On March 25, Dr. Daniel Lu¬changco posted on his Facebook page his views on how the country could deal with the new coronavirus disease (COVID-19) pandemic. After thanking people for supporting the medical front lines, he said: “The best way to help the hospitals is to stem the tide of new people getting sick and needing medical attention. The hospitals should be the last resort. We cannot win the battle in the hospitals. It should be fought on the streets, where you guys are.”

Luchangco, 42, is an emergency medicine consultant at Makati Medical Center, Victor R. Potenciano Medical Center and the University of the East Ramon Magsaysay Memorial Medical Center.

In his post, he strongly suggested a “serious quarantine, in separate, dedicated facilities to be managed according to recommendations—14 days, persons under monitoring (PUMs) vs persons under investigation (PUIs), etc. There have to be no exceptions and no excuses, rich or poor. No visitors. No need to bring in their own bedding and TV and other comforts. The people there have to be fed so they don’t have to go out to eat… It should come at no cost to the people being quarantined, but they should have no choice. I know this is not easy, but it is simple. It has to be simple, or else it will not work.”

Lifestyle interviewed Luchangco via email about his recommendations.

How about the plan to retool structures such as the Philippine International Convention Center (PICC), Rizal Memorial Stadium and other big venues to quarantine all PUMs and PUIs. (“Architect to design PICC, Rizal Memorial into quarantine facilities” by Eric Caruncho, Philippine Daily Inquirer, April 1, 2020; lifestyle.inquirer.net/360306/architect-to-design-picc-rizal-memorial-into-quarantine-facilities/)

One issue I have with the general idea is that the key to quarantine is separation and isolation of individuals to prevent the virus from spreading. For this reason, I think that the easiest model to start with is that of a hotel. This is not my idea. It has been done in other countries fighting COVID-19.

The important feature is that there are self-contained rooms with toilet and shower facilities. If food and basic needs are delivered to each room, it would be possible for the person being quarantined to not leave the room for any reason for the entire required quarantine period.

Large spaces such as convention halls and sports stadiums have common toilet facilities. That would be a hot spot for transmission… Additional advantages of a hotel are its large-scale kitchens, laundry and housekeeping facilities, internal communications systems, etc.

Who should foot the bill in feeding and sheltering the patients, and the salaries of nurses who will attend to them?

The private sector could step in and contribute. Private contributions and efforts have been instrumental in keeping our front lines supplied since the beginning of our fight. They have provided meals, transportation, accommodations and personal protective equipment (PPE) to health care workers.

It goes without saying that in a public health emergency like this, the government has the responsibility to coordinate and lead efforts. Whether or not people think the government response has not been enough is a matter of opinion. But no one can deny the government is taking steps. With a problem of this magnitude, however, we cannot sit back and wait for the government to do everything.

Hotels that are closed can be reopened to be quarantine centers. Closed restaurants or canteens can provide food. Pharmaceutical companies can provide medicines. Other basic needs like hygienic products can also be sourced through big manufacturers.

Professional managers and those in the finance industry can consolidate resources and allocate funds. Services need not be done for free. With financial support from government or donated funds, the hotels, caterers and other service providers can be paid for their work, and their employees can earn their salaries.

Tell us about your experience at work these past few weeks. Have you ever felt desperation or frustration? What keeps your hopes up?

We are at the stage when hospitals are full, beyond capacity. I have not yet heard of a major hospital running out of ventilators, but there are definitely more patients who need one each day. If we continue along this course, it is only a matter of time before we run out of ventilators. The longer this crisis drags on, the more we will be depleting our supplies of PPE for health care workers.

Sometimes we feel desperate or frustrated. But we have to work double-time to break the chain of events and reduce the number of people getting sick and needing hospitalization and mechanical ventilation.
What keeps my hopes up is seeing everyone coming together to fight this menace. Even if I am tired after long duties, I am inspired when I get messages asking how people can donate food or PPE to health care workers, advice on what else the hospitals need so they can source it, asking for guidance in the projects they are initiating.

Do you think the lockdown should be extended?

From a pandemic perspective, we need to eliminate, or at least reduce, new cases. One proven way to prevent the virus from spreading is to keep everyone separate. So, in some way, we have to extend the lockdown. Of course this is easier said than done, because there are practical and economic consequences. One problem with the current lockdown is that it is not exactly being followed.

We need stricter quarantine on high-risk individuals—PUMs, PUIs, as well as the COVID-19-positive with mild symptoms but who don’t need hospitalization. Another population we have to isolate for their protection are the elderly, and those with comorbidities, as they have been identified to have a high risk of dying from COVID-19 infection.

We need everyone to take the now-standard precautions against spreading infection—physical distancing, reducing nonessential movement, avoiding large groups, as well as taking an active role in identifying and reporting the special populations described. There are no easy answers.

One thing for sure, when the lockdown period ends, we can’t simply go back to business as usual. We have not yet hit the peak and we have to act decisively together to soften the blow. INQ