DOH’s Duque says don’t wait for test if you have COVID-19 symptoms; manage it

Department of Health (DOH) Secretary Francisco Duque III advised people who have symptoms of COVID-19 to manage their condition as if they really have the disease caused by the new coronavirus instead of waiting to get tested.

As quoted by Inquirer.net from a television interview, Duque said that “if you already know the symptoms, manage it as if it’s COVID-19. If all indications suggest that it’s probably COVID-19, why wait for a test? Manage it as COVID-19 right away. You assume. That’s the way to do it.”

Among the symptoms of COVID-19 are fever, dry cough, cold, shortness of breath, and diarrhea.

Duque, however, did NOT provide the “how to” on managing COVID-19, particularly for those who are not going to get tested, or access medical facilities.

But on February 17, DOH issued Memorandum No. 2020-0090, which contained the interim guidelines on the management of persons under monitoring (PUMs) suspected with COVID-19 for home quarantine.

The guidelines enumerate people who should be home quarantined:

1. Any person who does not exhibit any sign/symptom, has history of travel to other areas of China and/or history of exposure to a confirmed case of COVID-19 within the past 14 days.
2. Any person who exhibits fever or any symptom of lower respiratory illness, and has a history of travel to other countries with a confirmed case of COVID-19 but without any history of exposure.
3. Those undergoing home quarantine shall be prohibited to leave their rooms/hotels where they are quarantined until they have been certified by the local health official to have finished the 14-day requirement for quarantine procedures.

Now how to implement home quarantine?

PUMs should be isolated.

1. Place the PUM alone in a well-ventilated room, preferably with toilet and bathroom. If this is not possible, maintain a distance of at least one meter from the PUM (for example, sleep in a separate bed).
2. Assign one person who is of good health as caretaker of the PUM.
3. Do not allow visitors, family members and even caregivers in the room of the PUM.
4. Limit the activities of the PUM in his/her room only. If this is not possible, ensure that shared spaces are well-ventilated.

PUM should use surgical mask.

1. The PUM should wear a surgical mask fitted tightly to the nose, mouth and chin when in the same room with another household member or when talking to others.
2. If alone, the PUM is not required to wear mask.
3. Do not touch mask during use. If the mask gets wet or dirty with secretions (e.g. saliva), change immediately and dispose properly.
4. After eight hours, throw used mask. Do not reuse or wash masks.
5. After removal of mask, wash hands with water and soap, or rub hands with 70% alcohol.

Hand hygiene practice for all.

1. Everyone should perform hand hygiene following contact with PUM, or if in contact with immediate environment.
2. Perform hand hygiene by washing hands with water and soap. If hands are not visibly dirty, use 70% alcohol.
3. When using soap and water, dry hands using disposable paper towels. If not available, use dedicated cloth towels and replace when wet.
4. Hand hygiene should be performed before and after preparing food, before eating, after using toilet, and when hand is dirty.

Respiratory hygiene and precaution for all.

1. Cover mouth and nose when coughing or sneezing by using surgical mask, tissues, flexed elbows, sleeves of clothes or inside the neckline of shirts. Follow this up with hand hygiene.
2. Avoid direct contact with body fluids, particularly oral and respiratory secretions, and feces.
3. Avoid sharing toothbrushes, cigarettes, towels, bed linen, etc.

Food handling for PUM under home quarantine.

1. The assigned caretaker should serve the plates/tray only up to the room door (where the PUM is staying).
2. After eating, pick plates/tray using gloves. Perform hand hygiene afterwards.
3. Utensils should be cleaned thoroughly with water and soap. Reused as needed.
4. Do not share utensils with PUMs.

Disposal of used gloves, tissue papers and masks.

1. Immediately throw materials used to cover mouth or nose.
2. If reusable items are used (e.g. handkerchief), immediately wash after use with water and detergent soap.
3. Gloves, tissues and masks used by PUM should be placed in separate container before disposing with other household waste.

Cleaning and disinfection of quarantine venues.

1. Frequently clean/disinfect frequently touched surfaces (e.g. bedside tables, door knobs, bed frames, etc). Use household disinfectant; or diluted bleach solution (i.e. 1 part bleach and 99 parts water).
2. Clean/disinfect bathroom/toilet at least once a day.
3. Regularly clean clothes, bed linens, towels, etc. of PUMs.

Now, this is important.

PUMs who develop symptoms should be immediately transported to the nearest health facility. In the same way, all household members of PUMs should seek immediate medical care when signs/symptoms develop.

Because the DOH is not at all considering mass testing (yet) in the Philippines, these tips may offer temporary comfort as the country continues to come to grips with COVID-19 with the country’s health department’s weaknesses in offering quality healthcare for all now highlighted.