Contact tracing to identify persons exposed to island’s 1st COVID-19 case

Just a few days after announcing that Catanduanes remained free of COVID-19, Acting Governor Shirley A. Abundo last Sunday confirmed the fears of many islanders: that one of several Persons Under Investigation (PUI) who were previously confined at the provincial had tested positive.

In a hastily-called press conference at the provincial capitol held April 19, 2020, the acting chief executive disclosed that she received the bad news on Bicol’s 25th confirmed coronavirus case directly from Department of Health (DOH) Regional Director Dr. Ernie Vera.

“Dai na tabi magparatagas ang payo,” she said, telling the public to stay home so that the virus will not spread.

“Pagod na pagod na po kaming mga frontliners. Pakiusap lang namin sumunod naman kayo,” Abundo stated, warning Catandunganons that the island could become like the United States of America (USA) where more than 2,000 deaths are recorded daily.

Also receiving the same information from the DOH was Mayor Sinforoso Sarmiento Jr., who expressed hopes that the family members of the patient would still be able to remember the names of those they have been in contact with since the patient arrived.

Present during the press conference were Provincial Health Officer II Dr. Hazel Palmes, Provincial Health Officer I Dr. Franchette Amabella Panti, Eastern Bicol Medical Center (EBMC) chief of hospital Dr. Vietrez Abella, Virac Municipal Health Officer Dr. Elva Joson and DOH OIC-provincial officer Lilibeth Pabico.

Based on their accounts surrounding the island’s first COVID-19 case, the 63-year old female is a permanent resident of Japan who came home on March 5, 2020 purposely to attend the 95th birthday celebration of her father. At the time, no restriction had been imposed by the national government on travelers from Japan.

From the Ninoy Aquino International Airport, she traveled to Imus, Cavite where she presumably stayed with relatives and, on the following afternoon, boarded an airconditioned bus of the Bicol Isarog Transport System, Inc. bound for Tabaco City.

Arriving at the port city in the morning of March 7, the bus came aboard the 7 A.M. trip of the Calixta ferry, where she presumably stayed in the airconditioned cabin.

In Virac, the passenger alighted in front of Buddy’s Mami Haus at about 11:30 A.M. and proceeded to the family home, where the birthday party began immediately upon her arrival, with the festivities lasting until 5 P.M.

Three days later, on March 10, she began coughing and had a fever the next day. Although the fever disappeared on March 12, the cough and the sore throat remained, prompting her to voluntarily admit herself at the EBMC where she was placed in an isolation room after health personnel noted her travel history.

She reportedly told admission personnel that she wanted to make sure that family members, particularly her elderly father, would be safe.

Based on the case investigation conducted by the EBMC, the Provincial Epidemiology and Surveillance Unit (PESU) advised the hospital to take a nasal swab from Patient 1. Personnel in full Personal Protective Equipment (PPE) took the sample on March 13 and submitted the specimen to PESU, which sent it to the Research Institute for Tropical Medicine (RITM) in Mandaluyong City.

Meanwhile, the patient’s mild symptoms totally disappeared after just six days of confinement, with the hospital deciding to discharge her on March 18 with the instruction that she place herself under home quarantine pending the release of the testing result.

Responsibility over monitoring of the Person Under Investigation (PUI) was turned over to the Virac RHU, which sent an ambulance to bring her home, with its driver and accompanying nurse clad in full PPEs.

After the patient’s discharge, the hospital management ordered the health personnel who attended to her not to come home and immediately placed them under 14-day quarantine at the hospital.

None of the health personnel involved developed COVID-19 symptoms during the period and were allowed to return to work upon completing the quarantine on April 1.

On April 3, the result of the laboratory test done on the March 13 specimen returned from RITM with inconclusive results, as the swab did not contain sufficient material required for the test.

Inside the patient’s residential compound, she did not go out of her room at the back of the main house although health officials could not discount casual contact with the other six members of the family. One of them, reportedly a brother-in-law, regularly ventured out to do the marketing and buy essential goods and necessities.

During this period, Patient 1’s condition was monitored daily by a nurse hired by the DOH under the Human Resources for Health (HRH) program.

Following a directive from the Regional Epidemiology and Surveillance Unit (RESU) to conduct a repeat testing, two PPE-equipped personnel from the RHU went to the house to get a nasal swab, with the procedure probably irritating the patient’s nose and causing her to cough once.

When this specimen, sent to the Bicol Regional Diagnostic and Reference Laboratory (BRDRL) at the Bicol Regional Teaching and Training Hospital (BRTTH) in Legazpi City, came back positive, local health officials immediately ordered the strict home quarantine of the entire family.

They also validated the family member’s health condition and began tracing their contacts since the patient’s arrival in the country on March 5.

Even the HRH nurse who monitored her was told to isolate herself with her family at home as a precaution.

Based on various reports, Dr. Palmes said, there is no local transmission as far as Patient 1 is concerned but the situation of her contacts in Manila and Cavite will have to be checked.

She stressed that appropriate action being undertaken now will determine how long Catanduanes will remain under the Enhanced Community Quarantine (ECQ) which is supposed to be lifted on April 30.

Palmes appealed to the public to take seriously the measures being implemented by the government, expressing hope that the island would be able to maintain its being free of community transmission of COVID-19.

She urged them to stay at home and for PUIs to limit their contacts and inform their doctor once symptoms manifest.

For his part, Mayor Sinforoso Sarmiento Jr. said he and Dr. Joson will meet with the San Isidro Village barangay council headed by Chairman Rudy Tolentino and discuss initial actions to be taken.

The needs of the family will be bought through the barangay officials, he said, as he vowed to develop measures to resolve the situation quickly and satisfactorily. The total lockdown of any barangay will be carefully considered based on the advice of experts, Sarmiento added.

On the other hand, Dr. Joson said all contacts that will be traced will be monitored and placed in home quarantine if asymptomatic. If they manifest mild symptoms, she added, they will be taken to the isolation facility being set up at the Catanduanes National High School (CNHS).

The Tribune learned that a three-storey building inside CNHS is being converted to accommodate PUI’s with mild symptoms, courtesy of the Department of Public Works and Highways (DPWH)  Catanduanes Engineering District, the Provincial Environment and Natural Resources Office (PENRO), the Catanduanes Contractors Association and the Philippine Institute of Civil Engineers (PICE) Catanduanes Chapter.

Contacts who develop moderate or severe symptoms, particularly difficulty of breathing, will be taken straight to EBMC, Dr. Joson said, while senior citizens with pre-existing ailments who develop symptoms will also be hospitalized.

Any COVID-19 testing will be undertaken based on the priority determined by the DOH, she added.

The EBMC hospital chief disclosed during the meeting that the current admission protocol is being implemented due to the limited bed capacity of the provincial hospital as well as its lack of personnel, PPEs and equipment.

She suggested that Patient 1 be placed in isolation as the test showed she still has the coronavirus and continues to be infective.

Dr. Abella opined that securing blood plasma from the patient would be proper as it has yet to be determined if she has already produced antibodies to the virus and she may not be a good candidate for a plasma donation as she has other existing ailments.

The health officials averred that they could not discount that the patient was re-infected and that two subsequent negative tests are needed to declare her free of the virus.

We will do our best to monitor her condition, the RHU chief stated, saying that health personnel will respond if her symptoms return.

Meanwhile, Dr. Abella conveyed the EBMC’s readiness to accept and treat COVID-19 patients as the protocol is already in place, although the local health system is not 100% capable.

We have antibiotics but not the wide range of anti-virals being used by big Manila hospitals for the so-called shotgun treatments, she stressed.

Early intubation is not even suggested, Abella stated, with the hospital only needing to stockpile enough medical oxygen to be administered by mask.

The oxygen itself kills half the virus along with pPrompt intervention, she volunteered, noting that there is still no standard treatment for COVID-19.

She suggested that the public take Vitamin C 500mg capsule two times a day, 15 mg Zinc, enough sunshine exposure, as well as usual immune boosting measures like eight-hour sleep, rest, eight glasses of warm water daily, fruits and vegetables, moderate exercise of 15 minutes daily and proper precautions.

This unfortunate development unfolded just a few days after the provincial government denied reports that the island already had two COVID-19 cases, as these were confined in Metro Manila hospitals although the patients hailed from Virac and Panganiban towns. One of them died during the weekend.

As of Friday, April 17, 2020, Catanduanes had a total of eight (8) Persons Under Investigation (PUIs) and six of them were negative of the disease, the DOH-V case tracker showed.

However, it is claimed that 10 specimens have been sent by the PHO to two testing centers since the COVID-19 pandemic began in the country. Seven have allegedly returned with negative results while two more are pending completion at the Regional Inbstitute of Tropical Medicine (RITM) in Alabang.

The specimens of six of those who tested negative were examined at the Bicol Regional Diagnostic and Reference Laboratory (BRDRL). Two of the negatives have been discharged from a local hospital and are now in their own homes, according to Provincial Health Officer II Dr. Hazel Palmes.;

A source said that of the 10 specimens, three were from Baras, three from Virac, and one each from Pandan, San Andres, Bagamanoc and Viga. The two pending results are from Virac and Pandan.

It is claimed that as of last week, Catanduanes had a total of 5,093 Persons Under Monitoring (PUMs), with only 140 still to complete their 14-day quarantine.

The number of PUIs totaled 114, with only 15 being monitored. Virac and  Bagamanoc had the most PUIs with five each while Baras, Gigmoto, Pandan, Panganiban and Viga had one each, with Bato, Caramoran, San Andres and San Miguel with zero PUIs.

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