In Dinagat Islands, containment is key to coronavirus response
MANILA, Philippines – Dinagat Islands would rather be safe than sorry.
As early as February 4 or more than a month before local transmission of the novel coronavirus in the country was confirmed, Dinagat Islands put in place preventive measures against the novel coronavirus through an executive order.
As an island province still finding its footing, it focused more on prevention as it tried to nip the spread of the virus in the bud before it overburdened the provincial health care system.
An outbreak in the Dinagat Islands might spell trouble for the province. The Provincial Health Office (PHO) said the province only has 3 district hospitals scattered throughout its 7 municipalities, and that these are registered as infirmaries since they lack medical and nursing staff, and diagnostic facilities. There is also no accredited hospital in the province.
Found in the Caraga region, the province is also among the poorest in the Philippines, with 36.7% poverty incidence as of the first quarter of 2019. (READ: Kaka Bag-ao: Poverty, inequality are the 'enemies' in Dinagat Islands)
“Your response to a pandemic is as strong as your health system is, and ours isn't. Our 3 district hospitals only function as infirmaries. Of the 3, two have only one doctor each. We lack health human resources – physicians, nurses, midwives. We lack regular access to safe water. A large part of our population is poor, living hand-to-mouth. We can't handle an outbreak,” said Dr Jillian Francise Lee, a provincial health officer in Dinagat Islands.
With a population of over 127,400 people, the province’s first course of action in the face of an impending pandemic was screening and containment.
As of Monday, March 30, the province has no confirmed cases of coronavirus. While there are 892 persons under monitoring (PUM), Dinagat Islands recorded zero patients under investigation.
Keeping the coronavirus at bay
Since it’s an island province, people often head to Surigao City to embark on a one to two-hour trip to reach the ports of Dinagat Islands.
Following the executive order, the province set up a screening process in all main ports found in each of the 7 municipalities. Minor ports were closed and all commercial vessels were ordered to dock at the main ports.
Individuals who wanted to enter the island province had to answer a form to check if they had been to countries affected by coronavirus or interacted with anyone who went to such places for the past 14 days. They were also checked for symptoms of the coronavirus disease.
Those who answered yes to the questions were immediately declared as persons under monitoring. They were advised to undergo a 14-day home quarantine, where they would be regularly checked by personnel from the Rural Health Units, most of whom are part of the Doctors to the Barrios program, along with barangay health workers.
But since President Rodrigo Duterte ordered a lockdown on Luzon, many people in Metro Manila trickled to the provinces, triggering an exodus that brought some to Dinagat Islands.
On March 16, Dinagat Islands Governor Arlene “Kaka” Bag-ao issued an executive order that restricted tourists and vessels not registered in the 7 municipalities from entering the province.
“The advantage to being an island province is that you can still work on containment. If you work fast enough and well enough, you can contain the spread of the disease before it leads to an outbreak. But it's a community effort, not just a health concern,” said Lee.
As more cases of coronavirus swarmed several parts of the country, Duterte declared a state of public health emergency on March 8, which allowed local government units to mobilize necessary resources to combat the pandemic.
This prompted the provincial government of Dinagat Islands to make inter-agency guidelines on the prevention and containment of the disease on March 13, which sought to mobilize agencies including the province's information office, health office, disaster risk reduction and management office, the Philippine Coast Guard, and the Philippine Ports Authority.
These guidelines also reiterated national directives from various agencies such as suspension of classes and graduation rites, and application of alternative work arrangements. Regulations and processes of the PHO on how to respond to the outbreak were included as well.
Monitoring teams with representatives from law enforcement, the provincial government, and national agencies were also set up to collaborate with the Municipal Price Coordinating Board to prevent hoarding and overpricing. They were tasked to check availability and prices of basic goods in the province.
Fighting fear with facts
Among the priorities listed in the guidelines was the dissemination of verified information about the coronavirus to raise public consciousness, with the help of the PHO.
This included debunking claims about Dinagat Islands placed under lockdown, releasing fact checking hotlines, translating infographics to Bisaya, posting reminders about how to stay safe, and even simplifying terms and concepts such as person under monitoring.
For instance, the Dinagat Islands Provincial Information Office calls those who finished their 14-day home quarantine as PUM graduates, which they mention in their daily updates.
Caring for the community
To avoid confusion among the local governments, Bag-ao issued another executive order that sought to standardize all preventive measures across all municipalities of the province.
This included uniform rules on curfew hours, automatic quarantine of people coming from outside the province, and continuation of public transportation as long as the driver and passengers wear face masks, among others.
The new EO also mandated the creation of Municipal Care and Containment Centers, which will house and take care of remaining PUMs who show symptoms regardless of travel or exposure history and all individuals who enter Dinagat Islands for 14 days.
“Most of our work is not in our hospitals, but in our communities. We're focusing on containment.... Our goal is to prevent new arrivals and anyone else who could possibly be carrying the disease from spreading it around. Without testing, we have to rely on symptoms and exposure history,” said Lee.
“People worry, of course, because it isn't just those under home quarantine whose lives are affected. Limited trips to Surigao City means limited commerce, less income for port laborers and drivers and boat crew, more difficulty in purchasing supplies for sari-sari stores,” she added.
To help ease this transition, barangay and municipal local government units are providing persons in home quarantine with in-kind assistance, since they could neither work nor buy food.
Aside from screening and community support, the Province Health Office has a system in place for coronavirus patients.
Because Dinagat Islands’ hospitals would not be able to properly handle coronavirus patients, the provincial govenment has a working service delivery network and referral system with the Caraga Regional Hospital (CRH) in Surigao, which is the region's apex referral center.
There are also land and sea transport vehicles for patients suspected to have COVID-19, and who may require hospital admission to CRH.
The CRH, however, isn’t equipped with a laboratory that can test for the coronavirus disease. Samples collected at the CRH will be sent for processing to the Southern Philippines Medical Center in Davao City, which is 12 hours away.
So far, Dinagat Islands has not used this system yet because of its zero coronavirus cases.
“Hopefully, we can keep this up until the COVID-19 outbreak is quelled worldwide,” said provincial information officer Jeff Crisostomo. – Rappler.com