National Task Force Against COVID-19 National Incident Command — Emergency Operations Center Camp General Emilio Aguinaldo, Quezon City MEMORANDUM FOR : SECRETARY on N. LORENZANA Department of National Defense, and Chair, National Ts against COVID-19 Department of tht jor and Local Government, and Vice Chair Mationa\Task Force against COVID-19 FROM a SECRETARY CARLITO G. GALVEZ, JR. Chief Implementer, National Action Plan against COVID-19 National Incident Command - Emergency Operations Center SUBJECT : OPERATIONAL GUIDELINES ON THE APPLICATION OF THE ZONING CONTAINMENT STRATEGY IN THE LOCALIZATION OF THE NATIONAL ACTION PLAN AGAINST COVID-19 RESPONSE DATE fl 45 JUNE 2020 ACTION REQUESTED: For the consideration and approval of the Chairperson of the National Task Force Against COvID-19, REFERENCES: ‘A. 20th National Incident Command inter-Task Group Meeting Key Agreements dated 28 May 2020; B. 19th National Incident Command inter-Task Group Meeting Key Agreements dated 26 May 2020; C. National Task Group Meeting with the World Health Organization dated 19 May 2020; D. 37th Inter-agency Task Force for the Management of Emerging Diseases (IATF-EID) Meeting Key Agreements dated 15 May 2020; 41st IATF-EID, Key Agreements dated 29 May 2020; IATF-EID, Resolution No. 37 Series of 2020 dated 15 May 2020; Executive Order No. 112, series of 2020. Imposing an Enhanced Community Quarantine in High-Risk Geographic Areas of the Philippines of the Country from 01 ommto 15 May 2020, Adopting the Omnibus Guidelines on the Implementation Thereof, And for Other Purposes. Published on 30 April 2020. Il ANALYSIS; In the Philippines, the COVID-19 cases are reported and clustered only in several cities/municipalities and communities, making large-scale containment operations and blanket interventions unfeasible, inefficient and costly. Thus, a formal framework on how Local Government Units (LGUs) could monitor the pandemic more accurately, and adopt a calibrated response, adaptive to the emerging conditions in their respective areas and selective in its focus that will enable them to stay ahead of the outbreak trajectory, is therefore needed. Even though different communities strike a different balance in their own terms, the “suppress and lift” approach is generalizable to all. Localities must be ready to re-impose drastic restrictions as soon as critical parameters start rising again. This is where the application of the rolling classification of restrictions and recalibrated and selective responses can be imposed, lifted and reimposed, as deemed appropriate by the LGUs to contain and mitigate the impact of COviD-19, The Zoning Containment Strategy is applied in order to identify focused areas for implementation of varying levels of quarantine, depending on the risk and stage of transmission prevalent in the area. However, it is anticipated that no single containment measure by itself will be sufficient to stop the spread of this virus with 100% success. It is in this light that COVID-19 response operations with combined measures applying the Prevent-Detect-Isolate-Treat-Reintegrate Strategy shall be adopted to intervene early and stop the further spread of the pandemic. C. In support of this and in recognition of the integral role LGUs play in the localization of ‘the implementation of the National Action Plan against COVID-19 Response, Section 2 of EO 112s. 2020, provides that "provincial governors shall be authorized to impose, lift or extend ECQ in CCs and municipalities upon the concurrence of the relevant regional counterpart body of the IATF. The mayors cities and municipalities are likewise authorized to impose, lift or extend ECQ in barangays , upon the concurrence of the relevant regional counterpart body of the IATF. This is without prejudice to the authority of the IATF to directly impose, lift or extend ECQ in these areas should circumstances call for it". IV. COORDINATIONS MADE ‘A. In light of the foregoing analysis, Operational Guidelines on the application of the Zoning Containment Strategy in the localization of the National Action Plan Against COVID-19 Response need to be developed. This is to guide the local authorities in the transitioning of community quarantine measures to less or more stringent restrictions * office ofthe President ofthe Republicof the Pilpines Executlve Order No, 112 series 2020. Imposing an enhanced community ‘quarantine in hgh-sk geographic areas ofthe Philippines anda generl community quarantine in the rest ofthe county from 01 to 15. ‘May 2020, edopting the omnibus guidlines onthe implementation thereof and for other purposes, p. 3.while continuously monitoring COVID-19 risk indicators; and standardize the principles of community quarantine implementation among zones identified by LGUs. Itis for this reason that the following inclusive, participatory and consultative processes were undertaken with the concemed offices and bureaus of the member agencies of the National Task Force and LGUs. This is to ensure that the said guidelines are evidence-based and informed by government agency issuances and Executives Orders. The following are the highlights of the said processes and the agreements and parameters that serve as inputs to the Operational Guidelines: 1. Consultation and Coordination Meeting with the World Health Organization (WHO) on the Zoning Concept for the Operational Guidelines, 18 May 2020 Participating Offices: NIC Secretariat, DOH, DILG, DICT, NEDA, LGA, WHO, AFP, DSWD. a. Applic: of the National Action Plan (NAP) against COVID-19 in all levels was emphasized to be reflected in the policy. b, Guidelines should have provisions in the localization of the response as stipulated in the EO 112 series 2020. c. Identification of areas in component cities and municipalities should be considered in the operationalization taking on the mayor's perspective. d. Duration of the lockdown should be determined using epidemiological indicators, e. Surveillance on the deaths of Severe Acute Respiratory Infection (SARI), Influenza-like Iliness (ILI) and pneumonia should be considered in the operational guidelines. f. Outbreak investigation principles should be reflected in the policy. 2. Coordination and Consultation Meeting with the Joint Task Force (JTF) CV Shield on the Zoning Concept for the Operational Guidelines, 23 May 2020 Participating Offices: NIC Secretariat, DOH, DILG, AFP, JTF CV SHIELD a. _ Perimeter controls for each zone were identified and concurred by the JTF CV Shield as feasible for implementation. b. Outbreak investigation principles were recognized as implementable as they resemble police operations and civil military operations. ¢. Restrictions of movement were discussed as part of the scenario simulation activity to test the feasibility of implementation of the zoning concept in highly urbanized cities, component cities, municipalities, and provinces. d. Interventions for each zone were discussed for implementation purposes especially in managing public and private sector concerns, as well as anticipated issues of other development sectors.3. Consultation Meeting on the Zoning Concept as Localization of Community Quarantine in the Local Government Units (LGUs), 25 May 2020 4, Participating Offices: NIC Secretariat, DOH, DILG, DICT, NEDA, AFP It was discussed that IATF shall decide on the provision on the guidelines for the provinces, highly urbanized cities and independent component cities. Services/activities in each zone were identified and discussed. Itwas further emphasized that even if one case is reported, rapid response should be initiated. Consideration of the guidelines is opening up the economic corridor with special attention given to the densely populated area and informal sector. Domestic tourism was also discussed as COVID-19 is crippling the economy and paralyzing the nation and its capabilities. Consultation Meeting on the Zoning Concept with the Task Group Response Operations Members and the Local Government Units (LGUs) of Manila and Quezon City, 27 May 2020 Participating Offices: DOH, DILG, DOLE, PNP-CIDG, PCG, DSWD, AFP, OWA, BOQ, Local Government Units (Manila and Quezon City), NIC Secretariat a. b. It was discussed that the operational guidelines intend to provide a standardized localization process and parameters of the community quarantine response to be implemented by various LGUs in the country. Indicators for the zoning guidelines were identified and discussed. The LGU of Quezon City shared their community quarantine practice and parameters as one of the considerations in the formulation of the operational guidelines. Special considerations in the lockdown were discussed with challenges in the determination of clustering of active cases as a hot zone also known as a containment zone with the identification of the vicinity within 500-meter radius as a warm zone also known as buffer zone. While the areas with the index clusters of cases were identified as extreme special lockdown area/s of the critical zone. Monitoring of success and limiting factors were also raised to be included in the operational guidelines. Consultation Meeting with Public Health Epidemiologists on the Parameters of the Localized Implementation of COVID-19 Response, 01 June 2020 Participating Offices: NIC Secretariat and Consultants, DOH, DILG a b. c. ‘Overview of the NAP and Zoning Containment Strategy was discussed. Parameter-setting for building, business establishment, market, subdivision, village and barangay were identified and established Assumptions were made that the incidence or the number of new cases is decreasing over time. However, it is possible to see a resurgence of cases since lockdown was partially lifted.6. Consultation Meeting with Public Health Epidemiologists on the Parameters of the Localized Implementation of COVID-19 Response, 05 June 2020 Participating Offices: DILG NCR, DOH-Epidemiology Bureau, DILG CODIX, DOH-HEMB, DOH-DPCB Representative, NIC Secretariat and Consultants, LGUs in Luzon, Visayas and Mindanao (CHO Taguig, CHO Quezon City, CHO Manila; MHO, Gamay, Northern Samar, and MHO, Del Carmen, Surigao del Norte) a, Overview of the NAP and Zoning Containment Strategy was discussed. b. Updates on the local COVID-19 situation was discussed. . Assumptions were made that the incidence or the number of new cases is decreasing over time. However, it is possible to see a resurgence of cases ‘since lockdown was partially lifted. d. PCR tests are available so that all suspected and probable cases (and others needing tests are tested) are tested so they can be re-classified as confirmed COVID-19 cases and non-COVID-19 cases. If a test is indeterminate or inconclusive, the patient classification remains the same. If we know the correct case classification, then appropriate public health measures can be implemented. e. Parameters for the imposition and lifting of the movement restrictions were identified and discussed. f. Indicators that will be used to begin the “lockdown” and to end it were identified, determined and established with consideration of socioeconomic impacts of the intervention. The responses to be included in the operational guidelines include the following: i. Case investigations ii, Contact tracing and additional case finding iii, Test for the virus using RT-PCR iv. While waiting for the test results, isolate those with signs and symptoms consistent with ILI, SARI, or pneumonia (community isolation centers, if applicable) v. Quarantine those with close contact with COVID-19 cases but are without signs and symptoms (need for community quarantine centers and/or community isolation centers if applicable) vi. Conduct of community-based syndromic surveillance vii. Different surveillance systems (hospital-based like SARI and ILI or laboratory-based surveillance systems) are in place and functional. Death certificates may also be reviewed as additional sources of surveillance data. viii. Attention should also be given to the quality of data collected, including the appropriate analysis & interpretation of the data as well as the dissemination & sharing of information. Need to emphasize the importance of data sharing during public health emergencies while protecting data privacy & confidentiality.ix. Satisfactory & immediate completion of the necessary public health responses that follows contact-tracing can be used to determine when containment can be lifted. 7. Consultation and Coordination Meeting on the Parameters of the Localized Implementation of COVID-19 Response in the Operational Guidelines to the members of the Task Group Response Operations (TGRO), 08 June 2020 Participants: Chief Implementer's Representative, NTF TGRO member agencies present are DOH, DILG, DOLE, DSWD, AFP, PNP-CIDG, BOQ, OCD, Medical Center Chief Representatives, NIC Secretariat and Consultants for Epidemiology and COVID-19 Health Event Management b. Overview of the Zoning Containment Strategy was discussed alongside the updates on the local COVID-19 situation. Issues that cut-across all geographical units of interest were revised and resolved after consultation with the representatives of the TGRO member agencies, such as’ i. Close contacts of probable and suspected cases traced, including members of high risk cohorts (ie., Aged 60 years and above, with a comorbidity, high-risk pregnancy) should be placed under close surveillance). Infection surveillance of the health workers should be the responsibility of the health care facilities where they work There is a need to ensure that community-based surveillance for COVID-19 that includes contact -tracing and case finding are in place and functional in all barangays. iv. Data validation on the source of a probable or a suspected case. v. Revisions of the parameters for the localized lockdown were made and agreed upon. 8. Localized Implementation of COVID-19 Response (Zoning Concept) was presented for notation to the DOH ExeCom on the 78th Executive Committee Meeting, 08 June 2020 ‘A summary of the comments of the ExeCom from the June 1 draft was included in the presentation. ‘Submission of the summary of comments to the NIC through the TGRO. Comments from DOH Offices regarding the Operational Guidelines on the Localized Implementation of the National COVID-19 Response in LGUs of the Philippines, 01 June 2020, 1709H version were incorporated in the operational guidelines working draft. 9. Consultation Meeting on the Finalization of the Operational Guidelines for the Localized Implementation of COVID-19 Response, 09 June 2020 Cross validation of references, definitions, issuances, statutory guidelines and other related relevant materials were made.b. Consultation with the City Transportation Division of General Santos, Non- Government Organization (NGO) — Representative and Business/Entrepreneur and Microfinance Sector Representatives with operations in Luzon, Visayas and Mindanao were made. c. Suggestions from the NTF Inter-Task Group Meeting were incorporated in the draft operational guidelines. V. RECOMMENDATIONS Attached herewith for the approval and signature of the National Task Force against COVID-19 Chairperson and Vice-Chairperson are the Operational Guidelines on The Application of The Zoning Containment Strategy in The Localization of the National Action Plan Against COVID-19 Response. FOR THE NTF CHAIRPERSON AND VICE-CHAIRPERSON’S APPROVAL AND SIGNATURE.REPUBLIC OF THE PHILIPPINES: INTER - AGENCY TASK FORCE AY a FOR THE MANAGEMENT OF EMERGING INFECTIOUS DISEASE Prove NATIONAL TASK FORCE COVID19 MEMORANDUM CIRCULAR NO. 2, s. 2020 To ALL IMPLEMENTING AGENCIES, THE NATIONAL TASK FORCE AGAINST COVID-19 (NTF), ALL REGIONAL INTER-AGENCY TASK FORCES ON THE MANAGEMENT OF EMERGING INFECTIOUS DISEASES (RIATF), REGIONAL AND LOCAL COVID-19 TASK FORCES (RTFS AND LTFS) SUBJECT : OPERATIONAL GUIDELINES ON THE APPLICATION OF THE ZONING CONTAINMENT STRATEGY IN THE LOCALIZATION OF ‘THE NATIONAL ACTION PLAN AGAINST COVID-19 RESPONSE DATE 15 JUNE 2020 RATIONALE ‘As the world grapples with the Coronavirus Disease 2019 (COVID-19) pandemic, ‘countries have implemented numerous interventions in response to the pandemic with varying levels of success. Since April 2020, the World Health Organization (WHO) has emphasized the global COVID-19 response strategy’s goal, which is to delay the transmission and reduce mortality caused by COVID-19, with the aim that each country will reach a point where the number of cases reported daily is at steady low-levels or where there is an absence of COVID-19 transmission’. For this reason, several countries, including the Philippines, have implemented different degrees of “lockdown” and community quarantine interventions. In the Philippines, on 7 March 2020, the Department of Health (DOH) announced the country's first reported local transmission when a 60-year-old male, without any travel history outside the Philippines and with a history of hypertension and diabetes experienced respiratory symptoms was admitted to a hospital on 1 March 20202. Subsequently, the DOH has recorded a continuous increase in the number of COVID-19 cases in the country. Writ Heatn Organization (WHO), Intrim guidance: cansderation in adjusting pubic heath and soctal measures inthe context of COVIO-19, 2020 (18 Apr 2020), . 1, 2 Department of Heath (OOH), Press release: DOH confirms local transmission of COVID-19 in Ph; rports 6th case (7 March 2026) (accessed 28 May 2020), 1To curb the increasing number of COVID-19 cases in the country, President Rodrigo Roa Duterte signed Proclamation 922 declaring the whole country under a State of Public Health Emergency due to the threat of COVID-19° and placed Metro Manila under community quarantine on 8 March 2020*. Thereafter, on 16 March 2020, the President signed Proclamation 929 declaring the whole country under a State of Calamity for a period of six (6) months and placed the entire Luzon under Enhanced Community Quarantine (ECQ)*. Eventually, Local Government Units (LGUs) followed and declared their respective areas of jurisdiction under Community Quarantine. ‘Wuhan, China was the first to implement lockdown measures, and travel and movement restriction. During that time, the Chinese Government was highly criticized, even the World Health Organization (WHO) was cautioning against it. Afterwards, studies showed that the implementation of quarantine and lockdown measures anchored on the framework of “suppress and lift” policy in Wuhan, China, has reduced the magnitude of the epidemic peak of COVID-19 and lead to a smaller number of overall cases The epidemic response experienced by other countries on lockdowns, quarantines and extreme forms of physical distancing has unintended consequences. Hence, massive and blanket lockdowns and distancing measures are not sustainable for a long time. As such, imperative to design and implement interventions to effectively subdue the spread of the disease is a challenge to carefully consider huge impacts on the economies, people's good will, emotional well-being and resilience”. With this in view, preparation for several cycles of a “suppress and lift” policy wherein during which restrictions are applied and relaxed, re-applied and relaxed again, by which localities can keep the pandemic under control but to an acceptable economic and social cost. In the Philippines, the COVID-19 cases are reported and clustered only in several cities/municipalities and communities, making large-scale containment operations and blanket interventions unfeasible, inefficient and costly. Thus, a formal framework on how Local Government Units (LGUs) could monitor the pandemic more accurately, and adopt a calibrated response, adaptive to the emerging conditions in their respective areas and selective in its focus that will enable them to stay ahead of the outbreak trajectory, is therefore needed. Even though different communities strike a different balance in their ‘own terms, the ‘suppress and lift” approach is generalizable to all. Localities must be ready to re-impose drastic restrictions as soon as critical parameters start rising again. This is where the application of the rolling classification of restrictions and recalibrated and selective responses can be imposed, lifted and reimposed, as deemed appropriate by the LGUs to contain and mitigate the impact of COVID-19. ° Office ofthe President of the Republic ofthe Philippines, Proclamation No. 822 series 2020, Declaring a state of public health ‘emergency throughout the Philippines, (8 March 2020), 4 inter-agency Task Force forthe Management of Emerging Infectious Diseases (IATF-EID) Resolution No. 11 series of 2020, (12 March 2020), * office of the President ofthe Republic of the Philippines. Proclamation No. 929 series 2020, Declaring a stato of calamity ‘throughout the Philppines due to Coronavirus Disease 2019, (18 March 2020). © Prem, K, Yang, L, Russol, TW. ta. ‘The effect of control strategies to reduce social mixing on outcomes of the COVID- 18 epidemic in Wuhan, China: a modeling study.” Lancet Pubic Health 2020, Vol 8, May 2020 (published online 25 March 2020), . 10. DOI:10.1016/52468-2667(20)30073-6. Abrigo, M., Uy, J., Haw N. et.al. Projected Disease Transmission, Health System Requirements, Macroeconomics Impacts ofthe Coronavirus Disease 2019 (COVID-19) in the Philippines.” Philippine Insitute for Development Studies (PIDS), Discussion Paper Series No, 2020-15 (Apri 2020), 2The Zoning Containment Strategy is applied in order to identify focused areas for implementation of varying levels of quarantine, depending on the risk and stage of transmission prevalent in the area. However, it is anticipated that no single containment measure by itself will be sufficient to stop the spread of this virus with 100% success. It is in this light that COVID-19 response operations with combined measures applying the Prevent-Detect-Isolate-Treat-Reintegrate Strategy shall be adopted to intervene early and stop the further spread of the pandemic. In support of this and in recognition of the integral role LGUs play in the localization of the implementation of the National Action Plan against COVID-19 Response, Section 2 of EO 112 s. 2020, provides that “provincial governors shall be authorized to impose, lift or extend ECQ in CCs and municipalities upon the concurrence of the relevant regional counterpart body of the IATF. The mayors cities and municipalities are likewise authorized to impose, lift or extend ECQ in barangays , upon the conourrence of the relevant regional counterpart body of the IATF. This is without prejudice to the authority of the IATF to directly impose, lift or extend ECQ in these areas should circumstances call for it’*. 2. PURPOSE This Order intends to provide the National Government and the Local Government Units (LGUs) with guidelines to contain the spread of COVID-19 pandemic utilizing the Zoning Containment Strategy; guide the local authorities in the transitioning of community quarantine measures to less or more stringent restrictions while continuously monitoring COVID-19 risk indicators; and standardize the principles of community quarantine implementation among zones identified by LGUs. 3. SCOPE AND COVERAGE All Implementing Agencies, the National Task Force Against COVID-19 (NTF), all Regional Inter-Agency Task Forces on the Management of Emerging Infectious Diseases (RIATF), Regional and Local COVID-19 Task Forces (RTFs and LTFs) and all others concerned. 4. DEFINITION OF TERMS 4.1, Active Surveillance - refers to the systematic collection, analysis and dissemination of data where public health officers either collect the data themselves or seek reports from participants in the surveillance system on a regular basis, rather than waiting for reports®; 4.2. Case Finding - is a strategy for targeting resources at individuals or groups who are suspected to be at risk for a particular disease, involving active and systematic ‘surveillance of those at risk even before they present with signs of active disease; ° Office ofthe President ofthe Republic ofthe Philippines, Executive Order No. 112 series 2020, ‘imposing an enhanced ‘community quarantine in high-risk geographic areas of the Philippines and a general community quarantine inthe rest ofthe ‘country fom 07 to 15 May 2020, adopting the ornibus guidelines on the implementation thereot, and for other purposes’, P. 3 * DOH, Philippine Integrated Disease Surveillance and Response Manval of Procedures, 3rd Ealton, Vo.1 (Department of Health, 2014), p xi 343. 44. 45. 46. 48. 49. Case investigation - refers to the profiling of a suspect, probable, or confirmed COVID-19 case, which include but is not limited to review of medical, surveillance, and laboratory records, case interview, and review of other records and documentation’; Close contact - a person who may have come into contact with a probable or confirmed case two days prior to onset of illness of the confirmed COVID-19 case (use date of sample collection for asymptomatic cases as basis) until the time that said case tests negative on laboratory confirmation or other approved laboratory test. Close contact can mean any of the following: 4.4.1. Face-to-face contact with a probable or confirmed case within one (1) meter and for more than 15 minutes; 4.4.2. Direct physical contact with a probable or confirmed case; 4.4.3, Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment; OR 4.4.4, Other situations as indicated by local risk assessments"’; Cluster of cases - refers to a presence of two (2) or more cases of either suspect, probable and/or confirmed COVID-19, or any possible source of transmission until proven otherwise, aggregated in a certain area per time period; Community-based surveillance - is an active process of community participation in detecting, reporting, responding to and monitoring health events in the ‘community’; . Confirmed COVID-19 case - an individual who tested positive for COVID-19 through laboratory confirmation at the national reference laboratory, subnational reference laboratory, or a DOH-certified laboratory testing facility’®. A confirmed COVID-19 case can be either asymptomatic or symptomatic; Contact tracing - refers to the identification, listing and follow-up of persons who may have come into close contact with a confirmed COVID-19 case. Contact tracing is an important component in containing outbreaks of infectious diseases. Under Code Red Level 2, contact tracing is aimed at mitigating the spread of the disease“; Coronavirus Disease 2019 (COVID-19) - is a disease caused by SARS-CoV-2, 2 newly emergent coronavirus. COVID-19 signs and symptoms vary: 49.4. Most persons experience fever (83-99%), cough (59-82%), fatigue (44- 70%), anorexia (40-84%), shortness of breath (31-40%), myalgias (11-35%); 10 DOH Administrative Order No. 2020-0013 ‘Revised Administrative Order No, 2020-0012 "Guidelines forthe Inclusion ofthe Coronavirus Disease 2019 (COVID-19) in the List of Notffable Diseases for Mandatory Reporting tothe Department of Heath” ‘dated March 17, 2020 (09 April 2020) p. 2. "od, 2 12 Ho, integrated disease surveilance and response inthe Afican Region: A guide for establishing community-based ‘surveilance, (August 2014). 12 DOH Deparment Memorandum No. 2020-0189, ‘Updated guidelines on contact trecing on closed contacts of confimed Coronavirus Disease (COVID-19 cases. Department of Health’ (17 Apri 2020) p. 2. * bid, pt 4Other non-specific symptoms such as sore throat, nasal congestion, headache, diarrhea, nausea and vomiting have also been reported. Loss of ‘smell (anosmia) or loss of taste (ageusia) preceding the onset of respiratory symptoms has also been reported; 4.9.3. COVID-19 is also associated with mental and neurological manifestation including delirium or encephalopathy, agitation, stroke, meningo- encephalitis, anxiety, depression and sleep problems. In many cases, neurological manifestations have been reported even without respiratory symptoms; 4.9.4, Older people and immunocompromised patients in particular may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhea, loss of appetite, delirium and absence of fever; 4.9.5. Symptoms of dyspnea, fever, gastrointestinal symptoms or fatigue due to physiologic adaptations in pregnant women, adverse pregnancy events, or other diseases such as malaria, may overlap with symptoms of COVID-19; and 4.9.6. Children might not have reported fever or cough as frequently as adults"*, 4.10. Enhanced Community Quarantine - refers to the implementation of temporary measures imposing stringent limitations on movement and transportation of people, strict regulation of operating industries, provision of food and essential services, and heightened presence of uniformed personnel to enforce community quarantine protocols"*; 4.11. Epidemiologic linkage evidence - refers to one or more of the following exposures in the 14 days before the onset of symptoms: 4.11.4. Close contact with a confirmed or probable case of COVID-19 disease; 4.11.2, Close contact with a person with clinically compatible illness AND linkage toa confirmed case of COVID-19 disease; 4.11.3. Travel to or residence in an area with a sustained, ongoing community transmission of SARS-CoV-2; OR 4.11.4, Member of a risk cohort as defined by public health authorities during an outbreak”; 4.12. Essential goods and services - covers health and social services to secure the safety and well-being of persons, such as but not limited to, food, water, medicine, medical devices, public utilities, energy and others as may be determined by the IATF*S; 4.13. Geographical unit - represents a physical feature of an area or a physical structure which, in this Order, shall serve as the unit of implementation of the Zoning Containment Strategy; *8 WHO, Ciinical Management of COVID-19: Interim Guidance, (27 May 2020). "8 IATE-E10, Omnibus Guidelins on the Implementation of Community Quarantine in the Philppines (with Amendments as of 03 June 2020), 2. * Council of Stat & Teritorial Epidemiologist, Interim-20-10-01, 48 IATF-EID, Omnibus Guidelines onthe Implementation of Community Quarantine in the Philppnes (with Amendments 28 of 03 June 2020), 6. 3.4.44. 4.15. 4.16. 4.47. 4.48. 4.19. 4.20. 4.21. Tee, General Community Quarantine - refers to the implementation of temporary measures limiting movement and transportation, regulation of operating industries, and presence of uniformed personnel to enforce community quarantine protocols"®; Imported case - a case with virological or epidemiological evidence, or both, of ‘exposure outside the geographical area where the case is reported, where in this Order, shall pertain to those outside a province or municipality; Influenza-like IlIness (ILI) - is a conduction with sudden onset (within 3 days of presentation and fever should be measured at the time of presentation) of fever of 238C and cough or sore throat in the absence of other diagnoses™; Modified Enhanced Community Quarantine - refers to transition phase between ECQ and GCQ, when the following temporary measures are relaxed and become less necessary: stringent limits on movement and transportation of people, strict regulation of operating industries, provision of food and essential services, and heightened presence of uniformed personnel to enforce community quarantine protocols become less necessary”*; Modified General Community Quarantine - refers to the transition phase between GCQ and New Normal, when the following temporary measures are relaxed and become less necessary: limiting movement and transportation, the regulation of operating industries, and the presence of uniformed personnel to enforce community quarantine protocols, New Normal - refers to the emerging behaviors, situations, and minimum public health standards that will be institutionalized in common or routine practices and remain even after the pandemic while the disease is not totally eradicated through means such as widespread immunization. These include actions that will become second nature to the general public as well as policies such as bans on large gatherings that will continue to remain in force®; Parameter - refers to the technical factors such as epidemiological evidence to be used as indicators for the imposition and lifting of movement restrictions; Passive Surveillance - refers to a surveillance system in which reports are awaited and no attempt is made to seek reports actively from the participants in the system?*; (Omnibus Guidelines on the Implementation of Community Quarantine inthe Phifppines (with Amendments as of 03 June 2020), p. 3 2 DOH Administrative Order 2020-0013, Rovised Administrative Order No. 2020-0012, "Guidelines forthe Inclusion ofthe Coronavirus Disease 2019 (COVID-19) inthe List of Notifable Disease for Mandatory Reporting tothe Department of Heath” dated March 17, 2020, (8 Apri 2020). 21 iaTF-E1D, Omnibus Guidelines on the Implementation of Community Quarantine In the Philppines (With Amendments 28 of 03.June a8 2020), p. 4 22 ibid 4 2 bid. 4 2 DoH, Phlipine Integrated Disease Survellance and Response Manual of Procedures, 3rd Eton, Volt (Department of Health, 2014), p. xvi 64.22. Point of Entry - refers to a passage for entry or exit of individuals, travelers, baggage, cargo, containers, conveyances, goods and postal parcels as well as agencies and areas providing services to them on entry or exit®; 4.23, Probable COVID-19 case - a suspect case who fulfills anyone of the following listed below: 4.23.1. Suspect case whose test results for COVID-19 is inconclusive; Suspect who tested positive for COVID-19 but whose test was not conducted in a national or subnational reference laboratory or officially accredited laboratory for COVID-19 confirmatory testing; or 4.23.3. Suspect case who died without undergoing any confirmatory testing”; 4.24, Suspect COVID-19 case - a person who is presenting with any of the conditions below: 4.24.1. All SARI cases where NO other etiology that fully explains the clinical presentation; Influenza-like Illness (IL!) cases with any one of the following: 4.24.21. With no other etiology that fully explains the clinical presentation AND a history of travel to or residence in an area that reported local transmission of COVID-19 disease during the 14 days prior to symptom onset: or 4.24.2.2. With contact to a confirmed or probable case of COVID-19 disease during the 14 days prior to the onset of symptoms; Individuals with fever, cough or shortness of breath or other respiratory signs or symptoms fuffiling any one of the following conditions: 4.24.31. Aged 60 years and above; 4,24,3.2. With a comorbidity; 4,24,3.3. Assessed as having a high-risk pregnancy; and/or 4.24,3.4, Health worker”; 4.24. 4.24. 4.25. Severe Acute Respiratory Infection (SARI) - is an acute respiratory illness with onset during the previous seven (7) days requiring overnight hospitalization. A SARI case should meet the ILI case definition AND anyone of the following: (a) shortness of breath or difficulty of breathing, (b) severe pneumonia of unknown etiology, acute respiratory distress or severe respiratory disease possibly due to novel respiratory pathogens (such as COVID-19)"*; 4.26. Syndromic Surveillance - refers to methods relying on detection of clinical case features that are discernible before confirmed diagnoses are made”; 25 tid, p. xu 2° DoH Department Memorandum No. 2020-0189, Updated guidelines on contact tracing on closed contacts of confimed Coronavirus Disease COVID-19 cases, (17 Apri 2020), p. 2. 7 ibid, p.2. 28 DoH Administrative Order 2020-0013, Revised Administrative Order No. 2020-0012, "Guidelines forthe Inclusion ofthe Coronavirus Disease 2019 (COVID-19) in th List of Notifable Disease for Mandatory Reporting tothe Department of Heath" dated March 17, 2020, ( April 2020). 2° mandi, K.D., Overhage, M., Wagner, MLM. "implementing Syndromic Survelance: A Practical Guide Informed by the Early Experience’, Journal ofthe American Mcical Informatics Association, Vol. 11 Number 2, (Mar/Apr 2004). DOL 10.1197/amia M1366.4.27. 4.28. Zoning Containment Strategy - refers to a localized rapid response operation to contain the spread of COVID-19 as a preventive option for intervention; and Zone Classification - refers to the risk area/s identification based on the set parameters. 5. GENERAL POLICY 5.1. 5.2. 5.3. 5.4. 5.5. 5.6. The National Response Strategy in lifting of community quarantine measures and in easing movement restrictions in and within LGUs shall follow the principles set by the World Health Organization,*° ** and the guidelines and resolutions released by the inter-agency Task Force for Emergency and Re-emerging Infectious Disease (IATF-EID); and shall utilize the Zoning Containment Strategy in which lifting of ‘community quarantine measures is carried out in a gradual and phased manner to prevent resurgence of COVID-19 infections while ensuring a strong and resilient health system is in place; The Zoning Containment Strategy shall also anchor its interventions on two principles: Principle of Mass Concentration in which the national and local COVID- 19 efforts and responses are concentrated at the most advantageous areas/places and time to achieve decisive results; and the Principle of Economy of Force in which all available resources of the national government and LGUs are utilized in the most effective way, concentrating resources in areas/places where they are greatly needed while discriminately utilizing resources in any secondary interventions or efforts®? ®; The Zoning Containment Strategy aims to contain and prevent the spread of COVID-19; protect the Filipino people; and mitigate the social, economic and security impacts of the COVID-19 pandemic crisis; The COVID-19 response of LGUs, and specific areas or geographical units within it regardless of zoning classification, shall be guided by the National Action Plan for COVID-19 where the concept of End-to-End T3 Management System: Trace-Test- Treat is operationalized by employing six lines of efforts: prevent, detect, isolate, treat, reintegrate, and adapt to the new normal; With the Zoning Containment Strategy, the government shall adopt a nationally directed but decentralized execution of strategy to contain and mitigate the impact of COVID-19; Likewise, the rolling stages of community quarantine interventions in the Zoning Containment Strategy will allow and authorize the local authorities to implement a localized COVID-19 response that is calibrated, adaptive and selective; With the localization of the Zoning Containment Strategy, the Tiered-Response Framework implemented and institutionalized by the National Disaster Risk Reduction and Management Council (NDRRMC) can be applied in the COVID-19 response where interventions are implemented from the barangay, municipality, provincial, regional up to the national level; Likewise, the Concept of Supporting- 3° WHO, Interim protocol on rapi operations to contain the inal emergence of pandemic infuenze, (2007). 31 WHO, Interim guidance: consideration in adjusting public heath and social measures in the context of COVID-19. 2020, (18. ‘Ap#il 2020). 32 Rubin, H, Future Global Shocks: Pandemics. OECD/IFP Project on Future Global Shocks, (University of Pennsyivania, 14 January 2011). 3 Clausewitz, C.V, Principles of war. (Dover Publications, 2012) 85.7. 6.1. 6.2, 6.3. Supported can also be employed in the localized COVID-19 response where all barangays contribute in the efforts to help an at-tisk or affected barangay. This concept holds true also for municipalities, cities, and provinces; The local health systems and each of its building blocks”, namely - governance, service delivery, health workforce, health information systems, access to essential medicines and equipment, health financing - of all LGUs regardless of zoning classifications, shall be strengthened to hasten post-pandemic health system recovery and to enhance local capacity for pandemic preparedness and response as supported by the National Government. THE ZONING CONTAINMENT STRATEGY AND ITS PARAMETERS. LGUs shall apply the Zoning Containment Strategy in identifying areas needing prompt COVID-19 interventions and response, pursuant to the directives stated in Executive Order No. 112% and the pertinent IATF-EID Resolutions providing for the community quarantine classifications of LGUs including their appeals and commitments; Areas in the LGUs shall be categorized into four (4) zoning classifications, where its epidemiological parameters shall be contextualized based on respective geographical units as stated in Item 6.3. (see Annex A). 6.2.1. Critical Zone (CrZ) is an area where the initial number of cases or several clustering of cases are identified within the past seven (7) days. Specific epidemiological parameters with epidemiological threshold for CrZ are set depending on the geographical unit; 6.2.2. Containment Zone (CZ) is/are area/s without new cases but are adjacent to a geographical unit categorized as CrZ; 6.2.3. Buffer Zone (BZ) are areas without new cases but are adjacent to areas categorized as CZ; and 6.2.4. Areas Outside Buffer Zones (OBZ) all remaining areas without new cases not categorized as CZ or BZ; The zoning classifications under item 6.2 shall be applied to the following, but not limited to, geographical units below, whichever is applicable, with their respective level's epidemiological parameters (see Annex B): 6.3.1. House 6.3.1.1. A-house is a single-unit residential building or enclosed physical structure over a plot of land. A house can also be a condo unit, townhouse unit, apartment unit, dorm unit/room, prison/jail cell, among others; 6.3.1.2. Parameter: A house shall be categorized as a CrZ if at least one (1) case of either a suspect, probable or confirmed COVID-19 is present; 6.3.2. Residential Building 6.3.2.1. A residential building refers to a permanentitemporary enclosed construction or physical structure over a plot of land. It can be a * WHO, Monitoring ine building blocks of the health system: a handbook of indicators and their management strategies, 2010) Office of the President ofthe Republic ofthe Philippines. Executive Order No. 112, seres of 2020, Imposing an Enhanced Community Quarantine in High-Risk Geographic Areas of the Philppines ofthe Country from 01 to 15 May 2020, Adopting the Omnibus Guidelines on the implementation Thereof, And for Other Purposes, (30 Axil 2020), p. 3 96.3.2.2. condominium, tenement, dormitory, townhouse, multiple-door apartment; places of detention such as correctional, jails, and others; and religious formation centers such as church dormitories, convents, monasteries and seminaries, among others; Parameter: 6.3.2.2.1. In residential buildings with floors, a residential building floor shall be categorized as CrZ if at least two (2) cases of either a suspect, probable, and/or confirmed COVID-19 are present in two different units. within the same floor; 6.3.2.2.2. A residential building shall be categorized as a CrZ if at least two (2) cases of either a suspect, probable and/or confirmed COVID-19 are present in two different floors; 6.3.3. Business/Work establishment 6.3.3.1. 6.3.3.2, 6.3.4, Market 6.3.4.1, 6.3.4.2. A business/work establishment refers to any establishment Where goods are made, stored or processed, services are rendered and/or business/work is conducted. It can also be a factory; government, non-government and other statutory offices; call center, hotel, or resort, among others. Parameter: 6.3.3.2.1. A small business/work establishment, with less than 1,000 resident occupants shall be categorized as a CZ, if at least one (1) cluster of cases composed of either a suspect, probable and/or confirmed COVID- 19, where the individuals identified as such have been physically reporting to the business establishment for the past 14 days; and 6.3.3.2.2. A large business/work establishment, with 1,000 or more resident occupants shall to be categorized as a IZ, if at least two (2) olusters of cases composed of either a suspect, probable and/or confirmed COVID- 19, where each cluster of cases is reported from separate buildings, floors, wings or annexes of the business establishment, whichever is applicable, and where the individuals identified as such have been physically reporting to the business establishment for the past 14 days; A market refers to an area where commercial dealings are conducted. It can be a supermarket, dry market (e.g. fabric or furniture market), or wet markets (e.g. palengke, or talipapa), among others; Parameter: A market shall be categorized as a CrZ if at least three (3) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are present in the barangay where the market is located; 106.3.5. 6.3.6. 6.3.7. 6.3.8. 6.3.9. Street 6.3.5.1. 6.3.5.2. Block 6.3.6.1. 6.3.6.2. Purok 6.3.7.1. 6.3.7.2. Barangay 6.3.9.1. 6.3.9.2. A street refers to a single path, road, or thoroughfare between two places where houses, buildings and establishments are found in a community. The national highway shall be not be considered as a "street"; Parameter: A street shall be categorized as CrZ if at least two (2) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are present in different houses, buildings or establishments along a specified street, A parcel of land bounded on the sides by streets ocoupied by or intended for buildings; Parameter: A block shall be categorized as CrZ if at least three (3) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are present in at least two different streets surrounding the block; ‘A purok is a division within a barangay usually composed of twenty to fifty or more households; Parameter: A purok shall be categorized as CrZ if at least three (3) clusters of cases, composed of either suspect, probable andlor confirmed COVID-19, are present in different houses or buildings within the purok; niVillage ‘A subdivision or village refers to a group of residential plots/houses. It may also refer to a compound, and a gated community, village, among others; Parameter: A subdivision or a village shall be categorized as CrZ if at least four (4) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are reported in at least two different streets or blocks, whichever is applicable; A barangay is a small territorial and administrative unit forming the most local level of government”; Parameter: 6.3.9.3. A densely-populated barangay with population density greater than 1,000/km? shalll be categorized as a CrZ if at least five (6) clusters of cases, composed of either suspect, probable andlor confirmed COVID-19, are present in at least three different sitios, puroks or blocks, whichever is applicable; 6.3.9.4. A sparsely-populated barangay with population density below 1,000/km? shall be categorized as a CrZ if atleast two (2) clusters of cases, composed of either suspect, 25 Housing and Land Use Regulatory Board. Revised Rules and Standards for Economic and Socialized Housing Projects fo Implement Batas Pambansa 220. 57 parangay’. (Oxford Dictionaries, Retrieved 30 May 2020), "probable and/or confirmed COVID-19, are present in at least two different sitios, puroks or blocks, whichever is applicable; 6.3.9.5. A settlement area shall be categorized as CrZ if at least two (2) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are reported from at least two different areas within the settlement; 6.3.10. City/Municipality 6.4, 6.5. 6.6. 6.3.10.1. Municipality refers to a territorial and political subdivision consisting of a group of barangays properly identified by metes and bounds with technical descriptions, with contiguous land area sufficient to meet the requirements of its populace”. 6.3.10.2. Parameter: A municipality shall be categorized as CrZ, if 25% of its barangays were declared as CrZ, with causal link to areas reserved and ocoupied as residential and/or commercial corridors, and population density is greater than 1,000/km?; 6.3.10.3. City refers to a territorial and political subdivision consisting of two or more developed and urbanized barangays properly identified by metes and bounds with technical descriptions, with contiguous land area sufficient to meet the requirements of its populace™ 6.3.10.4. Parameter: A component city shall be categorized as a CrZ if 25% of its barangays were declared as CrZ, with causal link to areas reserved and occupied as residential and/or commercial corridors, and population density is greater than 1,000/km?; When smaller geographical units such as houses, residential buildings, business establishments, markets, streets, blocks, subdivisions among others, are categorized as CrZ, the radius method shall be used in determining the CZ and BZ. All geographical units or any establishments within the 500-meter radius from the geographical unit categorized as CrZ, shall be categorized as CZ. And all geographical units or any establishments within the five 500-meter radius from the CZ, shall be categorized as BZ. If a geographical unit or an establishment is only partially included with the radius, the whole geographical unit or establishment shall be considered as part of the identified zone; When larger geographical units such as puroks, barangays, municipalities and cities, among others, are categorized as CrZ, the zonal border method shall be used to categorize the CZ and BZ, in which the same geographical unit used to categorize a CrZ shall be the basis in determining the CZ and BZ, eg. if a barangay is categorized as CrZ, all barangays contiguous to it shall be categorized as CZ, and all barangays contiguous to CZ shall be categorized as BZ; In cases wherein a geographical unit is enclosed between geographical units categorized as CrZs, the LGU may categorize this geographical unit as CrZ, regardless of number or absence of cases reported within the geographical unit; and may appropriately consider the “clustered” CrZs as a single unit; 8 Local Government Code ofthe Philippines, Book il Local Governments, Tite Two, Chapter 1. Role and Creation ofthe City, Section 440, Role ofthe Municipality Local Government Code of the Philipines, Book il Local Governments, Tite Three, Chapter 1. Roe and Creation ofthe ity, Section 448, Role ofthe City. 127 6.7. 6.8. 6.9. 6.10. THE 7A. 7.2. 73. 74. For cases falling under the immediately preceding provision (item 6.7), the determination of CZ and BZ shall still follow the prescribed measures for the same geographical unit as provided for under this policy; Close coordination between mayors or governors of adjacent localities, through the RIATF, shall be made when areas categorized as CZ and BZ surrounding a particular CrZ are outside the jurisdiction of the mayor or governor; If the strict adherence to the guidelines, as provided herewith, shall by reason of unique, and special circumstances, cause serious deviation from the general intent of this policy, the LGU may, with permission and concurrence from the concerned RIATF, impose a specialized scheme; For any circumstance otherwise specified in the foregoing provisions on the zoning classification and categorization, the LTF shall have the discretion to decide on administrative matters relative to the implementation of the Zoning Containment ‘Strategy with concurrence of the RIATF without prejudice to the authority of the NTF as the oversight. ROLLING STAGES OF INTERVENTIONS The rolling stages of interventions shall be the framework to be applied in determining the interventions to be implemented in a particular zone; The rolling stages of interventions is a framework in which a type of community quarantine is designated for each zone, and in which upon every reassessment, a geographical unit may oscillate from one zone to the other, depending on the epidemic situation and circumstance, whereby the stages of interventions in each type of community quarantine is implemented towards the observance of the New Normal; Activities or interventions in each type of community quarantine shall be in accordance with the Omnibus Guidelines on the Implementation of Community Quarantine in the Philippines published by the IATF. The following types of community quarantine shall correspond with the following zoning classifications (see Annex C): 7.3.4. All geographical units declared as Critical Zone (CrZ) shall be placed under Enhanced Community Quarantine (ECQ); 7.3.2. All geographical units declared as Containment Zone (CZ) shall be placed under Modified Enhanced Community Quarantine (MECQ); 7.3.3. All geographical units declared as Buffer Zone (BZ) shall be placed General Community Quarantine (GCQ); and 7.3.4. All geographical units declared as Areas Outside Buffer Zones (OBZ) shall be placed under Modified General Quarantine (MGCQ); Consistent with EO No. 112 series of 2020, the Mayors of municipalities/cities are authorized to impose, lift or extend community quarantine interventions based on the respective zoning classifications and parameters on the following, but not limited to, these geographical units within his/her jurisdiction, upon the concurrence of the Regional IATF**: 7 Houses 40 \,TF-£1D, Omnibus Guidelines on the Implementation of Community Quarantine inthe Philippines, (May 2020) “4 offce ofthe President of the Republic ofthe Philippines, Executive Order No. 112 series 2020. imposing an enhanced community querantine in high-isk geographic areas ofthe Philippines and a general community quarantine in th rest ofthe Country rom Of 10 15 May 2020, adopting the omnibus guidelines on the implementation thereot, and fr other purposes, P. 3 137.8. 76. 77. Residential Building/s Business Establishment/s Market/s Streets Block/s Purok/s Subdivision/s Barangay/s Likewise, consistent with EO No. 112 series of 2020, the Provincial Governors are authorized to impose, lift or extend community quarantine interventions based on their respective zoning classifications and parameters of the component cities and municipalities within his/her jurisdiction, upon the concurrence of the Regional ATF; Upon thorough assessment, an authorized Local Chief Executive, with the concurrence of the Regional IATF, can declare a geographical unit as CrZ, immediately once the established parameters per zoning classification are met. Likewise, helshe can subsequently declare surrounding geographical units as CZ, BZ or OBZ based on their respective established parameters. Reassessment of the zoning classification of a geographical unit shall be done every 30th/31st and 15th day of the month. Categorized or recategorized zones shall be announced every 1st and 16th day of the month. Zones may be expanded or narrowed and community quarantine interventions may roll from one stage to the other based on updated number and location of cases upon reassessment; Lifting of a community quarantine imposed upon a geographical unit shall be done when all surveillance, testing and quarantinefisolation interventions/activities have been completed. And the following, but not limited to these scenarios are achieved: 7.7.1. Tests of suspected cases are negative; 7.7.2. No NEW suspect, probable or confirmed cases identifier 7.7.3. Completion of 14-day quarantine measures of individuals in the geographical unit; 8. SPECIFIC GUIDELINES 8.4. Ibid. p. 3 ‘Specific Guidelines of the Zoning Containment Strategy (see Annex D) 8.1.1. Ifa province, Highly Urbanized City (HUC), or Independent Component City (ICC) is under ECQ as classified by the IATF: 8.4.1.1. A geographical unit within a province, HUC or ICC may be classified as CrZ in which ECQ shall be implemented; 8.1.1.2, Likewise, geographical units classified as CZ, BZ, and OBZ shall also implement ECQ; 8.1.2. Ifa province, HUC, of ICC is under MECQ as classified by the IATF: 8.1.2.1. A geographical unit within a province, HUC or ICC may be classified as CrZ in which ECQ shall be implemented; 2. A geographical unit within a province, HUC or ICC may be classified as CZ in which MECQ shall be implemented; 2.3. Likewise, geographical units classified as BZ or OBZ shall also implement MECQ; 8. 8 148.1.3. Ifa province, HUC or ICC is under GCQ as classified by the IATF: 8.1.31. A geographical unit within a province, HUG or ICG may be classified as CrZ in which ECQ shall be implemented; 8.1.3.2. A geographical unit within a province, HUC or ICC may be classified as CZ in which MECQ shall be implemented; 8.1.3.3. A geographical unit within a province, HUC or ICC may be classified as BZ in which GCQ shall be implemented; 8.1.3.4. Likewise, geographical ul implement GCQ; classified or OBZ shall also 8.1.4. If a province, HUC or ICC is under MGCQ as classified by the IATF: 8.1.4.1. A geographical unit within a province, HUC or ICC may be classified as CrZ in which ECQ shall be implemented; 8.1.4.2. A geographical unit within a province, HUC or ICC may be classified as CZ in which MECQ shall be implemented; 8.1.4.3. A geographical unit within a province, HUC or ICC may be classified as BZ in which GCQ shall be implemented; and 8.1.4.4. Likewise, a geographical unit within a province, HUC or ICC may be classified as OBZ in which MGCQ shall be implemented. 8.2. Organization and Operationalization 8.2.1. For LGUs, the implementation of the Zoning Containment Strategy shall be under the Local Task Force against COVID-19 (LTF)*®. The LTF shall have the following teams pursuant to the provisions and functions stated in the Department of the Interior and Local Government (DILG) Memorandum Circular (MC) No. 2020-077: 8.2.1.1. Contact Tracing Team (CTT) 8.2.1.2. Diagnostic and Testing Team (DTT) 8.2.1.3. Patient Management and Monitoring Team (PMMT) COVID-19 Referral and Li (RPCU) Isolation Facility Management Unit (IFMU) )n Unit (CRLU) Reintegration and Psychosocial Counselling Unit 8.2.1.4. Logistics and Resource Support Team (LRST); and 8.2.1.5. Other teams may be organized as deemed necessary. 8.2.2. Upon organization, all LTFs shall conduct the following actions in addition to the directives stated in the DILG MC No. 2020-077: 8.2.2.1. Conduct of Community-based Syndromic Surveillance and Early Recognition of Patients with COVID-19 8.2.2.1.1. As recommended by WHO, the LTF, regardless of zone classification, shall conduct community-based syndromic surveillance; 8.2.2.1.2. Screening can be performed in areas such as the emergency unit, outpatient department, primary care clinic, City Health Office, Rural Health Unit, Barangay Health Station, in the community through the roving 4° DILG Memorandum Circular No, 2020.07, Rationaizing the Establishment of a Local Government Unit Task Force Against COVID-19, (24 April 2020). #* WHO, Clinical Management of COVID-19: Interim Guidance, (27 May 2020) p. 11. 158.2.2.2. 8.2.2.3. 8.2.24. BHERTs personnel or Barangay Health Workers, or telemedicine; 8.2.2.1.3. A simple set of questions shall be used based on the COVID-19 definition as stated in Item 4.9; 8.2.2.1.4. The LTF shall also determine and closely monitor any clustering or any unusual increase in the number of ILI and SARI cases in the community; 8.2.2.1.8. Sentinel Sites may be established to monitor ILI or SARI cases; 8.2.2.1.6. The LTF shall also conduct active surveillance to determine, identify and locate the following: potential imported cases or confirmed imported cases [e.g. Locally Stranded Individuals (LSIs) or Returning Overseas Filipinos (ROFs)], close contacts, suspect, probable and confirmed COVID-19 cases; Spot Mapping of Cases 8.2.2.2.1. The LTF shall map the entire LGU, where every individual, household and building is accounted for after the conduct of an LGU-wide surveillance and contact tracing effort; Categorization and Declaration of Each Geographical Unit ito Zones and Type of Community Quarantine 8,2.2.3.1. Upon thorough assessment, the LTF shall categorize each geographical unit into zones upon satisfaction of established parameters; 8.2.2.3.1.1. The LTF shall first determine if there are geographical units that satisfy the established parameters of the CrZ; 8.2.2.3.1.2, After determining the geographical units categorized as CrZ, the LFT shall determine the CZ and BZ; 8.2.2.3.1.3. If an overlapping of zone classifications occurs, the zoning classification with the stricter measures shall take precedence, e.g. ifa BZis also categorized as CrZ, the LTF shall categorize the geographical unit as CrZ; 8.2.2.3.1.4. Lastly, after determining the BZ, all remaining areas shall be categorized as OBZ; 8.2.2.3.2, The LTF, with the concurrence of the Regional ATF, shall then be authorized to declare geographical units within his/her area of jurisdiction into zones. Narrowing Down Community Quarantine Interventions to the ‘Smallest Possible Geographical Unit 8.2.2.4.1. The LTF shall endeavor to implement the recommended community quarantine interventions to the smallest possible geographical unit as long as it 168.2.2.5. 8.2.2.6, 8.2.2.4.2. Time Interval in Decisi 8.2.2.5.1. satisfies the established parameters, e.g, the LTF shall not impose ECQ on the whole block or whole purok, when only a particular building within the block has satisfied the required parameters; However, if the parameters of a larger geographical unit have already been satisfied, the LTF shall select the larger geographical unit as the unit where the community quarantine interventions shall_ be implemented; n-making Once it is made known to the LGU that the parameters of a certain geographical unit has been satisfied or met, decision to impose a community quarantine with the concurrence of the RIATF shall be made within 24 hours; Grievance Oversight 8.2.2.6.1. 8.2.2.6.2. 8.2.2.6.3. 8.2.2.6.4. 8.2.2.6.5. The RIATE shall be the grievance oversight body to monitor decision made by the LTFs with due cognizance of the jurisdictional powers of LGUs stipulated in the Local Government Code of the Philippines; Individual’s or groups adversely affected by decisions of the LCE relative to the implementation of the policy, when such decision and policy are determined to be excessive and/or without factual basis, may appeal in writing to the RIATF; Upon receipt of any appeal, a designated Officer of the RIATF shall screen the same and determine if such appeal is meritorious based on parameters as set forth under the preceding provision; The Officer shall record all appeals received including hisiher determination on the existence or non- existence of a valid cause for the appeal. The officer shall periodically submit a report to the RIATF on the matter; The Officer shall endorse to the RIATF all meritorious ‘cases for proper disposition/ administration. Reassessment 8.2.2.7.1. 8.2.2.7.2, The LTF shall regularly reassess and recategorize the zones of geographical units and areas of the LGU every 30th/31st and 15th day of the month. Categorized or recategorized zones shall be announced every ‘st and 16th day of the month; The LTF, in the event that the parameters per zoning classification are met and resurgence of cases are recognized and established prior to the set date of reassessment, has the discretion to recategorize a certain geographical unit immediately; and 178.2.2.7.3. The duration of ECQ in a CrZ or MECQ in a CZ shall not be lower than 15 days, provided that all social and public health measures are in place. 8.2.2.8. Data Gathering 8.2.2.8.1. In order to properly assess and categorize geographical units into zones, the LTF shall ensure that information, including, but not limited to, the following are to be gathered beforehand. 8.2.2. Population Number of Barangays Population Density per Barangay BHERTs Teams organized ‘Swabbing Teams organized Contact Tracing Teams organized Social Amelioration Teams organized Quarantine Facilities organized 8,2.2.8.1.9, Treatment Facilities organized 8.2.2.8.1.10. Spot Map of Cases 8.2.2.8.1.11. Syndromic Surveillance 8.2.2.8.1.12. Testing Kits available 8.2.2.8.1.13. Other information and/or data analysis deemed necessary 8.3. Risk Communication and Community Engagement 8.3.1. 8.3.2, 8.3.3. 8.3.4, 8.3.5. The LTFs shall follow the outbreak communications guidelines essential to the effective management of COVID-19. To reinforce the need to understand the communication process from the community's vantage point, all LTFs shall use the Communication for Behavioral Impact (COMBI) approach or any applicable approach in planning and managing health ‘communications; All LTFs shall ensure that a communications mechanism utilizing various ‘communication channels is set in place allowing even the furthest household ‘or purok within their area of jurisdiction to have access to the timely, valuable and correct information at the most possible time; In the spirit of bayanihan, the LTFs shall ensure that the communities are actively engaged, empowered and mobilized to implement any type of community quarantine intervention and practice all minimum public health standards; The LTFs shall also form partnerships and utilize available stakeholders to communicate to and engage the community; and, ‘The LTFs shall establish a feedback mechanism from the community by ensuring a continuous and meaningful dialogue on the implementation of the COVID-19 response to address people's issues and concerns, and perceptions of risk and actual risk; and, promote appropriate collective community participation and action. 8.4, Capacity Building 8.4.1. ‘The National Task Force Against COVID 19shall capacitate the RTFs in the implementation or the localization of the National Action Plan, specifically the Zoning Containment Strategy; 18Likewise, the RTFs shall capacitate LTFs in the implementation of the same plans and strategies; 8.4.3. The capacity building activities shall commence a week after the release of the guidelines and facilitated by the NTF through the National Incident Command, Task Group Response Operations (TGRO) and all concerned agencies to ensure that the target participants, e.g. the LTFs are fully equipped it the actual localized implementation; 8.5. Specific Zoning Interventions and Activities The following interventions and activities may be conducted in addition to those mentioned in the Omnibus Guidelines on the Implementation of Community Quarantine in the Philippines published by the IATF and all other guidelines set by DOH and or any concerned agencies’ 8.5.1. Critical Zone (CrZ) 8.5.1.1. Perimeter Control: Extremely Restrictive Movement and Perimeter Control 8.5111. 8.5.1.1.2. 8.5.1.1.3. 8.5.1.1.4. 8.5.1.1.5. Upon classification of a geographical unit as CrZ, the LTF shall enforce within 24 hours extremely restrictive perimeter control upon which movement of individuals, regardless of age and health status, within, inbound and outbound the CrZ is strictly prohibited, except for emergency instances such as medical and surgical procedures and treatments, and as determined by the LIF; The LTF shall establish and impose screening procedures at all points of entry, and shall inform the local population of the boundaries of the CrZ; Ifthe CrZ encompasses major air, land, and sea transit points it is recommended that these points of entry be closed temporarily in which the LTF shall coordinate accordingly with the concerned agencies; The LTF shall ensure that all individuals within the CrZ. are provided with or have access to essential goods and services, including, but not limited to, food and water rations, health care, for the whole duration of the ECA; and, The LTF shall place physical reminders such as signs and cues of the boundaries and points of entry. These must be written in clear instructions and are strategically placed in areas visible to the public. 8.5.1.2. Surveillance Activities: Case Finding, Case Investigation, and Contact Tracing, and Syndromic Surveillance 8.5.1.2. ‘Commencement of surveillance activities shall be done immediately based on the guidelines and protocols set by the DOH and DILG; #5 DOH Department Memorandum No, 2020-0189, Updated guidelines on contact tracing of lose contacts of confined Coronavirus Disease (COVID-19) cases, (17 April 2020). 198.5.1.3. 8.5.1.4, 8.5.1.2.2, 8.5.1.2.3. 8.5.1.2.4. Conduct of case investigation shall be done within 24 hours and contact tracing should be initiated as soon as possible; Active contact tracing of all close contacts of suspected, probable, and confirmed COVID-19 cases shall be accomplished, if possible within 48 hours; and, All close contacts of confirmed COVID-19 cases shall be monitored and assessed for 14 days. Mandatory Quarantine/\solation and Treatment: 8.5.1.3.1. 8.5.1.3.2. All persons with symptoms as defined in Item 4.9 and all suspected, probable or symptomatic confirmed COVID-19 cases should immediately be given a medical mask and directed to a single room. Suspected cases should not be cohorted together with confirmed COVID-19 cases‘; All persons with symptoms as defined in item 4.9 and all close contacts, suspected, probable and confirmed COVID-19 cases, including potential imported cases, as deemed necessary, shall be isolated or quarantined in their respective LGU's isolation or quarantine facilities within 48 hours, even before laboratory test results may be available; COVID-19 Testing: 8.5.1.4.1, 8.5.1.4.2, 8.5.1.4.3. In accordance with the DOH Guidelines on Expanded Testing for COVID-19", the LTF shall endeavor to conduct expanded (massive) testing utilizing Reverse Transcription Polymerase Chain Reaction (RT-PCR) or Gene Xpert, and if deemed necessary by the LTF, Antibody Tests / Rapid Diagnostic Tests, ensuring that al individuals suspected of having COVID-19 during the conduct of community-based syndromic surveillance, screening and active case finding; all probable and suspected COVID-19 cases and if possible close contacts, identified during contact tracing, are tested for COVID-19; The LTF shall also endeavor to establish, as deemed necessary, any of the following 8.5.1.4.2.1. Swabbing booths; 8.5.1.4.2.2. Drive through swabbing facilities; or 8.5.1.4.2.3. House-to-house (roving) swabbing teams; The RTF, in coordination with the DOH Center for Health Development, shall collaborate with a DOH- licensed COVID-19 laboratorylies to ensure that all LGUs are linked with a testing facility * WHO, cinical management of COVID-19: Interim guidance, (27 May 2020). 47 DoH, Department Memorandum No. 2020-0258, “Updated interim Guidelines on Expanded Testing for COVID-19", 29 May 2020, 208.5.1.5. Disinfection Activity: 8.5.1 4. All areas visited by a confirmed case as determined through case investigation and surveillance shall be disinfected immediately within 24-48 hours based on the guidelines and protocols set by the DOH; . If possible, public areas visited by a confirmed case shall be temporarily closed for the conduct of disinfection. 8.5.1.6. Social Distancing Measures: 8.5.1.6.1. To emphasize and reiterate particular provisions in the ‘Omnibus Guidelines on the Management of Community Quarantine in the Philippines published by IATF, the following social distancing measures shall strictly be implemented by the LTF: 8.5.1.6.1.1. Suspension of face-to-face classes shall strictly be observed; 8..1.6.1.2. Mass gatherings and public congregations shall be strictly prohibited; 8.5.1.6.1.3. Community-wide practice of handwashing and respiratory hygiene, including all other minimum public health standards, shall be observed in which the social environment is made conducive for the practice of these behaviors. 8.5.1.7. Social Amelioration and Socioeconomic Mitigation: 8.5.1.7.1. The LGU shall provide assistance to affected families in CrZ provided that they possess the same qualification as families originally targeted under the Social Amelioration Program (SAP); 8.5.1.7.2. The LGU may use their Quick Response Fund (QRF) and/or their Local Development Fund (LDF) to fund this. If the LGU has already exhausted the same, the DSWD may augment the LGU funds to be sourced from existing SAP funds. Subsequently, the DBM may authorize the use of any unexpended COVID-19 subsidy downloaded to the LGU pursuant to the Bayanihan to Heal as One Act. Containment Zone (CZ) 8.5.2.1. Perimeter Control: Restricted Movement with Stringent Perimeter Control 8.5.2.1.1. Upon classification of a geographical unit as CZ, the LTF shall enforce, within 24 hours, strict perimeter control to the CZ and shall impose screening procedures at points of entry for all individuals exiting the CrZ. Movement of individuals to the CZ is prohibited except for emergency and medical instances only; 8.8.2.1.2. Delivery of essential goods for CZ shall be conducted at the points of entry only. Officials in the CZ shall 218.5.2.1.3, 8.5.2.1.4. 8.5.2.1.5. 8.5.2.1.7. 8.5.2.1.8. 8.5.2.1.9. 8.5.2.1.10. ensure that essential goods are picked up at points of entry; If the CZ encompasses major air, land, and sea transit points, itis recommended that screening procedures be strictly implemented. But if possible, it is preferable to close that point of entry; Movement within CZs allowed but limited to movement of individuals accessing essential goods and services and those working in permitted offices, establishments or such other activities stated in the Omnibus Guidelines; Senior citizens, children, individuals with comorbidities and health risks, and other vulnerable groups will be restricted from movement; ‘The LTF shall establish a stringent perimeter control on the boundary between the CZ and BZ, allowing entry of essential goods and services, and work; The LTF shall inform the local population on the boundaries between CZ and CrZ and between CZ and Bz; Manufacturing and processing plants, and offices and establishments as mentioned in the Omnibus Guidelines located within the CZ, may operate up to maximum of 50% operational capacity, while work- from-home and other flexible work arrangements are encouraged; The LTF shall ensure that that all individuals within the CZ are provided with or have access to essential goods and services, including, but not limited to, food rations and health care for the whole duration of the MECQ; The LTF shall place physical reminders such as signs and cues of the boundaries. These must include clear instructions and are strategically placed in areas visible to the public; 8.5.2.2. Surveillance Activities: Active and Passive Case Finding, and ‘Syndromic Surveillance 8.5.2.2.1. 8.5.2.2.2. 8.5.2.2.3. If COVID-19 cases are newly identified upon surveillance and thorough assessment in a CZ, contact tracing must commence within 24 hours; ‘The LTF shall conduct active and passive case finding to all close contacts residing in the CZ of the confirmed COVID-19 cases; The LTF shall endeavor to conduct syndromic surveillance in the CZ: 8.8.2.2.3.1. Monitor local transmission of COVID-19 or clusters of ILI or SARI; 3.2, Intrazonal and interzonal coordination mechanisms shall be established with the 8.5.2. 22CrZ. Updates and information on the status of COVID-19 cases, ILI and/or SARI cases andior clusters within the CrZ shall be regularly shared and discussed with those in CZ for surillance, disinfection and clinical management purposes; 8.5.2.2.4. The CZ may provide assistance and support to CrZ on case finding, contact tracing and other surveillance activities; 8.5.2.2.5. Monitor indicators of localized transmission within the CZ using the following: 8.5.2.2.6.1. Presence of imported cases, primary (index) cases with no known epidemiological link, and clusters with >2 generations of close contacts; Identification of clustering of ILI and SARI cases, especially with decreasing influenza positivity (investigated or under investigation); Increasing health care worker (HCW) COVID-19 infections, or . Appearance of event-based reports of clusters of respiratory illnesses 8.5.2.3. Mandatory Quarantine/Isolation and Treatment: 8.5.2.3.1. All persons with symptoms as defined in Item 4.9 and all suspected, probable or symptomatic confirmed COVID-19 cases should immediately be given a medical mask and directed to a single room. Suspected cases should not be cohorted together with confirmed COVID-19 cases**; 8.5.2.3.2. All persons with symptoms as defined in Item 4.9 and all close contacts, suspected, probable and confirmed COVID-19 cases, including potential imported cases, as deemed necessary, shall be isolated or quarantined in their respective LGU’s isolation or quarantine facilities within 48 hours, even before laboratory test results may be available. Those requiring treatment shall be referred immediately to a designated health facility; 8.5.2.4. COVID-19 Testing: 8.5.2.4.1. In accordance with the DOH Guidelines on Expanded Testing for COVID-19", the LTF shall endeavor to conduct expanded (massive) testing utilizing Reverse 4® WH, Cical management of COVID-19: Interim guidance, (27 May 2020), 4° DOH, Department Memorandum No. 2020-0258, "Updated interim Guidelines on Expanded Testing for COVID-19", 29 May 2020. 238.5.2.4. Transcription Polymerase Chain Reaction (RT-PCR) or Gene Xpert, and if deemed necessary by the LTF, Antibody Tests / Rapid Diagnostic Tests, ensuring that all individuals suspected of having COVID-19 during the conduct of community-based syndromic surveillance, ‘screening and active case finding; all probable and suspected COVID-19 cases and if possible close contacts, identified during contact tracing, are tested for COVID-1 If possible, community-level seroprevalence surveys on COVID-19 within the CZ shall be conducted utilizing RT-PCR or Gene Xpert testing. And if deemed necessary, Antibody Tests or Rapid Diagnostic Tests may be utilized as well; 8.5.2.5. Disinfection Activity: 8.5.2.5.1. 8.5.2.5.2. All areas within the CZ visited by a confirmed COVID- 19 case as determined through case investigation and surveillance shall be disinfected immediately within 24- 48 hours based on the guidelines and protocols set by the DOH; If possible, public areas within the CZ visited by a confirmed COVID-19 case shall be temporarily closed for the conduct of disinfection and shall reopen or resume services upon completion of disinfection. 8.8.2.6. Social Distancing Measures: 8.5.2.6.1. To emphasize and reiterate particular provisions in the ‘Omnibus Guidelines on the Management of Community Quarantine in the Philippines published by IATF, the following social distancing measures shall strictly be implemented by the LTF: 8.5.2.6.1.1. Mass gatherings such as but not limited to movie screenings, concerts, sporting events, and other entertainment activities, community assemblies, and non-essential work gatherings shall be prohibited, Gatherings that are for the provision of critical government services and authorized humanitarian activities while adhering to the prescribed minimum health standards shall be allowed; 8.5.2.6.1.2. Community-wide practice of hand and respiratory hygiene shall be observed in which the social environment is made conducive for the practice of these behaviors; 8.5.2.6.1.3. Staggered work, alternative work arrangements and market hours shall be implemented to minimize person-to-person 24interaction in consideration of population dynamics. 8.5.2.7. Health System Capacity: 8.5.2.7, 8.5.3. Buffer Zone (BZ) 8.5.3.1. Perimeter Control: Perimeter Control on Points of Entry to CZ, Permissive Movement between BZ and OBZ 8.5.3.2. 8.5.3.1.1. 8.5.3.1.2. 8.5.3.1.3. 8.5.3.1.4. 8.5.3.1.5. The LTF shall ensure that areas that do not have any cases shall strengthen their surveillance and local health systems capacity guaranteeing that if an emergence and/or reemergence of COVID-19 cases will occur, the LGU will remain resilient and cope with any surge of cases. Upon classification of a geographical unit as BZ, the LTF shall impose perimeter control and establish points of entry between BZ and CZ; People movement between the BZ and OBZ shall be allowed with observance of minimum health standards; The operation of government offices and industries shall be allowed up to full operational capacity, or under such alternative work arrangements are encouraged in accordance to labor laws, civil service rules and regulations; Transporting services shall operate at a reduced operational and vehicle capacity limited to support government and private operations; ‘Schools shall operate at capacities to cater to students with flexible learning arrangements as specified in the Omnibus Guidelines; Surveillance Strategies: Active and Passive Case Finding, and Syndromic Surveillance 8.6.3.2.1. 8.5.3.2.2. 8.5.3.2.3. If COVID-19 cases are newly identified upon surveillance and thorough assessment in a BZ, contact tracing must commence within 24 hours; The LTF shall ensure that all close contacts residing in the BZ of the confirmed COVID-19 cases from the CrZ shall be actively surveyed; The LTF shall endeavor to conduct syndromic surveillance in the BZ: 8.5.3.2.3.1. Monitor local transmission of COVID-19 or clustering of ILI or SARI; 2.3.2, Intrazonal_ and interzonal coordination mechanisms shall be established with the CrZ. Updates and information on the status of COVID-19 cases, ILI and/or SARI cases and/or clusters within the CiZ shall be regularly shared and discussed with those in BZ for surveillance, 8.5.3. 25disinfection and purposes; ical_ management 8..3.2.4, Monitor indicators of localized transmission within the BZ using the following 8.5.3.2.4.1. Presence of imported cases, primary (index) cases with no known epidemiological link, and clusters with >2 generations of close contacts; 8.5.3.2.4.2. Identification of clustering of IL! and SARI cases, especially with decreasing influenza positivity (investigated or under investigation); 8.5.3.2.4.3. Increasing health care worker (HCW) COVID-19 infections; or 4.4. Appearance of event-based reports of clusters of respiratory illnesses. 8.5.3.3. Mandatory Quarantine/lsolation and Treatment: 8.5.3.3.1. All persons with symptoms as defined in Item 4.9 and all suspected, probable or symptomatic confirmed COVID-19 cases should immediately be given a medical mask and directed to a single room. Suspected cases should not be cohorted together with confirmed COVID-19 cases®; 8.5.3.3.2. All persons with symptoms as defined in item 4.9 and all close contacts, suspect, probable and confirmed COVID-19 cases, including potential imported cases as deemed necessary, identified in the BZ shall be isolated and quarantined to respective facilities within 48 hours, even before laboratory test results may be available. Those requiring treatment shall be referred immediately toa designated health facility; 8.5.3.4. COVID-19 Testing: 8.5. 4.1, In accordance with the DOH Guidelines on Expanded Testing for COVID-19"', the LTF shall endeavor to conduct expanded (massive) testing utilizing Reverse Transcription Polymerase Chain Reaction (RT-PCR) or Gene Xpert, and if deemed necessary by the LTF, Antibody Tests / Rapid Diagnostic Tests, ensuring that all individuals suspected of having COVID-19 during the conduct of community-based syndromic surveillance, screening and active case finding; all probable and suspected COVID-19 cases and if possible close contacts, identified during contact tracing, are tested for coviD-19; = WHO, cinical management of COVID-19: Interim guidance, (27 May 2020). 51 DOH, Department Memorandum No. 2020-0258, "Updated Interim Guidelines on Expanded Testing for COVID-19", 29 May 2020, 264.2. If possible, community-level seroprevalence surveys on COVID-19 within the BZ shall be conducted utilizing RT-PCR or Gene Xpert testing. And if deemed necessary, Antibody Tests or Rapid Diagnostic Tests may be utilized as well. 8.5.3.5. Disinfection Activity: 8.5.3.5.1. Alll areas within the BZ visited by a confirmed COVID- 19 case as determined through case investigation and surveillance shall be disinfected immediately within 24- 48 hours based on the guidelines and protocols set by DOH; 8.5.3.5.2. If possible, public areas within the BZ visited by a confirmed case shall be temporarily closed for the conduct of disinfection and shall reopen or resume services once completion of disinfection. 8.5.3.6. Social Distancing Measures: 8.5.3.6.1. To emphasize particular provisions in the Omnibus Guidelines published by IATF, the following social distancing measures shall strictly be implemented by the LTF: 8..3.6.1.1. Mass gatherings such as, but not limited to movie screenings, concerts, sporting events, and other entertainment activities, community assemblies, and — non- essential work gatherings shall be prohibited. Gatherings that are for the provision of critical government services and authorized humanitarian activities while adhering to the prescribed minimum health standards shall be allowed; 8.5.3.6.1.2. Community-wide practice of hand and respiratory hygiene shall be observed in which the social environment is made conducive for the practice of these behaviors; 6.1.3. Staggered work and market hours shalll be implemented; 8.5.3.7. Health System Capacity: 8.5.3.7.1. The LTF shall ensure that areas that do not have any cases shall strengthen their surveillance and local health systems capacity guaranteeing that if an emergence andlor reemergence of COVID-19 cases will occur, the LGU will remain resilient and cope with any surge of cases. 8.5.4. Areas Outside Buffer Zones: 8.5.4.1. Perimeter Control: Permissive Socioeconomic Activities with Selective Screening at Vital Entry Points 271.1. Upon classification of a geographical unit as OBZ, the LTF shall enforce permissive socioeconomic activities with implementation of minimum public health standards and shall impose screening procedures at vital entry points as deemed necessary. Movement within BZ and OBZ shall be allowed, however entry to CrZ is strictly prohibited except for emergency purposes; 8.5.4.2. Surveillance Strategies: Active and Passive Case Finding, and Syndromic Surveillance 8.5.4.2.1. If close contacts, suspected, probable or confirmed COVID-19 cases are identified in the OBZ upon surveillance and thorough assessment, contact tracing must commence within 24 hours; The LTF shall ensure that all close contacts of confirmed COVID-19 cases from the CrZ who are residing at OBZ shall be actively surveilled; 8.5.4.2.3. The LTF shall endeavor to conduct syndromic surveillance in the OBZ: 8.5.4.2.3.1. Monitor local transmission of COVID-19 and clusters of ILI or SARI in the area; 2.3.2. Intrazonal and interzonal_ coordination mechanisms shall be established with the CrZ, Updates and information on the status of COVID-19 cases, ILI and/or SARI cases andior clusters within the CrZ shall be regular shared and discussed with those in OBZ for surveillance, disinfection and clinical management purposes; 8.5.4.2.4. Monitor indicators of localized transmission within the ‘OBZ using the following 8.5.4.2.4.1. Appearance of imported cases, primary (index) cases with no known epidemiological link, clusters with >2 generations of close contacts; 8.5.4.2.4.2. Identification of clustering of ILI and SARI cases, especially with decreasing influenza positivity (investigated or under investigation); 8.5.4.2.4.3. Increasing health care worker (HCW) COVID-19 infections, or 8.5.4.2.4.4. Appearance of event-based reports of clusters of respiratory illnesses. 8.5.4.3, Mandatory Quarantine/Isolation and Treatment: 8.5.4.3.1. All persons with symptoms as defined in item 4.9 and all suspected, probable or symptomatic confirmed COVID-19 cases should immediately be given a medical mask and directed to a single room. Suspected 28cases should not be cohorted together with confirmed COVID-19 cases*; . All persons with symptoms as defined in Item 4.9 and all close contacts, suspect, probable and confirmed COVID-19 cases, including potential imported cases, as deemed necessary, identified in the OBZ shall be isolated and quarantined in their respective LGU's facilities within 48 hours, even before laboratory test results may be available. Those requiring treatment shall be referred immediately to a designated health facility; 8.5.4.4. Disinfection Activity: 8.5.4.4.1. All areas within the BZ visited by a confirmed COVID- 19 case as determined through case investigation and surveillance shall be disinfected immediately within 24- 48 hours based on the guidelines and protocols set by DOH; 8.5.4.4.2. If possible, public areas within the BZ visited by a confirmed COVID-19 case shall be temporarily closed for the conduct of disinfection and shall reopen or resume services once completion of disinfection; 8.5.4.5. Social Distancing Measures: 8.6.4.5.1, Movement within the OBZ is permissible, however, minimum public health standards must be implemented at all times in accordance with the protocols and guidelines published by the DOH; 8.5.4.6. Health System Capacity: 8.5.4.6.1. The LTF shall ensure that areas that do not have any cases shall strengthen their surveillance and local health systems capacity guaranteeing that if an emergence and/or reemergence of COVID-19 cases will occur, the LGU will remain resilient and cope with any surge of cases, 9, MONITORING 9.1. The NTF, together with the National Incident Command and its Task Groups, shall formulate a monitoring tool and system to be utilized in assessing and monitoring the implementation of this guideline; 9.2. The NTF, together with the RTFs will monitor the implementation of the Zoning Containment Strategy, taking note of the implementation problems and challenges; and, 9.3. Likewise, the RTFs will capacitate the LTFs in the monitoring of the implementation of the same plans and strategies. 52 WHO, Cinical management of COVID-19: Intern guidance, (27 May 2020). 2940. IMPLEMENTATION 10.1. All implementing Agencies shall issue the necessary Advisory/Memorandum to adopt this Order and ensure its widest dissemination within their respective jurisdiction. 10.2. All LTFs shall ensure that the purpose of this Order is faithfully complied with by all concerned. 10.3. Provisions from any issuances that are inconsistent or contrary to the provisions of this order are deemed rescinded and modified by the present guidelines. 41. REFERENCES 41.1. IATF and NTF Key Agreements and Minutes of the Meeting 11.2. AA. 14.4.2, 11.1.3. 11.4.4. 11.1.5. 11.1.6, 11.4.7. 1.1.8, 43rd Inter-agency Task Force for the Management of Emerging Diseases (IATF-EID) Minutes of the Meeting dated 3 June 2020 4fst Inter-agency Task Force for the Management of Emerging Diseases (IATF-EID) Minutes of the Meeting dated 29 May 2020 37th Inter-agency Task Force for the Management of Emerging Diseases (IATF-EID) Meeting Key Agreements dated 15 May 2020. IATF-EID, Resolution No. 37 Series of 2020, dated 15 May 2020. 21st National Incident Command Inter-Task Group Meeting Key Agreements dated 2 June 2020 20th National Incident Command Inter-Task Group Meeting Key Agreements dated 28 May 2020. 19th National Incident Command Inter-Task Group Meeting Key Agreements dated 26 May 2020. National Task Group Meeting with the World Health Organization dated 19 May 2020. Government Agency Issuances and Executives Orders 11.24. 11.2.2. 11.2.3. 11.2.4. 11.2.5. 11.2.6, 11.2.7. DILG Memorandum Circular No. 2020-077, Rationalizing the Establishment of a Local Government Unit Task Force Against COVID- 19, (24 April 2020). DOH Administrative Order 2020-0013, Revised Administrative Order No. 2020-0012, "Guidelines for the Inclusion of the Coronavirus Disease 2019 (COVID-19) in the List of Notifiable Disease for Mandatory Reporting to the Department of Health” dated March 17, 2020, (9 April 2020). DOH Department Memorandum No. 2020-0189, Updated guidelines on contact tracing of close contacts of confirmed Coronavirus Disease (COVID-19) cases, (17 April 2020). DOH Department Memorandum No. 2020-0258, Updated Interim Guidelines on Expanded Testing for COVID-19, (29 May 2020). DOH, Philippine Integrated Disease Surveillance and Response Manual of Procedures, 3rd Edition, Vol.1 (Department of Health, 2014). Housing and Land Use Regulatory Board. Revised Rules and Standards for Economic and Socialized Housing Projects to Implement Batas Pambansa 220. Local Government Code of the PI Title Three, Chapter 1. Role and of the City. ippines, Book Il. Local Governments, reation of the City, Section 448. Role 3011.28. 11.2.9. 14.2.10. 1.2.41. Local Government Code of the Philippines, Book Ill. Local Governments, Title Two, Chapter 1. Role and Creation of the City, Section 440. Role of the Municipality. Office of the President of the Republic of the Philippines, Proclamation No. 922 series 2020, Declaring a state of public health emergency throughout the Philippines, (8 March 2020). Office of the President of the Republic of the Philippines. Proclamation No. 929 series 2020, Declaring a state of calamity throughout the Philippines due to Coronavirus Disease 2019, (16 March 2020). Office of the President of the Republic of the Philippines. Executive Order No. 112, series of 2020. Imposing an Enhanced Community Quarantine in High-Risk Geographic Areas of the Philippines of the Country from 01 to 15 May 2020, Adopting the Omnibus Guidelines on the Implementation Thereof, And for Other Purposes. Published on 30 April 2020. 11.3. Published and Unpublished Reference Materials 11.3.4. 11.3.2, 11.3.3. 11.3.4. 11.3.5. 11.3.6. 11.3.7. 11.3.8. 11.3.9. 11.3.10. Abrigo, M., Uy, J., Haw, N., et. al. Projected Disease Transmission, Health System Requirements, Macroeconomics Impacts of the Coronavirus Disease 2019 (COVID-19) in the Philippines. Discussion Paper Series No. 2020-15. (Philippine Institute for Development Studies: April 2020). Bassetti, S., Bischoff, W.E., & Shererlz, R.J. Are SARS superspreaders cloud adults? Letters Volume 11, No. 4. (Emerging Infectious Disease: 4 April 2008). Clausewitz, C.V., Principles of war. (Dover Publications, 2012). Elbe, S. Our epidemiological footprint: The circulation of Avian Flu, SARS, and HIVIAIDS in the world economy. (Review of International Political Economy: 10 December 2007). doi. org/10. 1080/096922807011751324. European Centre for Disease Prevention and Control. Considerations relating to social distancing measures in response to COVID-19. ( 23 March 2020). Gabriel, L. Lockdown can't last forever. Here's how to lift it. (New York Times: 26 April 2020). Keogh-Brown, M. R. & Smith, R. D. The economic impact of SARS: how does the reality match the predictions? Health Policy 88(1): 110-120 (Elsevier: 2008). Mandl, K. D., Overhage, M., Wagner, M.M. ‘Implementing Syndromic Surveillance: A Practical Guide Informed by the Early Experience’, Journal of the American Medical Informatics Association, Vol. 11 Number 2, (Mar/April 2004). DO! 10.1197/jamia.M1356 Prem, K., Yang, L., Russell, T.W. & et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study. (Lancet Public Health 2020: 25 March 2020). Rubin, H. Future global shocks: Pandemics. (University of Pennsylvania 14 January 2011). 3111.3.1. Shen, Z., Ning, F. Weigong, Z., & et al. Superspreading SARS events, Beijing, 2003. Emerging Infectious Disease 10(2): 256-260 (2 February 2004). 14.3.12. Wong, T., Lee, C., Tam, W. & et al. Cluster of SARS among medical students exposed to single patient, Hong Kong. Emerging Infectious Disease 10: 269-276 (February 2004). 11.4. World Health Organization (WHO) Guidelines 14.4.1. World Health Organization (WHO). Clinical management of COVID-19: Interim Guidance, (27 May 2020) 11.4.2. WHO. Integrated disease surveillance and response in the African Region: A guide for establishing community-based surveillance, (August 2014). 11.4.3. WHO. COVID 19: Interim framework for imposition and lifting of movement restrictions based on epidemiological situation and public health systems requirements (May 2020). 11.4.4. WHO. Interim guidance: consideration in adjusting public health and social measures in the context of COVID-19. 2020 (16 April 2020). 41.4.8. WHO. Interim protocol on rapid operations to contain the initial emergence of pandemic influenza (2007). 11.4.6. WHO. Monitoring the building blocks of the health system: a handbook of indicators and their management strategies (2010). 12. EFFECTIVITY 12.4. This Order shall take effect immediately. FOR GUIDANCE AND COMPLIANCE OF ALL CONCERNED AGENCIES SECRETARY CARLITO G. GALVEZ, JR ECRET) DUARDO M. ANO Chief Implementer, NIC, NTF-COVID19 Vice Chairperson, NTF-COVID19 SECRETARY(DELFINNN. LORENZANA. Chairperson, NTF-COVID19 32ANNEX A. OPERATIONAL FRAMEWORK FOR ECQ TRANSITION Extremely Restrictive Perimeter Control Stringent Perimeter Control zone (C12) (eames) ANNEX B. THE ZONING CLASSIFICATION PARAMETERS NTs PARAMETERS ‘At least one (1) case of either a suspect, probable or confirmed COVID-19 is House Present. 1) Arresidential building floors: at least two (2) cases of either a suspect, probable, or confirmed COVID-19 are present in two different units within the same floor; and 2) Aresidential building: at least two (2) cases of either a suspect, probable or confirmed COVID-19 are present in two different floors. Residential Building 1) Asmall business establishment, with less than 1,000 resident occupants shall be categorized as a CrZ, if at least one (1) case of either a suspect, probable or confirmed COVID-19 is reported from the business establishment; and 2), Alarge business establishment, with 1,000 or more resident occupants shall to be categorized as a CrZ, if at least two (2) cases of either a suspect, probable or confirmed COVID-19 where each case is reported from separate buildings, floors, wings or annexes of the business establishment, whichever is applicable. Business establishments ‘A market shall be categorized as a CrZ if at least three (3) clusters of cases, Market ‘composed of either suspect, probable and/or confirmed COVID-19, are present in the barangay where the market is located. 33Street A street shall be categorized as CrZ if at least two (2) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are present in different houses, buildings or establishments along a specified street, Block A block shall be categorized as Cr2 if at least three (3) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are present in at least two different streets surrounding the block. Purok A purok shall be categorized as CrZ if at least three (3) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are present in different houses or buildings within the purok. Subdivision/ Village Assubdivision or a village shall be categorized as CrZ if at least four (4) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are reported in at least two different streets or blocks; Barangay 1) A densely-populated barangay with population density greater than 1,000/km? shall be categorized as a CrZ if at least five (5) clusters of cases, composed of either suspect, probable and/or confirmed COVID- 19, are present in at least three different sitios, puroks or blocks, whichever is applicable; 2) Asparsely-populated barangay with population density below 1,000/km? shall be categorized as a CrZ if at least two (2) clusters of cases, composed of either suspect, probable and/or confirmed COVID- 19, are present in at least two different sitios, puroks or blocks, whichever is applicable; and 3)_Asettlement area shall be categorized as CrZ if at least two (2) clusters of cases, composed of either suspect, probable and/or confirmed COVID-19, are reported from at least two different areas within the settlement, ‘Municipality ‘A municipality shall be categorized as CrZ, if 25% of its barangays were declared as CrZ, with causal link to areas reserved and occupied as. residential and/or commercial corridors, and population density is greater than 1,000/km? ity A component city shall be categorized as a CrZ if 25% of its barangays were declared as Cr2, with causal link to areas reserved and occupied as residential and/or commercial corridors, and population density greater ‘than 1,000/km?ANNEX C. THE FRAMEWORK ON ROLLING STAGES OF INTERVENTIONS ‘cmeatZone Contsinment Zone Buses Zone ‘eas out of Butler (rz) (cz) (ez) (can) PRS (Gradual Easing & Community Quarantine Based on Zoning Containment Sirategs) ANNEX D. RECOMMENDED COMMUNITY QUARANTINE POLICY FOR EACH ZONE Agency Task Force (IATF) Classification of a Local Government Unit Enhanced Community | Modified Enhanced | General Community Quarantine Community (urate Quarantine =a 35