No new COVID-19 cases for almost a week: How Mandaue City did it

For almost a week, Mandaue City recorded no new coronavirus cases from November 28 to December 3. This was a milestone for one of the 3 biggest cities in Cebu.

The number of active COVID-19 cases continues to drop. From around 100 active cases in October, Mandaue City, an industrial and highly-urbanized city of over 350,000 people, now has less than 50.

This is vastly different from the situation in early July, when the city had a positivity rate of 34.5% – its highest in data recorded by the Department of Health for the region at the time. This was a higher rate than what local government units (LGUs) in Metro Manila were recording then.

The World Health Organization considers a positivity rate below 5% as an indicator of a pandemic under control in any locality.

From July 1 to 15, Mandaue City recorded approximately 35 new positive cases on average per day. This was at the same time that neighboring Cebu City was called the “second epicenter” of the COVID-19 outbreak in the country.

While President Rodrigo Duterte sent Environment Secretary Roy Cimatu to help contain the outbreak in Cebu City, Mandaue began to work in parallel – also with the input of the national Inter-Agency Task Force on Emerging Infectious Diseases – to bring down the positivity rate and cases in their own LGU.

By August, the city government had managed to “downturn the curve” with a 9.53% positivity rate. From August 1 to 15, there were only 12 new positive cases on average per day.

Today, Mandaue City’s positivity rate stands at 2.38%. As of the second half of November, the daily average was at 5 new cases. It is expected to drop in December.

The low number of cases is reflected in the occupancy rates of the city’s isolation beds.

According to data from the Department of Health (DOH)-Central Visayas Region, only 33 out of 178 intensive care unit, ward, and isolation beds are currently being occupied. This means bed occupancy is at around 18.5%, significantly under the 70% danger zone – a sign that the pandemic is already getting out of control.

How did the cases go down?

Like any city that manages its pandemic well, Mandaue City has free testing available for residents at two sites: At Norkis Park near the Mandaue City Hospital and at the San Roque Gym in Barangay Subangdaku.

But beyond testing, tracing and isolating, the city believes dedicating a department solely to COVID was important in flattening the curve.

Before August, Mandaue City’s pandemic response relied solely on the management of contact tracing, patient monitoring, and data gathering efforts of the Mandaue City Health Office (MCHO). It was during this time that the MCHO was considered the “lead office” for all things COVID-related.

“By default, doctors would be in the lead, so City Health. However, somewhere along the way they realized it couldn’t be managed alone. City Health realized they were undermanned,” Emergency Operations Center head August Lizer M. Malate said in a mix of Cebuano and English.

Malate was initially the Business Permit and Licensing Office Department head. In late July, Mandaue City Mayor Jonas Cortes appointed him to work in the Local Task Force-Emergency Operations Center (EOC) as its new chief. There, he would implement what he calls “the city’s best COVID-19 response practices.”

This had been among the efforts of the city government to change strategy in handling the COVID-19 spread within city borders – shifting the lead from the city health office to the EOC.

Malate’s rationale was simple: a healthcare solution equals an economic solution. This later developed into a plan that would restructure the city’s pandemic response and automate as many parts of the LGU’s operations as it could.

Changing COVID-19 organizational structure

In a meeting arranged by Cimatu, the EOCs of Cebu’s highly-urbanized cities were told to reorganize the structure of their COVID-19 response.

The EOC created an independent team of responders whose primary focus would be pandemic response, outside the executive branch of the LGU. According to Cimatu, this would depoliticize the LGU’s coronavirus response.

For Mandaue City, this was done by first making the EOC the lead task force for pandemic response, and then separating it from the city’s more general response clusters (e.g., city health office, disaster risk management office, public information office).

“Since focused na ang EOC, purely COVID ra iyaha [priority]. Kay if imu na isagol sa day-to-day nga operations of the [government], dili siya ma-prioritize,” said Malate in an interview.

(Since EOC is focused, it’s [priority] became purely COVID. If it would be mixed with the day-to-day operations of the [government] then COVID wouldn’t be prioritized.)

What followed was the creation of specific teams under the EOC, such as contact tracing teams and data management teams that handle the data validation and surveillance of COVID-19 patients and probable carriers.

“We augmented our personnel and hired many contractuals for the sole purpose of focusing on this,” he added.

In August, Mandaue City had opened its contact-tracing center which started with about 50 contact-tracing personnel. The new facility was built at the former computer laboratory of the Mandaue City Public Library. (READ: Mandaue City opens contact tracing center)

Today, the city government has a total of 317 contact tracers. According to Mandaue City public information officer and executive secretary John Eddu Ibañez, 275 of the contact tracers are paid by the Department of the Interior and Local Government but are supervised by the city. The remaining 42 are under the payroll of Mandaue City.

“The key jud is the constant teamwork and close coordination sa teams na nagtutok karon sa COVID response sa Mandaue City,” said Karlo Cabahug, head of Mandaue City’s diagnostics and testing team.

(The key is constant teamwork and close coordination of teams that are focused on the COVID response of Mandaue City.)

Malate believes this eventually brought out confidence in governance among businesses and the public, leading to strengthened cooperation in all sectors of the city.

To push this, Malate said policymaking also needed to improve, which meant the city needed better data management.

Better data management

“If you have accurate real-time data, you make proper decision-making and policy and it gives you foresight,” said Malate.

This was the second practice that Mandaue City put in place which involved precise data gathering, expansion of surveillance, and even better data validation.

Malate explained that the translation of reports into numerical data proved useful in the creation of quarantine policies within the city. Data from the barangays and sitios to more industrial parts of the city were to be used to craft recommendations that would determine how the teams must operate.

These recommendations also helped create policies for businesses to return and operate safely within the city. Under Mandaue City’s EO No. 83 of 2020, businesses were allowed to return under IATF’s contact-tracing guide and allowed to apply for a mayor’s special permit to operate.

Under the city’s data management team, a data validation unit ensures that data submitted to the DOH in Central Visayas shows accurate counts.

“Our data now is corresponding with the data from DOH because now we have a dedicated management team for that,” he added.

Citizen and LGU cooperation

Malate said these practices paved the way for smoother operations for businesses. They also engendered trust between the LGU and the public which led to the gradual flattening of Mandaue City’s pandemic curve.

He noted how the consistency of the policies would not have been effective in flattening the curve if people did not cooperate. He said that if there was anyone to credit for almost a week without new cases, it would be the combined efforts of the Mandauehanons.

The city’s EOC chief said that while there were a few “stubborn” individuals who were caught violating quarantine rules, a majority of citizens cooperate and follow protocols.

Malate said that while they are confident about how they are managing the pandemic in Mandaue, they cannot promise the virus would be completely eliminated.

“The pandemic is volatile so we can’t confidently say anything is for sure. Even with having 6 days of no new confirmed cases, the seventh day still turned out with one,” he said.

“You can be zero now but you could be a hundred later on.”

He believes, however, that with the right set of data, consistent health policies and rigorous evaluation of its pandemic management, Mandaue City would be ready to contain any possible surges. – Rappler.com