Mobilize police for contact tracing

LAST Monday, I devoted my column to a slightly edited version of a May 20 report by a team of eight University of the Philippines professors evaluating the government’s response to the Covid-19 pandemic.

I am using my column today to publish their recommendations to continue government’s success in combating the pandemic, which I hope our policy makers will consider when and if they decide to lift the lockdowns next week for most of the country.

1. That the national government continue significant restrictions in the National Capital Region and Cebu City and expand the same as necessary to other high-risk areas. We urge government to also monitor the situation in Zamboanga City, Batangas province and Davao City, as the risk levels of the pandemic in these areas are still significant.

2. Given the recent decision by government to loosen restrictions and based on the experience of other countries, the likelihood of a resurgence seems to be not a question of if but where, and how bad. The virus is still with us and we have not yet developed herd immunity. In order to sustain the gains from the last enhanced community quarantine (ECQ) and to build a momentum towards pandemic deceleration, the government must ensure that health systems are capable of detecting, testing, isolating and treating every case of Covid-19, as well as tracing every contact. It should effectively enforce the rules on physical distancing and health safeguards, especially in malls and other establishments allowed to operate under the modified enhanced community quarantine (MECQ).

Mobilities

3. Next week, government will have to decide whether those under MECQ should transition to general community quarantine (GHQ), revert back to ECQ or extend the MECQ. This decision should be based on the best available evidence.

We recommend that government undertake, commission if necessary, studies on people’s mobilities in areas under quarantine. These studies, using mobile (location) data and drilling down to the barangay level, could provide scientific evidence on what has changed when we moved from ECQ to GCQ or MECQ.  They can then inform a more refined risk analysis — which is vital to evidence-based policy making. To this end, we are also recommending a simplified risk analysis decision tool in reopening sectors of the economy and lessen epidemiological uncertainty based on a) number of contacts, b) contact intensity and, c) modification and mitigation interventions.

4. We reiterate our previous recommendation for government to expand further the testing capacity as we move towards opening certain sectors of the economy.

We laud the Philippine government for ramping up testing to up to 10,000 tests per day. While this arguably may have caused an increase in the number of confirmed Covid-19 cases, it has given us a better picture of the state of the pandemic in the country that could serve as basis for the recalibration of the restrictions in the next few days.

We recommend that the first priority is the testing of people in the workforce in the economic sectors initially reopened followed by testing in other sectors as the national economy is gradually reopened. To this end, we also urge the government to study the possibility of using local trials of group testing protocols in order to potentially multiply the testing capacity for certain populations.

Furthermore, we also recommend the trial of randomized testing, possibly using group testing, in zone-based populations. Randomized testing may provide a more reliable basis for determining prevalence rates and may be potentially used for smarter workplace-based infection control policies.

Contact tracing

5. However, this testing capability would not be enough if we were to re-open. We reiterate that contact tracing is an important component in the fight against Covid-19. Aggressive contact tracing should be a centerpiece of the strategy. It will allow government to identify high-risk individuals and target them for isolation/quarantine. This way we can break infection transmission and avoid reverting to ECQ or unnecessarily prolonging the transition to GCQ — efforts that also hurt the economy and strain the psychosocial well-being of citizens.

6. The challenge with contact tracing is that it is labor-intensive and time-consuming. We laud government for committing resources to hire more contact tracers soon. But we need to mobilize other sectors of society to help undertake aggressive contract tracing. We need a people’s army of contact tracers. A possible first step is to re-task the Philippine National Police from primarily manning checkpoints and/or arresting quarantine violators to taking the lead in contact-tracing teams.

As contact tracing is similar to detective work, the police already have the basic skills to do it. A complementary step is to mobilize, on a voluntary basis, students from medical, nursing and other allied health professions as contract tracers.  Each contact-tracing team could be composed of police and students. Both the police and the students need minimal training to do contract tracing. But they should be given adequate support (remuneration, health insurance, etc.) and the necessary protective equipment (medical-grade face masks, face shields, and isolation gowns) and digital devices. The latter is important because documentation and reporting should be digital by default so that errors in reporting can be minimized.

The data reporting and platform should be standardized. This tracing data once anonymized can be incorporated into the Covid-tracker and must also be made open to all stakeholders. We reiterate that cultivating a culture of open data sharing will go a long way towards improving everyone’s (national government, local governments, private sector, civil society and individual citizens) effectiveness in contributing to the fight to stem the pandemic. Encouraging participative governance in this way can bring the country towards a better normal.

Mechanism

We also recommend that there should be a mechanism in place for placing a province or local government unit back in ECQ, should the threat of a pandemic become significant.

The threat of Covid-19 will still remain unless a vaccine is widely available. We need to provide criteria or a set of triggers not only for de-escalation but also to escalate restrictions that are clearly explained to the public.

We recommend the expansion of the health system in order to continue to have the ability not just to treat Covid-19 cases but also other patients suffering from other diseases.

Government allowing limited practice of medical students would add needed manpower.

Provision of standard personal protective equipment would also ensure that our health workers will not be exposed and will continue to be available to serve.

The effective implementation of the current MECQ can be realized through an aggressive government information drive to inform individuals and businesses of their responsibilities on the new normal, especially the guidelines issued by the various agencies. We exhort government to further refine and harmonize the various guidelines regarding the MECQ and ensure that they are cascaded to stakeholders.

It also is important that government messaging should be made clearer and guidelines be localized effectively. Educating citizens and local partners would make them less prone to misinformation and confusion and less susceptible to simplistic solutions not based on sound policy. Proactive monitoring of public reception of guidelines and information would ensure immediate clarification and correction of confusing or wrong information.

Also, it is important that Congress, through its stimulus package, allocate funds to government and other higher education institutions such as the University of the Philippines for research on Covid-19. The strategic areas of research could include the development of effective treatment methods and cheaper platforms of testing. These and other strategic concerns need focused study given the duration before a vaccine, if any, could be deployed. The best minds in the country from all institutions should come together instead of working in silos and exchange and test ideas.

Government cannot do everything. The cooperation of business, civil society, and each and every individual is necessary to ensure the effective implementation of quarantine rules, the safety of workplaces, and the strict enforcement of physical distancing and other important health protocols. We recommend the formation of a broader coalition of organizations to support this initiative.


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