Briefing on the Expanded

Pilot of the Alert Level

System
November 05 2021 - 9:30 AM

USec Maria Rosario S. Vergeire, MD, MPH, CESO II

Paradigm Shift
Goal: Reduce the severe and critical cases to safeguard our health care capacity

Current Disposition “Living with the Virus”

Transition Phase
Disease Disease
Elimination Control
↑ Vaccination Rate and coverage in
A1-A3 Focus on number of
Focus on case
severe/critical cases,
transmission/trends Ensuring adequate beds hospitalizations, and
(esp ICU beds) deaths
Overall, prevent Protection of the
infection among the Policies/restrictions geared towards vulnerable population
general population protection of vulnerable pop’n (HCWs, Seniors, w/
Comorbidities)
Review of Previous CQ Framework
In the Community Quarantine Decision Framework developed September 2020, HCUR, Case
Transmission, and Gatekeeping indicators were the basis for classifying areas into CQs.
The Alert Level System
Community Quarantine
Alert Level System Classifications

ECQ

MECQ

GCQ with HR

GCQ

MGCQ

ALERT LEVELS ARE NOT EQUAL TO CQ CLASSIFICATIONS. The CQ classifications focus

on widespread/sectoral restrictions while Alert Levels give emphasis on high risk activities
(Closed, Crowded, Close Contact) and implementation of granular lockdowns.
Rationale for Policy Shift
✓ Even with ECQ, implementation issues and violations abound
✓ Granular lockdown implementation is stricter than wide scale
community quarantine
✓ Cumulative impact of prolonged lockdowns to social, economic,
and health objectives
✓ Stronger emphasis on actions outside of community quarantine

COVID-19 Mitigation Strategies: Global

- Targeted restrictions of high risk activities (i.e. gatherings, indoor, non-essential)
- Guided by results of case investigations on causes of transmission
- Mobility restrictions (i.e. shelter-in-place) at smaller scale when there is community transmission
- Public messaging on risk levels
- Strong border control (i.e. restrictions, quarantine, monitoring)
The Alert Level System
For the current Alert Level System, beds utilization rate and ADAR/TWGR risk
classification are still used but BOTH are considered when classifying areas into Alert
Levels.

TOTAL BEDS
UTILIZATION RATE
Alert Level Decision Matrix

Prerequisites for Alert Level 1: (1) Vaccination coverage of >70% for A2, A3, and
Eligible Population (18 and above) and (2) Safety Seal coverage
Classification of Alert Levels look into two main metrics: (1) Risk Classification based
on growth rate and average daily attack rate; (2) total beds utilization
Vaccination
Focus: Reducing the number of severe and critical cases

Prevent

Detect

Isolate

Treat

Reintegrate

Vaccinate

● Vaccination serves as a primary intervention embedded in our PDITRV component strategies.

● Aside from increasing vaccination coverage for the vulnerable population, we must do so at
an increased rate; increasing coverage for the A2 remains to be an issue across all regions.
Summary of Action Points per Alert Level
Response
Component Alert Level 1 Alert Level 2 Alert Level 3 Alert Level 4 Alert Level 5
Vaccinate until 70% of the population is fully vaccinated + Increase vaccination rate in these areas;
Vaccination
especially priority groups Avoid using hospitals as vaccination sites to reserve resources for admissions

Case
Active case finding Ramp-up active case finding
Detection

Genome
Secure samples submitted for representativeness Secure samples from priority areas
Sequencing

Risk-based Targeted Aggressive Community Aggressive Community Testing; May use Antigen testing for areas with Delta
Testing
Testing Testing or those with spikes in cases to hasten result confirmation

Contact Ensure all close contacts Prioritization of contact tracing and identification of high
Intensive contact tracing until 2nd to 3rd generation contacts
Tracing traced, tested, quarantined transmission areas for advisory

Isolation FACILITY ISOLATION TO BE ENCOURAGED/IMPLEMENTED AT ALL TIMES

Triage and Refer cases to appropriate facility ↑homecare, telemed, Urgently address critical care capacity needs;
Referral Ensure mild and asymptomatic cases are in TTMFs stepdown strengthen triage and referral to decongest hospitals

Decongest hospitals of
Determine and address Convert/add ICU beds and equipment in Level 2 and 3
mild and asymptomatic
Treat Inventory of resources increase in healthcare hospitals and augment human resource; No elective
cases; ensure adequate
utilization rate surgeries. Secure availability of O2 supply.
ICU beds in L2 and L3

Increasing focus and intensity of interventions

3 C’s Activities
INDOOR 3Cs OUTDOOR 3Cs
Alert Alert Alert Alert Alert Alert Alert Alert Alert Alert
Level Level Level Level Level Level Level Level Level Level
1 2 3 4 5 1 2 3 4 5

Not
Vax 50% 30% 10% allowed Vax
Full
Subject Not
to LGU
capacity 70% 50% 30% allowed
+ MPHS

Unvax Not allowed Unvax

* With Safety Seal, additional 10% 1 LEVEL

* If A2 AND A3 > 70%, additional DOWN
20% allowed capacity
Alert Level System Roll-out
In the expanded pilot implementation of the Alert Level System, the following are
arrangements to be adopted:

1. Determination of Alert Levels: DOH will determine the Alert Level in coordination
and discussion with the STWG on Data Analytics

2. Area of Coverage: Provinces/Highly Urbanized Cities/Independent Component

Cities will be the unit for assignment of Alert Levels.

3. Frequency of Assessment: assessment of areas will be done weekly;

recommendations for change in ALs done every 2 weeks.

4. Appeals for increase/decrease in Alert Level: no appeal will be entertained.

Expansion of Pilot Implementation
To ensure a smooth transition to the Alert Level System, pilot implementation will be
expanded to include non-NCR areas in a phased approach. Currently, the pilot has been
expanded to 7 regions and 1 city.

For the third week of expansion, the IATF recommended the inclusion of PHIs from the
following regions:

1. Region 1 - Dagupan City, Ilocos Norte, Ilocos Sur, La Union, and Pangasinan;

2. Region 2 - Cagayan (as a special monitoring site)

3. Region 8 - Biliran, Eastern Samar, Leyte, Northern Samar, Ormoc City, Western Samar,
Southern Leyte, and Tacloban City;

4. Region 12 - North Cotabato, General Santos City, Sarangani, South Cotabato, and
Sultan Kudarat
Safeguards for Alert Level 1
To further ensure the protection of the population & the healthcare system when
most sectors reopen, the STWG-DA reviewed the safeguards in place for when areas
de-escalate to Alert Level 1.

1. Vaccination Coverage
● Areas must achieve 70% vaccination coverage for each of the following: Priority
group A2, A3, and eligible population (18 y.o and above)
● To ensure that there is adequate protection among population especially when
mobility is increased and with it, MPHS adherence is lessened

2. Safety Seal
● Addition of a threshold for the percentage of 3Cs establishments accredited
with Safety Seal in an area
● To ensure that measures are in place to mitigate the risk of transmission in
these settings
Safety Seal
To ensure safe reopening of most sectors, measures at the
establishment-level must be in place. This can be achieved through
increasing coverage of establishments that are Safety Seal-certified.

In preparation for this, there is a need for Local Government Units to:

1. Make an inventory of high-risk establishments—those closed, crowded, or

close-contact settings (3Cs) operating under their jurisdiction;

2. Identify offices and/or persons responsible for the inspection and regular
monitoring of Safety Seal coverage in their area; and

3. Prime establishments of our direction and their role as partners in this shift
towards safely reopening our economy.
Granular Lockdown Reporting
For areas included in the Pilot
Implementation, reports of
granular lockdowns implemented
required to be submitted.
Current granular lockdown
reporting template asks for the
following data PER granular
lockdown implemented
LESUs tasked to collect and
coordinate data submission
RTF tasked to ensure submission,
completion, and validation of GL
Report
Particulars Description
Dates of Implementation Start and end dates of lockdowns implemented
Information on Area of Barangay, specific area of coverage, and
geographical unit covered by lockdown area
Coverage
Number of Number of establishments affected, per type
Establishments Affected specified, by the granular lockdowns
Affected Population Affected individuals, families, initial number of cases,
cases traced, close contacts, and affected workers
Prevention Prevention strategies done, number of vaccinated
individuals (total and seniors in the affected area)
Detection (Testing) RT-PCR and Antigen Testing done as well as number
of positive results
Number of cases in home isolation and facility
Isolation
isolation, average case detection to isolation time
Socioeconomic Distribution of food packs and cash assistance; and
Mitigation provision of psychosocial interventions, if any
1. Dates
For input of date of implementation and status of the granular lockdown

● For the input date, instruction is to input the date the entry was logged into the reporting
sheet.

● Number of days in lockdown is automatically generated if start and end dates are given.

● Status is answered by a dropdown list if ongoing, completed, or elevated. ‘Elevated’

would mean that the lockdown was expanded to cover a larger area (e.g. from a house to
a whole street). If lockdown is elevated; simply input a new row entry for this expanded
lockdown.
2. Information on Area of Coverage
To indicate and describe the area covered by the lockdown

● For the complete address column, the reporter can freely type the areas covered by the
lockdown (e.g. if it spans multiple streets or series of houses in a street), provided that
the complete address is indicated.

● Geographical unit is answered with a drop down list derived from the DILG reporting on
critical zones (e.g. street, block, residential building, subdivision/village)
3. Number of Establishments Affected
To indicate the number of establishments affected in the granular lockdown
area per type specified

● For business establishments, this includes ANY non-government business/commercial

establishments and workplaces (e.g. stores/marketplaces, commercial spaces/offices,
food establishments, professional services, etc.)

● If there are establishments that do not fit the categories, simply count as ‘Others’
4. Affected Population
To describe and provide counts for the affected population

● No. of active cases contact traced within 24 hours added as a CT measure for granular
lockdown areas (from the active confirmed cases identified at start of lockdown)

● Last column is to indicate the number of workers who cannot physically report to work
due to the lockdown implementation.
5. Prevention
To provide COVID-19 Prevention strategy-related information

● If the LGU employed any other prevention strategies worth mentioning (such as
information drives or other novel interventions), do specify here IF ANY.

● For the succeeding four columns, the template asks for how many individuals have had
one or two doses of COVID-19 vaccine. The last 2 columns further asks for if how many
seniors in the GL area have had one and two doses of the vaccine.
6. Detection
Section indicates counts of testing done during the lockdown

● Counts here exclude the initial active cases at the start of lockdown.

● Also asked for is the number of fully vaccinated individuals who still tested positive for COVID-19.

● Requested for also is for a linelist of Antigen-tested individuals to be sent to the ESU/RESU for documentation
and reporting.
7. Isolation
Including initial cases and new cases detected during GL, indicate the
number of mild and asymptomatic cases and where they are isolated.

The fourth column requests that we indicate the average number of days between detection to isolation for the
reported positive individuals.

● Detection is defined as the date when the positive individual first developed COVID-19-like signs or symptoms
(onset date) or for those who were asymptomatic the date when positive sample was collected
● Isolation is the date said positive individual was isolated at home or in a facility.
8. Socioeconomic Mitigation
To indicate socioeconomic mitigation interventions implemented

For the first column, the form asks for if socioeconomic mitigation, by way of food packs AND/OR cash
assistance, was provided for the individuals covered by the granular lockdown.

For the second column, IF the LGU conducted any psychosocial interventions in the locked down area (e.g.
wellness activities, health promotion, debriefing following positive result, other community support activities),
specify here.
 Preliminary
Alert Level System Expanded Pilot Implementation Classification
May be subject to
Week 3 Areas (Nov. 8 - 21) change

Alert Level 1 Alert Level 2 Alert Level 3 Alert Level 4

- ● R1: Dagupan City, Ilocos Norte, Ilocos ● R2: Cagayan -
Sur, Pangasinan, La Union
● R8: Biliran, Eastern Samar, Leyte,
N LY.
Northern Samar, Ormoc City, Southern
T F O
Leyte, Tacloban City, Western Samar
F O R IA
.
● R12: General Santos City, North
L
NTIA
Cotabato, Sarangani, South Cotabato,

F I DE
Sultan Kudarat

CON
*Classification based on case data as of November 05, 2021 and healthcare utilization rates as of November 04, 2021.
**Note that classifications are reassessed weekly and areas may escalate or de-escalate.

CONFIDENTIAL. FOR IATF ONLY.

Department of Health, Philippines
Maraming salamat po!