From the Office of Dean Charlotte Chiong: UP College of Medicine

April 11, 2020

From the Office of the Dean:

BAYANIHAN: The Spirit of the Filipino Comes Alive During the COVID-19 Pandemic

COVID-19 came to Philippine shores with news of a 38-year old woman who traveled from Wuhan along with her husband who eventually was also diagnosed with the virus and was the first reported mortality. From this initial report on January 30, 2020, the first reported local transmission was documented on March 7, 2020, in a Filipino again with both husband and wife being infected but with no history of travel abroad but the man frequented a mosque in a popular shopping area. There have been subsequent reports of several people being infected suggesting a cluster such that this mosque had to be closed and disinfected along with the whole shopping area. As of this writing, a phone app run by the DOH (Department of Health) (DOH PH COVID-19) with 1.3M subscribers reported on 10 April 2020 (about 33 days post first local transmission) a total of 4195 COVID-19 cases in the country, 221 mortalities, and 140 recoveries. It should be noted that the Commission on Higher Education (CHED) in order to mitigate and suppress the spread of the virus ordered a suspension of classes on 11 March 2020 which included the postgraduate year (PGY) 1 interns and in our case the Level Unit 7 interns (senior year medical students). Within 24 hours of this declaration 130 of our interns in our 1500 bed national university hospital, the Philippine General Hospital (PGH) volunteered to stay. They were assigned in less risky areas of the hospital to assist in the work of residents who will now man the frontlines. Two weeks later, UP Manila Chancellor Carmencita Padilla opened the UP Manila Bayanihan Na Operations Center where the volunteer interns entertained questions from the public with a hotline 155200 provided by the telco PLDT (Philippine Long Distance Telephone Company led by President Manuel V. Pangilinan). On March 14, 2020, the DOH with the support of the National Government imposed a community quarantine or lockdown with the closure of schools, malls, and physical or social distancing measures and all foreigners were given until March 16, 2020, to leave the country. Filipinos working in Wuhan were repatriated and quarantined for 14 days at the Clark City’s Athlete’s Village, the site of the last Southeast Asia Games held last November 2019 and where a satellite clinic is run by the PGH. For universities and schools, there was a sudden shift to alternative learning schemes. The University of the Philippines College of Medicine (UPCM) survey showed 30-50 percent of the medical students in our college did not have stable internet service so, in the spirit of equitable access to learning sessions, online classes and evaluations were given but made non-mandatory. Reading assignments and non-graded self- assessments, a video demonstration of clinical skills and other forms of a video-return demo for all the courses became the norm. There was a sudden rise in the blended learning modules with UP Manila’s Virtual Learning Environment (UPMVLE Learning Platform) showing that all courses for medical students could be accessible 24/7. The PANOPTO software that we obtained for the college in October was a big help. It is clear that the challenges of UPCM could not have just revolved around ensuring continuing education for its students. Our faculty members particularly in Internal Medicine, Infectious Diseases, Pulmonary Medicine, Anesthesiology, Family Medicine, Emergency Medicine, and even Otolaryngology were particularly at higher risk among all medical professionals. Sadly, we have even lost a number of our alumni and revered faculty members in this fight against COVID-19.

This battle even became more crucial when the bigger private hospitals could no longer cope with the number of COVID-19 patients and PUIs (Persons Under Investigation) that flocked to their emergency rooms. The private hospitals put out a position paper asking the government and the DOH to assign COVID-19 referral hospitals other than the two previously considered referral hospitals for infectious diseases (Research Institute of Tropical Medicine and San Lazaro Hospital) to be identified. Led by its

Neurosurgeon Director, Dr. Gerardo Legaspi, the PGH true to its moniker of “People Giving Hope” was chosen to be one of three COVID-19 referral hospitals in Metro Manila, which had a population of 13 million. Our hospital’s architectural design has not changed much from its 1910 opening where an open pavilion design was utilized as a way of ensuring infection control in a tropical climate. Four wards had to be transformed by one of the most reputable construction companies in charge of building the 11 story UPCM- Henry Sy Sr. Medical Sciences Building, DMCI (David M. Consunji, Inc) to “negative pressure” wards with the installation of blowers and enclosures boarding up these wards and installing Hepa filters and isolating these “HOT COVID-19” zones from the rest of the hospital. The front liners in the hospitals were provided hotel accommodation gratis by hotel establishments and the city government as well as van or shuttle service to bring them to and from the hospital. Part of the decision to declare it a referral hospital for COVID-19 also emanated from the early response of the UP Manila (University of the Philippines Manila) National Institutes of Health (NIH) after the publication of the whole genome sequence of SarsCov2. An RTPCR test (GenAmplify) was developed by UPM-NIH scientists led by Dr. Raul Destura and now manufactured by Manila Health Tek, Inc. with funding coming from the Department of Science and Technology and this was validated and finally approved by the FDA on April 3. This is now under field implementation and two laboratories both within PGH and the NIH are now being capacitated to be able to process 2000 samples daily from a baseline of 130 at the start of the pandemic. This will also be timely in utilizing about 20,000 A*STAR Fortitude kits donated to the University hospital by private company Monde Nissin with its president Henry Soesanto and General Counsel Atty. Helen Tiu. Some of our faculty members have been serving in the Technical working groups for the IATF (Inter-Agency Task Force) that was convened to tackle the pandemic. Some have taken charge of a command center (Head: Dr. Anthony Perez) for donations of PPEs and ventilators to PGH.

Our college (thru Dr. Ana Melissa Hilvano-Cabungcal ) participated in putting out a position paper recommending a ‘whole of society’ approach pushing for grassroots and community-based intervention knowing fully well that the battlefront in the hospital should be ameliorated dramatically with strict quarantine measures, isolation of symptomatic patients in community isolation hubs while not ignoring the need for food, shelter services to be extended to urban poor communities.

As I write this, there are three mega isolation facilities (World Trade Center, PICC, and Rizal Coliseum) that can each accommodate 150 Persons with mild symptoms of COVID-19 being constructed and soon to be handled by military doctors and partner hospitals. The economic measures to mitigate the effects of this pandemic, the support for the movement of essential goods and manpower to service the population needs were put in place with inputs from scientists from different institutes like the Asian Institute of Management along with epidemiology experts from UPCM. Our own UP Medical Foundation in partnership with TOWNS (Ten Outstanding Women of the New Society, Inc.) raised more than PHP 37 Million pesos for the procurement and distribution of more than 500,000 PPEs. The dire lack of personal protective equipment at the start of the pandemic was met by engineers pooling together their 3D printers to make face shields, and design of ventilators from open source as well as patented designs of neonatal ventilators (Ostreavent) for modification into adult ventilators, decontamination and disinfection as well as telemetry with the repurposing of the RxBox (developed by the National Telehealth Center, UP-NIH led by Dr. Portia Marcelo with Prof. Luis Sison of Electronics and Engineering Institute of UP Diliman). This device that was used for Maternal and Child Health community clinics are now being deployed for use in isolation rooms at the Philippine General Hospital. The collaboration of engineers with clinicians under the UP College of Medicine SIBOL (Surgical Innovation and Biotechnology) set up in 2019 that received an initial PHP 30 Million from PCHRD (Philippine Council for Health Research Development) was instrumental in mounting over the weekend of March 20-21, a SIBOL COVID-19 response team (with Project leader Dr. Edward Wang) and well over ten projects (PPEs, telemetry, tracking and decontamination) are soon to receive additional funding from DOST-PCHRD along with ten other projects undertaken with the UP College of Engineering (under Dean Ferdie Manegdeg) being fully funded by the UPERDFI (UP Engineering Research and Development Foundation headed by its President Rico Trinidad) with about PhP 3.5 Million from 87 donors.

The University President Danilo Concepcion recently issued an administrative order dated March 3, 2020, creating a Collaborative Research Structure between the two constituent universities UP Diliman and UP Manila to provide a stronger framework by which cooperation and collaboration can be fostered as a culture in science, discovery and innovation for the public good. The university’s COVID-19 research team led by Drs. Marissa Alejandria and Aileen Wang have identified and prepared many projects with multidisciplinary teams of microbiologists, virologists, data scientists, social scientists, epidemiologists, MD-PhD students, and clinical experts and also pushed for the country’s inclusion as part of the WHO Solidarity Trial thus gaining access to some of the unavailable therapies like remdesivir (from the U.S.) and favipiravir (Avigan from Japan). Among these studies were the use of convalescent plasma therapy for patients in which a classroom at Paz Mendoza has now been converted for the donation from COVID-19 survivors. This pandemic served as the inflection point and catalyst for this “bayanihan” spirit to prevail and in true Filipino fashion not only in the local but global arena (with organizations like the Philippine American Association of Scientists and Engineers and the UP Medical Alumni Society of America) in a climate for compassionate care driven by highest scientific evidence and not unduly restricted by a litigious society mostly encountered in other countries. The creativity and ingenuity of the Filipino have indeed come to fore in this global pandemic crisis

My gratitude goes to the members of the Dean’s Management Team who all have helped and continue to help the college in countless ways. Thanks also to our alumni and friends of the college who have been most willing to extend their much-needed help during this difficult time.

Charlotte M. Chiong, MD Ph.D.

Professor and Dean

UP College of Medicine