Return To Work Interim Guide On Pum, Pui and Covid-19 Cases: Philippine College of Occupational Medicine, Inc
Return To Work Interim Guide On Pum, Pui and Covid-19 Cases: Philippine College of Occupational Medicine, Inc
RETURN TO WORK
INTERIM GUIDE ON
PUM, PUI and COVID-19 CASES
Part 2 As of April 2, 2020
TABLE OF CONTENTS
Definition of Terms 4
SIGNS AND SYMPTOMS OF COVID-19 INFECTION 6
Detection of PUM, PUI, and confirmed COVID-19 cases 6
Reporting of PUM, PUI, and COVID-19 cases to the DOH Surveillance System 7
FLOW OF NOTIFICATION FOR IMMEDIATELY NOTIFIABLE DISEASES, SYNDROMES & EVENTS 9
CONCEPT FRAMEWORK FOR THE PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND
RESPONSE (PIDSR) 10
ALGORITHM ON FIT TO GO BACK TO WORK FOR WORKERS 11
ALGORITHM ON FIT TO GO BACK TO WORK FOR HEALTHCARE WORKERS 12
ALGORITHM ON RISK ASSESSMENT AND PUBLIC HEALTH MANAGEMENT DECISION MAKING13
RISK ASSESSMENT FOR HEALTH WORKERS 13
LEAVE OF ABSENCES/ ENTITLEMENTS 16
DOLE COVID-19 ADJUSTMENT MEASURES ORIGRAM (CAMP) 17
DOLE COVID-19 ADJUSTMENT MEASURES PROGRAM DIRECTORY 18
PERSONAL PROTECTIVE EQUIPMENT RECOMMENDATION 19
GOVERNMENT, INSTITUTIONS AND SOCIETIES: ADVISORIES AND GUIDELINES 21
A. DOLE 21
B. OFFICE OF THE PRESIDENT 21
C. PHILIPPINE SOCIETY FOR MICROBIOLOGY AND INFECTIOUS DISEASES 21
D. WHO 21
ETHICAL GUIDELINES FOR LEADERS IN THE HEALTH CARE INSTITUTION DURING THE COVID-19
PANDEMIC 22
PHILIPPINE COVID-19 TESTING CENTERS 26
CASE INVESTIGATION FORM: COVID-19 27
Line list of PUM from COUNTRIES Reporting with Local Transmission (SAMPLE) 28
Line list of Mild PUI from COUNTRIES and LOCAL AREA reporting with local transmission (sample) 28
This part 2 interim guidelines is compiled and written with the intention to help our doctors in
their recommendation for employees and companies on return to work.
DEFINITION OF TERMS
1. Person under Monitoring (PUM) is a person who is asymptomatic with any of the
following:
a. Travel history in the last 14 days to countries with local transmission and high risk of
importation of COVID-19; or
a. who has fever and/or respiratory illness (e.g. cough or shortness of breath) and/or
diarrhea, with any of the following:
4. Home Quarantine
a. Any person, regardless of nationality, race and age, who does not exhibit any sign nor
symptom, has history of travel to other areas of China and/or history of exposure to a
confirmed case of COVID-19, within the past 14 days, shall be required to undergo
monitored home quarantine.
b. Any person, regardless of nationality, race and age, who exhibits fever or any symptom
of lower respiratory illness, and has a history of travel to other countries with a
Isolation:
a. PUM should be alone in a well-ventilated room, preferably with a toilet and bathroom. If
not possible, maintain a distance of at least 1 meter from PUM
e. Confine activities of PUM in one room only. If not possible, ensure shared space like
kitchen, toilet etc. is well ventilated (open windows)
f. No sharing of items like towels, bed linens, eating utensils, dishes and other personal
items.
Restrictions:
Prohibited to leave their room/homes where they are quarantined until they have been
certified by the local health official to have finished the 14-day requirement for
quarantine procedures
Reporting:
5. Self-monitoring means PUM should monitor themselves for fever by taking their
temperature twice a day and remain alert for respiratory symptoms (e.g., cough, shortness
of breath, sore throat etc). Anyone on self-monitoring should be provided a plan for whom
to contact if they develop fever or respiratory symptoms during the self-monitoring period
to determine whether medical evaluation is needed.
6. Active monitoring means that the local public health authority assumes responsibility for
establishing regular communication with potentially exposed people to assess for the
presence of fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat
etc.)
a) being within approximately 6 feet (2 meters), of a person with COVID-19 for a prolonged
period of time (such as caring for or visiting the patient; or sitting within 6 feet of the
patient in a healthcare waiting area or room); or
b) having unprotected direct contact with infectious secretions or excretions of the patient
(e.g., being coughed on, touching used tissues with a bare hand).
The reported symptoms are mainly fever and dry cough. Other commonly reported symptoms
are breathing problems, runny or blocked nose, sore throat, headache, nausea, muscle and
joint pain. New reports suggest patients experiencing loss of sense of taste and smell. Most of
those infected get mild symptoms that can be managed at home. Some people become
severely ill with breathing difficulties and pneumonia.
1. Ports of Entry
The staff of the Bureau of Quarantine shall perform clinical examination of identified
and/or referred individuals for appropriate case classification and disposition.
2. Health Facilities
All health facilities shall inquire for travel histories to COVID-19 affected countries
among consultations presenting with fever, cough, colds, and other respiratory
conditions. For patients with no history of travel or exposure but presenting with severe
acute respiratory infection or atypical pneumonia shall be treated with high index of
suspicion. They shall be guided by the set case definitions for the proper classification
of these consultations.
All Local Health Offices shall ensure proper coordination with the public and private
facilities including civil society organizations, professional societies, and academic
institutions in the community on raising community awareness on COVID-19. The
officials of these offices and institutions shall implement the following activities:
a. To heighten awareness among facilities and areas under their jurisdiction and the
community in the identification and appropriate referral of residents, employees,
students, and other individuals who may be classified as PUM and PUI;
1. Health authorities from the government and private health facilities shall report PUM, PUI,
and confirmed cases of COVID-19 within 24 hours of identification. Data that will be
collected shall consist of, but not limited to:
Last Menstrual Period (for female of Mobile and Landline phone numbers
reproductive age)
History of Travel
History of Illness
2. Country/ies visited
2. Signs and symptoms of illness
3. The reporting facility shall notify the concerned RESU within 24 hours of identification of a
PUI or PUM. The RESU shall in turn notify the EB immediately/ However, upon detection of
a confirmed COVID-19 case, the reporting unit shall notify the RESU and EB immediately
4. The laboratory process, including request forms and guidelines for specimen collection,
storage, and transport, and reporting of results shall be developed by RITM, in coordination
with EB.
5. Recording and reporting forms and a database management system to ensure faster and
easier encoding, submission, and analysis shall be identified or developed by EB. A unique
identifier or identification number (IDNUM) will be assigned by the reporting unit to all PUIs
seen and reported in the health facility. The IDNUM shall be the reference number of the
PUI to be used by both EB and RITM in recording the data of the PUI in a reporting
software.
In the Workplaces:
a. Symptomatics
2. The MHO/CHO should then report to the Regional Epidemiology Surveillance Unit (RESU)
using the Event-Based Surveillance System (ESR) of epidemiology Bureau (EB) of DOH.
1. The DOH shall reach out to the employer first and it is the joint DOH and LGU’s contact
tracing team which shall assess who among such persons should be placed on quarantine
and advise which area to vacate & cordon-off.
2. Employers should cooperate and provide the necessary assistance and support to the joint
DOH and LGU’s contact tracing team by helping identify any persons at the workplace who
may have had close contacts with the confirmed case. For those who are not placed under
quarantine, follow instructions above.
3. Employers should immediately vacate and cordon-off the prescribed section of the
workplace premises where the confirmed case worked. There is no need to vacate the
building or the whole floor if there had been no sustained and close contact with the
confirmed case; and
4. Carry out a thorough cleaning and disinfecting of that section of the workplace premises
particularly those that come in frequent contact, using 0.1% bleach.
5. For employees who may not be able to remain physically at their workplaces if they have
been asked to vacate their work stations or are pending assessment by the joint DOH and
LGU’s contact tracing officers, employers are urged to enable flexible work /or treat such
absences in accordance with Department of Labor arrangements and Employment Civil
Service Commission guidelines.
7. Employers should regularly keep in touch with an employee who is a suspect or confirmed
case or was placed on quarantine.
WORKPLACE
SAFETY OFFICER/ OH PHYSICIAN
To report:
Accomplish:
• Symptomatics
LOW RISK
• Caution
• Must wear mask for 14 days from last exposure
(≤ 2 min)
• Self monitoring daily
• Distance from patient within
6ft (2 meters)
P
U MAY RESUME WORK
M MEDIUM RISK NO SYMPTOMS within 7 days • Must wear mask for 14
• Frequent and Prolonged days from last exposure
STRATEGY
• Negative result from Assay for
COVID-19
SYMPTOM CHECKLIST:
Fever Difficulty of Breathing
Headache Sore throat
Muscle pains
ALGORITHM ON FIT TO GO BACK TO WORK FOR WORKERS
Nausea References:
Fatigue Vomiting https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html#table1
Cough Diarrhea https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html
Colds Abdominal Pain Occupational Health and Safety Services, Inc. Health guidelines
Shortness of Breath https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-
Loss of Taste
with-possible-coronavirus-covid-19-infection
Loss of Smell
Page 11 of 30
FIT TO GO BACK TO WORK
HEALTHCARE WORKER(s) identified as PERSON UNDER MONITORING (PUM)
and with Suspected Infection PERSON UNDER INVESTIGATION (PUI)
LOW RISK
• Caution
• Must wear mask for 14 days from last exposure
(≤ 2 min)
• Self monitoring daily and report to triage if symptomatic
• Distance from patient within
6ft (2 meters)
P
U
M MEDIUM RISK
• Frequent and Prolonged
contact (> 2 min) MAY RESUME WORK
• Distance from patient within NO SYMPTOMS within 7 days • Must wear mask for 14
6ft of people who maybe 7 days HOME days from last exposure
I
NO SYMPTOMS within/after 14 days
TEST-BASED
• Negative result from Assay for
SYMPTOM CHECKLIST: STRATEGY COVID-19
Fever Difficulty of Breathing
Headache Sore throat
Muscle pains Nausea
Fatigue Vomiting
Cough Diarrhea Sources:
ALGORITHM ON FIT TO GO BACK TO WORK FOR HEALTHCARE WORKERS
Page 12 of 30
Coronavirus Disease 2019 (COVID-19) Risk Assessment and Public Health U.S. Department of
Health and Human Services
Centers for Disease
Management Decision Making Each question refers to within the past 14 days Control and Prevention
Did the person being NO Did the person have any contact with a laboratory-confirmed case of COVID-19*? NO
evaluated travel from China?
YES
YES
Is the person being evaluated a healthcare worker in a U.S. healthcare setting?
YES NO
NO YES NO
YES Did the person being evaluated Were all recommended Did the person contact respiratory
have contact with a person with YES precautions for home care and secretions or was the person within 6 feet
confirmed COVID-19 in the context isolation followed consistently? of a case for a prolonged period?
of living with, being an intimate
partner of, or caring for the person,
YES NO
outside a healthcare facility?
Was the person in the same indoor
NO environment as a case for a prolonged
period but did not meet the definition of
NO close contact (e.g., in the same classroom
or same hospital waiting room)?
YES
Actions for people Remain under quarantine authority; Stay home; active monitoring or Self observation None
without symptoms no public activities; daily active self-monitoring with public health
consistent with monitoring; controlled travel supervision; recommend to not travel
COVID-19
Actions for people Immediate isolation; medical Immediate isolation; medical Stay home from work or school, avoid None; routine medical care
with symptoms evaluation guided by PUI definition; evaluation guided by PUI definition; contact with others, don’t travel. Seek
consistent with pre-notify healthcare services; pre-notify healthcare services; health advice These examples may not cover all potential
exposures to laboratory confirmed case of COVID-19.
COVID-19 controlled travel controlled travel
If you are concerned about an exposure that does not
align with these categories, please contact the CDC
Emergency Operations Center at 1-770-488-7100
*Or a case diagnosed clinically with COVID-19 infection outside of the United States who did not have laboratory testing
**Healthcare provider (HCP) guidance outlines risk categories to determine work exclusion and monitoring procedures. After
02/28/20
ALGORITHM ON RISK ASSESSMENT AND PUBLIC HEALTH MANAGEMENT DECISION MAKING
identifying risk category in the HCP guidance, use the categories outlined here to determine quarantine requirements.
Page 13 of 30
Philippine Society of Microbiology and Infectious Diseases
Source: PSMID Facebook page: https://www.facebook.com/psmid.org.ph/photos/
a.571641916588291/945072549245224/?type=3&theater
According to the Labor Advisory No. 4 Series of 2020 for workers who are requested by their
employers to stay at home or who are served quarantine order for reasons related to 2019-
nCoV, the following arrangements may be considered during the period of absence:
1. Worker’s leave of absence may be charged to their annual sick/vacation leave credits under
the company policy or practice or as stipulated in their collective bargaining agreement, if
there are any. If the worker’s leave have been used up, employers could consider granting
leave of absence without pay. However, employers are encouraged to exercise flexibility
and compassion on granting additional leave with pay.
2. By mutual agreement, employers and workers could also agree on other arrangements for
the worker’s leave of absence.
According to the Centre for Evidence-Based Medicine (CEBM) standard surgical masks are as
effective as respirator masks (ex. N95 FFP2, FFP3) for preventing infection of healthcare
workers in the outbreak of viral respiratory illnesses such as influenza. However, there is no
direct evidence from COVID-19 outbreaks.
In settings where face masks are not available, employees or healthcare workers might use
homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort.
However, homemade masks are not considered PPE, since their capability to protect is
unknown. Caution should be exercised when considering this option. Homemade masks
should ideally be used in combination with a face shield that covers the entire front (that
extends to the chin or below) and sides of the face. (https://www.cdc.gov/coronavirus/2019-
ncov/hcp/ppe-strategy/face-masks.html)
April 2, 2020, the Inter-Agency Task Force on Infectious Diseases said it is now mandatory for
individuals leaving their residences for whatever reason to wear any type of face mask (face
masks, ear-loop masks, indigenous, reusable or do-it-yourself masks, face shields, and
handkerchiefs) while the Luzon-wide enhanced community quarantine is in effect due to the
coronavirus disease 2019 (COVID-19) crisis to help prevent the further spread of the respiratory
disease.
(new releases)
A. DOLE
1. Guidelines for the Implementation of Mental Health Workplace Policies and Programs
for the Private Sector. http://bwc.dole.gov.ph/images/Issuances/DepartmentOrder/
DO_208_20_GuidelinesfortheImplementationofMentalHealthWorkplacePoliciesandProgr
amsforthePrivateSector.pdf
2. DOLE Establishment report on COVID-19: https://www.dole.gov.ph/wp-content/
uploads/2020/03/ER-COVID19-Monitoring-Form.docx
(Note: submission can be done once all the COVID issue has already settled and have
assured the health and safety of your workers and your workplace)
https://www.officialgazette.gov.ph/downloads/2020/03mar/20200313-MEMO-RRD.pdf
2. Community Quarantine Over the Entire Luzon and Further Guidelines for the
Management of the Coronavirus Disease 2019 (COVID-19) Situation:
https://www.officialgazette.gov.ph/downloads/2020/03mar/20200316-MEMORANDUM-
FROM-ES-RRD.pdf
3. Administrative Order No. 26: Authorizing the grant of Hazard Pay to Government
personnel who physically report for work during the period of implementation of an
enhanced community quarantine relative to the COVID-19 Outbreak:
https://www.officialgazette.gov.ph/downloads/2020/03mar/20200323-AO-26-RRD.pdf
D. WHO
1. Rational use of personal protective equipment (PPE) for coronavirus disease
(COVID-19)
https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-
IPCPPE_use-2020.2-eng.pdf
Luzon
Research Institute for Tropical Medicine, Muntinlupa City
Visayas
Western Visayas Medical Center, Iloilo City
Mindanao
Southern Medical Center in Davao
LINE LIST OF PUM FROM COUNTRIES REPORTING WITH LOCAL TRANSMISSION (SAMPLE)
LINE LIST OF MILD PUI FROM COUNTRIES AND LOCAL AREA REPORTING WITH LOCAL
TRANSMISSION (SAMPLE)
Line list of Mild PUI from COUNTRIES and LOCAL AREA reporting with local transmission
Sources:
• https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf
• https://www.doh.gov.ph/sites/default/files/health-update/ao20200012.pdf
• https://www.doh.gov.ph/sites/default/files/health-update/DM-
Interim%20Guidelines%20for%20Home%20Quarantine.pdf
• https://www.doh.gov.ph/sites/default/files/health-update/DC2020-0039-Reiteration-of-DM2020-056-
Interim-Guidelines-on-2019-nCoV-ARD-Response-in-the-Workplace.pdf
• https://www.doh.gov.ph/sites/default/files/health-update/dc2020-0131.pdf
• https://www.osha.gov/Publications/OSHA3990.pdf
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
• https://www.facs.org/covid-19/clinical-guidance/surgeon-protection
• https://www.doh.gov.ph/sites/default/files/publications/PIDSRMOP3ED_VOL1_2014.pdf
(Disclaimer: Pertinent information were lifted from different sources to avoid misinterpretation of
content)
APPROVING BODY
PCOM National Officers and Board of Directors 2019-2020
(02) 894-COVID
www.doh.gov.ph
989-USAP (8727)
www.ncmh.gov.ph
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