymptomatic are no longer included in the DOH’s new classification.

The DOH maintained that only those patients whose results came back positive using the polymerase chain reaction-based tests are to be classified as confirmed cases.

A person is considered a suspect COVID-19 case if he suffers from fever, cough or sore throat two weeks after he had come in contact with a confirmed case or had visited a place with local transmission of SARS-CoV-2.

Those who exhibit the same symptoms and belong to the vulnerable population, such as the elderly, those with preexisting ailments, pregnant women and health-care workers also belong to this group.

A suspect patient becomes a probable case if his lab test results are inconclusive. He would remain in that category, even if his results came back positive, if his test was “not conducted in a national or subnational reference laboratory or officially accredited laboratory for COVID-19 confirmatory testing.”

Severe and critical cases, whether they are suspect, probable or confirmed, are to be admitted to any of the three COVID-19 referral hospitals—Philippine General Hospital (PGH) in Manila, Lung Center of the Philippines in Quezon City and Jose N. Rodriguez Memorial Medical Center in Caloocan City.

Community quarantines

The DOH earlier said that all mild cases and the confirmed cases who are asymptomatic would be brought to the community quarantines. There are three currently: the World Trade Center, the Philippine International Convention Center and the Rizal Memorial Coliseum, which could accommodate about 900 patients.

There are also 11 recognized testing centers across the country.

These are the Research Institute for Tropical Medicine, San Lazaro Hospital, Lung Center of the Philippines, St. Luke’s Medical Center Quezon City, The Medical City and the University of the Philippines National Institutes of Health in Metro Manila.

The others are Baguio General Hospital and Medical Center in Baguio City; Bicol Public Health Laboratory in Legazpi City, Albay; Vicente Sotto Memorial Medical Center in Cebu City; Western Visayas Medical Center in Iloilo City; and the Southern Philippines Medical Center in Davao City.

The DOH gave no figures for the number of suspected and probable cases.

When they were still using the previous tags, Health Undersecretary Maria Rosario Vergeire said the 6,002 PUIs and 6,021 PUMs recorded last week were just cumulative figures.

In its last report of tests for SARS-CoV-2 on April 6, the DOH said it had tested 20,092 individuals and only 3,246 had tested positive for the virus.

No order to conceal

Responding to allegations on social media that he issued a directive to hospitals to stop doing a census on patients who have died from COVID-19, Duque said on Twitter that the DOH “did not and will never issue a directive for hospitals to conceal the number of COVID-19 deaths.”

But an investigation of the alleged hospital involved was under way, according to Duque.

Also on Saturday, the PGH said it had received plasma from four COVID-19 survivors.

Plasma, which is the liquid portion of the blood, contains antibodies against the virus, which could be used to treat other patients.

PGH spokesperson Jonas del Rosario said they planned the first plasma treatment on Monday.

In the United States, which has the most number of confirmed COVID-19 cases worldwide, its Food and Drug Administration (FDA) recently allowed its emergency use.

“It is possible that convalescent plasma that contains antibodies to SARS-CoV-2 might be effective against the infection,” the US FDA said in a March 24 advisory.

The use of convalescent plasma has been studied in outbreaks of other respiratory infections, including the 2009-2010 H1N1 influenza virus pandemic, 2003 SARS-CoV-1 epidemic and the 2012 MERS-CoV epidemic, it said.