This emergency medicine specialist has figured out a plan to better enforce community quarantine 2
Business as usual at a barber shop in ParaƱaque the week the lockdown was implemented. Photograph by Neil Daza

This emergency medicine specialist has figured out a plan to better enforce community quarantine

The COVID-19 battle shouldn’t be fought in the hospitals alone. But we need a more efficient, comprehensive plan for implementing community quarantine. By JAM PASCUAL
| Apr 07 2020

"Flatten the curve" is a call to action you're probably tired of hearing at this point, but you're going to have to get used to hearing it for a long while. 

Our medical frontliners are working hard, but we're not near the finish line. The curve is still expected to reach its peak, and there seems to be a consensus that the Luzon lockdown will go on longer than initially expected. This post suggests that institutions like schools, malls and offices remain closed until the beginning of May. We’re going to be here a while.

And yet there seems to be no solid plan that aims to maximize this extension. Is there such a thing as a robust community quarantine plan? And if so, is it more than just many of us collectively agreeing to stay at home?

You may also like:

Turns out there is such a thing. This plan comes to us by way of a document written up by Dr. Daniel Luchangco. Dr. Luchangco is an emergency medicine specialist. He’s an Emergency Medicine Consultant in Makati Medical Center, Victor R. Potenciano and University of the East Ramon Magsaysay Memorial Medical Center. Luchangco previously held the following positions: Chairman of the Department of Emergency Medicine of Rizal Medical Center, Head of the Emergency Department of the Mandaluyong City Medical Center, and member of the Board of Directors of the Philippine College of Emergency Medicine.

The proposed community quarantine plan is best understood as a three-parter. The first part of the plan diagnoses the weaknesses of the government’s current scheme. Shine a light on the way community quarantine is imposed now, and you’ll see the cracks: self-entitled people who see themselves as exceptions to the rule (a certain senator fits this bill); poor people and daily wage earners who have to make frequent trips to buy food and supplies, assuming they have money at all; people who live with family, and therefore cannot properly self-isolate; and a lack of means to monitor those who are self-quarantining or have shown minor symptoms. The desire to flatten the curve is there, sure, but we’re not working with ideal conditions.

“In order to effectively stop or slow the spread of the disease, we need to have more aggressive, organized, and supervised quarantine of individuals at a higher risk for having and spreading it,” Luchangco emphatically states. “In order to get people to accept being placed in, and comply with the rules of quarantine facilities, conditions must be acceptable, and basic needs have to be provided. Then there is no excuse for them to leave during the quarantine period.”

This emergency medicine specialist has figured out a plan to better enforce community quarantine 3
Residents of Barangay Highway Hills, Mandaluyong City line up to shop for food and supplies at a supermarket amid the enhanced community quarantine being implemented in the whole of Luzon. Photo by Jire Carreon, ABS-CBN News

According to this quarantine plan, the key to preventing the spread of coronavirus is increased isolation and separation. The second part of this plan lists the best facilities for carrying our community quarantine, and how to distinguish their functions.

These include:

1) Field hospitals. They can be large, communal structures like tents, run by medical personnel donning hazmat suits, using the best medical equipment possible. Field hospitals will strictly be for sick patients, and are meant to prevent the medical system from being overwhelmed.

2) Quarantine facilities, where people who show minor symptoms but don't need much medical attention can properly self-quarantine. Luchangco suggests hotels as quarantine facilities, where people can have their own bedroom and restroom and not share with anyone else.

3) Facilities to support people who aren't sick. These will accommodate the homeless, daily wage earners, and other people whose material conditions leave them more at risk to coronavirus. "These can be communal facilities, but with enforced hygiene and social distancing. The moment anyone shows symptoms or is exposed to a confirmed positive, they get shipped off to the quarantine facility.

So that covers the problems and the required facilities. But what about executing the plan? Luchangco lays it out in four phases, summarized below.

Phase 1 is entitled Voluntary Quarantine Accommodations. Quarantine facilities, like the aforementioned hotels, will be used to accommodate Persons Under Investigation (PUI), Persons Under Monitoring (PUM), and people who tested positive for COVID-19 but show minor symptoms. Not only does this phase propose that accommodations be made completely free, but also proposes that food be prepared for those accommodated, and even utilities such as television, wifi, laundry, trash collection, and transportation services. Some of these services and utilities can be sponsored, which means that this phase might have to rely on the contributions of the private sector and big businesses.

Phase 2 involves coordinating with hospitals. These hospitals will refer people who qualify for Phase 1 accommodations. Phase 2 also involves coordinating with the government to enforce Phase 1.

Phase 3 is when we set up Community Quarantine for the poor who display no symptoms. Again phase 1 provides food, TV, wifi, and basic services, while also strictly enforcing hygiene practices and social distancing. Phase 3 also proposes a "refugee camp setup," a communal space with common restroom facilities and family cubicles. Social workers will collect census data, and look out for whoever develops symptoms. Those who do develop symptoms will be transferred to either a PUI Mild Quarantine or a PUM facility.

Phase 4 goes beyond the usage of the aforementioned facilities, and is meant to accommodate the most vulnerable. Phase 4 seeks out the elderly, people who have co-morbids or are immunocompromised, and seeks to bring them to facilities where they can be separated from other people as much as possible, therefore minimizing risks. Again, basic needs will be provided.

The best thing about Dr. Luchangco’s plan is that none of these spaces need to be constructed. Each of these phases can be executed with big spaces that we already have: stadiums, convention centers, and hotels. Government agencies have already been furnished a copy of this document for serious consideration. 

But part of what makes this plan so appealing is its holistic approach. It knows that flattening the curve needs more than a tunnel vision focus on test kit acquisition, and foregoes the idea of increasing police and military forces. It knows that providing basic services for the disenfranchised is a non-negotiable, and rightfully details the way basic resources can be provided and distributed to those who need it the most. Flattening the curve takes more than just staying at home. It warrants making society a home.