No need to buy meds vs swine flu, says Duque

Health Secretary Francisco Duque III and Inquirer columnist Neal Cruz
Let government do its job, Health Secretary Francisco Duque III said in a press conference Monday (May 3) at the Manila Hotel, when asked about people buying Tamiflu, the drug against the new swine flu virus.
The government has enough supplies at the moment, Duque said, and will make these available for free to those who do get infected with AH1N1, the new swine flu virus. Also, the Tamilfu now in the country expires in November.

Duque: hog industry suffering reduction in sales because of the misnomer…what we have done…decided lines of defense against the ah1n1, already the new and official nomenclature as released by who. For purposes of proper naming the virus, let’s confine ourselves to use…stepping up screening and quarantine measures in all entry points as well as coordinating with affected countries where people can be traveling out and into…kailangan binabantayan. Thermal scanning, everybody subjected, no exemption…temperature higher than 36.5. We isolate you, nicely, we give you two yellow forms, one health alert to more or less inform inbound traveller of what to expect especially if came from infected country. Within 10 days of arrival, have to monitor for possible development of symptoms…influenza like symptoms plus diarrhea and vomiting. Reports that diarrhea and vomiting are part of symptomatology. The second yellow form is the health declaration check list, series of questions where you came from, who are with you, contacts you had, purpose of travel…airports and seaports…process flow…shows what steps are being taken by bureau of quarantine…no fever, only give two yellow forms. Talk to you a bit, essentially allowed to go. If you are positive in scan, they isolate you, evaluate your condition, classify as suspect or would be case under investigation. If index of suspicion is high, bring to ritm for more comprehensive evaluation treatment and management. Second is enhanced disease surveillance, second of 7 lines of defense. Our sentinel sites, designated hospitals of doh will report incidents or increasing incidents of influenza like illnesses plus unusual or strange occurrence of deaths due to acute respiratory illness. Down to provicial level are doing this to report to central office. Advocacy campaign for personal preventive measures. Social distancing, proper coughing…number five if infection control thru use of personal protective equipment like masks, caps, gowwns, gloves, slippers.
Prioritizing health workers who will be taking care of people suffering from illness. Sixth would be gov’t would not hesitate to use state powers to ensure there is no breakdown of law, peace and order.
Services of police and military will be made available for efficient and immediate delivery of areas affected. We make sure we do everything to maintain peace and order, no lawlessless, all systems in place and unhampered in implementation and execution. Lastly if we do have mass casualties, ensure quick burial…these are seven points or aspect of our defense system.

(wake…where people view…would that increase risk of spreading) kung maraming tao, proven..you would know in area who has it…still, should maintain reasonable distance… (people go to casket to look) corpse will not…patay na…virus, bacteria, lahat na…wala nang pagkakabuhayan…mas nakakatakot yung nakatayong kalinya ninyo.

(mrt, lrt crowded everyday…that is dangerous) certainly. (what can we do about it) important that point of entry aggressive screening. Prevent entry. Once it’s there, even who has ruled, beyond containment…waste of time trying to contain once it’s already there. Idea is seal off while early.

(lot of Filipinos went to las vegas to watch pacquiao fight…will quarantine congressmen) I think that was a misappreciattion of facts…asked by one how we would treat the case of these congressmen who will be arriving from an affected country and estate…nobody is exempted from quarantine measures. Spectrum of activities, to begin with, normal scanning, followed by provision of health alert notice and declaration check list. Thermal scanning, hassle-free, everybody walks through that’s the time we isolate them…more thorough evaluation, send to ritm…to help everyone and give necessary cure and care that everybody…deservees to be given…bounden duty to provide those needed services. There should be no malice…positioned as if they were attributing….only they would be subjected to quqarantine measures and thermal scanner…nobody’s exempted…our duty to protect public health. Not do to demonize anyone. Not our objective and what we want to ensure is put in place necessary measures….health declaration checklist, address is there, name, we keep in touch with this passenger.

(symptoms of swine flu and ordinary flu are similar) very similar except in this case you also have diarrhea and vomiting. Saka itong flu na ito mabilis. Bakit sa mexico people die and in US you have just one? A child from mexico. They’re trying to understand, nobody can come up with conclusions just yet…

The numbers we have to remember are following: the doh hotlines are 7111001, 711, 1002. National epidemiology center of doh, 0632-743197. Bureau of quarantine, 06323019100 local 17. Designated hospital, ritm – 807 2628 up to 232, 8097599. San lazaro hospital 7323776 up to 78. Lung center. 92406101.

(among places to get virus is infected countries…airline where you arrive…would the doh issue statement discouraging Filipinos from traveling at this time so as not to get virus and spread it here when they come back) we are informing the general public to forgo plans of travel especially to countries where there are proof of human to human transmission. Unless question of life and death, may want to reschedule. We already released statement ot discourage Filipinos from going to countries, no tjust countries with human to human trnasmission, butl ike hongkong…just limit shopping to local tiange or divisoria.

(what about tourists coming in) tourists we have to sit down with dot to tell them that tourists in the meantime coming from affected countries should be dissuaded through diplomatic channels quarantine measures put in place…subject tourists to such…allowed to go on with visit or tourist activities…

(instructions to consular officers in affected countries) for affected…Mukhang mahirap…at this point it hink we have to respect some bilateral or diplomatic agreemetns bet countries. What I have done was talk to Mexican embassy last Tuesday…told him to dissuade people from getting out of mexico and going to different destinations. Might ask for spread…asked for visas of Filipinos…

(pal has promo for Filipinos who want to go to California, have discounted rates. A lot of people are going there…very cheap…going to California…just across border to mexico) I think not just pal but many airlines have resorted to discounted airfares. Like serpent tempting eve have to make sure risks…no amount of discounted fare will neutralize that risk. Let us not be tempted by this icing of discounted airfares.

(china has closed doors to Mexican travellers. See that in near future) it’s a possibility but not probable at this point. Not yet. Mexico has shut down the entire country, we should respect the action of the sovereign state.

(virus has spread outside of mexico…us has one of the most popular destination for Filipinos…risk of carrying virus) if we shut our doors to one country…other countries are also affected, cannot isolate us. Not possible for obvious reasons. We have to continue holding dialogues with our counterparts…one objective in chairing plus health ministers meeting in Bangkok…we want ot be hyper protective, but you have to have sense of balance in implementing all these measuers. You cannot be isolationist.

(pistachio, dengue) just gave instructions…so preoccupied with this ah1n1 we might miss what ought ot be done in our campaign to prevent upsurge of dengue. Told our people to make sure our measures are given prominence…commercials put in place especially in regions where relatively increase of dengue. Not remiss in our duties to address public health threats and emergencies.

(if virus…enters rp, metro manila will be shut down) off the cuff statement from ndcc…because mexico city did exactly just that. Business temporarily suspended, public places shut close, certain usual day to day activities restricted…incubation three to five days, symptoms manifest 7 to 10 days in all.

(how many courses of tamiflu are you planning to import) level is 600,000 capsules good for 60,000 cases. Ndcc, resolved to bring it up to 1m capsules good for 100,000 cases. That should be baseline stockpile level.

(bulk of stocks expire in 2009. Good for another year?) some this year some 2010 and 2011. That was validated by bfad, what we did in those expiring this may and june, requested supplier and manufacturer to conduct stability study…showing they’re good 93-98% at that level. Had bfad validate…extendible by 36-40 months.

(all other countries are stockpiling) that’s also one of items in agenda for asean ministers’ meeting on thursday.

(enough supply for whole world) that’s why suppliers are in mad rush to manufacture as much as they can. But given number of cases heard so far, ucrrent stockpile more than enough. Have to take within three days, 48-72 hours. Have to stop after five days, that is the extent to which the drug beyond that is useless. Within 48-72 hours, you don’t want to wait until the virus repelciates and induces overwhelming viral load into body so tamivil is rendered inutile or useless.

(dragon air kair 912 not sanitized, co passengers not put under quarantine) standard operating procedure once there is person that has been isolated brought to ritm automatic probable case, person who manifest influenza like illness, upon lab testing showed positive influenza type a plus non sub typable components of virus. Cdc, japan or Australia…evaluate at entry ponit, tonsils, see if other causes might be responsibe for symptoms…have to get whole report…

(quarantine officer while interviewing passenger was not wearing mask) look into that. Have it investigated as soon as possible.

Iloilo: community acquired pneumonia…transfer patient to ritm..case under investigated, eventually discharged because suffering from usual human influenza virus. Only two we have seen…plus this one makes it third but want to scrutinize report more closely.

(private hospitals properly instructed on what to do) their capacities are being developed but at policy level agreed private hospitals will refer immediately to doh hospitals in meantime. Next week we hope capacitation already there at level of private hospitals. Ngayon hanggang hinahanda…

(enough facilities) yes of course we do. Like in dengue, enough facilities. Just that people do not heed advice to bring patient immediately to hospital…almost always too late. Dengue, once entered phase of dengue hemorrhagic shock syndrome, you’re a goner. Our facilites are okay. There is a cure for the virus, which is the ozeltamivir and relenza.

(vacciantion of travelers) vaccination against swine flu in pigs and usual ordinary flu…some people are…one say not necessary because not hitting the same virus so waste of resources. The other school of thought don’t discourage…because there are four viruses reassorting to produce one deadly virus…human, avian, and two pig viruses. If you vaccinate against two and one against human, reassortment probability is dimished. That is the rationale…they don’t encourage either because spending so much resources…there might not be adequate supply…in touch with bai… catbagan…really inclined to pursue vaccination of swine population against classical swine flu. No classical swine flu outbreak in phil pig population.

(what will tackle in asean meeting, what can learn from phil experience in avian flu and sars) meeting on thurs discuss and deliberate on individual countries’ pandemic flu preparedness and action plans. Compare notes, see which one is doing what…might be able to come to agreement to share our resources as well. Japan, sk, china are there. Might be in position to give support to countries…to come up with very good pandemic action plan…

(how many days will the alert be…everybody can ease up and feel safe) situation continues to evolve. Just have to be…to adapt, not just adapt but to be ten steps ahead on how situation evolving…firm up response plan and execution must be crisp, very very efficient and well targeted. Who is always there to give us advice…implementing agencies under doh…thoroughly discussing situation…even doh sometimes not sure what direction this virus is pursuing.

(why of all diseases it is the flu that is most dangerous) because of its ability…very easy to spread, one of the most efficiently transmitted scourge, not need vector like dengue..this one straight, direct contact…flu virus is not, but dengue is also a virus…

Ndcc has approved this and we see no problem because even pres herself initially instructed us to buy P10m additional…additional 200 or 300k more after 10m will certainly pose no problem already put in place a distribution pipeline…regional, hospital distribution points..down to the lgu level. For the meantime our policy position is to centralize so we have control…we are taking stock of which hospitals have capacity to provide proper treatment and services, and pressurized chamber…most of tamiflu donated, some P10m from rouche international. Oseltamivir. Even those about to expire, give it to us we will take them.

Ordinarily six months (expiration date of drugs) but we don’t supportt that as matter of policy. Then people will dump expired drugs in rp becomes problem if we make it as policy. Procurements have to have 28 mos shelf life.

Dengue is a danger as it has always been. Especially on account of climate change, incidents of dengue has tremendously increased. Typhoid,cholera, whose incidents…more pronounced because of climate change. There is association.

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2 Responses

  1. Nice piece,well done!

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