Community-Oriented Health Care During a COVID-19 Epidemic...

Community-Oriented Health Care During a COVID-19 Epidemic:

A Consensus Statement by the PAFP Task Force on COVID-19

PAFP Task Force on COVID-19

Maria Victoria Concepcion P. Cruz, MD (Chair)

Karin Estepa-Garcia, MD

Lynne Marcia H. Bautista, MD

Jane Eflyn Lardizabal-Bunyi, MD

Policarpio B. Joves, Jr. MD

Limuel Anthony B. Abrogena. MD

Ferdinand S. De Guzman, MD

Noel L. Espallardo, MD

Aileen T. Riel-Espina, MD

Anna Guia O. Limpoco, MD

Leilanie Apostol-Nicodemus, MD

Contributors

Ma. Rosario Bernardo-Lazaro, MD

Ma. Louricha Opina-Tan, MD

April 2020

PAFP Community-Oriented Health Care During COVID-19 Epidemic of 16

Community-oriented Health Care During a COVID-19 Epidemic:


The Philippine Academy of Family Physicians, Inc.

Community-based response to control an outbreak has been used in previous experience. With

the main objective of prevention, such programs usually involve; 1) avoidance of infection, 2) awareness

of the need for a rapid diagnosis, and 3) awareness of the benefits of mask use and environmental

sanitation control. The PAFP Task Force on CoViD-19 assigned an expert to review the published medical

literature to identify, summarize, and operationalize the evidences in clinical publication on how to

manage CoViD 19 in the community and summarized into statements. The statements were then

reviewed by the task force who acted as panel of experts and approve the statements.

Community in the context of our statement refers to a group of households/individuals sharing the

same norms and values in a given geographical area. This can be a province, city/municipality, barangay

or sitio, or neighborhood i.e. residential subdivision/condominiums. The PAFP membership vary from

private practice family physicians to public health community physicians and their role in the community

vary from one setting to another. We leave it to our members on how they can contribute to the

realization of the statements and recommendations in their community. We encourage everyone to

exercise their sound clinical judgement and sense of social responsibility in performing their roles. While

these statements were primarily developed to guide family and community physicians who are

members of the PAFP, our recommendations can also be used by other community health workers who

may be involved in the control of CoViD 19 epidemic if they find it applicable.

Statement of Recommendations

Initial Planning

Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the

community organization, environment, health care and social processes in order to mitigate the effects of

the COVID-19 epidemic on the community should be developed.

Statement 2: The plan should also include adjustments needed to continue the delivery of other health

services (i.e. maternal and child health, immunization, treatment of other communicable and non-

communicable diseases), but with strict COVID-19 transmission precautions.

Adjustment in the Community Organization and Environment

Statement 3: A local task force should be organized to develop and implement the community health plan.

The task force should be recognized and supported by the whole community.

Statement 4: A facility in the barangay that can be used for isolation in case a member is diagnosed to

have mild COVID-19 should be identified. A hospital facility for referral of high-risk cases should also be

identified and an emergency referral and transport plan should be established.


Statement 5: All community health workers should wear appropriate personal protective equipment while

performing their community health work.

Statement 6: Households in the community which have high-risk members ( i.e. more than 60 years old,

with existing chronic illness or other life-threatening conditions) should be identified and advised to take

extra precautions (i.e. personal hygiene, wearing mask, and social distancing).

Statement 7: During the quarantine period declared by the community or higher-level authority, all

household members should be advised to stay at home, limit celebrations and community gatherings.

Performance of Routine Tasks and Activities

Statement 8: A community-directed information, education and communication (IEC) plan should be

developed and implemented for the following:

a) Informing every household in the community about COVID- 19 and the community plan.

b) Encouraging everyone to practice personal hygiene which includes regular and appropriate

hand washing, daily bathing, coughing and sneezing etiquette, wearing of mask, minimize

hand contact with eyes, nose, and mouth, and strict personal use of eating utensils, bath

towels, etc.

c) Encouraging everyone to clean frequently touched surfaces like doorknobs, light and appliance

control switches, gadgets, armchairs and tabletops daily. Cleaning agents can be ordinary

detergents and water or 70% alcohol.

d) Encouraging everyone to report to and seek help from a community health worker if a

household member is exposed and has developed mild symptoms of COVID-19.

What to Do When a Member or Household is Exposed or Diagnosed with COVID-19

Statement 9: If a household member or members are exposed to a suspected COVID-19 case, the person/s

should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and

maintain at least 2 meters physical distance from other family members.

Statement 10: Other household members should be advised to watch out and monitor for the appearance

of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or

worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and

symptoms appear, the family is encouraged to notify a community health worker who then informs a

referral hospital and facilitates the transport arrangement.

Statement 11: If the symptoms are mild, continue isolation at home or in the community facility, take over-

the-counter medications like Paracetamol for fever, increase water intake and ensure adequate nutrition,

sleep and rest. Family members and community health workers are encouraged to provide psychological

and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within

14-21 days.


Epidemiology and Surveillance

Statement 12: The municipal or city health office should be provided with a situation report on the

implementation of community-oriented health care for COVID-19 daily. Situation report should include:

a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases

referred to the hospital and number of cases recovered or died

b) Brief description of best practices.


Philippine Academy of Family Physicians

Officers and Board of Directors 2020-2021

President Maria Victoria Concepcion P. Cruz, MD

Vice-President Karin Estepa-Garcia, MD

Secretary Lynne Marcia H. Bautista, MD

Treasurer Jane Eflyn Lardizabal-Bunyi, MD

Immediate Past President Policarpio B. Joves, Jr. MD

National Directors Limuel Anthony B. Abrogena. MD

Disi Yap-Alba, MD

Ryan Jeanne V. Ceralvo, MD

Ferdinand S. De Guzman, MD

Noel L. Espallardo, MD

Aileen T. Riel-Espina, MD

Ricardo S. Guanzon, MD

Cheridine Oro-Josef, MD

Josefina S. Isidro-Lapeña, MD

Anna Guia O. Limpoco, MD

Leilanie Apostol-Nicodemus, MD

Regional Directors Rhodora M. Falcon-Pesebre, MD (North Luzon)

Ceasar V. Palma, MD (South Luzon)

Jimmy Jay F. Bullo, MD (Visayas)

Ricardo B. Audan, MD (Mindanao East)

Belinda Cu-Lim, MD (Mindanao West)

Josephine A. Chikiamco-Dizon, MD (NCR)


Community-oriented Health Care During a COVID-19 Epidemic:


The Philippine Academy of Family Physicians, Inc.

Background

After releasing the Family-focused Home Care Plan During a COVID-19 Epidemic: A Consensus

Statement by the PAFP Task Force on COVID-19 last March 25, 2020, the number of diagnosed patients

with COVID-19 continued to increase. As of April 1, 2020, confirmed cases in the Philippines increased to

2,311 with 96 (4.15%) reported deaths. (DOH. https://www.doh.gov.ph/2019-nCoV. Visited April 1,

2020) There were reported deaths among health workers and many are also under quarantine. If this

trend persists, hospital facilities will be overwhelmed and alternative sites for care and quarantine will

need to be established in the community. It is therefore necessary to prepare the community for this.

Community-based response to control an outbreak has been used in previous experiences like

Ebola or Dengue. In one experience, the program led to reduction in reported Dengue cases. (Lin et al,

2016) Such programs usually involve collaboration between the health care workers and the

community. (Stein-Zamir et al, 2019) With the main objective of prevention, such programs usually

involve: 1) avoidance of infection, 2) awareness of the need for a rapid diagnosis, and 3) awareness of

the benefits of mask use and environmental sanitation control. (Takahashi et al, 2017) These strategies

and activities are developed and implemented at the community level. Unfortunately, the capacity of

the health system at the community level may need to be augmented.

These consensus statements by the Philippine Academy of Family Physicians, Inc. were

developed to guide family physicians and community practitioners on how to implement community-

oriented strategies and activities to face the current COVID-19 epidemic. It is recommended that these

statements be disseminated to family physicians and community health practitioners and applied to

their community prevention program for COVID-19.

Methods of Development

The PAFP Task Force on COVID-19 assigned an expert to review the published medical literature

to identify, summarize, and operationalize the evidences on how to manage COVID-1 in the community.

PubMed search was done using the terms “COVID-19” and “community” and limited the search to

“guidelines”. The articles were reviewed, and recommendations relevant to community health care

were summarized into statements. Each statement was updated by further search and review of articles

with priority on meta-analysis, randomized controlled trials and clinical trials. The statements were

reviewed and approved by the task force who acted as panel of experts. The task force also invited

experts in Community Medicine and Public Health.

https://www.doh.gov.ph/2019-nCoV


The consensus statements were designed primarily to guide PAFP members who are involved in

community health work, on strategies they can employ to mitigate the effects of COVID-19 epidemic in

their community. Community in the context of our statement refers to a group of

households/individuals sharing the same norms and values in a given geographical area. This can be a

province, city/municipality, barangay or sitio, or neighborhood i.e. residential subdivision/condominium.

The PAFP membership varies from private practice family physicians to public health community

physicians and their roles in the community vary from one setting to another. We leave it to our

members to ensure the realization of the statements and recommendations in their community. We

encourage everyone to exercise their sound clinical judgement and sense of social responsibility in

performing such roles towards the realization of a community-oriented health plan. While these

statements were primarily developed to guide family and community physicians who are members of

the PAFP, our recommendations can also be used by other community health workers who may be

involved in the control of COVID-19 epidemic if they find it applicable.

Initial Planning

Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the

community organization, environment, health care and social processes in order to mitigate the

effects of the COVIC-19 epidemic on the community should be developed.

Community health planning is about the community explicitly developing strategies and

activities toward the achievement of health objectives. The process may depend on existing top-down

policies (Hassan OB et al, 2018), the planners’ capacity and the available resources. (Panagiotoglou et

al, 2018) The planning approach also calls for whole-of-community participation to epidemic response.

This needs enhanced cooperation, trust building, resource sharing, and consensus-oriented decision-

making among the community members, stakeholders, and leaders. This will result to an acceptable and

holistic community epidemic preparedness and response plan. (Schwartz et al, 2017) It must be

emphasized that this community epidemic plan is dynamic in nature, so it is recommended that the plan

be continuously updated to address the community’s evolving needs. (Charania et al, 2012)

Statement 2: The plan should also include adjustments needed to continue the delivery of other health

services i.e. maternal and child health, immunization, treatment of communicable and non-

communicable diseases but with strict COVID-19 transmission precautions.

In a cross-sectional study about access to other health care services during the Ebola outbreak,

about 67% of urban and 46% of rural respondents stated that it was very difficult to access health care

during the epidemic. Only 20-30% of patients in urban and 70-80% in rural areas were able to gain

access. Prenatal and obstetric and emergency services were the most difficult to access. (McQuilkin et

al, 2017)

It is therefore important that other essential health services be identified and prioritized by the

community. Immunization for example is one, since the disruption of immunization services will result in

an accumulation of susceptible individuals and a higher likelihood of increase of vaccine-preventable


disease, like the recent Poliomyelitis outbreak. (WHO Europe, 2020) Treatment of other communicable

diseases like Tuberculosis, Malaria, and HIV should also be continued, as well as care for the vulnerable

population with chronic non-communicable diseases (i.e. diabetes, heart disease and kidney disease).

They still account for significant morbidity and mortality.

Since the public health sector will usually be involved in epidemic response, family physicians or

civil society organizations can be mobilized to offer these services in a public-private partnership

scheme. This partnership is also called for in Universal Health Care.

Adjustment in the Community Organization and Environment

Statement 3: A local task force should be organized to develop and implement the community health

plan. The task force should be recognized and supported by the whole community.

In our current health system, the LGU has a local health board at the province, city, municipal

and barangay level. They have varying levels of function and activity. Under ordinary conditions, the

health board is organized. Under emergency or disaster situations, the barangay health emergency

response team (BHERTS) is activated. Recently, the DILG advised the LGUs to organize their COVID TASK

FORCE. In some situations, the presence of civil society organizations or faith-based organizations is

strong and might also perform a similar function. It would depend on the community as to which of

these existing structures needs to be organized to achieve this goal.

While the Department of Health (DOH) and LGUs have existing systems for community health

service management and delivery, the local response to an epidemic will not always be that effective

when the approach to planning is top-down. Higher-level health systems often have some unrealistic

assumptions on the effectiveness of the local response. What is needed is the combination of the

recommended system from the top and grounded planners/implementers with specific strengths in

terms of expertise and influence at the community level. We need to emphasize the importance of local

health service delivery planning management and health governance to develop a local line of defense

against an epidemic. (Hoffman, 2013) The plan must therefore have inputs from both the top level and

what is applicable at the local level.

Statement 4: A facility in the barangay that can be used for isolation in case a member is diagnosed to

have mild CoViD-19. A hospital facility for referral of high-risk cases should also be identified and an

emergency referral and transport plan should be established.

To identify this community facility and establish the referral system, it might be helpful to

conduct a quick community health resource mapping in terms of nearest level 2 or 3 hospital, outpatient

clinics, pharmacies, diagnostics centers, ambulance services, funeral parlors, health human resources,

community organizations and other stakeholders that can assist in the realization of this

recommendation. It might also be helpful to make a list of contact information to facilitate coordination

and referral.

This community facility will be very helpful for households with inadequate space or room for

the isolation of a family member. In ordinary times, health care services are given at various settings,


including individual clinics and hospitals. During epidemics, changes may be made. Hospitals may be

overloaded and health services for mild cases may have to be given to ambulatory clinics or community

health facilities. In the latter, the function should be more on the management of mild cases,

surveillance and outbreak investigation, isolation precautions, community health education, and

advocacy. They should also address triaging and standard transmission-based precautions. (Flanagan et

al, 2011) These changes must be incorporated into the community health plan. The community is also

advised to follow guidance from higher-level authorities on how to operate and maintain such facilities.

Statement 5: All community health workers should wear appropriate personal protective equipment in

the process of performing their community health work.

The most effective way to protect health workers from a viral infection and prevent them from

passing it to someone is by vaccination. In the experience with influenza epidemics, policies of health

worker influenza vaccination resulted to reductions in patient risk. (De Serres et al, 2017) Unfortunately,

there is no vaccine available for COVID-19.

An effective alternative is the use of personal protective equipment (PPE). For community

health workers who are doing the usual function of public health, minimum PPE such as masks is

necessary. But those who are in contact with those exposed or diagnosed cases of COVID- 19 should

wear higher-level protection which includes a mask, gown, and eye protection. Use of such equipment

protects both the health worker as well as the community against the spread of the infection.

However, this is not always something that the community prepares for, even in countries that

can afford it. In countries with advanced economies, high-level personal protective equipment such as

N95 masks, gowns and eye protection were stocked at a low rate. Community clinics are less prepared

than hospitals. (Tomizuka et al, 2013) Regarding this problem, the community can request for donations

from higher-level health authorities or the private sector. While waiting for appropriate PPEs, the health

workers are advised to be resourceful (i.e. improvised face masks/protection or gowns that are

washed/cleaned daily).

Statement 6: Households in the community which have high risk members ( i.e. more than 60 years

old, with existing chronic illness or other life-threatening conditions) should be identified and advised

to take extra precautions (i.e. personal hygiene, wearing mask and social distancing).

In our previous consensus statement on family-focused home care plan, we emphasized that the

elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes.

We recommended that high-risk individuals should take extra effort to reduce the risk of getting sick.

They should be advised to wear masks, practice social distancing, and other transmission-prevention

measures. Community health workers should be patient in doing this, as cross-sectional studies showed

that older patients spend significantly longer time during visits, were found to have a different visit content

and level of satisfaction as compared to younger clients. (Callahan et al, 2004)


Statement 7: During the quarantine period declared by the community or higher-level authority, all

household members should be advised to stay at home, limit celebrations and community gatherings.

As early as 2011, there has been published studies predicting the possibility of a potentially

"lethal" second wave of a viral disease without a vaccine ready to mitigate its impact. Community

mitigation measures are actions that persons and communities can employ to help slow the spread of

respiratory viral infections. CDC has issued guidelines that replaced the 2007 Interim Pre-pandemic

Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States. The

mitigation measures included policies aimed at increasing social distancing (e.g., school closures and

dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings). (Qualls et al,

2017) Such can be effective for countries with limited resources. (Prosper et al, 2011)

There is empirical evidence that individual adaptive human behavior may shape the

development of epidemics. In a simulated modeling study of 10 years, voluntary reduction of time spent

in public places may reduce the total number of cases. Thus, the WHO and other public health bodies

have emphasized an important role for 'distancing' during epidemics. (Bayham et al, 2015)

Unfortunately, recommendations to change behavior can run counter to social norms. Instructions to

avoid shaking hands or public gatherings run counter to current community practices. Expecting

voluntary behavior change may be ineffective. Exerting social and even legal pressure within the

community to promote change may be necessary. (Kozlowski et al, 2010) Local community ordinances

can aid the community health workers in implementing the community health plan.

If there is a school in the community, early suspension of classes should be done. School closure

is a controversial aspect of epidemic mitigation strategy. However, such strategy especially during the

holiday season showed a reduction of spread by 14-27% in one study. (Ali et al, 2013) School closure

and community contact reduction was also shown to be cost-effective especially in epidemic situations.

In low severity epidemics, costs are dominated by productivity losses due to illness and social

distancing. In higher severity epidemics, costs are dominated by healthcare costs and those arising from

productivity losses due to death. (Kelso et al, 2013)

Performance of Routine Tasks and Activities

Statement 8: A community-directed information, education and communication (IEC) plan should be

developed and implemented for the following:

a) Informing every household in the community on COVID-19 and the community plan.

b) Encouraging everyone to practice personal hygiene which includes regular and

appropriate hand washing, daily bathing, coughing and sneezing etiquette, wearing of

mask, minimize hand contact with eyes, nose, and mouth, and strict personal use of eating

utensils, bath towels, etc.

c) Encouraging everyone to clean frequently touched surfaces like doorknobs, light and

appliance control switches, gadgets, armchairs and tabletops daily. Cleaning agents can

be ordinary detergents and water or 70% alcohol.

d) Encouraging everyone to report to and seek help from a community health worker if a

household member is exposed and has developed mild symptoms of COVID-19.


General Public Information Campaign

The implementation of strict quarantine measures may result in a wide variety of psychological

problems, such as panic, anxiety, and depression. (Qiu J et al, 2020). Sharing accurate scientific

information is an effective way to reduce public panic about COVID-19. (Song et al, 2020) Majority of

health education strategies focus on the individual, family and community level. The effectiveness of

health education is affected by interpersonal relationships and social determinants of health. There is

evidence supporting the effectiveness of community interventions for improving not only health

behavior but some social outcomes as well. (Castillo et al, 2019)

Currently, most information is disseminated through social media. While it can induce positive

healthy behavior practices (i.e., handwashing, social distancing) in individuals that will reduce the

probability of contracting the disease, false information can also have negative effects. (Collinson et al,

2015) Exaggerated or incomplete information can also result in relaxing of healthy behaviors in one end

and panic resulting to social hysteria in the other. It is therefore necessary to develop an effective

information and communication plan to disseminate accurate and truthful information regarding

COVID-19. The content should include general awareness of the potential for epidemic, concerns and

perceptions about risk of contracting the disease, factual information about the risks among healthy

individuals, those who have existing illness, and the elderly. Knowledge of all these influence the

performance of healthy behavior. (Tooher et al, 2013) The content should also include social distancing

AND environmental sanitation that might control the spread of infection, and other important elements

in the community health plan that require the community’s cooperation.

Personal Hygiene

Another mitigation recommendation by CDC includes personal protective measures for

everyday practice e.g. respiratory etiquette and hand hygiene. (Qualls et al, 2017) One trial in a village

in China compared intensive education and training on hand hygiene while the other group received

general hygiene education. The hand hygiene group resulted in better knowledge, improved practice

and reduced incidence of hand-foot-and-mouth disease. (Guo et al, 2018) However, with the current

situation, community intensive education and training may not be feasible. An alternative will be the use

of community posters or household distribution of educational flyers.

Environmental Sanitation

Environmental measures e.g., routine cleaning of frequently touched surfaces is also

recommended by the CDC. (Qualls et al 2017) An intensive education and training at the household

level may also be effective for this but may similarly be difficult based on the current situation. An

alternative will be the use of community posters or household distribution of educational flyers.


Reporting and Surveillance

In some countries or with some diseases, mandatory notification is required for some types of

infection. It can improve further understanding, diagnosis and management of the disease. It can result

in an increase detection of newly diagnosed infections, reduce the levels of missing data and provide a

more realistic picture of the epidemiology of the disease. (Reyes-Urueña et al, 2013) We do not have

such laws for COVID-19 yet. Because of the data privacy law, we can only rely on voluntary reporting by

the household. Its importance should be emphasized for the greater benefit of the community.

What to Do When a Member or Household is Exposed or Diagnosed with COVID-19

Statement 9: If a household member or members are exposed to a suspected COVID-19 case, the

person/s should be encouraged to stay home preferably in a room or area adequate for isolation,

wear mask and maintain at least 2 meters physical distance from other family members.

Epidemics in the community may also start from household transmission of viral infection.

Estimates of the risk of household secondary infection ranged from 3% to 38%. (Lau et al, 2012).

Control of community epidemics should therefore start with household transmission control. Persons

who have been exposed to Covid-19 should voluntarily be quarantined at home and use face mask.

(Qualls et al, 2017) Asymptomatic carriers and transmission have been reported for COVID-19. (Lai et al,

2020). But during the asymptomatic phase, social behavior like distancing is often lax thereby increasing

the probability of spread within the family and community. In an epidemiologic investigation in Japan,

there were identified communities wherein virus transmission occurred during the pre-symptomatic

phase of the infection. This suggests that viral transmission in communities cannot be prevented solely

by isolating symptomatic cases. (Gu etal, 2011) Thus the need for isolation of exposed persons even

before the symptoms appear.

Statement 10: Other household members should be advised to watch out and monitor for the

appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of

breathing or worsening of symptoms or if the person is high risk( i.e. elderly or with existing chronic

disease and symptoms appear), the family is encouraged to notify a community health worker who

informs the referral facility and facilitates the transport arrangement.

Transmission of viral infection is high among symptomatic individuals, 66% in one study. There is

a need to treat the symptomatic patient and encourage home isolation. (Van Kerckhove et al, 2013) The

household should be encouraged to inform and update the community health worker on the status of

the patient. This is very important especially for the high-risk patients. The importance of the household

informing a community health worker on the presence of a case is to control secondary attack rates.

Secondary case is defined as any household member with new onset of acute respiratory illness after

the first member was identified. This is estimated to be at 10-20% and the attack rates may be higher in

children or immunocompromised adults. If this is not adequately controlled, a full community level

epidemic might develop. (Savage et al, 2009)


Statement 11: If the symptoms are mild, continue isolation at home or in the community facility, take

over-the-counter medications like Paracetamol for fever, increase water intake and ensure adequate

nutrition, sleep and rest. Family members and community health workers are encouraged to provide

psychological and social support to isolated patients. Discontinuation of isolation can be done if

symptoms resolve within 14-21 days.

In a review of academic articles that provide cost-effectiveness or cost-benefit analyses for

pandemic interventions since 2009, hospital quarantine was noted to be cost-effective even for mild

epidemics. However, this must be carefully considered as this may not apply to a specific country.

(Pasquini-Descomps et al, 2017) Our hospitals do not have enough bed capacity to quarantine everyone

affected in an epidemic. Mild cases may have to be treated or quarantined in alternative sites. The

community health worker should inform the members of the affected household that symptoms usually

resolve within 14 days, after which isolation can be discontinued between 14-21 days. If symptoms

persist beyond 14 days but did not worsen, they should inform the community health worker or consult

the family/community doctor for advice.

Epidemiology and Surveillance

Statement 12: The municipal or city health office should be provided with a situation report on the

implementation of community-oriented health care for COVID-19 daily. Situation report should

include:

a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases

referred to the hospital and number of cases recovered or died.

b) Brief description of best practices.

Public health surveillance which is the ongoing systematic collection, analysis, interpretation,

and dissemination of health data for the planning, implementation, and evaluation of public health

action is an essential tool in facing an epidemic. Reporting of essential data from the community to a

higher-level health system is essential. This strategy will improve epidemic investigation, data collection,

analysis, dissemination, and use. Qualitative or narrative report on best practices should also be

included. This will lead to an enhanced capacity of the community to handle future epidemic problems.

(Choi, 2012)

Surveillance information is usually heavy and valuable during the first 2 months of the epidemic.

This may require additional staff and adjustments on other health services. The community must be

made to understand this, otherwise community support for health managers will be jeopardized and

implementation of the community health plan might fail. People should be aware that giving priority to

information about the epidemiology and surveillance response will have implications for the

community’s preparedness and emergency response to the current and future epidemics. (Enanoria et

al, 2013)

Recently, the use of computer technology has started to take root in our work environment.

COVID-19 is associated with substantial morbidity and mortality among the high risk. Mathematical


models can be done to quantitatively predict the course of epidemics, given underlying mechanisms of

disease. This should be done by higher-level health management and disseminated at the community

level. This will enhance the community’s capacity to handle the current and future epidemics. (Wu et al,

2011)

Recommendation for Dissemination and Implementation

The recommendations for dissemination of these statements will be similar to the dissemination

of clinical pathways developed by the PAFP QA Committee. The PAFP Task Force on COVID-19 will

circulate the consensus to PAFP chapters and accredited Family Medicine training programs in the form

of letters and circulars via emails. Other task force members will develop communication materials

containing the consensus statements and promote its use through their respective committees, and

adapted to be relevant to their tasks. At the clinic level, family physicians are encouraged to use this as

family-focused health education, to advise the patient and family in every consultation opportunity,

whether the consultation is for an infection or not.

At the organizational level, aside from dissemination, the PAFP will establish a new model of

service delivery, training, and quality improvement initiative related to the implementation of the

community-oriented consensus statements. Training programs (hospital or practice-based) are

encouraged to develop education and training packages for members and community health workers.

References

1. Song T, et al. Community Involvement in Dengue Outbreak Control: An Integrated Rigorous

Intervention Strategy. PLoS Negl Trop Dis. 2016 Aug 22;10(8):e0004919.

2. Stein-Zamir C, Abramson N, Edelstein N, et al. Community-Oriented Epidemic Preparedness and

Response to the Jerusalem 2018-2019 Measles Epidemic. Am J Public Health. 2019

Dec;109(12):1714-1716.

3. Takahashi S, Sato K, Kusaka Y, et al. Public preventive awareness and preventive behaviors

during a major influenza epidemic in Fukui, Japan. J Infect Public Health. 2017 Sep -

Oct;10(5):637-643.

4. Hassan OB, Herman KM, Kryzanowski CD, et al. Active living in Saskatchewan: A review of official

community plans. Can J Public Health. 2018 Jan 22;108(5-6):e551-e557.

5. Panagiotoglou D, Olding M, Enns B, et al. Building the Case for Localized Approaches to HIV:

Structural Conditions and Health System Capacity to Address the HIV/AIDS Epidemic in Six US

Cities. AIDS Behav. 2018 Sep;22(9):3071-3082.

6. Schwartz J and Yen MY. Toward a collaborative model of pandemic preparedness and response:

Taiwan's changing approach to pandemics. J Microbiol Immunol Infect. 2017 Apr;50(2):125-132

7. Charania NA and Tsuji LJ. A community-based participatory approach and engagement process

creates culturally appropriate and community informed pandemic plans after the 2009 H1N1

influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario,

Canada. BMC Public Health. 2012 Apr 3;12:268.


8. McQuilkin PA, Udhayashankar K, Niescierenko M, et al. Health-Care Access during the Ebola

Virus Epidemic in Liberia. Am J Trop Med Hyg. 2017 Sep;97(3):931-936.

9. WHO Europe. Guidance on routine immunization services during COVID-19 pandemic in the

WHO European Region. Guidance issued as of 20 March 2020.

10. Hoffman LM. The return of the city-state: urban governance and the New York City H1N1

pandemic. Sociol Health Illn. 2013 Feb;35(2):255-67.

11. Flanagan E, Chopra T and Mody L. Infection prevention in alternative health care settings. Infect

Dis Clin North Am. 2011 Mar;25(1):271-83.

12. Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese

people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr.

2020 Mar 6;33(2):e100213.

13. Song P and Karako T. COVID-19: Real-time dissemination of scientific information to fight a

public health emergency of international concern. Biosci Trends. 2020 Mar 16;14(1):1-2.

14. Castillo EG, Ijadi-Maghsoodi R, Shadravan S, et al. Community Interventions to Promote Mental

Health and Social Equity. Curr Psychiatry Rep. 2019 Mar 29;21(5):35.

15. Collinson S, Khan K, Heffernan JM. The Effects of Media Reports on Disease Spread and

Important Public Health Measurements. PLoS One. 2015 Nov 3;10(11):e0141423.

16. Tooher R, Collins JE, Street JM, et al. Community knowledge, behaviours and attitudes about the

2009 H1N1 Influenza pandemic: a systematic review. Influenza Other Respir Viruses. 2013

Nov;7(6):1316-27.

17. De Serres G, Skowronski DM, Ward BJ, et al. Influenza Vaccination of Healthcare Workers:

Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLoS

One. 2017 Jan 27;12(1):e0163586.

18. Tomizuka T, Kanatani Y and Kawahara K. Insufficient preparedness of primary care practices for

pandemic influenza and the effect of a preparedness plan in Japan: a prefecture-wide cross-

sectional study. BMC Fam Pract. 2013 Nov 19;14:174.

19. Callahan EJ, Stange KC, Zyzanski SJ, et al. Physician-elder interaction in community family

practice. J Am Board Fam Pract. 2004 Jan-Feb;17(1):19-25.

20. Qualls N, Levitt A, Kanade N, et al. Community Mitigation Guidelines to Prevent Pandemic

Influenza - United States, 2017. MMWR Recomm Rep. 2017 Apr 21;66(1):1-34.

21. Prosper O, Saucedo O, Thompson D, et al. Modeling control strategies for concurrent epidemics

of seasonal and pandemic H1N1 influenza. Math Biosci Eng. 2011 Jan;8(1):141-70.

22. Bayham J, Kuminoff NV, Gunn Q, et al. Measured voluntary avoidance behaviour during the

2009 A/H1N1 epidemic. Proc Biol Sci. 2015 Nov 7;282(1818):20150814.

23. Kozlowski LT, Kiviniemi MT and Ram PK. Easier said than done: behavioral conflicts in following

social-distancing recommendations for influenza prevention. Public Health Rep. 2010 Nov-

Dec;125(6):789-92.

24. Ali ST, Kadi AS and Ferguson NM. Transmission dynamics of the 2009 influenza A (H1N1)

pandemic in India: the impact of holiday-related school closure. Epidemics. 2013 Dec;5(4):157-

63.

25. Kelso JK, Halder N, Postma MJ, et al. Economic analysis of pandemic influenza mitigation

strategies for five pandemic severity categories. BMC Public Health. 2013 Mar 8;13:211.

26. Guo N, Ma H, Deng J, et al. Effect of hand washing and personal hygiene on hand food mouth

disease: A community intervention study. Medicine (Baltimore). 2018 Dec;97(51):e13144.


27. Reyes-Urueña JM, de Olalla PG and Perez-Hoyos S, Caylà JA. Time series analysis comparing

mandatory and voluntary notification of newly diagnosed HIV infections in a city with a

concentrated epidemic. BMC Public Health. 2013 Apr 12;13:338.

28. Lau LL, Nishiura H, Kelly H, et al. Household transmission of 2009 pandemic influenza A (H1N1):

a systematic review and meta-analysis. Epidemiology. 2012 Jul;23(4):531-42.

29. Lai CC, Liu YH, Wang CY, et al. Asymptomatic carrier state, acute respiratory disease, and

pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and

myths. J Microbiol Immunol Infect. 2020 Mar 4. pii: S1684-1182(20)30040-2.

30. Gu Y, Komiya N, Kamiya H, et al. Pandemic (H1N1) 2009 transmission during presymptomatic

phase, Japan. Emerg Infect Dis. 2011 Sep;17(9):1737-9.

31. Van Kerckhove K, Hens N, Edmunds WJ, et al. The impact of illness on social networks:

implications for transmission and control of influenza. Am J Epidemiol. 2013 Dec

1;178(11):1655-62.

32. Savage R, Whelan M, Johnson I, et al. Assessing secondary attack rates among household

contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June

2009: a prospective, observational study. BMC Public Health. 2011 Apr 14;11:234.

33. Pasquini-Descomps H, Brender N and Maradan D. Value for Money in H1N1 Influenza: A

Systematic Review of the Cost-Effectiveness of Pandemic Interventions. Value Health. 2017

Jun;20(6):819-827.

34. Choi BC. The past, present, and future of public health surveillance. Scientifica (Cairo).

2012;2012:875253.

35. Enanoria WT, Crawley AW, Tseng W, Furnish J, Balido J, Aragón TJ. The epidemiology and

surveillance response to pandemic influenza A (H1N1) among local health departments in the

San Francisco Bay Area. BMC Public Health. 2013 Mar 27;13:276.

36. Wu JT and Cowling BJ. The use of mathematical models to inform influenza pandemic

preparedness and response. Exp Biol Med (Maywood). 2011 Aug;236(8):955-61.

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