DM 2020-0439

“OMNIBUS INTERIM GUIDELINES

ON PREVENTION, DETECTION,
ISOLATION, TREATMENT, AND
REINTEGRATION STRATEGIES FOR
COVID-19”
D E PA R T M E N T O F H E A LT H E A S T E R N V I S AYA S - C E N T E R F O R H E A LT H D E V E L O P M E N T
Health Emergency Management, DOH-EVCHD, Palo, Leyte| 2020

MARC STEVEN DE PAZ CAPUNGCOL, RN, MD, CLC, MPH

RESU/HEMS Unit Head
 DM 2020-0439
• Entitled “Omnibus Interim Guidelines Prevention,
Detection, Isolation, Treatment, and Reintegration
Strategies for COVID-19”
• Issued last October 6, 2020
• Provides interim guidelines on surveillance,
screening, contact tracing, quarantine or isolation,
and testing as part of COVID-19 response

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 Definition of Terms
TERM DEFINITION
Suspect A person who meets the clinical AND epidemiologic criteria:

Clinical Criteria:
• Acute onset of fever AND cough OR
• Acute onset of any 3 or more of the following signs & symptoms:
fever sore throat
cough coryza
general weakness dyspnea
fatigue anorexia/nausea & vomiting
headache diarrhea
myalgia altered mental status
Epidemiologic Criteria:
• Residing/working in an area with high risk of transmission of the virus
• Residing in or travel to an area with community transmission anytime within the 14days prior to
symptom onset
• Working in health settings, including within health facilities & within households, anytime within
the 14 days prior to symptom onset

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 Definition of Terms
TERM DEFINITION
Probable • A patient who meets clinical criteria above AND is a contact of a probable or confirmed case, or
epidemiologically linked to a cluster of cases which has had at least one confirmed case
identified within that cluster

• A suspected case with chest imaging showing findings suggestive of COVID 19

• A person with recent onset of anosmia (loss of smell) or ageusia (loss of taste) in the absence of
any identified cause

• Death, not otherwise explained, in an adult with respiratory distress preceding death AND who
was a contact of a probable or confirmed case or epidemiologically linked to a cluster which has
had at least one confirmed case identified within that cluster

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 Definition of Terms
TERM DEFINITION
Confirmed A person with laboratory confirmation of COVID 19 infection, irrespective of clinical signs and
symptoms

Mild
- Patients with mild symptoms and stable vital signs. Unless the patient belongs to high risk
subgroups or has comorbidities, they are often not admitted to a treatment facility
Moderate
- Patients with difficulty breathing, altered mental status, considered high-risk or in need of
hospital care
Severe
- Confirmed cases classified as either severe pneumonia based on Philhealth Circular 2020-009; or
suspect, probable or confirmed case of COVID 19, exhibiting severe signs and symptoms

Critical
- suspect, probable or confirmed case with impending or ongoing respiratory failure, in need of
mechanical ventilation or with evidence of end-organ damage

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 General Guidelines

A. Implementation of the Prevention, Detection, Isolation, Treatment ,

and Reintegration strategies shall be cornerstone of response and
shall be a SHARED RESPONSIBILITY of the National Government,
Local Government Units, Private Sector & the Public

1. DOH- provide guidelines and oversight response managemet

activities
2. External agencies – comply with specific roles and corresponding
guidelines issued by IATF

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 B. Minimum public health standards (hand hygiene, physical
distancing, cough etiquette, wearing of masks) shall be strictly
implemented across ALL SETTINGS, REGARDLESS OF SEVERITY
OF RISK

C. Contact Tracing shall be initiated after case investigation of every

reported probable and confirmed COVID case.

*CLOSE CONTACTS shall refer to persons who has experienced any of

the following exposures during the 2 days before and 14 days after the
onset of symptoms of a probable or confirmed case.
1. Face to face contact within 1 meter and for at least 15 minutes;
2. Direct physical contact with a probable or confirmed case;
3. Direct care for patient with probable or confirmed COVID-19 case

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 without using recommended personal protective equipment OR;
4. Other situations as indicated by local risk assessments.

D. Contact Tracing shall also commence for contacts of suspect

cases upon detection, while waiting for specimen collection for SARS-
CoV-2 diagnostic testing or while waiting for RT-PCR results.

E. Proper clinical assessment shall be the basis for quarantine or

isolation, and testing algorithms anchored on two main factors:
symptoms and exposure and shall reflect the most cost- effective
intervention following the pretest probability framework:
QUARANTINE/ISOLATE ONLY
QUARANTINE/ISOLATE & TEST
TEST ONLY
B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 F. The difference of isolation and quarantine shall be emphasized:

Isolation – separation of sick people with a contagious disease from

people who are not sick

Quarantine – separation and movement restrictions of people who

were exposed to a contagious disease to see if they
become sick.

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B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 1. All contacts of probable and confirmed cases, and travelers shall be
placed under quarantine. In the event that they develop symptoms
or test positive for COVID-19, they shall be isolated.

2. All suspect, probable and confirmed cases shall be isolated in the

proper facility depending on the severity of symptoms.
Asymptomatic confirmed & mild cases – TTMF
Moderate cases – Level 1 or Level 2 hospitals
Severe & Critical cases – Level 3

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 G. Second & third generation close and general contacts shall be
advised to SELF- MONITOR, strictly adhere to the minimum health
standards and report for appearance of signs and symptoms.

H. Contacts of suspect of cases shall be notified and advised to self-

monitor, and adhere to the minimum public health standards. Should
the suspect case turn out to be probable or confirmed, contacts will be
asked to undergo quarantine or isolation whichever is appropriate.

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B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 I. COVID-19 Expanded Testing is defined as testing all individuals who are
at-risk of contracting the infection. This includes testing the following
groups: (1) suspect cases or (2) individuals with relevant history of
travel and exposure (or contact), whether symptomatic or
asymptomatic, and (3) health care workers with possible exposure,
whether symptomatic or asymptomatic. Sub-groups of at-risk individuals
arranged in order of greatest to lowest need for RT-PCR testing are
identified.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 J. Reasons for testing the identified priority groups are emphasized:
1. Diagnostic Testing/ Testing for Diagnosis
- looks for presence of COVID-19 at the individual level &
performed when there is a particular reason to suspect
(i.e. manifestation of symptoms, history of exposure)

2. Screening Testing/ Testing for Screening

- identify infected individuals prior to development of
symptoms or those infected who are asymptomatic

3. Surveillance Testing/ Testing for Surveillance

- to obtain information at a population level
- done to monitor for increasing/decreasing prevalence
and to determine effects of community intervention

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 K. In determining the right test for the right reason, the following shall be
considered:
1. Availability of test
2. Best time to use the test
3. Turn around time of results and
4. Test specificity and sensitivity which shall be independently
validated

L. Use and limitations on the reliability and validity of available test kits
shall be recognized. Interpretation of results shall be done by a
physician and shall always be correlated with clinical picture of
the
patient.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 1. RT PCR is the currently recommended test to confirm COVID-19
2. The use of rapid antigen test (AgT) as a substitute for
RT-PCR shall be allowed provided that FDA- certified
antigens are used and for the following reasons:
a. in community/hospital when RT-PCR is insufficient
b. in hospital where the turn around time is critical to guide
patient cohort management
c. community outbreaks for quicker case finding

* Symptomatic close contacts with positive AgT – final diagnostic test result
* Symptomatic close contacts with negative AgT – shall undergo PCR test
(as well as asymptomatic close contacts regardless of AgT result)
3. Pooled testing may be used for surveillance testing of asymptomatic
workers

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 M. Discharge criteria shall no longer entail repeat testing and should not be a
requirement for clearance/certification issued by medical doctors:
1. Mild symptoms – completed at least 10 days isolation from the
onset of illness inclusive of 3 days of being clinically
recovered and asymptomatic
2. Moderate, Severe or Critical – completed at least 21 days of
isolation in a hospital from the onset of illness, inclusive of 3
days of being clinically recovered and asymptomatic
3. Asymptomatic – remained asymptomatic for at least 10 days
isolation from date of specimen collection
4. Close contacts – remains asymptomatic for 14 days from date of
exposure can discontinue quarantine without the
need for any test.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 N. Surveillance, contact tracing, quarantine, isolation and testing activities
shall endeavor to meet the following targets:
1. surveillance staff of 1:100,000 population ratio
2. > 80% of investigation done within 48hrs of RT-PCR test in
areas with new sources of infection
3. Contact tracing staff of 1:800 population ratio
4. 70% close contacts traced within 24hrs of getting RT PCR test
results; and 100% traced within 48hrs of getting RT PCR test
results
5. 100% of asymptomatic confirmed cases are isolated in an
Isolation facility within 48hrs
6. 100% of those quarantined/isolated who opt to use their homes
are in households that meet the criteria for home isolation

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 O. Reporting of full line-list of all RT-PCR specimen tests shall use the
COVID-19 Repository Document System (CDRS)

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 P. The COVID-19 Case Investigation Form (CIF) shall be used for case
investigation and testing

Q. All hospitals, isolation facilities and testing facilities shall utilize the
appropriate Philhealth benefit package or any benefit packages of HMO

R. Travel for tourism shall comply with the requirements of LGU.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 Specific Guidelines:
A. Surveillance General Process
1. Disease surveillance & response systems of DOH along with its
local counterparts shall be the 1st line of defense to epidemics &
health events that pose risk to public & security
2. Disease surveillance shall be done by DOH along with its
local counterparts following the provisions in the 2020 Revised
IRR of RA 11332:
a. regular updating of priority diseases
b. declaration of public health emergency by the Secretary
of Health, President, Provincial/City/Municipal Health
Officers provided that it is supported with data

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 c. Ensuring that DOH and its local counterparts maintain functional
disease and response systems
d. Establishment of ESU in every province, city & municipality
e. Disease Surveillance by BOQ in ports and airports of entry
f. Facilitation of CHD (RESU) on the weekly submission of notifiable
disease surveillance reports from public and private

B. Contact Tracing General Process

1. Contact Identification
a. all DRUs shall complete CIF & submit to DOH system
b. patients who self report symptoms personally or patients
reported by OSH shall be included in the LGU’s list of
contacts
c. all LESUs shall initiate case investigation

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 2. Case Investigation/ Contact Listing
a. all LESUs shall develop contact tracing team composed
of community support teams e.g. BHERTs, interviewers,
encoders, analysts & technical support staff
b. all LESUs shall assign a contact tracer for each case
c. Laboratory confirmation shall not delay the initiation of
contact tracing
d. case & contact interviews shall be conducted in safe &
conducive environment to establish rapport
e. cognitive interview techniques shall be done to elicit the
following data:
(1) all people with direct physical contact
(2) all people who lived with the case in the same
household
B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 (3) all places, establishments & workplace visited
(4) all healthcare facilities visited
(5) anyone else who might be exposed
f. other methods (e.g. CCTV), other entities (e.g.
workplaces, ports, etc) shall ensure that LESU be given
access to facilitate contact tracing
g. patients shall provide information to communicate with
contacts such as contact numbers and address
h. each contact tracer shall identify all close contacts &
exposure histories of the case
i. all identified close contacts that belong to a different
LGU shall be forwarded to the LESU of the LGU where
the case resides for appropriate action

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 3. Case Management
a. all contact tracers shall ensure that all close contacts
identified shall be:
1. informed of the protocols for communicating
with, managing, & secure reporting of identified
close contacts;
2. informed of protocols for daily symptom monitoring
3. referred by BHERTS to appropriate quarantine,
isolation, or tertiary care facilities
4. requested to personally notify close contacts
for preemptive quarantine/isolation 5.
referred for testing
6. Monitored by BHERTS for 14 days

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 b. Contact tracers shall be deputized to provide test
results to confirmed cases using information available
from DOH systems, while waiting for official result
c. contact tracers/ LESUs shall notify establishment or
workplaces that suspect, probable & confirmed cases
have visited
d. Contact tracing team shall be composed of physicians,
nurses, midwives, sanitary inspectors, population officers
staff from LDRRMO, BFP, Local PNP, AFP & volunteers
e. Close contact shall be managed accordingly based on
the latest Interim Management Guidelines for COVID-19

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 C. Setting-Specific Pathways for Contact Tracing, Quarantine or
Isolation, and Diagnostic Testing
1. Asymptomatic close contacts of probable & confirmed cases in
the community shall undergo immediate quarantine & be monitored
whether symptoms will manifest within 14 days:
a. if symptoms did not manifest, may be discharged after
14 days
b. if symptoms develop, they shall be admitted to TTMF & be
tested for RT PCR
(-) result – discharged after completion of 10 day isolation
inclusive of at least 3 days asymptomatic
(+) result – isolated, managed & discharged accordingly

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 2. Symptomatic close contacts of Probable & Confirmed cases in the
community shall be referred to an appropriate health facility for
isolation, testing and clinical management
3. Asymptomatic close contacts of Probable & Confirmed cases in
the Workplace shall undergo immediate quarantine. The OSH shall
inform the concerned LESUs. LESUs to generate the list of close
contacts outside workplace and refer to contact tracing team.
Algorithm for monitoring of closed contacts in the community shall
be followed
4. Symptomatic close contacts of Probable & Confirmed cases in the
workplace shall be referred to appropriate facility. OSH shall
determine & trace all close contacts. OSH shall also inform the
concerned LESUs. Same algorithm for symptomatic shall be
followed
B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 5. Self reporting Close contacts & Asymptomatic shall contact
respective BHERTS for assessment & proper referral to facility;
monitored for 14 day quarantine
6. Self-reporting Suspects (Symptomatic) shall contact respective
BHERT for assessment, referral & testing. Same algorithm for
symptomatic shall apply
7. Contacts of Suspect cases in the workplace or community shall
be notified and advised to self monitor, and adhere to stringent
minimum public health standards.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
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D. Pathways for Screening, Quarantine or Isolation, and Testing for
Screening of Travelers at Points of Entry

1. Returning Residents (RRs) – may only be allowed to travel if they

are asymptomatic; screening testing
shall be required on the prevalence
of COVID-19 in the places where
they came from
a. RRs from low and mid prevalence areas & asymptomatic
shall not be required negative test results nor to undergo
quarantine & testing at points of entry or upon arrival to
their localities of destination
b. RRs from high prevalence areas shall be required to have
negative test results.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
  At their places of origin, RRs shall be tested using RT-PCR and
placed under quarantine.
If negative- they shall be allowed to travel provided strict
adherence to MPHS and symptoms monitoring.
If positive- contact tracing shall be initiated and case shall be
admitted to the appropriate facility for isolation

 At their localities of destination, they shall be screened for symptoms

and quarantined upon arrival in the appropriate facility. If they
remain asymptomatic during the quarantine period, they shall be
discharged after 14 days from arrival. If they turn symptomatic,
they shall be tested with RT-PCR.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 c. All asymptomatic RRs identified, whether during screening prior to
travel or at their places of destination shall be admitted to the appropriate
facility and testing shall be done.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
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 2. Returning Filipinos (RFs), and Persons with Official International
Business shall be screened for symptoms at points of entry.

a. If they are from low/mid prevalence country & asymptomatic, they

shall not be required to undergo quarantine & testing at points of
entry/arrival

b. If they are from high prevalence country & asymptomatic, they shall
be quarantined immediately, and tested after 5 days

c. At localities of destination, RFs and persons with official

international business shall follow the same pathway for RRs

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 d. All symptomatic RFs and persons with international business,
whether during screening at points of entry shall be admitted to the
appropriate facility and testing shall be done.

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 3. Diplomats shall be screened for symptoms upon arrival to the
country:
a. if symptomatic, contact tracing shall be initiated, and the
diplomats shall be admitted and tested within 24hrs
b. if symptomatic upon arrival, they shall be quarantined
immediately & tested 5days after arrival

4. International Tourists coming from high prevalence countries

shall NOT be allowed to travel to the Philippines.
For those coming from low to mild prevalence may be allowed to
enter and shall be screened for symptoms.
a. if asymptomatic, they shall be allowed to travel provided
that they adhere to protocols
b. if symptomatic, contact tracing shall be done and tourist
shall be isolated immediately

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
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 5. Domestic Tourists and Staycationers – all domestic tourists and
staycationers shall be screened
for symptoms

a. if they are from low to mid prevalence areas & asymptomatic,

they shall be allowed to travel provided that they strictly follow
the protocols

b. if they are from high prevalence areas & asymptomatic, they

shall be quarantined & tested.

c. if they are from high prevalence areas & symptomatic, contact

tracing shall be initiated and shall be admitted

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E. Pathways for Screening, Return to Work & Surveillance Testing of Workers

1. proper clinical assessment shall be the primary basis for

return to work decisions
2. Surveillance testing using pooled testing of healthcare workers
may be conducted in areas with <10% prevalence of COVID 19
a. if pooled test result is negative, then all specimens can
be presumed negative with a single test. However, if
pooled test result is positive, then all the specimens in
the pool have to be retested individually and all individuals
included in the pool have to be quarantined immediately.
b. if individual tests negative, they can discontinue quarantine
c. if individual tests positive, they shall be contact traced
and continue quarantine
B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
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 F. Treatment of COVID-19 Cases

1. For mild COVID-19 cases, supportive care is recommended.

2. For moderate, severe and critical symptoms, they shall be
admitted to the hospital and shall be managed accordingly.

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s
 Maraming
Salamat !!!

B u i l d i n g a D i s a s t e r- R e s i l i e n t P h i l i p p i n e s