RETURN TO WORK INTERIM GUIDE ON PUM, PUI and COVID-19 …€¦ · RETURN TO WORK: INTERIM GUIDE FOR PERSONS UNDER MONITORING (PUM), PERSONS UNDER INVESTIGATIONS (PUI), AND CONFIRMED

RETURN TO WORK INTERIM GUIDE ON

PUM, PUI and COVID-19 CASES Part 2 As of April 2, 2020

PHILIPPINE COLLEGE OF OCCUPATIONAL MEDICINE,INC.

TABLE OF CONTENTS

Definition of Terms 4

SIGNS AND SYMPTOMS OF COVID-19 INFECTION 6

Detection of PUM, PUI, and confirmed COVID-19 cases 6

Reporting of PUM, PUI, and COVID-19 cases to the DOH Surveillance System 7

FLOW OF NOTIFICATION FOR IMMEDIATELY NOTIFIABLE DISEASES, SYNDROMES & EVENTS 9

CONCEPT FRAMEWORK FOR THE PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (PIDSR) 10

ALGORITHM ON FIT TO GO BACK TO WORK FOR WORKERS 11

ALGORITHM ON FIT TO GO BACK TO WORK FOR HEALTHCARE WORKERS 12

ALGORITHM ON RISK ASSESSMENT AND PUBLIC HEALTH MANAGEMENT DECISION MAKING 13

RISK ASSESSMENT FOR HEALTH WORKERS 13

LEAVE OF ABSENCES/ ENTITLEMENTS 16

DOLE COVID-19 ADJUSTMENT MEASURES ORIGRAM (CAMP) 17

DOLE COVID-19 ADJUSTMENT MEASURES PROGRAM DIRECTORY 18

PERSONAL PROTECTIVE EQUIPMENT RECOMMENDATION 19

GOVERNMENT, INSTITUTIONS AND SOCIETIES: ADVISORIES AND GUIDELINES 21

A. DOLE 21

B. OFFICE OF THE PRESIDENT 21

C. PHILIPPINE SOCIETY FOR MICROBIOLOGY AND INFECTIOUS DISEASES 21

D. WHO 21

ETHICAL GUIDELINES FOR LEADERS IN THE HEALTH CARE INSTITUTION DURING THE COVID-19 PANDEMIC 22

PHILIPPINE COVID-19 TESTING CENTERS 26

CASE INVESTIGATION FORM: COVID-19 27

Line list of PUM from COUNTRIES Reporting with Local Transmission (SAMPLE) 28

Line list of Mild PUI from COUNTRIES and LOCAL AREA reporting with local transmission (sample) 28

Philippine College of Occupational Medicine, Inc. Page of 3 30

RETURN TO WORK: INTERIM GUIDE FOR PERSONS UNDER MONITORING (PUM),

PERSONS UNDER INVESTIGATIONS (PUI), AND CONFIRMED COVID-19 PATIENTS

This part 2 interim guidelines is compiled and written with the intention to help our doctors in their recommendation for employees and companies on return to work.

DEFINITION OF TERMS

1. Person under Monitoring (PUM) is a person who is asymptomatic with any of the following:

a. Travel history in the last 14 days to countries with local transmission and high risk of importation of COVID-19; or

b. History of exposure to a known confirmed COVID-19 case within 14 days.

History of exposure means:1. Providing direct care without proper PPE to confirmed COVID-19;2. Staying in the same close environment (including workplace, classroom, household,

gatherings);3. Traveling together in close proximity (1 meter or 3 feet) in any kind of conveyance.

2. Patient under Investigation (PUI) is a patient:a. who has fever and/or respiratory illness (e.g. cough or shortness of breath) and/or

diarrhea, with any of the following:1. Travel history in the last 14 days to countries with local transmission of

COVID-19; or2. Has exposure from a known confirmed COVID-19 case; OR

b. With severe acute respiratory infection or atypical pneumonia AND requiring hospitalization AND with no other etiology to fully explain the clinical presentation, regardless of exposure history; OR

c. With severe acute respiratory infection or atypical pneumonia AND residing or working where there is clustering of influenza-like illness (ILI) cases.

3. COVID-19 positive is a patient under investigation (PUI) with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.

4. Home Quarantine a. Any person, regardless of nationality, race and age, who does not exhibit any sign nor

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, shall be required to undergo monitored home quarantine.

b. Any person, regardless of nationality, race and age, 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 , shall be advised to undergo monitored home quarantine.

Isolation:a. PUM should be alone in a well-ventilated room, preferably with a toilet and bathroom. If

not possible, maintain a distance of at least 1 meter from PUMb. Sleep in a separate bedc. Assign one person in good health as caretaker d. No visitor allowed in the roome. Confine activities of PUM in one room only. If not possible, ensure shared space like

kitchen, toilet etc. is well ventilated (open windows)f. No sharing of items like towels, bed linens, eating utensils, dishes and other personal

items.

Restrictions:Prohibited to leave their room/homes where they are quarantined until they have been certified by the local health official to have finished the 14-day requirement for quarantine procedures

Reporting:Initial coordination should be done with the Local Government Epidemiologic Surveillance Unit on the logistical, administrative and clinical parameters to be standardized in any attempt to refer a PUM for transfer or consultation.

5. Self-monitoring means PUM should monitor themselves for fever by taking their temperature twice a day and remain alert for respiratory symptoms (e.g., cough, shortness of breath, sore throat etc). Anyone on self-monitoring should be provided a plan for whom to contact if they develop fever or respiratory symptoms during the self-monitoring period to determine whether medical evaluation is needed.

6. Active monitoring means that the local public health authority assumes responsibility for establishing regular communication with potentially exposed people to assess for the presence of fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat etc.)

7. Close contact for healthcare exposures is defined as follows: a) being within approximately 6 feet (2 meters), of a person with COVID-19 for a prolonged

period of time (such as caring for or visiting the patient; or sitting within 6 feet of the patient in a healthcare waiting area or room); or

b) having unprotected direct contact with infectious secretions or excretions of the patient (e.g., being coughed on, touching used tissues with a bare hand).


SIGNS AND SYMPTOMS OF COVID-19 INFECTION

The reported symptoms are mainly fever and dry cough. Other commonly reported symptoms are breathing problems, runny or blocked nose, sore throat, headache, nausea, muscle and joint pain. New reports suggest patients experiencing loss of sense of taste and smell. Most of those infected get mild symptoms that can be managed at home. Some people become severely ill with breathing difficulties and pneumonia.

DETECTION OF PUM, PUI, AND CONFIRMED COVID-19 CASES

1. Ports of EntryOfficials of points of entry shall ensure proper examination and investigation of documents for history of travel to countries with confirmed COVID-19 cases and implement mandated travel restrictions and refer individuals requiring further investigation.

The staff of the Bureau of Quarantine shall perform clinical examination of identified and/or referred individuals for appropriate case classification and disposition.

2. Health FacilitiesAll health facilities shall inquire for travel histories to COVID-19 affected countries among consultations presenting with fever, cough, colds, and other respiratory conditions. For patients with no history of travel or exposure but presenting with severe acute respiratory infection or atypical pneumonia shall be treated with high index of suspicion. They shall be guided by the set case definitions for the proper classification of these consultations.

3. Local Health OfficeAll Local Health Offices shall ensure proper coordination with the public and private facilities including civil society organizations, professional societies, and academic institutions in the community on raising community awareness on COVID-19. The officials of these offices and institutions shall implement the following activities:

a. To heighten awareness among facilities and areas under their jurisdiction and the community in the identification and appropriate referral of residents, employees, students, and other individuals who may be classified as PUM and PUI;

b. To activate and supervise the Barangay Health Emergency Response Teams (BHERTS) in monitoring of PUMs on home quarantine; and

c. To coordinate International Organizations and Partners involved in disease surveillance.


REPORTING OF PUM, PUI, AND COVID-19 CASES TO THE DOH SURVEILLANCE SYSTEM

1. Health authorities from the government and private health facilities shall report PUM, PUI, and confirmed cases of COVID-19 within 24 hours of identification. Data that will be collected shall consist of, but not limited to:

2. This information shall be reported using a reporting template to their respective epidemiology and surveillance units (ESUs) The laboratory reporting of cases and corresponding results shall be developed by RITM, in coordination with epidemiology bureau (EB).

3. The reporting facility shall notify the concerned RESU within 24 hours of identification of a PUI or PUM. The RESU shall in turn notify the EB immediately/ However, upon detection of a confirmed COVID-19 case, the reporting unit shall notify the RESU and EB immediately

4. The laboratory process, including request forms and guidelines for specimen collection, storage, and transport, and reporting of results shall be developed by RITM, in coordination with EB.

5. Recording and reporting forms and a database management system to ensure faster and easier encoding, submission, and analysis shall be identified or developed by EB. A unique identifier or identification number (IDNUM) will be assigned by the reporting unit to all PUIs seen and reported in the health facility. The IDNUM shall be the reference number of the PUI to be used by both EB and RITM in recording the data of the PUI in a reporting software.

In the Workplaces:1. The Safety Officer and/or Occupational Health Officer of the workplace/organization/

company shall report to the Municipal Health Officer(MHO) or City Health Officer (CHO) for verification and initial investigation the following:

a. Symptomaticsb. Asymptomatics with history of travel to China andc. Asymptomatic with history of exposure

2. The MHO/CHO should then report to the Regional Epidemiology Surveillance Unit (RESU) using the Event-Based Surveillance System (ESR) of epidemiology Bureau (EB) of DOH.

Name of Person Contact Details

Age Postal Address

Sex Civil Status

Last Menstrual Period (for female of reproductive age)

Mobile and Landline phone numbers

History of Travel1. Date of travel from country/ies visited2. Country/ies visited3. Date of arrival in the Philippines

History of Illness1. Date of onset of illness2. Signs and symptoms of illness3. Date of consultation/admission


If a confirmed case is detected in the workplace:1. The DOH shall reach out to the employer first and it is the joint DOH and LGU’s contact

tracing team which shall assess who among such persons should be placed on quarantine and advise which area to vacate & cordon-off.

2. Employers should cooperate and provide the necessary assistance and support to the joint DOH and LGU’s contact tracing team by helping identify any persons at the workplace who may have had close contacts with the confirmed case. For those who are not placed under quarantine, follow instructions above.

3. Employers should immediately vacate and cordon-off the prescribed section of the workplace premises where the confirmed case worked. There is no need to vacate the building or the whole floor if there had been no sustained and close contact with the confirmed case; and

4. Carry out a thorough cleaning and disinfecting of that section of the workplace premises particularly those that come in frequent contact, using 0.1% bleach.

5. For employees who may not be able to remain physically at their workplaces if they have been asked to vacate their work stations or are pending assessment by the joint DOH and LGU’s contact tracing officers, employers are urged to enable flexible work /or treat such absences in accordance with Department of Labor arrangements and Employment Civil Service Commission guidelines.

6. Employers shall provide timely information to employees on latest developments and reassure employees and other relevant persons, e.g. customers, of the measures being taken to ensure their well-being at the workplace.

7. Employers should regularly keep in touch with an employee who is a suspect or confirmed case or was placed on quarantine.


WORKPLACE SAFETY OFFICER/ OH PHYSICIAN

Municipal Health Officer (MHO) or City Health Officer (CHO)

Regional Epidemiology Surveillance Unit (RESU)

To report: • Symptomatics• Asymptomatic with history of travel• Asymptomatic with history of exposure

Accomplish:• Case investigation form • Line list of PUM,PUI

FLOW OF NOTIFICATION FOR IMMEDIATELY NOTIFIABLE DISEASES, SYNDROMES & EVENTS


CONCEPT FRAMEWORK FOR THE PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (PIDSR)


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Philippine Society of Microbiology and Infectious Diseases Source: PSMID Facebook page: https://www.facebook.com/psmid.org.ph/photos/

a.571641916588291/945072549245224/?type=3&theater


https://www.facebook.com/psmid.org.ph/photos/a.571641916588291/945072549245224/?type=3&theater




LEAVE OF ABSENCES/ ENTITLEMENTS

According to the Labor Advisory No. 4 Series of 2020 for workers who are requested by their employers to stay at home or who are served quarantine order for reasons related to 2019-nCoV, the following arrangements may be considered during the period of absence:

1. Worker’s leave of absence may be charged to their annual sick/vacation leave credits under the company policy or practice or as stipulated in their collective bargaining agreement, if there are any. If the worker’s leave have been used up, employers could consider granting leave of absence without pay. However, employers are encouraged to exercise flexibility and compassion on granting additional leave with pay.

2. By mutual agreement, employers and workers could also agree on other arrangements for the worker’s leave of absence.


http://bwc.dole.gov.ph/images/Issuances/LaborAdvisory/2020/LABOR_ADVISORY_NO_04_20_GUIDELINES_ON_2019_NOVELA_CORONAVIRUS_2019_nCOV_PREVENTION_AND_CONTROL_AT_THE_WORKPLACE.pdf

DOLE COVID-19 ADJUSTMENT MEASURES ORIGRAM (CAMP)


https://www.dole.gov.ph/wp-content/uploads/2020/03/labor-advisory-no.-12-1.pdf

DOLE COVID-19 ADJUSTMENT MEASURES PROGRAM DIRECTORY


https://www.dole.gov.ph/covid-19-mitigating-measures/

PERSONAL PROTECTIVE EQUIPMENT RECOMMENDATION

According to the Centre for Evidence-Based Medicine (CEBM) standard surgical masks are as effective as respirator masks (ex. N95 FFP2, FFP3) for preventing infection of healthcare workers in the outbreak of viral respiratory illnesses such as influenza. However, there is no direct evidence from COVID-19 outbreaks.

In settings where face masks are not available, employees or healthcare workers might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face. (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html)

April 2, 2020, the Inter-Agency Task Force on Infectious Diseases said it is now mandatory for individuals leaving their residences for whatever reason to wear any type of face mask (face masks, ear-loop masks, indigenous, reusable or do-it-yourself masks, face shields, and handkerchiefs) while the Luzon-wide enhanced community quarantine is in effect due to the coronavirus disease 2019 (COVID-19) crisis to help prevent the further spread of the respiratory disease.


https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html


GOVERNMENT, INSTITUTIONS AND SOCIETIES: ADVISORIES AND GUIDELINES(new releases)

A. DOLE 1. Guidelines for the Implementation of Mental Health Workplace Policies and Programs

for the Private Sector. http://bwc.dole.gov.ph/images/Issuances/DepartmentOrder/DO_208_20_GuidelinesfortheImplementationofMentalHealthWorkplacePoliciesandProgramsforthePrivateSector.pdf

2. DOLE Establishment report on COVID-19: https://www.dole.gov.ph/wp-content/uploads/2020/03/ER-COVID19-Monitoring-Form.docx(Note: submission can be done once all the COVID issue has already settled and have assured the health and safety of your workers and your workplace)

B. OFFICE OF THE PRESIDENT 1. Stringent Social Distancing Measures and Further Guidelines for the management of the

Coronavirus Disease 2019 (COVID-19) Situation: https://www.officialgazette.gov.ph/downloads/2020/03mar/20200313-MEMO-RRD.pdf

2. Community Quarantine Over the Entire Luzon and Further Guidelines for the Management of the Coronavirus Disease 2019 (COVID-19) Situation: https://www.officialgazette.gov.ph/downloads/2020/03mar/20200316-MEMORANDUM-FROM-ES-RRD.pdf

3. Administrative Order No. 26: Authorizing the grant of Hazard Pay to Government personnel who physically report for work during the period of implementation of an enhanced community quarantine relative to the COVID-19 Outbreak: https://www.officialgazette.gov.ph/downloads/2020/03mar/20200323-AO-26-RRD.pdf

C. PHILIPPINE SOCIETY FOR MICROBIOLOGY AND INFECTIOUS DISEASES 1. Interim Guidelines on the Clinical Management of Adult Patients with Suspected or

Confirmed COVID-19 Infection: https://www.dropbox.com/s/hja8h49q8k9b77r/PSMID%20COVID%20tx%20guidelines%20v.3.31.20a.pdf?dl=0

D. WHO 1. Rational use of personal protective equipment (PPE) for coronavirus disease

(COVID-19) https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf


http://bwc.dole.gov.ph/images/Issuances/DepartmentOrder/DO_208_20_GuidelinesfortheImplementationofMentalHealthWorkplacePoliciesandProgramsforthePrivateSector.pdf



https://www.dole.gov.ph/wp-content/uploads/2020/03/ER-COVID19-Monitoring-Form.docx



https://www.officialgazette.gov.ph/downloads/2020/03mar/20200313-MEMO-RRD.pdf

https://www.officialgazette.gov.ph/downloads/2020/03mar/20200316-MEMORANDUM-FROM-ES-RRD.pdf

https://www.officialgazette.gov.ph/downloads/2020/03mar/20200316-MEMORANDUM-FROM-ES-RRD.pdf

https://www.officialgazette.gov.ph/downloads/2020/03mar/20200323-AO-26-RRD.pdf

https://www.dropbox.com/s/hja8h49q8k9b77r/PSMID%20COVID%20tx%20guidelines%20v.3.31.20a.pdf?dl=0



https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

ETHICAL GUIDELINES FOR LEADERS IN THE HEALTH CARE INSTITUTION DURING THE COVID-19 PANDEMIC





PHILIPPINE COVID-19 TESTING CENTERS

Luzon Research Institute for Tropical Medicine, Muntinlupa City

San Lazaro Hospital, Manila CityUP National Institutes of Health, Manila CityLung Center of the Philippines, Quezon City

Baguio General Hospital and Medical Center in Benguet

Visayas Western Visayas Medical Center, Iloilo City

Vicente Sotto Memorial Medical Center, Cebu City

Mindanao Southern Medical Center in Davao


CASE INVESTIGATION FORM: COVID-19


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LINE LIST OF PUM FROM COUNTRIES REPORTING WITH LOCAL TRANSMISSION (SAMPLE)

LINE LIST OF MILD PUI FROM COUNTRIES AND LOCAL AREA REPORTING WITH LOCAL TRANSMISSION (SAMPLE)


Reporting Facility: ________________________________________________________________ Date: _______________________________

FULL NAME AGE/SEX BIRTHDATE NATIONALITY COMPLETE ADDRESS (with barangay) TRAVEL HISTORY (specify countries)

DATE OF ARRIVAL

DATE OF COMPLETION OF QUARANTINE CONTACT NO.

Line list of PUM from COUNTRIES Reporting with Local Transmission

Cagayan Valley Center for Health Development

Republic of the PhilippinesDEPARTMENT OF HEALTH ANNEXA

Cumulative no. of PUM to area reporting with LOCAL transmission : ________

Reporting Facility: ________________________________________________________________ Date : ________________________________Name of Interviewer: ______________________________________________________________ Contact No. :__________________________

FULL NAME AGE/SEX BIRTHDATE NATIONALITY COMPLETE ADDRESS (with barangay) TRAVEL HISTORY (specify countries and areas)

DATE OF ARRIVAL

DATE OF COMPLETION OF QUARANTINE CONTACT NO.

Republic of the PhilippinesDEPARTMENT OF HEALTH

Cagayan Valley Center for Health Development

Line list of Mild PUI from COUNTRIES and LOCAL AREA reporting with local transmission

ANNEX B

Sources:

• https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf • https://www.doh.gov.ph/sites/default/files/health-update/ao20200012.pdf • https://www.doh.gov.ph/sites/default/files/health-update/DM-

Interim%20Guidelines%20for%20Home%20Quarantine.pdf • https://www.doh.gov.ph/sites/default/files/health-update/DC2020-0039-Reiteration-of-DM2020-056-

Interim-Guidelines-on-2019-nCoV-ARD-Response-in-the-Workplace.pdf • https://www.doh.gov.ph/sites/default/files/health-update/dc2020-0131.pdf • https://www.osha.gov/Publications/OSHA3990.pdf • https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html • https://www.facs.org/covid-19/clinical-guidance/surgeon-protection • https://www.doh.gov.ph/sites/default/files/publications/PIDSRMOP3ED_VOL1_2014.pdf

(Disclaimer: Pertinent information were lifted from different sources to avoid misinterpretation of content)


https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf

https://www.doh.gov.ph/sites/default/files/health-update/ao20200012.pdf

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

https://www.facs.org/covid-19/clinical-guidance/surgeon-protection

https://www.doh.gov.ph/sites/default/files/publications/PIDSRMOP3ED_VOL1_2014.pdf

AUTHOR

Marilen Evangeline M. Cruz, MD, MHA, FPCOM

TECHNICAL WORKING GROUP ON COVID-19

Anna Sofia Victoria S. Fajardo, MD, MBAH, DPCOM Margaret L. Leachon, MD, FPCOM

Phil M. Pangilinan, MD, MHA, DPCOM Rommel B. Punongbayan, MD, MBA, FPCP

Reynold M. Sta Ana, MD, MOH, FPCOM

APPROVING BODY

PCOM National Officers and Board of Directors 2019-2020

For more information please call DOHs COVID Emergency Operations Center at

(632) 8651-7800 loc 1149 -1150 or(02) 894-COVIDwww.doh.gov.ph

National Center for Mental Health 24/7 Crisis Hotline+63 0917 899-USAP (8727)

989-USAP (8727)www.ncmh.gov.ph

___________

PCOM DETAILS Cellphones:

+63 998 9545 338 +63 925 8175 026 +63 906 4743 471 +63 917 6276 246

Landline: (02) 8929 7741

Your feedback is important to us. Please email the PCOM Secretariat at: [email protected] [email protected]

Address: Room 106, PMA Bldg., North Ave., Quezon City


http://www.doh.gov.ph

Documents

RETURN TO WORK INTERIM GUIDE ON PUM, PUI and COVID-19 …€¦ · RETURN TO WORK: INTERIM GUIDE FOR PERSONS UNDER MONITORING (PUM), PERSONS UNDER INVESTIGATIONS (PUI), AND CONFIRMED