Cebu City will remain under Enhanced Community Quarantine (ECQ) while Metro Manila and other areas will stay under a General Community Quarantine (GCQ) starting today, as the Palace sought to open up more areas of the country currently under lockdown to help restart the economy.
READ: Rural doctors buck transfer to Cebu City
In a televised message late Tuesday night, President Rodrigo Duterte also chastised residents of Cebu City and neighboring Talisay City, noting that the Visayas metropolis was now the hotspot of the country’s coronavirus pandemic “kasi hindi kayo sumunod” (you did not follow orders).
Duterte noted that Metro Manila and other areas showed “substantial compliance” to government directives to control the COVID-19 epidemic, an observation shared by the World Health Organization (WHO) (see list of quarantine areas below—Editors).
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The President admitted there were quarantine violations in these areas, “but not on the scale I’ve seen” in Cebu, as he upbraided its residents—using his native Cebuano language—for their hard-headedness and non-compliance with health protocols.
“Think of your fellowmen. You might be the (coronavirus) carrier. Stay healthy.
Then, avoid crowded places. Observe the distance rule, at least one meter. When somebody coughs, turn around or leave immediately,” he said.
Health Secretary Francisco Duque III—whom Duterte vouched for again, saying his trust in him “was not a press release”—announced the areas under varying levels of quarantine starting July 1, with more areas put under “low-risk modified GCQ.”
This was necessary because, as Finance Secretary Carlos Dominguez explained in the same meeting with the President last night, the National Capital Region and the Calabarzon areas south of Metro Manila “should move to MGCQ as quickly as possible since 67% of economy is based on these areas.”
Meanwhile, localized lockdowns in Metro Manila will suffice to control the transmission of COVID-19, the WHO said Tuesday.
The coronavirus situation in Metro Manila does not warrant a stricter lockdown, WHO Philippine representative Dr. Rabindra Abeyasinghe said.
But he described as a "worrying situation" the local government units' (LGUs) "poor compliance" with guidelines set by the Department of Health (DOH) with regards to combatting COVID-19.
Also, the DOH said it has decided to make the deployment of rural doctors to Cebu City voluntary after several doctors and organizations criticized the plan.
Health Undersecretary Maria Rosario Vergeire said during a media briefing that the DOH was trying to bring all its resources to bear when it decided to deploy physicians under the Doctors to the Barrios (DTTB) program to Cebu City, which is experiencing a surge in new COVID-19 cases.
“When we talked to the doctors, many refused, and this is quite disheartening,” Vergeire said in Filipino.
Vergeire confirmed that some of the government doctors may be placed in private hospitals but said the DOH would ensure that they are not taken advantage of. The doctors won’t be posted in operating rooms, but instead serve to supplement staff in hospital triage areas, she added.
During the regular Laging Handa briefing on Tuesday, Abeyasinghe praised the DOH guidelines on managing positive cases and putting them on quarantine as "very good."
However, compliance by LGUs with the guidelines "does not seem to be universally good," Abeyasinghe said.
“The DOH issued very good guidelines in managing positive cases, how to quarantine them, but the implementation in local government units is different,” Abeyasinghe said.
“We see poor compliance with guidelines, we see [the] number of [COVID-19] cases increasing, and this is actually becoming a worrying situation,” he added.
Pending the discovery of a vaccine, countries, including the Philippines, should heavily invest on non-pharmaceutical interventions such as contact tracing to minimize the health and economic impact of COVID-19, Abeyasinghe said.
“What we are advocating is that the DOH and the government invest in expanding testing capacity and contact tracing so we can isolate and prevent further transmission,” he said.
“Unfortunately, this aspect of Philippine response needs strengthening,” Abeyasinghe said.
There has been improvement in the country's contact tracing efforts in the last month “but it is not keeping pace with the expansion of testing capacity,” he said.
While the Philippines has the capacity to conduct 60,000 COVID-19 tests per day, the actual COVID-19 tests done per day is just around 15,000 due to lack of laboratory supplies, Abeyasinghe said.
The WHO official recommended that LGUs impose localized lockdowns instead.
"We don't believe that the situation in the metro requires a reversal (of a strict community quarantine). We recognize the impact of this outbreak not only on health but also on the economy," he said.
"There is a provision for localized lockdowns and while we are seeing an upsurge of cases within the NCR, in some localized cities, barangays, there is a need to make use of those provisions to suppress the transmission," Abeyasinghe added.
He reminded the public of the importance of the minimum health standards such as observing physical distancing and wearing face masks.
Metro Manila transitioned to a GCQ at the start of June from a modified ECQ as the government sought to restart economic activity.
The NCR had been the epicenter of the COVID-19 outbreak in the Philippines, but recently government officials have reported Cebu City and Cebu Province as among the emerging hotspots because of the recent spike in cases.
The DTTB was established by the DOH in 1993 to address the lack of doctors in far-flung rural areas.
When the DOH announced it was going to deploy DTTB doctors to Cebu City, two batches questioned the move, saying they were not consulted.
The doctors called it an “exploitative order,” especially since some would be placed in private hospitals. They said it went against the thrust of the DTTB program, which was to serve disadvantaged areas.
The Community Medicine and Development Foundation also said that the DOH was “gaslighting” the doctors to make it appear that they are being unpatriotic when they are only ensuring that they serve “resource-poor communities who are also in dire need of care.”
Vergeire said the original plan was to deploy 40 doctors in batches of 10.
“The rotation will be every two weeks, then two weeks quarantine, before they go back to their area,” she said.
However, they found out that 11 could not be deployed since three of them were pregnant while others were serving areas that did not have any other doctors.
To address the demand for doctors in Cebu City, Vergeire said there are slots for Cebu from the department's emergency hiring program.
Vergeire said they will also check if they can lend doctors from other hospitals.
“We are trying to source out some professionals from other universities in Cebu,” she said.
Cebu City has recorded 5,915 confirmed COVID-19 cases, as of 5 p.m. of June 29, of which, 3,374 are active.
The neighboring cities of Mandaue and Lapu-lapu have 772 and 609 confirmed cases, respectively, of which, 530 and 475 are active. For the rest of Cebu province, a total of 1,120 cases have been recorded, of which, 834 are active.
A week after the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) went to Cebu City to help manage the public health crisis, it called for the efficient management of patient care centers to decongest hospitals handling severe cases.
Melquiades Feliciano, IATF deputy chief implementer for Visayas, said proper management of isolation and quarantine facilities will enable medical front-liners to better handle severe COVID-19 cases.
Feliciano said if mild to moderate cases, suspected, and probable ones are taken to the patient care centers, doctors will be able to focus on serious COVID-19 patients brought to hospitals.
“We need to enhance the system to avoid people from going straight to the hospitals. We have Barangay Isolation Centers (BICs) and quarantine facilities. If we are able to manage them well, we will certainly decongest our hospitals,” Feliciano said in Filipino.
He said patient care centers are well-equipped and manned by experienced health workers who are capable of taking good care of coronavirus patients.
“We have health workers and medical front-liners assigned in the isolation centers and quarantine facilities to care and attend to the needs of the patients,” he added.
Mary Jean Loreche, DOH chief pathologist, confirmed that many patients who have been experiencing mild and moderate symptoms of COVID-19 are not following referral protocols by going straight to private hospitals.
“Many of our patients want to be admitted in private hospitals because our government hospitals, like the Vicente Sotto Memorial Medical Center, have eventually been converted into a COVID-19 facility. But private hospitals only allocated a certain percentage of their capacity for COVID patients,” she said.
The DOH-7, Loreche said, has already deployed more than a hundred nurses to augment the front-liners in private hospitals.
Earlier, DOH-7 regional director, Dr. Jaime Bernadas, called on barangay officials to coordinate with the operations center of the health agency in the region for the referral of COVID-19 patient from their locality.
The coordinated referral, Bernadas said, will ensure that patients with mild to moderate symptoms will only be treated in BICs and avoid clogging hospitals.
Meanwhile, Feliciano responded to some allegations that the city has been “militarized”, explaining that while Covid-19 is a medical issue, the main task of the military and police is to strictly enforce the enhanced community quarantine (ECQ) guidelines.
“No matter what medical intervention that we do, if people are violating the rules, the minimum health standards, we will never be able to stop the threat. The priority effort here is medical intervention. In fact, medical practitioners are our advisers,” he said.
Quarantine areas as of July 1
Enhanced Community Quarantine (ECQ)—Cebu City
General Community Quarantine (GCQ)—National Capital Region, Benguet, Cavite, Rizal, Leyte, Southern Leyte, Lapu-Lapu City, Mandaue City, Ormoc City, Talisay City, Minglanilla (Cebu), Consolacion (Cebu)
Modified General Community Quarantine (MGCQ)—Cordillera Autonomous Region (Abra, Baguio City, Ifugao, Kalinga); Region 1 (Ilocos Norte, La Union, Pangasinan); Region 2 (Cagayan, Isabela); Region 3 (Bataan, Bulacan, Nueva Ecija, Pampanga, Angeles City); Region 4-A (Batangas, Laguna, Quezon, Lucena City); Region 4-B (Palawan, Puerto Princesa City); Region 5 (Albay, Camarines Norte, Camarines Sur, Naga City); Region 6 (Capiz, Iloilo, Iloilo City, Negros Occidental, Bacolod City); Region 7 (Cebu Province, Bohol, Negros Oriental); Region 8 (Tacloban, Western Samar); Region 9 (Zamboanga City, Zamboanga Del Sur); Region 10 (Bukidnon, Misamis Occidental, Misamis Oriental, Cagayan de Oro City); Region 11 (Davao del Norte, Davao del Sur, Davao City, Davao de Oro); Region 12 (Cotabato, South Cotabato). Region 13 (Agusan del Norte, Butuan City, Lanao del Sur, Maguindanao)
• All other areas not on this list will be under “low-risk classification.”
In other developments:
• Senator Juan Edgardo Angara called for the establishment of more mega quarantine facilities in Region 7, especially in Cebu as the number of cases continue to rise in the various provinces in Central Visayas. “We need to put up more mega quarantine facilities in Region 7, especially in Cebu City, which could become the country’s next COVID-19 hotspot in the country. The Department of Health should step up its response in Cebu City because the only way that we can flatten the curve is if all areas of the country are able to control the spread of the disease,” Angara said.
• The Department of Health (DOH) said on Tuesday it is closely monitoring several areas in Mindanao, considered now as “emerging hotspots” for COVID-19. Vergeire identified these as Bukidnon, Lanao del Norte, and Misamis Occidential for Region X; Davao del Norte, Davao del Sur and Davao Oriental for Region XI; South Cotabato ang Sultan Kudarat for Region XII; and Maguindanao within the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). With Macon Ramos-Araneta
