DOH admits “low level community outbreak” of A(H1N1) in Metro Manila

There is a “low level community outbreak” in some parts of Metro Manila, the health department said Tuesday, as it reported that there are now 473 cases of Influenza A(H1N1) in the country. Health Secretary Francisco Duque III however did not specify which areas in Metro Manila have a “low level community outbreak.”

The DOH had earlier said that Quezon City had the most number of cases in Metro Manila. Given the number of schools in Manila reporting cases of Influenza A(H1N1), however, those stats could well have changed.

There are probably cases of third generation transmission, the authorities said, adding that it would be hard to determine exactly which of the cases reported so far would be second or third generation.

They refused to say, however, that there is a community outbreak in the whole of Metro Manila, insisting that the numbers are low compared to the population and the number of schools in the metropolis.

Twenty-two schools have reported cases of Influenza A(H1N1), and the third generation transmission would probably be in some of those schools.

The rate of transmission, the health department said, is faster than health personnel can trace those who have been infected.
A first generation transmission would be someone who got it from abroad, since the virus came from outside the country. If the first person infects someone else, that would be a second generation transmission; a third generation is when that second person infects another person.

Meanwhile, only the Medical City is so far capable of testing for A(H1N1). All other hospitals take throat swabs and send these to the RITM, which does the final confirmation for all tests.

RITM Director Dr. Olveda said the test would cost P4,000; it could be higher in private hospitals, because they’ll be adding “handling fees” for taking the throat swab and sending the sample to the RITM.

The symptoms of H1N1 are the same as the symptoms of seasonal flu — cold, fever, cough. Some patients had vomiting and diarrhea, but not all. The only way a person could know for sure if one has H1N1 is to undergo a laboratory test.
The quarantine period for those who suspect they might have A(H1N1) is ten days.

The World Health Organization (WHO) had earlier warned there might be asymptomatic cases — people who have the virus but have no fever or other symptoms of a flu-like illness.

Meanwhile, the best thing to do is to behave as if you’re moving through a crowd of people with sore eyes — don’t touch them, and if you do, wash your hands before touching your face.

Again, here are my notes on the press conference the DOH held today. I’m putting them online to give people an idea of how the DOH discusses developments on A(H1N1) with the press, as well as to make available some little details that weren’t important enough to be included in a news story.

One example is the concern about the high-risk groups: the DOH had repeatedly warned those with underlying medical conditions to check with their doctors if they get symptoms of flu. The warnings were made early enough, but it was just one line in a story until a woman with a chronic heart disease died…and turned out to be positive for A(H1N1) as well.

DOH PRESSER:

Good for ah1n1 information campaign and we at doh are glad we have this partnership…Mondays to Friday, 8am to 5pm. Doh will be providing contents that smart will give its subscribers. Given them all relevant info vis a vis novel virus that they will need…will be ones manning hotline…tougher questions, refer callers to doh open. (health info center)…text messaging solution…info on ah1n1 can soon be accessible through texting.

26 more ah1n1 cases fully recovered. 85% of all confirmed cases since may21. There are 28 more confirmed mild cases of virus in country, total of 473 cases. The 28 new cases, 16 males 12 females, 7months to 49 years old with 19 years of age as median. All Filipinos with no history of travel to an affected country. Only one death reported. All contacts being monitored and now in quarantine.

We’re approaching 50% threshold (of countries worldwide).

(how many members of household) five.

Marami naman tayong history of travel but history of exposure to people confirmed…meron na tayong third gen transmission in manila…low level community outbreak in metro manila. Schools…other schools that have been reported might have extended all the way beyond second generation…

Mon isberto: healthwatch hotline…700 doh…tawag we apply the normal call rates. Public service hotline, unless we put some kind of tariff, swamped by prank calls. Imperfect filtering mechanism but only mechanism we have right now. 117, when there were no tariffs, prank calls about 97%. We’re imposing normal coverage…for sms one peso per send. 155- P6.50 per minute.
There is…hard for us to differentiate right if you’re calling hotline or charging service. Only reason why we’re imposing this is to screen out prank calls.

Duque: but perception is you might be viewed negatively…and misrepresenting products as if they are cure…you might be put in that situation…farthest from your objective…if able to give discount, shows sincerity to help in doh public info campaign and truly become public service…becomes corporate social responsibility.

Mon: will work on that.

Duque: there is commitment. Pero kung mapapalibre mo mas magaling.

Mon: we’ll work on that…

Duque: even assuming you have prank calls but bottomline…those prank calls are easily absorbed by huge margins you have made. Tomorrow morning, globe will be here, giving it for free. 38 million subscribers. Talk, smart and talk and text.

Mon: system must be able to distinguish whether you’re calling normal number or this number….people who need to call hotline, hindi na makapasok. Because the lines are being used by people who are making prank calls.
(how long last) habang may h1n1. If there are other situations like dengue, we will work with doh to make available basic information.

(areas with low level community transmission) numbers wise and percentages, not alarming..22 schools are affected but looking at total number, anywhere 40 to 60,000 schools. 22 schools affected miniscule percent of total number…total number of persons affected very small compared to total population….rate of detection may not be as quick or as fast as rate of spread of virus. Already known in us where us cdc has conceded rate of detection cannot keep up with rate of transmission.

25% projection rate…much much less rate of transmission. We don’t have specific data but we feel rate of transmission can be likened to seasonal influenza…one in five or twenty percent…in community at large…seven to ten percent. That’s what I think is the data insofar as seasonal influenza concerned.

Where the schools are, and where you already have school community transmission…limited numbers, low level human to human transmission…at first…noong nag cuos 10-15% turned positive but increased over time. More cuos that actually got ill were increasing number of confirmed cases.

(policy in hospital handling or admitting cases…some claim they’re capable of testing…accreditation system) ritm only one authorized to do testing and confirmation…but cannot take result as official…only becomes official once confirmed by ritm…

(how public can be assured) that’s part of our guidelines.

Villaverde: only confirmatory laboratory is ritm and we have interim guideline no.3 is the one related to lab diagnosis. Details will be there. Don’t think there are other hospitals except the ones we are now starting to have the capability which is Vicente sotto and san lazaro hospital to back up current load of ritm

(no private hospital capable) duque: meron capacity ang iba like medical city…not sure in makati med…pgh…readying…medical city already has…but it needs confirmatory testing by ritm.

(doh will allow private hospitals who have capability to test) we should because if we’re expecting more cases, overburden limited capacities of ritm…good to expand testing capacities not only public sector but also private…ritm began coordination with private testing centers. Has to make sure testing has level of confidence acceptable to ritm.

Three to four weeks before we see the final pattern or trend.

(house announced one of their employees was the one who died) duque: a ganun? The contact tracing has been started since the other night, all the contacts am sure our investigating team is carrying out contact tracing also to work place contacts. (house pinauwi ang mga tao, will test all employees) that is unnecessary. Why do you want to do that? I will talk to leaders of the house. I already spoke to him, this morning.

(closing offices for one week. Is that recommended) no that’s not recommended, you’re assuming that one patient had contacts with majority of people there, which is not the case. Just reiterate our current guidelines…hope the lower house of congress will look into these guidelines and make sure that those guidelines are followed. Otherwise there might be unnecessary effort to do what they want to do, not necessary, might be construed, going beyond what guidelines actually prescribe.

(define low level) villaverde: if you will look at the cases, ang ating mga schools, some of them, index case may travel, then we have kasama sa classroom, some of the cases, wala na sa classroom, that becomes third generation. Some of those in classroom, may nag positive sa household, that’s also third generation. Beyond third gen difficult for us to do contact tracing. As we move towards more cases, will be beyond the capacity…infection rate faster than humanly possible. Contact tracing only good kung may index case ka and immediate contact up to second up or probably third…in some case difficult to do that especially pag nakikita mong may 3rd gen transmission. Mitigation…look for those who are ill and turn positive, treat for this particular disease or illness. The others, depende sa final diagnosis.

(how many schools) latest count is about 22…or another few others have been added.

Villaverde: halo-halo na…may index case…may history of travel…(today) most likely second or third. Mahihirapan na tayong distinguish ang second or third, less containment and more on mitigation na ang approach ng doh.

Duque: containment still what doh doing in areas where few confirmed cases…malaking numbers na, hindi na ma-trace…combination again.

Metro manila…mixture because we have to be area specific…in the same vein we crafted response level measure…school specific, area, community specific para mas maayos ang trabaho…school specific, area specific, the schools now, depending on recommendation…can tweak response…building lang, or classroom lang…there’s elbow room within which school authorities are allowed to modify general guidelines in mitigation or response level system.

(wake) safe. Ililibing na nga this afternoon, when patient dies everything goes with that death.

Villaverde: remember illness droplet, not airborne, not dahil sa fluids…wala naman sigurong patay na bumahin o umubo.

(sa pera) duque: pag ginamit mong pambahin tapos binigay mo sa katabi mo, tapos iclean mo ilong mo, swak na swak yun…opportunity where public awareness on importance of health, never as heightened as it is today.

Mon: pldt and smart also taking measures regarding h1n1…initial conclusions…many measures taking will be made permanent, help out in alleviating ordinary seasonal flu, save money in the long time.

Duque: lately emphasizing high risk groups, serendipitous the high risk groups are being given special focus because some of these high risk groups tend to take for granted chronic illnesses…so used to it because chronic, tend to do away with regular intake of proper medication. Take for granted regular follow up with physician…all these erratic way of dealing with their chronic diseases and tendency to self medicate. All of these, given warnings we have been strongly issuing out, people will now be more conscious of need to regularly follow up, appreciating objectives of having healthy lifestyle..

(94 countries worldwide) out of 182…about 50% na. yung countries na hindi pa nagre-report, cook island…(surprise first death in asia in rp) I think the entire asia…not really. We’ve been saying we’re expecting sooner or later people with compromised health…they’ll be the ones affected by ah1n1 and may tend to complicate, aggravate, conditions, pre existing conditions.

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