Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

ADMINISTRATIVE ORDER APR 0 9 2020

No. 2020-_ 0013
.

SUBJECT: Revised Administrative Order No. 2020-0012 “Guidelines for the Inclusion of
the Coronavirus Disease 2019 (COVID-19) in the List of Notifiable Diseases
for Mandatory Reporting to the Department of Health” dated March 17, 2020

RATIONALE
Due to the recent developments related to the Coronavirus Disease 2019 (COVID-19) health
event, the case definitions and surveillance system for notification of COVID-19 should be
revisited and updated regularly. The availability of additional epidemiological information
on COVID-19 further directs the Department of Health on how we detect, confirm, and
report cases in the country.
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Since January 28, 2020, the Philippines have used decision tools to classify individuals as
either Patients Under Investigation or Persons Under Monitoring. However, the evidence of
local and community transmission of COVID-19 necessitated a review on the assessment
and classification of individuals with the aim of early detection and laboratory confirmation,
especially among high risk and vulnerable populations, to guide appropriate clinical
management and referral. The country is also challenged on how to cope with the sudden
surge of confirmed cases and must identify measures to ensure that the health system will
capably respond to this emergency to reduce the number of serious and critically ill cases
and fatalities while maintaining essential and other routine health services. This amendment
also adapted certain provisions of the World Health Organization (WHO) interim guideline
on global surveillance for COVID-19 released on March 20, 2020, which provides for the
use of case definitions for surveillance (suspect, probable, and confirmed),
recommendations for laboratory testing, and reporting of surveillance data.

Thus, the following provisions of Administrative Order No. 2020-0012 on the guidelines
for the inclusion of the COVID-19 in the list of notifiable disease for mandatory reporting
to the DOH is hereby amended, as follows:
1. Shift from classifying individuals as Patients Under
Investigation (PUD and Persons
Under Monitoring (PUM) to
using case definitions to classify cases into Suspect,
Probable, and Confirmed COVID-19 cases.
2. Establish a standard for and system of case detection, investigation, laboratory
confirmation, and notification

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 I. OBJECTIVES

This Order seeks to provide the guidelines on how COVID-19 cases shall be detected in
health facilities through: (a) reporting health facilities that will serve as sentinel sites, such
as the reporting sites for Severe Acute Respiratory Infection (SARI) and Influenza-like
Illness (ILI) surveillance systems andcity health offices of highly urbanized cities, (b) non-
sentinel sites, such as hospitals and health centers, and (c) national and subnational reference
laboratories and other laboratory facilities. Also, it describes the use of the Event-Based
Surveillance and Response (ESR) system to capture clustering or sudden increase of cases
of ILI and SARI and deaths of unknown etiology in the community.

Specifically, these guidelines on COVID-19 case detection, laboratory confirmation, and

notification shall:
1. Establish a standardized mechanism of case detection, laboratory
confirmation, and
notification among existing surveillance systems and among the Epidemiology
Bureau (EB), regional and local epidemiology and surveillance units, sentinel, non-
sentinel, and laboratory facilities in terms of case definition, epidemiologic
investigation, laboratory sample collection and confirmation, notification, and
feedback;
2, Establish epidemiological, clinical, and virologic characteristics of COVID-19;
w Characterize areas as to status of local and community transmission; and
4. Generate data as the basis for informed policy and intervention measures to contain
and mitigate the spread of COVID-19.

Ii. SCOPE AND COVERAGE

This Order shall cover all individuals, health facilities and offices (public and private),
national and sub-national laboratories, other laboratory facilities, civil society organizations,
professional/medical/paramedical societies, and international organizations/donors/partners
involved in disease surveillance; mandatory reporting of notifiable diseases; health events
of public health concern; and the implementation of these guidelines.

IV. DEFINITION OF TERMS

As used in this Administrative Order, the
following terms shall mean:
A. Case — a person with a particular problem requiring or receiving medical or welfare
attention. A case is often used to label individuals further as suspect, probable, or
confirmed.
B. Case definition — a set of standard criteria for classifying whether a
person has a
particular disease, syndrome, or other health condition.
C. Case investigation — profiling of suspect, probable, and 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.
D. Close contact — is a person without proper personal protective equipment (PPE) who
providing direct care for a confirmed COVID-19 case and a person who had direct
is
physical contact, or lived, worked, transacted, or travelled in close proximity (less than
1
meter) for more than 15 minutes with a confirmed COVID-19 case.

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2
E. Cluster —
real or perceived, of health events that are grouped
is an unusual aggregation,
together as
to time and space and that is reported to a public health department.
F. Influenza-like Imess (ELI) — is a condition with sudden onset (within 3 days of
presentation and fever should be measured at the time of presentation) of fever of >38°C
and cough orsore throat in the absence of other diagnoses
G. Public Health Authority — the Department of Health, specifically, the Epidemiology
Bureau, Disease Prevention and Control Bureau, Bureau of Quarantine, Food and Drug
Administration, Regional Offices of DOH, Regional Epidemiology and Surveillance
Units (RESU); local health offices (provincial, city, or municipality); or any person
directly authorized to act on behalf of the Department of Health or the local health office.
-
H. Severe Acute Respiratory Infection (SARI) is an acute respiratory illness with onset
during the previous 7 days requiring overnight hospitalization. A SARI case should meet
ithe ILT case definition AND any one 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),

GENERAL GUIDELINES
A. Coronavirus Disease 2019 (COVID-19) is a notifiable disease as per Administrative
Order No. 2020-0012 dated March 17, 2020 and its reporting shall be mandatory.
B. The COVID-19 Surveillance shall utilize existing surveillance systems, such as the IL]
and SARI surveillance systems and the Event-based Surveillance and Response System,
for detection of COVID-19 cases.
C. All DOH hospitals and level three (3) private hospitals and medical centers and health
offices of highly urbanized cities shall serve as the sentinel reporting sites for COVID-
19 surveillance. Cases seen at non-sentinel hospitals and health centers and results of
COVID-19 tests done at
laboratory facilities shall also be mandatorily reported.
D. Case definitions for COVID-19 shall be used to ensure proper classification and
appropriate management of
cases.
E. Laboratory confirmation for COVID-19 remains essential in determining the true
burden of this disease.

SPECIFIC GUIDELINES

A. COVID-19 Surveillance System

1, The Epidemiology Bureau (EB) of the Department of Health shall lead in
establishing and implementing the COVID-19 Surveillance System and cases will
be detected through the following:

1.1. Expanded SARI Sentinel Surveillance System

The COVID-19 surveillance shall utilize existing SARI sentinel sites as well
as the additional sentinel sites to be identified, including DOH and Level III
hospitals and medical centers, as sites for sentinel-based notification of
COVID-19 cases.

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 1.2. Enhanced ILI Sentinel Surveillance System

The COVID-19 surveillance shall utilize existing ILI sentinel sites as well as
the additional sentinels to be identified, prioritizing inclusion of hi ghly
urbanized cities, as sites for sentinel-based notification of COVID-19 cases as
well as reporting of aggregate ILI data.

1.3. Notification from Health Facilities and Laboratory Facilities

Health facilities, such as hospitals and health centers, shal! record and report
consultations and/or admissions who fit any of the COVID-19 case definitions.
Also, laboratory facilities conducting testing for COVID-19 shall
notify DOH,
through the set notification system, of individuals who underwent testing for
COVID-19 and their results.

1.4, Event-based Surveillance and Response

Clustering or sudden increase of ILI and SARI cases and deaths of unknown
etiology shall be reported through the ESR system

. Case definitions for notification shall be based on the current information available
and shall be updated accordingly. This amendment shall define the transition from
reporting individuals as Patients Under Investigation (PUI) and Persons Under
Monitoring (PUM) (See Annex A) to Suspect, Probabie, and Confirmed COVID-19
cases,
2.1. Suspect case — is a person who is presenting with any of the conditions below.
a. All SARI cases where NO other etiology fully explains the clinical
presentation.
b. ILI cases with any one of the following:
ii. with no other etiology that fully explains the clinical presentation
AND 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
lii, with contact to a confirmed or probable case of COVID-19 in the
two days prior to onset of illness of the probable/confirmed
COVID-19 case until the time the probable/confirmed COVID-19
case became negative on repeat testing.
¢. Individuals with fever or cough or shortness of breath or other respiratory
signs or symptoms fulfilling any one of the following conditions:
i. Aged 60 years and above
ii. With a comorbidity
iii. Assessed as having a high-risk pregnancy
iv. Health worker

2.2. Probable case — a suspect case who fulfills anyone of the following listed
below.

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 a.
b.
Suspect case whom testing 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

2.3. Confirmed case — any individual, irrespective of presence or absence of

clinical signs and symptoms, who was laboratory confirmed for COVID-19
a test conducted at the national reference laboratory, a subnational reference
in
laboratory, and/or DOH-certified laboratory testing facility.

3. Case Detection
3.1. SARI and ILI Sites and Other Health Facilities, Providers, and
Institutions

The identified SARI and ILI surveillance sites shall detect COVID-19 cases
among its consultations and admission using the set case definitions. Other
health facilities and providers and other institutions, including hospitals, health
centers, and clinics, shall also detect COVID-19 cases among
and admission using the set case definitions.
its
consultations

The ILI sites and identified health offices in highly urbanized cities shall
submit weekly aggregate data on total consultations of ILI disaggregated as to
age, sex, date of onset of illness, and place of residence.

Case investigation of detected and/or reported suspect, probable, and

confirmed COVID-19 cases shall be undertaken by designated or trained
disease surveillance officers (DSO)
at these facilities using a standard case
investigation form (See Annex B). In the absence of a designated ortrained
DSO
at the facility, personnel of the Infection Control Unit or a similar office,
shall conduct the case investigation. In the absence of any personnel capable
of conducting case investigations at these facilities, the higher level office shall
supervise and provide technical guidance or take the lead. Provincial
Epidemiology and Surveillance Units (PESU) shall supervise or take lead for
health facilities, providers, and offices and institutions at the municipal and
component city and the Regional Epidemiology and Surveillance Unit (RESU)
for those in highly urbanized cities and PESU,
if latter has limited capability
to supervise or lead. The investigation shall include but
following: review of medical
is not limited to the
records, case interview, and laboratory sample
collection and its results.

Officials and staff of health facilities and providers and concerned institutions
shall comply with the request for access to patient and laboratory records for
the purpose of this case investigation.

The health facility where any of these suspect, probable, or confirmed COVID-
19 cases are admitted shall conduct daily monitoring of cases as to
their status

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 and consolidate hospital census related to COVID-19 using the set template
(See Annex C). Identified deaths among these cases shall be profiled using the
set format.

Confirmed COVID-19 cases assessed as asymptomatic or clinically recovered

at
by their attending physician shall be tested and will be discharged after least
one negative result. Confirmed COVID-19 cases who have clinically
recovered or are well with negative results on repeat testing shall be reported
as RECOVERED. If said discharged cases develop new signs or symptoms or
progression from mild to more serious signs and symptoms, he/she shall be re-
admitted once more to isolation and re-testing done. This guideline shall be
reviewed and revised accordingly.

3.2. Laboratory Facilities

ALL Laboratory facilities conducting testing for COVID-19 shall notify DOH
daily of official results of individuals tested for COVID-19, regardless of the
test result.

Laboratory confirmation for COVID-19 shall be performed by the Research

Institute for Tropical Medicine (RITM), five (5) sub-national laboratories
(SNL) following the Regional Zoning of Services of National Reference and
Subnational Laboratories for SARI (See Annex D), and officially accredited
laboratory facilities. Note that this zoning may be updated in subsequent
issuances. The RITM and DOH will work to improve the capabilities of these
laboratories.

Current available laboratory confirmation for COVID-19 is done through real

time/conventional Reverse Transcriptase-Polymerase Chain Reaction (RT-
PCR). This may be updated as additional, officially recognized laboratory
confirmatory testing becomes available.

Laboratory testing facilities should fulfill the following for

it to be officially
accredited by RITM as a COVID-19 laboratory confirmation testing facility:
a. Submit a self-assessment to RITM
b. Undergo and pass Proficiency Testing
c. Have five positive samples pass RITM external quality assessment.

If the laboratory does all

not pass three criteria, result of any test conducted at
their facility shall not be recognized as a laboratory confirmation test but shall
still be submitted to DOH.

3.3. Event-based Surveillance and Response System

Local health authorities through the local epidemiology and surveillance units
(LESU) shall report all health events, to include rumors of clustering or sudden
increase of cases of ILI and SARI and deaths of unknown etiology.

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 4. Epidemiologic Investigation
Confirmed COVID-19 cases shall be investigated using the WHO Revised Case
Report Form for COVID-19 (See Annex E). This epidemiologic investigation shall
provide a more comprehensive profile of the confirmed COVID-19 case, including
exposure and travel histories priorto onset of illness and until the case’s isolation as
well as clinical information. The concerned LESU,
as determined by RESU, shall
lead this epidemiologic investigation and corresponding response activities.
However, in the absence of any personnel capable of conducting epidemiologic
investigations and/or response activities at local health offices, the higher level
office can take the lead. The PESU shall take lead for health offices at the municipal
and component city and the RESU for health offices of highly urbanized cities and
PESU, if latter has limited capability to lead.

Also, where clustering or sudden increase of SARI and ILI cases and deaths of
unknown etiology or any reported confirmed COVID-19 case had been identified,
the local health authorities through the LESU shall coordinate with their respective
RESU for a joint or a supervised investigation of cases or health event. This
investigation should be able to provide better understanding of the epidemiology of
the event and to ensure proper case and health event management.

Officials and staff of health facilities and other institutions shall comply with the
provision of R.A, 11332, otherwise known as Mandatory Reporting of Notifiable
Diseases and Health Events of Public Health Concern Act, regarding epidemiologic
investigation of notifiable diseases, including COVID-19. Representatives of EB
and its regional and local counterparts shall be given full access to patient and
laboratory records for the purpose of this epidemiologic investigation,

The investigating team shall be equipped with appropriate and complete personal
protective equipment (PPE) during investigation.

B. Laboratory Confirmation
Current guidelines recommend the collection of nasopharyngeal and oropharyngeal
swabs (NPS/OPS) for laboratory confirmatory testing. For a SARI case who
is
a suspect
COVID-19 case, lower tract specimens like sputum, tracheal aspirate, and/or bronchi
alveolar lavage, may also be collected aside from NPS/OPS. These guidelines on sample
collection shall be reviewed and updated.

Current guidelines also list cases we shall prioritize for testing. However, once
additional epidemiological information and projections are available, said guidelines
shall be reviewed and revised, as needed. The following shall be prioritized for testing:
a. Suspect cases who are assessed as serious or critical
b. Suspect cases fitting any one of the conditions:
i. Aged 60 years and above
ii. With a comorbidity
iii. Assessed as a high-risk pregnancy
iv. Health workers
 c. Health workers assessed as with high risk of exposure, even in the absence of
any sign or symptom
d. Clusters of ILI or SARI

The collection, storage, and transport of specimens from reporting health facility or
office to the laboratory shall be facilitated by the designated disease surveillance officer.
Laboratory collection shall be done by trained health staff in the health facility where
case was detected and submitted to designated and official laboratory testing facilities.
Staff who conduct laboratory sample collection shall be equipped with appropriate and
complete personal protective equipment (PPE) during collection of specimens. All cases
with laboratory specimens collected shall be coordinated with the RESU.

All collected specimens shall be transported within 48 to 72 hours upon collection and
stored at 2 °C to 8 °C. If specimens will not be transported within 72 hours, store the
specimen inthe freezer.

A laboratory quality assurance of DOH shall be implemented by RITM through

SNL
Molecular Biology Laboratory (MBL). The MBL should ensure that a Biosafety,
its
Biosecurity, and Laboratory Quality Assurance team shall be deployed to all DOH SNL.

Other hospitals with existing capacity for laboratory confirmatory testing for COVID-
19 shall provide RITM with aliquots of their samples for re-testing as
part of Laboratory
Quality Assurance.

- Recording and Notification System

Health authorities from the government and private sectors, including health facilities,
laboratory testing facilities, offices, institutions, and individuals, are mandated to report
suspect, probable, and confirmed cases of COVID-19 and results of COVID-19 testing
done within 24 hours of identification or completion of testing.

1. Designation of a Dedicated COVID-19 Coordinator

All public and private health facilities and providers that admit and give
consultations fo suspect, probable, and confirmed COVID-19 cases and/or
laboratory facilities that conduct testing for COVID-19 must identify and designate
a COVID-19 coordinator and his/her alternate. The COVID-19 Coordinator shall
ideally be the head of or point person for the concerned epidemiology and
surveillance unit, ICC, or laboratory facility, whichever is applicable. The COVID-
19 coordinator shall:
a. Serve as the main liaison between the DOH and the health facility, health
provider, or laboratory facility for all communication on COVID-19
concerns including but not limited to data requests, validation, and follow-
up;
b. Continuously coordinate with the EB COVID-19 surveillance team to
facilitate immediate and timely accommodation of all surveillance,
laboratory data submission, and contact tracing activities such as but not

as
 limited to: reviewing patient records, interviewing patients, relatives, and
other health care providers and other concerned personnel of the facility, and
immediate submission of laboratory results;
c. Promptly and correctly update the DOH COVID-19 Information System.

All public and private health facilities, health providers, and laboratory facilities
shall provide the DOH with the following details of their assigned COVID-19
coordinator and alternate:
a. Name
b. Position
c. Cell phone number
d. E-mail Address

Details shall be submitted to the EB COVID-19 surveillance team

covidcontacttracing. [email protected] with the subject header “[COVID-19]
Coordinator for <name of facility>”.

2. Case Notification and Monitoring

2.1. Case Notification and Submission of COVID-19 Laboratory Test Results

Information on suspect, probable, and confirmed COVID-19 cases shall be recorded

using the COVID-19 Case Investigation Form or CIF (See Annex B) and reported
within 24 hours using
a set notification system (See Annex F). The health facility or
provider or concerned institution, shall submit within 24 hours of detection the
accomplished CIF to RESU, who shall in turn submit this to EB.

For reported clustering or sudden increase of ILI and SARI cases or deaths of
unknown etiology, these shall be reported through the ESR system also within 24
hours. The health facility or provider or concerned institution shall inform the RESU
of identified suspect cases and health events. The RESU shall in turn notify EB
immediately. However, upon detection of a probable or confirmed COVID-19 case,
the reporting unit shall immediately notify the EB and RESU, simultaneously.

Laboratory results from the national reference laboratory, subnational referral

laboratory, and laboratory testing facilities shall be submitted to DOH within 24 hours
of completion of test using the same notification system. However, if the result was
equivocal or positive, this report should be submitted immediately. Laboratories
should diligently accomplish the lab reporting form in Annex G.

A transmittal of laboratory results shall be released by RITM following the protocol

for releasing laboratory results. The transmittal shall be shared to designated officials
after vetting of their Head of Office. This transmittal shall be considered official.
Signed individual laboratory results shall be shared as soon as available. These
transmittal and individual laboratory results shall be released by RITM to the Office
of the Secretary of Health and duly identified members of DOH Executive
Committee, the Infection Control Committee (ICC) head or point person of requesting

9
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 hospitals, EB, and the concerned RESU. The RESU will
inform their regional director
(RD) and assistant regional director (ARD), who in turn inform the concerned LGU.

For subnational reference laboratories and other testing facilities, laboratory results
shall be immediately sent by their heads of offices to the DOH Executive Committee,
EB, RITM, RESU, and the Infection Control Committee (ICC) head or point person
of requesting hospitals. An official transmittal shall be sent immediately but signed
individual laboratory results should follow. The RESU in turn informs their respective
RD and ARD, who in
turn inform the concerned LGU.

2.2. Case Monitoring

A template shall be submitted daily by 5 PM which will include status of admitted

suspect, probable, or confirmed COVID-19 cases (See Annex B). If any of these
became a fatality, this should be immediately reported to RESU using the set
format, who shall in turn immediately notify EB. The following information shall
be updated:
a. Medical Status (of condition, as of time of update), including current signs
and symptoms
b. Laboratory Status
c. For fatalities:
Date and Time of Death
i,
Cause of Death
ii.
iii. Comorbidities
d. Disposition
e. Remarks: any other relevant notes from the patient chart; indicate especially
if the patient is using a ventilator.

The COVID-19 coordinator shall provide detailed information on the death listed
above, as well as other pertinent information from patient records.

For health facilities and providers and laboratory facilities with capability to set-
up and use the COVID-19 Information System, the EB COVID-19 surveillance
teamshall assist the assigned COVID-19 coordinators in
setting up their accounts
to access the COVID-19 Information System website. This shall serve as the main
data repository of COVID-19 data from all health facilities.

Confirmed COVID-19 cases who are

currently isolated at home or
in a non-health
facility, the LESU shall be responsible in monitoring the clinical status of the
patients and collect sample for repeat testing at the end of the 14-day isolation
period.

2,3. Utilizing the COVID-19 Information System

The COVID-19 coordinator shall accurately and diligently input all required
information on all suspect, probable, and confirmed COVID-19 cases that are
 admitted or have consulted at the facility using this system. In turn, laboratory
facilities conducting COVID-19 testing shall input case information and
the
upload official transmittal and laboratory result.

The COVID-19 coordinator must update the COVID-19 Information System

website sheets daily without need for prompting by 5:00 PM. The COVID-
19 coordinator must pay special attention to ensure that the following variables
are updated:
a. Medical Status (of condition,
as of time of update), including current
signs and symptoms
b. Laboratory Status
c. For fatalities:
i. Date and Time of Death
ii. Cause of Death
iii. Comorbidities
d. Disposition
e. Remarks: any other relevant notes from the patient chart; indicate
especially if the patient is using a ventilator.

The RESU will review the data after submission. They may call the COVID-
19 coordinator to follow-up for updates or clarify certain data entries.
Likewise, the COVID-19 coordinator may contact the RESU for any questions
or clarification with regards to the reporting forms. The EB Data Managers
shall coordinate with the RESU for data requiring further verification.

Designated disease surveillance staff in these sentinel sites and disease

reporting units shall implement and exercise zero reporting and notify the
RESU, who shall in turn notify EB.

VIL ROLES AND RESPONSIBILITIES

A. The Epidemiology Bureau shall:
1. Lead in the establishment and implementation of the COVID-19 Surveillance
System.
Zs Draft and issue required policies and guidance inrelation
Bs
to this surveillance system.
Conduct training, orientation, and/or technical assistance to ensure that disease
reporting units and concerned stakeholders will know how to implement the system.
Shall be the process owner of the COVID-19 Information System and as such shall:
a. Actas the Database Managers for surveillance data
b. Liaise with the COVID-19 coordinators for the timely turnover of
complete
data and information
c. Review and approve updated attribute data which may be submitted by the
users
wa
Draft and disseminate COVID-19 surveillance report.
Assess and coordinate with respective RESUs all reported clustering, sudden
increase, and local transmission of COVID-19 within 24 hours upon receipt of
detection of clustering, sudden increase, or local transmission.

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 7. When necessary, provide support through technical staff and logistic assistance
during epidemiologic investigation and response.
8. Oversee the design of appropriate reporting software for the inclusion of COVID-
19 into the SARI/ILI, existing hospital sentinel surveillance and/or information
system, and community-based disease surveillance system.
9. Facilitate dissemination of related information, policies, and recommendations from
DOH Central Office and the World Health Organization (WHO)
agencies institutions.
and
to
the concerned

10. Allocate funds for the operation of the COVID-19 surveillance system.
11. Monitor the implementation of the system.
12, Notify the WHO as part of International Health Regulations commitment
B. The RESU shall assume the roles and responsibilities of EB at the regional level:
1. Lead
inthe establishment and implementation of the COVID-19 Surveillance
System at the regional level.
2. Identify strategies and activities to operationalize the surveillance system at their
level and at local health offices and disease reporting units.
3. Conduct data verification of submitted CIF and/or records and reports encoded in
the COVID-19 Information System.
4, Conduct training, orientation, and/or technical assistance to ensure that disease
reporting units and concerned stakeholders will know how to implement the
system.
5. Prepare and disseminate COVID-19 surveillance report.
6. Disseminate related information, policies, and recommendations from DOH
Central Office and the World Health Organization (WHO) to the health facilities,
disease reporting units, and concerned agencies and institutions at their level.
7. Allocate funds for the COVID-19 surveillance system.
8. Monitor the implementation of the system.

C. The Bureau of Quarantine (BOQ) shall:

1. Conduct surveillance in ports and airports of
entry and sub-ports as well as the
airports and ports of origin of international flights and vessels.
2. Collect completed health declaration cards and enter into the database management
system.
3. Perform entry screening and preliminary investigation of all suspected cases
identified in all ports of entry and exit.
4. Provide the passenger manifest and other relevant information to EB and/or RESU
for case investigation and contact tracing.
5. Allocate funds for the COVID-19 surveillance system.
6. Monitor public health threats in other countries.

D. The National Reference Laboratory (Research Institute for Tropical Medicine):

1. Allocate funds for laboratory testing for COVID-19 and other SARI
pathogens.
2. Allocate funds to support quality assurance activities of sub-national and other
laboratories
3. Provide confirmatory services to COVID-19 cases.

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 4. Provide funds and technical support for specimen collection, transport, and storage
from the sites to the laboratory.
5. Provide technical support, training, and quality assurance to the subnational
laboratories and officially accredited laboratory testing facilities.
6. Assess testing facilities for accreditation as an official laboratory confirmatory
testing facility.
7. Provide laboratory results to designated DOH officials, EB, RESU, and health
facilities and disease reporting units.

E. Subnational Reference Laboratories and DOH-Certified Laboratory Testing

Facilities shall:
1. Provide confirmatory services to suspect COVID-19 cases.
2. Provide laboratory results to DOH and its
identified officials and offices and
requesting health facilities.
3. Allocate funds for the COVID-19 surveillance system.

F. Field Implementation and Coordination Team, Centers for Health Development,

Health Facility and Services Regulatory Bureau, and PhilHealth
1. Assist EB and RESU in ensuring compliance
of health facilities, health providers,
and laboratory facilities, both government and private, to guidelines for recording,
investigation, and notification of suspect, probable, and confirmed COVID-19 cases
2. Assist the DOH Database Managers in following up and ensuring the timely
submissions of government and private health facilities, health providers, and
laboratory facilities

G. Knowledge Management and Information Technology Service (KMITS) shall:

1. Provide assistance in using the data entry platform
2. Resolve issues, concerns, and problems on the development, utilization, and
implementation of the system;
3. Implement monitoring and evaluation mechanisms to improve data quality and
use,
including documenting and reporting of users’ feedback and recommended
improvements in the system

H. Provincial and City/Municipal Health Offices of Highly Urbanized Areas shall:

1. Orient and or re-orient hospital staff on mandatory disease reporting
requirements
2. Support the operation of the epidemiology and surveillance unit through the
following:
a. Identify and designate health staff to be trained and assigned as the COVID-
19 Coordinator
b. Assign a staff for data encoding and a dedicated table top computer and other
IT requirements such as internet connection for reporting are available.
c. Allocate budgetary support through the incorporated in the annual work and
financial plan of the provincial/city/municipal health office the operation of
the ESU for effective disease surveillance system

I. Local (Provincial, City, and Municipal) Epidemiology and Surveillance Units shall:
 1. Lead in the investigation, validation, contact tracing, monitoring of reported
cases of COVID-19, and other response activities. This includes investigation of
reported clustering cases.
2. Conduct training, orientation, and/or technical assistance to public health
associates (PHAs) and barangay health emergency response teams (BHERTs) on
case identification, close contact monitoring, and reporting of persons under
quarantine, underscoring the importance of mandatory disease reporting
requirements for COVID-19 surveillance.
to
Operationalize the surveillance system at their level
4. Allocate funds for the operation of the COVID-19 surveillance and response

J. Role of Health Facilities and Disease Reporting Units shall:

1. Orient or re-orient hospital/health facility staff regarding mandatory disease
reporting requirements for COVID-19 surveillance.
2. Designate disease surveillance coordinators who will be responsible for
preliminary investigation of suspect cases seen at the hospital.
3. Designate an COVID-19 coordinators, ideally the Hospital Epidemiology and
Surveillance Unit or Infection Prevention and Control Head or Point Persons,
who shall be responsible in: (a) ensuring completion and submission of CIF
and/or encoding using the COVID-19 Information System, (b) ensuring
laboratory sample collection and transport, (c) receive laboratory results, and
(d) disclose laboratory results to attending physicians and/or case.
4. Assign a dedicated encoder and provide IT requirements for recording and
notification.
5. Coordinate with EB and RESU, especially during case investigation and close
contact tracing.
6. Provide access to medical records, facilitate case interviews, and other case
investigation and contact tracing activities.
7. Provide daily updates to RESU as to case status of admitted suspect, probable,
or confirmed cases using prescribed template.
8. Allocate funds for the COVID-19 surveillance system.

VO. REPEALING CLAUSE

Administrative Order No. 2020-0012 dated March 17, 2020 entitled “Guidelines for the
Inclusion of the Coronavirus Disease 2019 (COVID-19) in the List of Notifiable
Diseases for Mandatory Reporting to the Department of Health” and all other issuances
inconsistent with this Order are hereby repealed, rescinded, amended or modified
accordingly.

IX. EFFECTIVITY
This Order shall take effect immediately.

ho T. DUQUE, U1, MD, MSc

Secretary of Health
 Annex A. Transition of the Old versus New Classification for COVID-19

OLD CLASSIFICATION NEW CLASSIF ICATION

Neither a Person Under Monitoring (PUM) or Not a COVID-19 Case

Patient Under Investigation

PUM Not included in the new classification*

PUI (mild, severe, or critical) who was not Suspect
tested or awaiting test results

PUI (mild, severe, or critical) with Probable

inconclusive test results

COVID Positive Confirmed

*Because of evidence of local or community transmission in the country, its residents are
assumed to have been exposed to the infection
0
lw
Annex B, COVID-19 Case Investigation Form
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 Annex C. Status Update for COVID-19 Admissions
Name of Reporting Hospital:
Address:

Total Number of Admissions:

@ No. Suspect Cases:
@ No. Probable Cases:
@ No. Confirmed Cases:

Name of Medical Status Laboratory If DEATH, fill in the following Disposition Remarks t
j

Patient Update and Status information

1

(Discharged,
i

Current DAMA, (intubated,

Significant (Positive, HAMA, On
Signs and Negative, Absconded, ventilator,
Symptoms Pending) Date Canse List of Transferred; etc.)
and of Comorbidities if
(Asymptonratic, Timeof Death transferred,
Mild, Severe, Death indicate
Critical, Death) which
facility)

iti

et
 Annex D. Regional Zoning of Services to National Reference and Sub-
national Laboratories for SARI

Ocoee maul tay Referring Region

Baguio General Hospital Subnational Region I — Ilocos Region
Laboratory Region Il ~ Cagayan Valley
Cordillera Autonomous Region

Lung Center of the Philippines Subnational Region IH — Central Luzon

Laboratory National Capital Region — First
District
National Capital Region — Second
District

San Lazaro Hospital Subnational National Capital Region — Third

Laboratory District
Region IVA (CALABARZON)}-
Only Rizal Province
-
Region IVB MIMAROPA
Research Institute of Tropical NRL National Capital Region — Fourth
Medicine District
Region IVA (CALABARZON)-
Except Rizal Province
Region V — Bicol
Vicente Sotto Memorial Subnational Region VI — Western Visayas
Medical Center Laboratory Region VII — Central Visayas
Region VIII — Eastern Visayas
CARAGA Region
Southern Philippines Medical Subnational Region IX — Zamboanga
Center Laboratory Region X — Northern Mindanao
Region XI — Davao
Region XH —SOCCSKSARGEN
Bangsamoro Autonomous Region
for Muslim Mindanao

Ov ia
 Annex E. WHO Case Report Form

Revised case report form for Confirmed Novel Coronavirus COVID-19

(report to WHO within 48 hours of case identification)
Date of reporting to national health authortig: |. JL 7 JL LL: JIL LHL LIL J
Reporting country:

tested for (OVID 1S;

Wéby
atontactofacase cll] Seeking Healthzare due to suspicion of COVID-19 = Detected at pointofentry © Repatriation
a Routine respiratory disease survellance systems fe.9, influenza) c Unknown
¥ mone of the above, please explain

Unique Case Identifier (used in country}:

age (years: EWE if <? year old, L_ WL] in months or if < 1 menth, L_JL_}in daw

Sex at bin: s Male a Fanvle

Place where the case was dlagnoseds Countiy:

Admin Level ? (province:

Case usual place of residency Country:

Date of first laboratory coniimation test Lo Vt Jb VO Ib It ak

Any syinptoms* or signs at time of speciven collection that resuiterdt in first tabarefary confirmation?

LO
aNo iLé, asymptomatic) a Yes c Unknown
fyves. date of onset of synyptoms
LIL AL
J JL
Underhing conditions and comorbidity:
Anyuncerlying conditions? c No o Yes oc Unknown

if yes, ease check all thaé apply:

3 Pregnancy (trimester: 5 & Post-parbuin (« 6 weeks}
= Camtliovascular disease, inchiding hypertension s lnumunodeficiency, Including HIV
om Diabetes = Renal disease
o Liver disease = Chronic lung disease

a Chronic neuralogical or neuromuscular disease 3 Malignancy

2 Other(s), please specify:
ce
Health Status at time of reporting:

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country City Date of Departure from the place

J dogegsiey . -
‘

i-ag Laon wistted any health care facility othe 14 diye greet ta sem
pin onset? “Yes oilrkresean i

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Date of re-subn nof this fpr: JL WL JL: LL Jb 23
if case was asymptomatic af time of specimen collection resulting in fist laboratory confirmation, did the case develop any
symptoms or signs atany Gare prior to discharge or death:

a No (Le, case remains asymptomatic}

2 Yes asymptomatic case (an previously reporbed | developed symptoms areivor signs of illness

ifves, date of onset of symptomessigns- of illness: Lo

Jb EL 4 J Ub JL

a Unknown

Clinical Course:
Admission te hospital (may have beeri previowsly reported: = Mo ses oc Unknown

if admitted to huspita:
First date of admission te tespital: LSE AL IL VL LUIL UL LIL J
Dicl Hie case receive care in an intensive care unit CU? aNo = Y8s o Unknowt
Did tye case receive ventilation? oa No c Yes a Unknown
Did dye case receive extracorporeal mennbrare oxygenation? oo No co Yes a Unkroyirs

Health Outcome: a Recovered Healy m Mot recevered co Death Dkeowin o ttthern

¥ other, please explain:

Date of Release tram isolations hospital or Date of Death: LUE LL IL vl Jb JL JE 3

if released from hospital isolation, date of last laboratory test:
Co
Ib VEL IL VL IL IL JL]
Results of last tesk o positive o negative oo Unknown

Total number of contacts followed for this case: o Unknown

© World Health Organization 2020, Al rights reserved,

This is a draft. The content of this document is not final, and the text may be subject to revisions before publication. The

document may not he reviewed, abstracted, quoted, reproduces), transmitted, distributed, trangdated or adayted, in part or
in whote, in any form or by any means without the permission of the World Health Groanization,
WH reference number WHOSMNS-nCoV/SurveillanceCRF/2020.2
 Annex F, COVID-19 Surveillance Notification System

a
SUSPECT CASES

Disease Reporting
Unit (Sentinel

City/ Municipal/
Provincial Health
Office
sites,
hospitals, heatth centers) an
.PROBABLE/
CONFIRMED

Laboratory
Y
CASES.

National Reference :
=
sp
men Executive
camlEeae

Epidemiology
Buremu
caste tts
elt |
eee
Be Regionat
Municipal
(+
fae
e

CLUSTERING pe» Epidemiologyand

ne
OF CASES Sub-national and Saovsillance Unit

eS oo
Health Office
Officially Accredited
an
4]
Regiona! |
Epidemiotogyand Disease Reporting
Surveillance Unit — Unit

Epidemiology
Bureau

viii
{
Annex G. Laboratory Results Reporting Template
Name of Laboratory Facility:

Address:

Name Age Sex Name Of Type Of Type Of Date Date Date Test
(Last Name, Requesting Laboratory Specimen Specimen Specimen Results Results
First Name, Facility Facility : (NPS, Collected Received Released
Middle NRL, SNL, OPS, (mm/dd/yyyy) (mm/dd/yyyy) (mm/dd/yyyy)
Name) Or Non- Serum,
NRL/SNL Ete.)

Approving Official: Date Approved:

Name
Designation

Jer