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Dilg Doh Jao 2020 0001

The document provides guidelines for Local Government Units (LGUs) on establishing Local Isolation and General Treatment Areas (LIGTAS COVID Centers) and managing mild COVID-19 cases at the community level. It outlines procedures for identifying, admitting, and referring suspect, probable, and confirmed COVID-19 cases. LIGTAS COVID Centers should provide basic care, monitoring, and prompt referral according to DOH guidelines. The document specifies requirements for LIGTAS COVID Centers including dedicated spaces, staffing, and infection control protocols.

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0% found this document useful (0 votes)
106 views31 pages

Dilg Doh Jao 2020 0001

The document provides guidelines for Local Government Units (LGUs) on establishing Local Isolation and General Treatment Areas (LIGTAS COVID Centers) and managing mild COVID-19 cases at the community level. It outlines procedures for identifying, admitting, and referring suspect, probable, and confirmed COVID-19 cases. LIGTAS COVID Centers should provide basic care, monitoring, and prompt referral according to DOH guidelines. The document specifies requirements for LIGTAS COVID Centers including dedicated spaces, staffing, and infection control protocols.

Uploaded by

Novie Fenecios
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Guidelines on

Local Isolation and General Treatment Areas for COVID-19


Cases (LIGTAS COVID) and the Community-based
Management of Mild COVID-19 Cases

DOH & DILG Joint Administrative Order No. 2020-0001


Rationale
• LGUs play the lead role in the prevention, mitigation, preparedness for, and
containment of the Coronavirus Disease 2019 (COVID-19) outbreak at the
local level.
• Any action by the LCEs should be anchored on, and cognizant of, the plans
and recommendations of, and in coordination with the DOH and other
competent government agencies to ensure coherence of actions and
accuracy of interventions
• Ensure that all LGUs are implementing standards of Community Quarantine
consistent with what the National Government has laid down for the
subject area, while allowing LGUs to continue exercising their autonomy in
matters undefined by the National Government or are within the
parameters it has set; and are fully cooperating towards a unified,
cohesive and orderly implementation of the national policy to address
COVID-19
General Objective
• This Order aims to guide LGUs, the instrumentalities and constituent
households and individuals in the prevention of transmission and
management of contact, suspect, probable, and confirmed cases of
COVID-19 at the family and community level.
Specific Objectives
1. Streamline identification, admission, management, and referral
protocols for contacts, suspect, probable and confirmed cases of
COVID-19 with mild symptoms and who are not vulnerable persons,
in households and communities;
2. Guide health workers in assisting individual households on how to
prevent transmission and manage suspect, probable and/or
confirmed cases of COVID-19 and to deal with adverse outcomes
of the disease; and
3. Guide LGUs in planning, establishing, and maintaining designated
isolation or quarantine units in their localities for contacts, suspect,
probable and confirmed cases of COVID-19 whose living conditions
cannot support home quarantine
Transition of the Old VS New Classification
for COVID-19
OLD CLASSIFICATION NEW CLASSIFICATION
Neither a Person Under Monitoring Not a COVID-19 Case
(PUM) or Patient Under Investigation
PUM “Contact” (Not included in the new
classification*)
PUI (mild, severe, or critical) who was not Suspect
tested or awaiting test results
PUI (mild, severe, or critical) with Probable
inconclusive test results
COVID Positive Confirmed
*For purposes of this Order which focuses on community-based management, the term "Contact" shall be adopted. For purposes of
mandatory reporting to the DOH of COVID-19 as a notifiable disease, DOH Administrative Order No. 2020-0013 and its subsequent
iterations shall govern.
General Guidelines
• The overall strategy shall be community-mobilized active case finding,
testing, isolation, and monitoring. There shall also be timely and
coordinated referral to be aligned with relevant DOH guidelines
• The LGU shall ensure that public and private health care providers, in
coordination with the local health office, shall continue to provide
basic health services, such as prenatal and postnatal care, EPI, TB
program, etc., for its constituents
• DOH shall issue separate guidelines pertaining to health care provider
networks (HPCNs) during the COVID-19 pandemic, which all
concerned including LGUs are enjoined to follow.
• BHERTs shall focus on active case finding (i.e. contact tracing) in
coordination with the LIGTAS COVID Center
General Guidelines
• The rapid national scale up of Mega LIGTAS COVID Centers across
the country is in response to the national policy shift of promoting
facility quarantine and isolation
• The Provincial Government shall manage the establishment of all
LIGTAS COVID Centers within its territorial jurisdiction, in
coordination with the local governments of component cities,
municipalities, and barangays therein. The City Government shall take
on this management role in the case of HUCs or ICCs
• All LIGTAS COVID Centers shall provide the following services:
• provision of basic room and board; case management limited to symptomatic
treatment; monitoring and prompt referral at the first sign of clinical
deterioration; and discharge instructions for continued home care and follow-
up
General Guidelines
• Repatriates that have already undergone the required 14-day
quarantine upon their arrival to the country, shall not be subjected to
quarantine again
• Limited and special authorization for medical students who have
completed the first four years of the medical course, graduates of
medicine, and registered nurses to render services as deputized
physicians for the purposes of this Order, where the services of duly
registered physicians are not available
• LGUs shall ensure that all health care workers and other frontline
personnel exposed to the risk of infection are provided with proper
and adequate PPEs according to their roles and responsibilities
Variations of TTMF
Temporary Treatment & Step Down Care Community Isolation Units
Monitoring Facilities DOH DM 2020-0161 DOH & DILG JAO 2020-0001
DOH DM 2020-0123 April 7, 2020 April 15, 2020
March 16, 2020
1. Persons under investigation or PUIs 1. Admitted probable and confirmed 1. Contacts,
(previous classification under DOH COVID-19 positive patients who 2. Suspect and Probable COVID with
DM 2020-0072), and meet all of the following criteria: mild symptoms, and
2. mild COVID-19 cases. a) Clinically recovered or stable 3. Confirmed COVID-19 cases with
(with resolution of mild symptoms.
symptoms); and
b) Completing the 14-day
quarantine protocol or
waiting for a repeat test
2. Resolution of symptoms may
include the following:
a) Body temperature returns to
normal >3 days;
b) Respiratory Symptoms have
improved significantly; and
c) Chest radiograph show
significant improvement
TTMFs, Ligtas COVID Centers, CIUs
serves as:
▪ Facilities for Suspect , Probable and Confirmed COVID-19
cases with MILD symptoms
▪ Ages 18-59 yrs old
▪ Without comorbidities
▪ Step down facilities for recovering patients

*Intended for patients without optimal isolation space in their


home
Specific Guidelines
A. Establishing a LIGTAS COVID Center
Separate LIGTAS COVID-19 Facilities shall be provided for the following:
1. Contacts;
2. Suspect and Probable COVID-19 Cases with mild symptoms; and
3. Confirmed COVID-19 Cases with mild symptoms

The LCTF, BHERTs, Sanitation Officer, and an assigned LIGTAS COVID manager
shall jointly identify:
• existing infrastructure in the LGU that can be converted into LIGTAS COVID Centers
• a temporary structure can be established in accordance with the requirements of this
policy
• arrangements according to law with private sector entities to build or refurbish
existing infrastructure and operate the same as LIGTAS COVID Centers
Specific Guidelines
B. Requirements for LIGTAS COVID Centers
1. Space
• can either be a permanent or temporary structure (e.g. school , gym, multipurpose hall,
church, or other establishment) equipped with utilities and basic amenities granting that
the requirements set in DOH DM No. 2020-0I23 are followed
• In compliance with IPC protocols, each suspect and probable case of COVID-19 shall
have his/her dedicated individual room with own toilet and bath. If and only if dedicated
individual rooms are not available, beds shall be spaced at least two (2) meters apart,
preferably with an opaque impermeable sheet or divider (e.g. tarpaulin , shower curtain,
etc) between them
• Shared toilets and baths shall be cleaned and disinfected by staff wearing the appropriate
PPEs at least twice a day. Patients using shared toilets and baths shall be trained and
assisted in cleaning and disinfection immediately after each use. Ensure that all toilets and
baths, either dedicated or shared, are well-ventilated with natural or mechanical or hybrid
ventilation
Specific Guidelines
B. Requirements for LIGTAS COVID Centers
2. Staff
• staff of each LIGTAS COVID Center shall be trained on proper use of PPEs and infection
control measures
• Composed of: (1) Manager; (2) Sanitation Officer; (3) Facility Physician (either physically
present or remote but accessible thru telehealth 24/7); (4) Nurse or Midwife (2 shifts);
(5) BHW or Community Health Volunteer (1 shift); (6) Data Manager; (7) Security &
Maintenance Officer (1 shift);
• shall be engaged by the LGU and shall receive their salaries and applicable benefits from
the city or municipality in which the LIGTAS COVlD Center is located
• deployment of deputized physicians and nurses under the NDP, whose contracts of
service shall be under the DOH
• DOH shall provide LGUs with an updated roster or pool of physicians and deputized
physicians it shall engage
Specific Guidelines
B. Requirements for LIGTAS COVID Centers
3. Supplies
• Must have PPEs and comply with DOH policy on its rational use, non critical patient-care
equipment (stethoscope, thermometer, sphygmomanometer), hygiene kits and food supply for
patients, supportive medication
4. Special Services
• No visitors are allowed but communications thru remote means is allowed (mobile phones)
• Mental health and psychosocial support
• Provide safe, comfortable and free board and lodging for staff (off and on duty days) to be
sourced from PhilHealth reimbursements
5. Financing
• Sources of funds include Quick Response Fund; 20% Development Fund; Bayanihan Grants
• Should there be funding gaps, cities/municipalities/barangays may submit a resolution to its
respective provinces in coordination with DOH, DILG and DBM
• patients who sought consult at the Mega LIGTAS COVID Centers or LIGTAS COVID Centers
but were later on assessed to be capable of home quarantine or isolation shall be counted as
patients of the respective facilities until the completion of their prescribed quarantine or isolation
period
Specific Guidelines
C. Identification of COVID-19 Cases in the Community
• The LCTF shall setup or adopt an existing hotline dedicated to case finding
and monitoring that community members can call if they report symptoms or
any contact with a confirmed case of COVID-19
• dedicated cellular phone or landline that is disinfected regularly; dedicated
healthcare worker with training on the COVID-19 patient algorithm for triage
and hospitalization; and adequate dissemination of the hotline number in the
respective LGU
• The dedicated HCW shall classify households based on exposure of members
to COVlD-19 and report information on suspect, probable, and confirmed
cases of COVID-19 to the BHERTs thereafter
• Family without exposure to COVID-19
• Family on home quarantine
• Family with Ligtas COVID or healthcare facility admission
Specific Guidelines
C. Identification of COVID-19 Cases in the Community
• The HCW shall carefully assess household members based on the COVID-19
patient algorithm for triage and hospitalization. The algorithm shall guide the
HCW whether admission to the LIGTAS COVID Center or home
quarantine/self-isolation will be advised
• While admission to a LIGTAS COVID Center or Mega LIGTAS COVlD
Center is preferred especially where these facilities are available, home
quarantine is allowed for suspect and probable cases of COVID-19 who are
either asymptomatic or with mild symptoms only, provided that ALL the
requirements in the home care checklist are complied with
• The HCW shall assess the household's capability using the home care checklist.
The assessment includes ocular inspection and family interview.
Home Care Checklist
Infrastructure Accommodations Resource for Patient Care &
Support
• Line for communication with • Ability to provide a separate • Primary caregiver who will remain
family and health workers bedroom for the patient, or in the residence and who is not at
• Electricity separate bed with enough distance high risk for complications, and is
• Potable water (>3 feet or 1 meter) so long as educated on proper precautions
• Cooking source there are no vulnerable persons in • Medications for pre- existing
• Bathroom with toilet and sink, if the household conditions, as needed; family
possible a separate one for the • Accessible bathroom in the planning supplies as desired
family member affected (if none, residence; if multiple bathrooms are • Digital thermometer, preferably one
disinfect on a regular basis) available , one bathroom designated per patient, disinfected before and
• Solid waste and sewage disposal for use by the patient after use
• Meal preparation
• Essential shopping
• Mask, tissue, hand hygiene product
• Laundry
• Household cleaning products
Specific Guidelines
C. Identification of COVID-19 Cases in the Community
• All members of families that have at least one member who is a suspect, probable,
or confirmed COVID-19 case regardless of place of quarantine or isolation shall be
tested according to the guidelines prescribed by DOH
• The Barangay having jurisdiction over the place of residence of patients who shall
practice home quarantine/self-isolation shall provide the patient and his/ her family
with nutritious food and basic necessities that his/her household may need during
the entire time of home quarantine/isolation.
• The Barangay shall also ensure that the patient and the members of his/her
household shall stay at home. For the purposes of this provision, the Barangay may
seek assistance from the PNP to strictly yet compassionately and respectfully
monitor and implement the same, while protecting the household from any acts of
violence that may arise from discrimination
• If self-isolation is not possible based on assessment, the contact, suspect, probable,
or confirmed case of COVID-19 with mild symptoms shall be admitted to a
LIGTAS COVID Center
Specific Guidelines
D. Admission of Identified COVID-19 Cases to the LIGTAS COVID Center
• The HCW shall exercise due care and compassion in disclosing the presumptive
diagnosis and management plan to the patient and family representative/s.
• HCWs shall accomplish the COVID-19 Case Investigation Form and secure
informed consent from the contact, suspect, probable or confirmed case of
COVID-19 (with mild symptoms) before admission to the LlGTAS COVID Center.
• Should the patient refuse to be admitted, the HCW shall notify the Manager; the
Manager and the HCW shall compassionately explain the rationale for admission
and implement the same even if involuntarily, making a notation in the patient's
chart of such refusal and the medical justification for the enforcement as a rapid
containment, quarantine and isolation measure pursuant to law.
• A patient chart should be kept for every patient containing an admitting history,
monitoring sheet, and administered medications.
Specific Guidelines
E. Case Management in the LIGTAS COVID Center
• All patients shall be reminded of respiratory etiquette and home care
instructions.
• HCWs shall instruct and/or assist patients on how to monitor oneself and
record in a daily monitoring sheet twice a day (8 AM-4 PM) the following:
• body temperature; respiratory symptoms (fever, cough, colds, sore throat); and other
symptoms (e.g. , body malaise , fatigue, etc.), and to call the attention of a HCW if with
any symptom.

• HCWs shall provide symptomatic treatment for mild symptoms such as


antipyretics during the duty shifts. HCWs shall report to the Manager any
suspect cases that become symptomatic, and shall immediately refer cases
with signs of severe pneumonia and new co-morbidities to the designated
hospital or facility using referral criteria
Specific Guidelines
F. Flow of Entry and Exit in the LIGTAS COVID Center
• Before entry, a health worker or trained volunteer shall act as a gatekeeper and
determine whether entry is warranted. Entries and exits of alI visitors and staff
shall be recorded in a logbook. Proper hand hygiene before and after handling
the logbook must be observed.
• Staff are required to perform proper hand washing and donning of the proper
PPEs before entering the facility.
• Before exiting, staff must remove all PPEs in the designated area and dispose of
them in the proper receptacles . Finally, they must perform proper handwashing
Specific Guidelines
G. Infection Control in the LIGTAS COVID Center and LGUs in
General
• Admitted patients in LIGTAS COVID Centers shall be responsible for cleaning
and disinfecting the immediate surroundings of their beds, as well as common
areas they have used.
• Maintenance staff, under the supervision of a sanitation officer, shall orient
patients on the guidelines and provide support
• The DOH through its CHDs or the BARMM Ministry of Health, within their
respective jurisdictions and/or authorized partners shall systematically and
regularly work with LGUs to ensure the strict and consistent enforcement of
infection prevention and control measures in LIGTAS COVID Centers, other
health facilities, and settings such as schools and workplaces, among others
Specific Guidelines
H. On the Spraying or Misting of Persons and Large-Scale Surfaces
• LGUs shall avoid spraying or misting of persons and large-scale surfaces with
disinfectant solution as the practice is not supported by scientific evidence at
this time and may also pose additional health and safety concerns

I. Discharge Protocols
• Patients in the LIGTAS COVID Centers may be discharged, and persons under
home quarantine may end home quarantine once asymptomatic for the
number of days prescribed in the latest clinical practice guidelines.
• The local health officer or his/ her designated physician shall issue a
Certificate of Completion of Quarantine or Isolation to those who are
discharged or who shall be ending home quarantine
Specific Guidelines
J. Referral and Transport of Patients and Specimens
• The LCTF shall immediately identify the nearest field or referral hospital catering to
probable and confirmed COVID-19 cases. In the event of clinical deterioration of a
patient, the LCTF in coordination with the MESU/CESU /HESU/PESU/RESU shall
provide referral and transport mechanisms to designated field or referral hospitals.
The LCTF shall also provide transport mechanisms for patients who are discharged
to lower-level facilities, or to home.
• The LGU shall provide access to at least a Type I Basic Life Support Ambulance.
Where applicable, the LGU may make arrangements with the local chapter of the
Philippine Red Cross or other reputable and reliable institutions/entities for the
purpose of this provision.
• During ambulance conduction, the patient will be accompanied solely by a
healthcare worker with proper PPE and monitor the well-being of the patient while
in transit from the place of pick-up to the receiving health facility.
• The driver shall also observe the appropriate infection controls and avoid contact
with the patient. After the patient is accepted by the receiving facility, the
ambulance shall be disinfected by its owner/operator in coordination with the
LIGTAS COVID sanitation officer
Specific Guidelines
J. Referral and Transport of Patients and Specimens
• PNP shall provide the appropriate services to ensure the compassionate, safe
and secure transfer of patient between LIGTAS COVID Centers and other
health faciIities
• For the purposes of laboratory testing of suspect COVID-19 cases,
specimens shall be collected on-site at the level of care/facility closest to the
patient's place of residence or work.
• The LGU with the assistance of the PNP and BFP (as well as the AFP and
DPWH, upon request) shall ensure that these samples are transported from
the point of collection to the designated laboratory. LGUs shall coordinate
the timing of sample collection with the chain of specimen transport to
ensure the quality and reliability of the specimen for laboratory purposes
Specific Guidelines
K. End of Life Care, Management of the Dead and Bereavement Care for
Families
• Healthcare workers shall provide end-of-life and bereavement care for all patients
and their families, aligned with protocols for mental health and psychosocial
support
• Care for dying patients includes:
• management of pain and symptoms, ensuring support for family members, assigning primary and
back-up family caregiver, establishing expectations on end-of-life or improvement and care
planning.
• Health providers should ensure different needs are discussed within the family,
including psychological and physical health, social, spiritual, cultural, financial and
practical elements.
• Health care workers shall assist families in planning how these needs can be
addressed. Possible actions can be noted as the family's bereavement plan.
Bereavement support includes communication to the family following death and
allowing the family to discuss needs and act on the bereavement plan.
• DOH provides guidelines on the disposal and shipment of the remains of confirmed
cases of COVID-19. Other existing guidelines on the disposal and shipment of the
remains of human bodies apply for non-COVID-19 cases
Reporting and Coordination
• The LIGTAS COVID Center Manager shall draft and submit a brief
daily situation report including a census of contacts, suspect, probable
and confirmed cases, including daily monitoring using the COVID-19
information system prescribed by the DOH to the BHERT, which in
turn shall review and endorse the same to the LCTF and MESU/CESU
who shall in turn submit a consolidated report to the PESU and RESU
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