Annex A.

1 Recommended Algorithm for Referral and Admission in the Community Isolation Unit
The Philippines has already reached level 2 where community transmission is possible. Hence, all persons with acute respiratory symptoms are
assumed to have been exposed locally. Given this scenario, the following definitions are recommended.

CONTACT
A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a
probable or confirmed case:
1. Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes;
CONTACT 2. Direct physical contact with a probable or confirmed case;
3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment; OR
4. Other situations as indicated by local risk assessments.

For confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was
taken which led to confirmation.
Acute respiratory
symptoms with or Y SUSPECT
Local recommendation: This category to include acute respiratory illness (ARI) without fever
without fever in the A. Patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of
past 14 days ? travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset; OR
B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of contact) in the
N last 14 days prior to symptom onset; OR
C. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND
requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.

PROBABLE
A. A suspect case for whom testing for the COVID-19 virus is inconclusive. OR
B. A suspect case for whom testing could not be performed for any reason.

Household CONFIRMED
A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.
quarantine +
BHERT Monitoring Source: WHO (2000). Global surveillance for COVID-19 caused by human infection with COVID-19 virus – Interim Guidance, 20 March 2020.

Acute respiratory
symptoms with Y SUSPECT Severe Y
or without fever CASE symptoms?
within 14 days?
N
N Refer/
Elderly > 60 Y Admit to
and/or with CPG
Higher
co-morbids? Level
Facility
End household N
quarantine Y
Pregnant? CPG
N
Acute Respiratory Illness (ARI) within the past 14 days:
COVID – 19 PCR Y Is test result Y CONFIRMED
Mild: flu-like symptom (cough, colds, sore throat, body
Test Available? available and
malaise; fatigue, fever) CASE
positive?
Severe:
For adolescent or adults: high grade fever (>40℃) or
N N
suspected respiratory infection, plus one of the
following: Respiratory Rate of >30 cycles/min with
signs of respiratory distress; high grade fever (>40℃);
SaO2 of <90% at room air
For children: cough or difficulty in breathing, plus at least
one of the following: central cyanosis or SpO2 < 90%;
PROBABLE
severe respiratory distress (e.g. grunting, chest CASE
indrawing); signs of pneumonia with a general danger
sign: inability to breastfeed or drink,
lethargy/unconsciousness, or convulsions. Other signs Strict home
of pneumonia may be present: fast breathing (in
breaths/min): isolation +
< 2 months: ≥ 60; 2–11 months: ≥ 50; 1–5 years: ≥ 40
household
Home facility
Y quarantine +
appropriate Community Isolation Unit
The aim of this guideline is to empower families and communities to be units of care. This decision tool BHERT
for self (Area for Confirmed Cases)
was designed for task shifting to the level of midwives/BHWs. It is best implemented in conjunction monitoring
with the accompanying Guidelines for Households and Community Isolation Units. isolation?
Notes from community experience and recommendations: There are cases of ARI and ILI without
fever. Our recommendation is household quarantine for 14 days with monitoring or admission to the N
Barangay Isolation Unit. For cases of SAR or ILI with fever, hence, severe symptoms, this will be a
SUSPECT case. Our recommendation is admission to the hospital following appropriate CPGs.

These provisional recommendations were prepared through collective inputs from 1) feedback
synthesis from the DOH Health Care Workers Viber Group (6,000 members) through the 2) UP
College of Medicine Intern volunteers 3) representatives of the Philippine Academy of Family Discharge Y
Physicians 4) volunteer Municipal Health Officer and Doctor to the Barrio reviewers 5) maternal and Community criteria met?
child health experts from Kalusugan ng Mag-ina, 6) members of the Asia Pacific Center for Evidence- Isolation Unit
based Healthcare 7) Philippine Society of Public Health Physicians (PSPHP), 8) the Alliance for
Improving Health Outcomes (AIHO) and representatives from the DOH.

These are Provisional Recommendations and are currently discussed among practitioners, policy
N
makers experts in DOH and professional societies. Initial implementation and feedback will be
monitored so that the Philippines can develop guidance for all health workers in the field.
Refer/admit
The group would like to thank the following for consolidating the inputs: if with signs of
Lei Camiling-Alfonso, Aileen Riel Espina, Miguel Dorotan, Paolo Medina
deterioration

Discharge