Max K (not his real name) sat nervously as he waited for his Covid Test results. He works as a security guard in a Butuan realty corporation. He was one of the 14 close contacts of a previously confirmed case. He did not want to be tested. He claimed that he had not been in contact with the previous case for the last 6 months. He feared being quarantined as he is the family’s sole breadwinner. Max was not incentivized to self-report or self-quarantine. Max is a typical case.
Unfortunately for Max, he tested positive for covid. What happened next for Max can shed light to a mystery. You see, Butuan bested some of the Philippines more prosperous cities in terms of quarantine efforts. DOH data as of April 11, 2021 shows that Butuan was able to quarantine 77 out of every 100 positive covid cases in the last 30 days. (Capture5.jpg)
At 77% quarantine ratio, Butuan puts to shame Manila at 2.442%, Quezon City at 0.5%, and Makati at 0.11%. But how did Butuan achieve this amazing feat? How does a city isolate exposed contacts when positive cases are unwilling to get tested?
Unravelling the mystery
Following Max’s case, a female City Health officer learns that Max lost his sense of taste on a Wednesday. She retraces Max's whereabouts. She needed to know all the people Max met - starting from two days before Wednesday. This is important as patients are already infectious around two days before the onset of their symptoms. Contact tracing his 1st-degree contacts included his family, close contacts, and workmates.
Max claimed that his family was living apart in another province. But little did Max know that the City Health Office would verify his claims. Butuan sent out teams to the barangays and workplaces and verified his claims. It turns out that Max K was living with his family in Libertad. This contrasts with his earlier claim. And if the truth were not uncovered, it could have caused more infections to spread – farther and faster.
The Butuan City health office wasted little time. They endorsed Max's 1st-degree contacts to their extraction teams. These teams fetched all 1st-degree contacts and sent them to JT Domingo (Capture1.jpg), Butuan's isolation facility.
From here, the City’s bio-molecular facility - which operates an RT PCR laboratory- will conduct a swab test on Max's 1st-degree contacts. The results come out the next day. And what happens next will depend on the case status.
Asymptomatic cases go to Grand Palace Hotel (capture2.jpg). This hotel serves as the City's quarantine facility for asymptomatic cases.
Mild cases go to Science and Technology Education Center (STEC School). The facility’s 12 airconditioned rooms can EACH serve 6 patients (capture4.jpg)
The City shoulders the expenses for tests and both facilities. Butuan also allows home quarantine with a containment strategy (lockdowns). The lockdowns apply either at the household, compound, or purok level. This could be their “secret sauce”. Butuan leverages its resources with home quarantines to avoid unnecessary collateral damage from wider lockdowns.
A city-wide lockdown is somewhat like carpet bombing. You do this because you do not know where the enemy is. Unfortunately, it carries huge collateral damage. Butuan avoided this fate because of its impressive contact tracing efforts. They knew where the virus was hiding. Lockdowns were strategic and surgical.
Additionally, Butuan understood human behaviour. They provided a safety net for its constituents. They coordinated with the Liga ng Barangay and the Department of Social Welfare and Development (DSWD) for the distribution of relief packs to affected individuals. The families of 1st-degree positives are documented in google sheets. People in this list are well taken care of and because of this, more people were tested. Butuan slowed down local transmissions.
Good Leadership with a plan of action
Butuan had the good fortune of having two agencies working together. In this case, Butuan City Health Office led by Dra Teresita Makiling and Disaster Risk Reduction Management Office (DRRMO) headed by Mark July Yap. Together, they both anticipated and prepared Butuan for the coming surge in Covid.
They organized - as early as December 2020 - a covid planning workshop. Here they worked out the budget and procedures needed. It covers contact tracing, extraction, testing, triage, isolation, quarantine, and social safety nets.
The plan called for the city to set up three health centers. One in Ampayon that covered 36 Barangays. The second in Obrero covered 21 Barangays and the third in Libertad covered 29 Barangays. Each of these health centers has a focal head. Everything is organized and contact tracing of 1st-degree contacts is done at this level.
Contact tracing starts as soon as positive test results come in. They are routed using emails and triaged by Ms. Rowena Cueto. Her emails go out to one of these three focal heads.
The City also works with DILG. The DILG teams perform contact tracing for 2nd and 3rd-degree contacts. These are the close contacts of the 1st degree contacts. The City monitors its performance by paying close attention to metrics. They look at reports of contacts traced, total number with Case Investigation Forms (CIF), and exemptions from quarantine.
Lessons Learned
Butuan City had committed leaders. They anticipated the holiday surge. They set aside a budget for contact tracing. They set up isolation and quarantine facilities. Their containment strategy enabled granular home quarantines. They understood the harsh realities on the ground. And they provided social safety nets for the needs of their constituents. They were PREPARED.
If the rest of the country’s Local government units had the same quarantine ratio as Butuan’s, they might be able to open their local economies AND learn to cope better with covid in their midst. The local economy can be open amidst covid.
You can access our COVID dashboard (https://public.tableau.com/views/DOHDatDropMarch2021/CovidDatatoExplainSpike?:language=en&:display_count=y&:origin=viz_share_link) and drill down to the barangay level for any of the LGUs in the country. This is based on DOH Data Drop.
If you think Butuan’s model can help your hometown, kindly share this with your friends.