CORONAVIRUS DISEASE 2019 (COVID-19)
CLINICAL FINDINGS (DOH)
1. Complete Blood Count (CBC)
 leukopenia and lymphopenia are
common findings, with non survivors
or critically ill patients in the ICU
developing more severe lymphopenia
compared  to those not in the ICU
(median 1 vs. 0.4 cells/mm ).
2. Blood chemistries and inflammatory
markers such as lactate dehydrogenase
(LDH), C- reactive protein (CRP), and
procalcitonin
 elevation in LDH, CRP, and
procalcitonin are common findings  respiratory tract specimens from both
3. Prothrombin and D-Dimer
 Prolonged prothrombin time and
elevated D-Dimer are observed
4. Arterial Blood Gas (ABG) measurement
4. Blood cultures (2 sets), ideally before
antimicrobial therapy
4. Respiratory tract specimen for influenza
A/B testing, if available
4. Respiratory tract specimen to determine
other co infections through standard
bacterial tests (e.g., Gram’s stain and
culture) or respiratory panels (e.g.
Respiratory Film Array)
4. Serology for diagnostic purposes is
recommended only when RT-PCR is not
available
4. Chest x-ray
 may reveal pulmonary infiltrates  tonsillar areas. Rub swab over both tonsillar pillars
10. High resolution chest CT scan
may reveal ground-glass infiltrates or
consolidations with bilateral distribution
SPECIMEN TYPE
 CDC recommends collecting and testing
an upper respiratory specimen
 Best time to test using PCR is 5-7 days
after exposure, approximating the time of
symptom onset. (CDC)
 Case is no longer infectious after 10 days
from onset of symptoms. But to be sure,
DOH errs on the side of caution and adds
a 4 day buffer. This 4-day buffer takes
into account that in some cases,
incubation period is 12 days
 The test to confirm SARS-CoV-2 infection
is a real-time reverse transcription–
polymerase chain reaction (rRT-PCR)
assay that can be used to detect the virus
in respiratory and serum samples from
clinical specimens. The following
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specimens should be sent for SARS-CoV-2
testing1
1. Nasopharyngeal swabs (NPS)
Oropharyngeal swabs (OPS)
2. Sputum, endotracheal aspirate, or
bronchoalveolar lavage fluid as
appropriate. Clinicians may elect to
collect only LRT samples when these are
readily available (for example, in
mechanically ventilated patients).
SPECIMEN COLLECTION
 Use sterile Dacron or rayon viral swabs
with a plastic shaft for collecting upper
the nasopharynx and the oropharynx. Do
not use calcium alginate swabs or swabs
with wooden shafts, as they may contain
substances that inactivate some viruses
and may inhibit molecular tests.
 COLLECTING THE NPS:
Insert flexible wire shaft swab through the nares
parallel to the palate (not upwards) until
resistance is encountered or the distance is
equivalent to that from the ear to the nostril of
the patient indicating contact with the
nasopharynx. Gently, rub and roll the swab. Leave
the swab in place for several seconds to absorb
secretions before removing. Do not sample the
nostrils.
 COLLECTING THE OPS:
Insert swab into the posterior pharynx and
and posterior oropharynx and avoid touching the
tongue, teeth, and gums. Do not sample the
tonsils. Avoid swabbing the soft palate (sensitive
to gag reflex).
 Lower respiratory tract specimens should
be collected in sterile containers.
 Avoid sputum induction to reduce the
risk of aerosol transmission.
SPECIMEN HANDLING 
A. LABORATORY BIOSAFETY AND CABINET
 WHO: Non-propagative diagnostic
laboratory work (e.g. sequencing, Nucleic
acid amplification test/NAAT) should be
conducted at facilities and procedures
equivalent to BSL-2 and propagative work
(e.g. virus culture, isolation or
neutralization assays) at a containment
laboratory with inward directional airflow
(BSL-3).
 WHO: Perform all manipulations of live
virus samples within a Class II (or higher)
biological safety cabinet (BSC).
  CDC: Procedures that concentrate
viruses, such as precipitation or
membrane filtration, can be performed in
a BSL-2 laboratory with unidirectional
airflow and BSL-3 precautions, including
respiratory protection and a designated
area for donning and doffing PPE. The
donning and doffing space should not be
in the workspace. Work should be
performed in a certified Class II BSC.
B. PERSONAL PROTECTIVE EQUIPMENT
 When collecting respiratory tract
specimens, healthcare workers should
wear the following PPE: Face
shield/visor , surgical mask, double
gloves, a disposable impermeable,
breathable, long-sleeved, laboratory
gown fastened at the back. If the
specimen is collected with an aerosol-
generating procedure, staff should wear a
particulate respirator at least as
protective as a NIOSH-certified N95, an
EU standard FFP2, or the equivalent.
C. SPECIMEN STORAGE
 Swabs should be placed immediately into
a sterile transport tube containing 2-3mL
of either viral transport medium (VTM),
Amies transport medium or sterile saline.
 Label the vial with the patient’s name,
specimen type, date collected and other
required information.
 Both swabs (NPS&OPS) can be placed in
the same vial, to maximize test
sensitivity, increase the viral load and
limit use of testing resources.
 If specimens will be examined within 48
hours after collection, keep specimens at
4 C and ship on wet ice or refrigerant gel-
o
packs. If delay is expected (more than 72
hours after collection), store specimens
at -70 C or below and ship on dry ice.
o
Avoid freezing and thawing specimens.
D. LOCAL TRIPLE PACKAGING SYSTEM
(DOH)
Specimens should be packaged using the triple
packaging system detailed below:
1. Seal the primary receptacle containing
the swabs and viral transport media using
Parafilm. Wrap the primary receptacle
with an absorbent material e.g., cotton or
gauze.
2. Place the primary receptacle into the
second container. The second container
should be durable and leak-proof e.g.,
plastic bottle.
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3. Place the second container into the outer
container e.g., ice box. Ensure that the
required temp is maintained in the outer
container through the use of wet ice or
refrigerant packs
GENERAL GUIDELINES FOR ALL BIOLOGICAL
SPILLS
 Report all spills to the immediate
supervisor. Seek immediate medical
attention (if needed).
 Perform hand hygiene before and after
clean-up.
 Don appropriate PPE before clean-up.
 Use a freshly prepared 1:10 dilution of
Sodium Hypochlorite (household bleach);
allow at least 20-30 minutes contact
time. (viscous spills: 15-20 mins, non-
viscous: at least 30 mins)
 Buddy system must be observed during
biological spill response.
 Prepare a written report about the
incident and conduct incident
investigation.
 Dispose-off clean-up materials along with
any contaminated PPE as biohazard
waste and place in a biohazard bag
before autoclaving.
 Prepare a written report about the
incident and conduct incident
investigation.
INTERIM GUIDELINES ON EXPANDED TESTING
(DOH MEMO 2020-0151, March 31, 2020)
For Symptomatic Non-Health Care Workers
1. Testing of symptomatic patients who are
close contacts of a known or probable
case with rapid antibody-based test kits
alone is not recommended, and can be
dangerous if not done with proper
Personal Protective Equipment. Isolate
the patient and conduct RT-PCR testing as
recommended.
2. If there is no available RT-PCR due to
limited availability, rapid antibody-based
testing can be used, but the patient
should remain isolated for 14 days
regardless of result
A. If IgM negative, collect samples for RT-
PCR testing
I. If RT-PCR negative, the patient is not a
COVID-19 case but has to complete the 14-
day quarantine.
II. If RT-PCR positive, the patient is a
confirmed COVID-19 case and shall be
treated and undergo isolation accordingly.
III. If RT-PCR testing is not available, isolate
the patient for 14 days. Repeat rapid
antibody-based testing once asymptomatic,
and follow protocols for asymptomatic
patients.
B. If IgM positive, the patient is a probable
COVID-19 case. Collect swab for RT-PCR
testing.
I.  If RT-PCR positive, the patient is a
confirmed COVID-19 case and shall be
treated and undergo isolation
accordingly.
II. If RT-PCR negative, the patient has to
complete the 14 day home quarantine
and repeat rapid antibody-based test.
III. If RT-PCR testing is not available, isolate
for 14 days. Repeat rapid antibody-based
testing once asymptomatic, and follow
protocols indicated for asymptomatic
patients.
For Asymptomatic Non-Health Care Workers :
Rapid antibody testing may be used for
asymptomatic non-health care workers,
particularly for close contacts of confirmed COVID-
19 cases.
1. If the patient tests negative for both IgM
and IgG,there is no need to isolate, unless
the patient becomes symptomatic.
However, they shall strictly observe the
quarantine procedures in their locality.
2. If the patient tests positive IgG only, the
patient is considered a presumed
recovered case, and there is no need to
isolate. However, they shall strictly
observe the quarantine procedures in
their locality.
3. Patients who test IgM positive shall be
isolated at home or at a community
quarantine facility for 14 days. If they
become symptomatic, they will be
treated as probable COVID-19 cases and
shall follow the protocol indicated.
ANTIBODY TESTING INTERIM GUIDELINES (CDC,
August 1, 2020)
ANTIGENIC TARGETS
1. Spike glycoprotein (S)  SARS-CoV-2 expressing reporter proteins.
 Essential for virus entry and is present on
the viral surface
 Multiple forms of S protein-full-length
(S1+S2) or partial (S1 domain or receptor
binding domain [RBD])—are used as
antigens.  protein of SARS-CoV-2. This testing can be
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2. Nucleocapsid phosphoprotein (N) 
 Most abundantly expressed
immunodominant protein that interacts
with RNA
 The protein target determines cross-
reactivity and specificity because N is
more conserved across coronaviruses
than S, and within S, RBD is more
conserved than S1 or full-length S.
TYPES OF ANTIBODY TESTING
1. BINDING ANTIBODY DETECTION 
 These tests use purified proteins of SARS-
CoV-2, not live virus, and can be
performed in lower biosafety level
laboratories (e.g., BSL-2).
a. Point-of-care (POC) tests 
 Generally are lateral flow devices that
detect IgG, IgG and IgM, or total antibody
in serum, plasma, whole blood, and/or
saliva. An advantage of some point-of-
care tests using whole blood is that they
can be performed on blood samples
obtained by fingerstick rather than
venipuncture.
b. Laboratory tests use ELISA (enzyme-linked
immunosorbent assay) or CIA
(chemiluminescent immunoassay) methods
for antibody detection, which for some
assays may require trained laboratorians and
specialized instruments. Based on the
reagents, IgG, IgM, and IgA can be detected
separately or combined as total antibodies.
2. Neutralization Tests - not yet authorized
by FDA
 Surrogate virus neutralization tests
(sVNT) have also been developed. These
are binding antibody tests designed to
detect potential neutralizing antibodies,
often those that prevent interaction of
RBD with angiotensin-converting enzyme
2 (ACE2, the cell surface receptor for
SARS-CoV-2). 
a. Virus neutralization tests (VNT), such as the
plaque-reduction neutralization test (PRNT)
and microneutralization, use a SARS-CoV-2
virus from a clinical isolate or recombinant
This testing requires BSL-3 laboratories and
may take up to 5 days to complete.
b. Pseudovirus neutralization tests (pVNT) use
recombinant pseudoviruses (like vesicular
stomatitis virus, VSV) that incorporate the S
 performed in BSL-2 laboratories depending
on the VSV strain used.
 Serologic testing by itself should not be
used to establish the presence or
absence of SARS-CoV-2 infection or
reinfection.

Bayanihan to Heal As One Act (Republic Act No.

11469)
Signed: March 24, 2020
Effective: March 25, 2020
 An Act Declaring the Existence of
a National Emergency Arising
from the Coronavirus Disease
2019 (COVID-19) Situation and a
National Policy in Connection
Therewith, and Authorizing the
President of the Republic of the
Philippines for a Limited Period
and Subject to Restrictions, to
Exercise Powers Necessary and
Proper to Carry Out the Declared
National Policy and For Other
Purposes
 Effective only for three (3)
months, unless extended by

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