NT Ge «we 4 SU OFFICAL SRELEASE : Republi ofthe Phippines & Signature DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT=':_— 77-77: DILG-NAPOLCOM Center, EDSA comer Quezon Avenue, Quezon City slime ‘wor ig. gov ph “Ayaaconos s2270n “409 qwo0" ADVISORY JUN 22 2020 TO ALL PROVINCIAL GOVERNORS, CITY MAYORS, MUNICIPAL MAYORS, BARMM MINISTER FOR LOCAL GOVERNMENT, DILG REGIONAL DIRECTORS, AND OTHERS CONCERNED SUBJECT: GUIDELINES FOR LOCAL GOVERNMENT UNITS ON THE APPLICA- TION OF THE ZONING CONTAINMENT STRATEGY FOR COVID-19 The Interagency Task Force-National Task Force COVID-19 has approved and issued Memorandum Circular No. 2, Series of 2020 which provides, among others, a Zoning Containment Strategy for COVID-19 response. The strategy is applied in order to iden- tify focused areas for implementation of varying levels of quarantine, depending on the risk and stage of transmission prevalent in the area. Generally, geographical units ranging from houses as the smallest unit up to a city/mu- nicipality, as the largest, shall be categorized into four (4) zoning classifications (crit cal, containment, buffer, and areas outside buffer zones). Central in the zoning clas- sifications are the critical zones which are areas where the initial number of cases or several clustering of cases are identified within the past seven (7) days. Essentially the LGUs, through their local chief executives, have the authority to deter- mine and declare zoning classification and lockdown depending on preset parameters, including the existence of suspected, probable, or confirmed COVID-19 case (e.g. at least 1 suspected, probable, or confirmed COVID-19 case for houses, and at least two (2) cluster of cases located in at least two different sitios in sparsely populated baran- gays). This authority maybe exercised immediately to ensure timely response, subject to the review, and assessment of the RIATF-RTF. For small geographical units includ- ing but not limited to houses, commercial establishments, residential buildings, mar- kets, streets, blocks, puroks, and barangays, it is the city/municipal mayor who is granted the authority to determine and reclassify zoning classifications, on the other hand, the governors are the ones responsible for larger geographical units including component cities, and municipalities. Zoning classifications shall determine the interventions to be imposed and imple- mented by the LGU on subject geographical units but in no case shall interventions be lower than what is prescribed by the policy for each zoning classification taking into consideration also the existing level of community quarantine imposed on the area. In meeting the objectives of the policy, LGUs are also directed to closely coordinate and work together. The RIATF-RTF's concerned are also expected to exercise utmostdiligence in assisting, and guiding LGUs so as they are able to perform all their re- sponsibilities, and implement to its fullest the zoning strategy. All are also directed to review, study, and use as main reference the above cited IATF-NTF Memorandum Circular. All DILG Regional Directors and the BARMM Minister for Local Government are di- rected to cause the widest dissemination of this Advisory. For your strict compliance.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 Te against COVID-19 Department of tht jor and Local Government, and Vice Chair National 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 15 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 Cs 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 seres 2020. mpsing an enhanced community {quarantine In hgh-sk geographic areas of the Philipines anda generl community quarantine in the est ofthe county frm Oto 15 ‘May 2020, edpting the omnibus guidlines onthe implementation thereof, and fo other purposes. 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 concems, 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 Wo FOR THE MANAGEMENT OF EMERGING INFECTIOUS DISEASE Porto 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. *Wortd Hoan Organization (WHO), Intrim guidance: cansderation in adjusting pubic heath and social measures inthe context of COVI0-19, 2020 (18 Apr 2020), . 1, 2 Department of Heath (OOH), Press release: DOH confirms local transmission of COVID-19 in Ph rports th caso (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 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, Russoll, TW. ot. a. ‘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, lft 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. ‘mposing an enhanced ‘community querantine in high-risk geographic areas ofthe Philippines and a general community quarantine in the rest ofthe ‘country from 07 to 15 May 2020, adopting the omnibus 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, a 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. 1d, 2. 12 \wHo, integrated disease surveilance and response inthe African Region: A guide for establishing community-based ‘surveilance, (August 2014). 12 DOH Department Memorandum No. 2020-0189, ‘Updated guidelines on contact tracing 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; 4.14.3. 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, Clinical Management of COVID-19: Interim Guidance, (27 May 2020). "8 IATE-E1D, Omnibus Guidelines on the Implementation of Community Quarantine in the Philppines (with Amendments as of 03 June 2020), 2. *” Council of State & 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. aTe-EID, 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 (wth 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 Notiable Disease for Mandatory Reporting tothe Department of Heath” dated March 17, 2020, (8 Apri 2020). 21 aTF-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: 4.24.3.1. 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”; 75 tid, p. xv 28 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 the List of Notifable Disease for Mandatory Reporting tothe Department of Heath" dated March 17, 2020, ( April 2020). 2° Mandl, K.D., Overhage, M., Wagner, MLM. "implementing Syndromic Survellance: A Practical Guide Informed by the Early Experience’, Journal ofthe American Mocical 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- °° WHO, Interim protocol on rapi operations fo 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. ‘Apt 2020). 32 Rubin, H, Future Global Shocks: Pandemics. OECD/IFP Project on Future Global Shocks, (Unversity 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 unitfroom, prisonvjail 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 permanent/temporary enclosed construction or physical structure over a plot of land. It can be a * WHO, Monitoring tne building blocks of the health system: a handbook of indicators and their management strategies, 010) Office of the President ofthe Republic ofthe Philippines. Executive Order No. 112, series of 2020, Imposing an Enhanced Community Querantine in High-Risk Geographic Areas ofthe 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