__

Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

July 23,2021
DEPARTMENT MEMORANDUM
No. 2021-_0327

TO: ALL ERSECRETARIES; ASSISTANT ECRETARIES;

DI R E FOR_HEALTH DEVELOPMEN
BUREAUS, AND _SERVICES: MINISTER OF HEFAITH -
BANGSAMORO AUTONOMOUS REGION IN MUSLIM
INDANAO = i E IVE DI F
PECIALTY H T ; EFS OF M NT
PITALS. AND ITARIA; THE E D

SUBJECT: Interim Guidelines on COVID-19 Surge Response Plan for Health

Facilities

I. RATIONALE
The advent of COVID-19 variants such as the Alpha and Delta variants which have
higher transmissibility rates poses a huge risk to the health system. There is a need for an
automatic escalation and de-escalation of COVID-19 response in Centers for Health
Development, Local Government Units, and health facilities.
Lessons from previous surges have emphasized the need for health facilities and local
implementers to prepare beforehand and quickly respond in the event of an actual surge in
COVID-19 cases. A three-stage response plan, namely, the Preparedness Stage, Response Stage,
and the Surge Response Stage with well-defined triggers is introduced to facilitate a harmonized
response at the health facility level and at the community level. Action plans recommended in
this policy includes an accordion type of bed capacity during a surge, in which a hospital shifts
its focus to COVID-19 thereby increasing its COVID-19 dedicated beds in a step-by-step
manner, depending on the needs of the situation.
These Interim guidelines are issued for guidance for preparatory activities. An
administrative order on final guidelines will follow.

II. OBJECTIVES
A. General Objective
Define indicators and specific strategies for health facilities, local implementers, and
Centers for Health Development to guide their continuous COVID-19 response.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ® Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ® URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
 B. Specific Objectives
1. Identify critical indicators and thresholds to efficiently monitor health facilities;
2. Set corresponding strategies and action points for local implementers and health
facilities; and
3. Guide health facilities when to escalate and de-escalate COVID-19 response
including when to increase or decrease dedicated COVID-19 hospital and ICU
beds.

HI. SCOPE OF APPLICATION

This Order shall apply to DOH Central Office bureaus, units and attached agencies,
DOH Centers for Health Development, DOH Hospitals, including the Bangsamoro Autonomous
Region of Muslim Mindanao subject to the applicable provisions of RA 11054 or the
“Bangsamoro Organic Act” and subsequent rules and policies issued by the Bangsamoro
government, Local Government Units (LGUs), all public and private health facilities, and other
relevant stakeholders involved in the COVID-19 response.

IV. GENERAL GUIDELINES

A. The Inter-Agency Task Force for the Management of Emerging Infectious Diseases
(IATF-EID) shall release a risk classification of provinces that will determine the
quarantine status of provinces and highly urbanized cities. The risk classification
shall guide the CHDs, LGUs, and health facilities in their planning and response for
COVID-19.
B. The surge response shall be activated at two levels regardless of community
quarantine status: 1) community-level surge response, and 2) facility-level surge
response (Annex A).
C. The surge response shall focus on the following five (5) major areas:
1. Increasing COVID-19 dedicated beds;
2. Increasing ICU beds for COVID-19;
3.Increasing TTMF beds and implementation of home care during surge;
4. Human Resources for Health (HRH) augmentation; and
5. HRH support in the form of transportation, accommodation, etc.
D. All CHDs shall monitor province and city level indicators and shall guide the
COVID-19 community response of all LGUs and health facilities in their provinces
and/or region.
E. The DOH, through the Epidemiology Bureau, shall communicate to CHDs and
LGUs areas with moderate to high risk classification to heighten their response.
F. All health facilities shall monitor facility level indicators and activate facility’s
contingency plans when indicated.
G. All hospitals shall admit patients based on the Department Memorandum No.
2020-0512, “Revised Omnibus Interim Guidelines on Prevention, Detection
Isolation, Treatment, and Reintegration Strategies for COVID-19" and its updates.
Patients shall be isolated in the appropriate health facility depending on the case
severity and in consideration of their comorbidities.
H. Primary Care Facilities, during a surge, shall endeavor to continue to provide health
services mainly through the use of telemedicine in accordance with the latest DOH
guidelines and standards.

SPECIFIC GUIDELINES
A. Three (3) Stages of Surge Response
1. The Surge Response shall be organized into the following stages with
well-defined triggers:
a. Preparedness Stage - refers to the period in which there is no surge in the
area;
b. Response Stage - refers to the period right before there is a surge in the
facility or there is anticipated surge in the area (i.e. identified variant in
the area); and
c. Surge Response Stage - refers to the period in which there is a surge in
the health facility or community transmission in the area.
2. All CHDs, LGUs, and health facilities shall determine the stage of surge
response in their area or facility, and endeavor to follow the recommended action
points identified per stage.

B. COVID-19 Community Surge Response

1. All CHDs shall analyze province and city level indicators and determine the
response stage in their area every 2 weeks (see Annex B, Table 1.1).
2. All CHDs shall institute the necessary action points and guide LGUs and health
facilities in the COVID-19 response. The action points per stage presented in
Table 1.2 during a Community Surge Response shall serve as a guide to local
implementers.
a. During the Preparedness Stage, CHDs and LGUs shall ensure that health
facilities have contingency plans in the 5 major areas. All health facilities
shall endeavor to utilize telemedicine as an alternative to face-to-face
consultations. At this stage, hospitals may utilize their previously
dedicated COVID-19 beds for non-COVID-19 cases, provided that the
hospital maintains their bed occupancy rates below 50%, provided further
 that they are able to revert these beds into COVID-19 beds once
thresholds for the response stage have been reached.
b. During the Response Stage, CHDs shall strictly monitor the 30%
COVID-19 dedicated beds in government hospitals and 20% for private
hospitals.
¢. During the Surge Response Stage, CHDs shall issue a Regional Order
instructing a region or province-wide increase of dedicated beds to 50%
for government hospitals and 30% for private hospitals. For Levels 2 and
3 hospitals, 15% of their total dedicated beds should be ICU beds or ICU
ready beds, which are converted regular hospital beds that can cater to
critical cases. At this stage, HRH augmentation and support (e.g.
transportation, accommodation) shall be provided accordingly. A
localized lockdown may be considered and activated through the Local
Government Unit or the Regional IATF.

C. COVID-19 Facility Surge Response

1. All hospitals shall weekly analyze facility level indicators and determine the
response stage in their facility (see Annex C, Table 2.1).
All hospitals shall endeavor to have an accordion-type or progressive surge
response and allocate beds and re-assign human resources depending on the
stage of COVID-19 response.
All hospitals shall activate their surge plans depending on the stage. The action
points per stage presented in Table 2.2 shall serve as a guide to hospitals.
During a community surge response stage, all hospitals shall comply with the
increase in dedicated beds upon the issuance of a Regional Order from their
respective CHDs. At this stage, all hospitals shall coordinate with their
respective Regional One Hospital Command Centers for proper patient
navigation.

ROLES AND RESPONSIBILITIES

These offices shall perform the following roles and responsibilities:

A. Field Implementation and Coordination Team (FICT)
1. Coordinate with concerned Central Office units to provide technical assistance to
CHDs, Local Government Units, and health facilities.

Epidemiology Bureau (EB)

1. Communicate to CHDs areas with moderate and high risk classification.
 2. Provide technical assistance to CHDs on surveillance and monitoring indicators
with regard to cases, among others.
. Health Emergency Management Bureau (HEMB)
1. Provide technical assistance on the development of surge capacity plans in
relation to other emergency and disaster plans;
2. Provide logistical and funding support to health facilities to address their surge
capacity requirements; and
3. Assist in coordination and partnership with relevant stakeholders to ensure
continuity of operations.

. Health Facility Development Bureau (HFDB)

1. Provide technical assistance to CHDs on monitoring province/city level
indicators with regard to health facilities.

. Knowledge Management Information and Technology Service (KMITS)

1. Set guidelines for the use of telemedicine in health facilities.

. Centers for Health and Development (CHD)

1. Monitor indicators at the province/city level for the region, determine the stage
of surge response, and communicate their status to health facilities and LGUs to
guide their local planning;
2. Provide and/or facilitate the provision of technical assistance to health facilities
and LGUs depending on the stage; and
3. Regulate the increase and decrease of COVID-19 dedicated beds in regions
depending on the stage of response as necessary through the Regulation,
Licensing and Enforcement Divisions (RLEDs) in accordance with Department
Circular 2020-0406.

. PhilHealth
1. Implement financing mechanisms (i.e. Debit-Credit Payment Method) which will
support health facilities during a COVID-19 surge.

. Local Government Units (LGU)

1. Ensure contingency plans for their catchment area are in place.
 2. Provide necessary assistance (i.e. reopen Temporary Treatment and Monitoring
Facilities) to health facilities depending on the surge response stage.

I. Health Facilities
1. Ensure that their facilities’ contingency plans are in place.
2. Monitor facility level indicators every week and report to CHDs when indicated.
3. Increase the percent of their COVID-19 dedicated beds upon the issuance of the
Regional Order from CHDs.

For guidance.

By Authority of the Secretary of Healt

LILIBETH C. DAVID, , MBH, MPM, CESO I

Undersecretary of Health
Health Facilities and Infrastructure Development Team
ANNEX A. COVID-19 Surge Response at Two (2) Levels: Community vs Facility Response

le

Ie
te ti IIH

i PR tn
“
1 {

.
—————

mi
.
—
1

Community Surge Response Facility Surge Response

Surge in the community Surge in the facility
(province/region)
Trigger of response for all health Trigger of facility surge plans
facilities in the area (province/region)
CHDs/L.GUs supported by Central Office Health Facility
ANNEX B. Community Surge Response for Health Facilities

Table 1.1. Thresholds of the 3 Stages of Community Surge Response for Health Facilities

Preparedness Stage Response Stage Surge Response Stage

Description No surge in the area Anticipated surge Surge in the area

in the area (i.e.
identified variant in
the area)

Criteria All indicators below Any indicator that Any indicator above
threshold is fulfilled the surge threshold

Risk Classification QWGR, Low or Minimal Moderate High

ADAR)*

2-Week Growth Rate <0% 0 to <200% >200%

(province/city)

Average Daily Attack Rate <1 1-7 >7

(province/city)

Proportion of dedicated <50% 50 to 70% >70%

COVID-19 hospital beds
occupied (province/city)

Proportion of dedicated <50% 50 to 70% >70%

COVID-19 ICU beds
occupied** (region)

*Risk Classification follows matrix of IATF for 2WGR and ADAR

**¥[CU means with bed, mechanical ventilator, and human resources for health
Table 1.2. Action points for LGUs and
COVID-19 Community Surge Response
CHDs in the 3 Stages of

Action Point/s Preparedness Stage Response Stage Surge Response Stage

Description No surge in the area Anticipated surge in the Surge in the area
area (i.e. identified
variant in the area)

Criteria All indicators below Any indicator in the Any indicator that reached
threshold response threshold that is surge threshold
fulfilled
LGUs and CHDs Ensure/monitor health Ensure/monitor 30% of Ensure/monitor 50% of
a. COVID beds facilities have government beds and 20% government beds and 30%
contingency plans in of private beds for of private beds for
the 5 major areas. COVID-19 response COVID-19 response

b. ICU beds For Level 2 and 3 For Level 2 and 3

hospitals, ensure 15% of hospitals, ensure 15% of
ALL DEDICATED BEDS ALL DEDICATED BEDS
are ICU beds are ICU beds
c¢. TTME/ 1. Reopen TTMFs (% Emphasize Home Care**
Home Care LGUs) to health facilities to
2. Ready infrastructure decongest TTMFs
and HR to support
home care in the area
(% public and private
facilities)

d. HRH Identify doctors and Deploy of doctors and

augmentation nurses ready for possible nurses to health facilities
deployment in surge

e. HRH support Contract hotels for mild CHD assistance: HRH

HRH cases transportation and
accommodation

Other Prepare of EOC/ 1. Activate of 1. Request assistance

interventions Regional OHCC* EOC/Regional from the National
OHCC* Government — DOH,
2. Heighten contact NTF, etc
tracing 2. Consider localized
3. Increase targeted lockdown with
testing RIATF/LGUs
*depending on the region
**following latest guidelines and standards on Home Care
ANNEX C. Facility Surge Response

Table 2.1. Thresholds and Target Dedicated Beds of the 3 Stages of Facility Surge Response

Preparedness Stage Response Stage Surge Response Stage

Action Point: % of 30% identified beds for 30-50% dedicated beds 50% dedicated beds or
ABC that are COVID- gov’t; 20% for private for gov't; more for gov’t;
19 dedicated beds* 20-30% for private 30% for private

Description No surge in the facility Before the surge in the Surge within the facility
facility

Criteria All indicators are ANY indicator is ANY indicator is fulfilled

Sulfilled fulfilled

Risk Classification of Low Moderate High

community
(province/region)

Proportion of Less than 50% 50-70% occupancy of More than 70%

dedicated COVID-19 occupancy of preparedness stage occupancy of response
hospital beds preparedness stage dedicated beds stage dedicated beds
occupied dedicated beds

Proportion of Less than 50% 50-70% occupancy of More than 70%

dedicated COVID-19 occupancy of preparedness stage occupancy of response
ICU beds occupied** preparedness stage dedicated beds stage dedicated beds
dedicated beds

Human Resources Less than 5% of HRH 5-10% HRH are More than 10% HRH are
for Health are unavailable unavailable unavailable
unavailability ***
*Exception: COVID-19 Referral Hospitals
**Indicator is not applicable for Level 1 hospitals
*¥*¥*Number of human resources for health quarantined and isolated out of human resources assigned to COVID-19
areas
***¥*Note: If there is 25% increase in the total number ILI/SARI cases in the emergency department, investigate for
causes of increase

10
Table 2.2. Action points for Health Facilities in the 3 Stages of
COVID-19 Facility Surge Response
Preparedness Stage Response Stage Surge Response Stage

Description No surge in the facility Before the surge in the Surge within the facility
Jacility

Criteria All indicators below Any indicator in the Any indicator that reached
threshold response threshold that surge threshold
is fulfilled

Health Facility 1. Ensure surge plans Dedicate 30% of gov't 1. Dedicate 50% of
a. COVID beds for hospitals are in beds and 20% of private government beds and
place (Identify beds for COVID-19 30% of private beds for
beds for response COVID-19 response
conversion for the 2. Construct modular
different stages) hospitals to augment
2. Identify 30% of hospital beds
gov’t beds and
20% of private
b. ICU beds beds for COVID- For Level 2 and 3 For Level 2 and 3
19 response hospitals, ensure 15% of hospitals, ensure 15% of
ALL DEDICATED ALL DEDICATED BEDS
BEDS are ICU beds (or are ICU beds (or ICU ready
ICU ready beds) beds)

c. TTMF/ 1. Plan for Home 1. Transfer mild, 1. Suspend face-to-face

Home Care Care infrastructure asymptomatic, step OPD services and
2. Use telemedicine down care patients elective surgeries in
as alternative for from Hospitals to hospitals
COVID-19 and TTMFs 2. Provide of Home Care
non-COVID-19 2. Limit face-to-face Services
consultations and OPD services and

triage elective surgeries in

hospitals

d. HRH 1. Ensure 1. Organize HRH into Accept deployment of

augmentation contingency plans COVID-19 duty HRH
for HRH are in teams
place and 2. Prepare contingency
communicated request for HRH
e. HRH support 2. Ensure Infection from CHDs/NGA Provide transportation and
Prevention and accommodation with the
3. Identify and control
Control measures sources of HRH help of LGU/CHD
are in place infection*
3. Re-train HRH on
COVID-19 topics
*See Department Circular 2021-0168, “Recommendations to Address the Rising Numbers of Healthcare Workers
Infected by COVID-19""

11