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ETIKA NG BAKUNA LABAN SA COVID-19

Ang Philippine Health Research Ethics Board (PHREB) ay nilikha ng batas (PNHRS Act of 2013) upang protektahan ang mga taong kalahok sa mga pananaliksik na may kinalaman sa medisina. Ginagawa ang mga pananaliksik para patunayan kung mabisa at ligtas ang mga gamot bago gamitin ang mga ito nang mas malawakan.

Katungkulan ng PHREB na tiyaking may mga safeguard para maiwasan o mabawasan ang mga panganib para sa mga taong kalahok at matiyak ang kanilang kaligtasan. Dahil dito, masinsinang sinusuri muna ang protokol na nagsasaad ng proseso kung paano isasagawa ang pag-aaral. Ang pagsusuri ay isinasagawa ng mga Research Ethics Review Committee (Komiteng Etikal) na binigyang-kapangyarihan ng PHREB.

Katulad ng PHREB, ang mga Komiteng Etikal ay binubuo ng mga eksperto sa ibatibang larangan – etika, batas, relihiyon, medisina, agham panlipunan, at iba pa. Mayroon ding kinatawan ang pangkaraniwang mamamayan. Kung nakita ng Komiteng Etikal na malalagay sa di makatwirang panganib ang mga kalahok, hindi nila inaaprubahan ang pag-aaral. Ganito rin ang ginawa ng mga Komiteng Etikal bago pinayagan ang pagsasagawa ng pag-aaral sa bakuna laban sa COVID-19.

Kusang loob at ang kahalagahan ng Informed Consent (Maalam na Pahintulot )

May Informed Consent Form (Maalam na Pahintulot) na dapat pirmahan nang kusang loob ng taong pumapayag magpabakuna kontra sa COVID-19. Mahalaga para sa pagbabakuna at anumang pag-aaral na pangkalusugan ang kusang loob na paglahok. Karapatan ng bawat isa sa atin na gumawa ng sariling desisyon kung magpapabakuna o hindi. Ipinapatupad ito sa pamamagitan ng paghingi ng informed consent. Hindi tamang puwersahin o takutin ang sinumang kontra o tutol na magpabakuna.

Gabay para sa pagpapasya tungkol sa pagbabakuna

Ang gabay na ito ay ginawa ng PHREB para makatulong sa pagpapasya ng mga taong nag-iisip kung magpapabakuna sila o hindi. May tatlong importanteng tanong na dapat sagutin ng isang tao sa pagpapasya kung siya ay dapat magpabakuna:

A. Mahalaga ba ang bakuna para masugpo o mabawasan ang problemang dala ng COVID-19 sa lipunan?

B. Malaki ba ang magiging benepisyo para sa indibidwal kung magpapabakuna siya?

C. Sulit ba ang panganib na aking haharapin kapalit ng benepisyo na aking makakamit?

Makabubuting magpabakuna kung masasagot ng “oo” ang mga tanong na ito.

TANONG 1: Bakit mahalaga ang bakuna o pagbabakuna?

SAGOT 1:

a.) Pagbabakuna ang pinakamabisang panangga laban sa paglaganap ng mga sakit na nakakahawa . Bakuna ang matagumpay na ginagamit laban sa paglaganap ng tigdas (measles), dipterya, hepatitis, human papillomavirus (HPV) at iba pa. Bakuna ang dahilan kung bakit halos naglaho na ang polio sa buong daigdig.

b.) Masyadong laganap na ang sakit na COVID-19. Wala pang gamot na tiyakang makapagpapagaling sa mga nagkakasakit. Bakuna ang inaasahang makapagbigay ng pinakamabisang proteksiyon sa lahat nang tao. Bakuna rin ang inaasahan para pigilan ang mas malawakang paglaganap muli ng COVID-19.

c. Ito ang ilang nakakalungkot na katotohanan tungkol sa bagsik at naging epekto nang COVID19:

Higit na sa 110 milyon ang nagkasakit sa buong daigdig—kasinglaki na ito ng populasyon ng buong Pilipinas. Halos 2.5 milyon na ang namatay – kasingdami na ito ng tao sa Quezon City.

Mahigit na sa kalahating milyon (500,000) ang nagkasakit ng COVID-19 sa Pilipinas. Labindalawang libo (12,000) na ang namatay – kasingdami ng nanonood sa Rizal Memorial Stadium kung puno ito

Patuloy na tumataas ang mga bilang na ito habang wala pang lunas ang COVID-19.

d.) Habang hindi napapababa ang bilang ng mga taong nagkakaroon ng COVID-19, at ang bilis ng pagkalat nito, magtatagal pa ang mga lockdown at quarantine na sumasakal sa kalayaaan ng pagkilos at pumipigil sa paghahanap-buhay ng napakaraming tao.

e.) Habang patuloy ang paglaganap ng pandemya, marami ang hindi makakabalik sa kanilang trabaho, kabilang ang mga tsuper at ang mga trabahador sa konstruksiyon, kainan, sinehan, lugar palakasan, at lugar bakasyunan. Hindi rin makabalik sa kanilang lugar ng trabaho ang maraming OFW.

f.) Dahil sa kawalan ng trabaho, nabawasang kita at kakulangan ng pera, marami din ang nagugutom at hindi nakakakain nang sapat.

g.) Habang hindi nababakunahan ang nakararami sa atin at patuloy na lumalaganap ang COVID-19, maaaring magbagong-uri ang virus. Sa ngayon, nakapasok na sa ating bansa ang ilang bagong uri (variant) na mas nakamamatay o mas mabilis kumalat at makahawa.

Mahalaga ang maramihan at malawakang pagbabakuna laban sa COVID-19, para malampasan natin ang mga problemang nabanggit. Dapat isaalang-alang ang mga ito pag nagdedesisyon kung magpapabakuna ang isang tao o hindi. Dapat din natin itong timbangin kaugnay ng mga panganib na maaari nating harapin kung tayo ay magpapabakuna.

TANONG 2: Ligtas ba ang mga bakuna?

SAGOT 2: Kung ang tinutukoy na bakuna ay nabigyan na ng Food and Drug Administration (FDA) ng Emergency Use Authorization (EUA), oo – ligtas ang mga ito.

Ganito ang ibig sabihin ng pagiging ligtas ng mga bakuna:

a) Napatunayan na sa mga pag-aaral na mahina lamang ang mga karaniwang side effects na dulot ng mga bakunang ito.

b) Ang tindi ng side effects ay tama lamang kung ikukumpara sa proteksiyon na maibibigay ng bakuna laban sa malalang sintomas ng COVID-19.

c) Ang mga side effects ay pansamantala lamang.

d) May mga doktor at iba pang medical professional na nakahanda para tumulong sa mga makakaranas ng side effects.

e) May pagkakataon ang mga babakunahan na ipaalam sa mga nagbabakuna kung mayroon silang kondisyon o karanasang medikal na maaaring maging dahilan para magkaroon ng di mabuting epekto sa kanila ang pagbabakuna.

f) Umpisa pa lamang, dumaan na ang mga bakuna sa pag-aaral ng mga Komiteng Etikal bago inumpisahan ang tatlong yugto ng clinical trial sa iba’t ibang bansa. Ang mga Komiteng Etikal na ito ay may mga kasamang eksperto sa gamot at sa iba’t ibang larangan ng siyensiya. May kasama ring mga kinatawan na pangkaraniwang tao.

TANONG 3: Anong mga panganib ang maaaring dala ng bakuna para sa COVID-19? Ano ang mga maaring maging “side effects” ng bakuna ?

SAGOT 3:

a. Kabilang sa mga panganib ang mga side-effects ng bakuna. Halimbawa, isinasaad sa Informed Consent Form (Philippine National COVID-19 Vaccine Deployment and Vaccination Program) na nakatakdang gamitin para sa bakuna ng Pfizer-BioNTech (BNT162b2) ang mga sumusunod na maaaring maging side effects:

• Pananakit sa lugar ng pagbabakuna
• Pamamaga sa lugar ng pagbabakuna
• Pamumula sa lugar ng pagbabakuna
• Pagkapagod
• Sakit ng ulo
• Panlalamig
• Pananakit ng mga kasu-kasuan
• Lagnat
• Pakiramdam na nasusuka
• Panghihina
• Pamamaga ng lymph node (kulani)

b. Mapapansin sa listahang ito na ang mga side effects ay katulad ng mga nararamdaman ng isang taong may trangkaso. Ang mga side effects na ganito ay pansamantala lamang at tanda na nag-uumpisang maghanda ang katawan para sa banta ng virus.

c. Sa ilang mga kaso, maaaring tumindi at maging malala (halimbawa, maaaring makaranas ng mataas na lagnat, pagkahimatay, panginginig, walang tigil na pagsusuka) ang mga side effects at dapat nang dumulog ang binakunahan sa itinalagang pagamutan o health center ng Department of Health (DOH).

(TANDAAN: Bago magpabakuna, tiyakin na alam ninyo kung nasaan ang itinalagang health center na dapat puntahan ng mga makakaranas ng lumalang side effects.)

d. Maaaring may karagdagang panganib para sa mga taong nasa listahan ng kulang pa ang pag-aaral sa epekto ng bakuna sa kanila. Ganito ang sinasabi ng World Health Organization (WHO) tungkol dito:

• Mga may nakamamatay na allergy o “anaphylaxis” sa mga sangkap ng bakuna – para maiwasan ang panganib, dapat alamin muna ng indibidwal sa pinagkakatiwalaang doktor kung maaaring may allergy siya sa mga sangkap ng bakuna.

• Mga buntis at nagpapasuso – kulang pa ang mga nagawang pag-aaral. Kailangang magkonsulta sa pinagkakatiwalaang doktor para makapagpasya tungkol sa mga partikular na panganib.

• Mga may pagkukulang ang immune system (immunocompromised) dahil sa ibang sakit o dahil sa mga gamot na ginagamit – Kailangang magkonsulta sa pinagkakatiwalaang doktor para makapagpasya tungkol sa mga partikular na panganib.

• Mga kabataan – batay sa rekomendasyon ng World Health Organization (WHO) hindi muna dapat bakunahan ang kulang sa 16 taon (bakunang Pfizer) o kulang sa 18 taon (bakunang Astra Zeneca) dahil hindi pa napagaralan kung ligtas para sa kanila. (Interim Recommendations, 8 Enero 2021/ 10 Pebrero 2021).

Para makaiwas sa mga panganib ng bakuna kontra COVID-19, at makapaghanda nang mabuti para sa mga ito, dapat magbigay ng tama at buong impormasyon sa mga tagapagbakuna.

Tanong 4: Ligtas ba ang bakuna kontra COVID-19 sa mga taong may iba pang karamdaman o kaugnay na kondisyon? May mga pag-aaral na bang ginawa tungkol dito ?

Sagot 4:

Dahil sa iba’t ibang kondisyon o lagay ng kalusugan ng mga babakunahan, ang inirerekomendang bakuna ay iyon lamang mga angkop para sa kalagayan o kondisyon nila. May panayam na isinasagawa bago magbakuna. Kailangang sumagot nang tapat at maglahad ng makatotohanang impormasyon para makaiwas sa pagkakamali na mapanganib. Kung may pagdududa, makakatulong ang pagkonsulta sa pinagkakatiwalaang doktor bago pumunta sa lugar ng pagbabakuna.

TANONG 5: Kung talagang ligtas ang mga bakuna kontra COVID19, bakit para sa Emergency Use lamang ang pahintulot na ibinigay ng FDA para dito?

SAGOT 5:

Ang ibinigay na Emergency Use Authority ay batay sa kaligtasang naobserbahan sa mga pag-aaral na naisagawa na sa libo-libong tao sa ibat ibang bansa. Emergency Use ang tawag sa pahintulot sapagkat nasa health emergency tayo na nangangailangan ng madaliang aksyon upang mapigil ang paglaganap nang COVID-19 at mabawasan ang perhuwisyong dulot nito. Ipinapagamit na ang mga bakuna habang patuloy pang pinag-aaralan ang bisa ng mga sangkap sa mas marami pang tao.

TANONG 6: Kung talagang ligtas na ang mga bakuna, bakit may mga clinical trials pa rin na isinasagawa kahit nag-umpisa na ang pagbabakuna? Hindi ba’t nauna na sana ang mga clinical trials para mapatunayan na epektibo at ligtas ang mga bakuna?

SAGOT 6:

a) Kailangang magkaroon pa rin ng mga clinical trials sapagkat ito ang paraan para patuloy na masubaybayan ang epekto ng mga bakuna sa masmahabang panahon. Importanteng matiyak ang tagal ng proteksiyon na ibinibigay ng bawat bakuna, ang epekto ng pampalakas na pangalawang dosis, ang posibilidad ng paggamit ng magkakaibang tatak ng bakuna, at ang kaligtasan sa pangmatagalang paggamit nito.

b) Dapat ding makahanap pa ng ibang mabisang bakuna. Sa kasalukuyan, hindi pa sapat ang mga bakuna para sa lahat ng may pangangailangan. Pakay din na patunayan ang bisa ng mga bakuna para sa mga sektor na hindi pa ganap na nakasama sa mga naunang pag-aaral – mga bata, mga buntis, at mga may ibang kundisyong pinag-iingatan.

TANONG 7: Bakit pa kailangang magpabakuna kung hindi naman nagkasakit ng COVID19 ang isang tao sa loob ng isang taon?

SAGOT 7:

Kung sinuwerte siya nang isang taon, hindi siya makakaasa na magpapatuloy ang kanyang suwerte, lalo na sa harap ng mga bagong uri (variant) ng virus. Ang taong hindi nakaramdam ng sakit ay maaaring nagkaroon na rin ng COVID-19 pero hindi lamang nagkaroon ng sintomas. Maaari din siyang magkaroon ulit ng COVID-19 at makahawa sa iba. Kung iniisip niya ang kapakanan ng kanyang pamilya at sambayanan makabubuting magpabakuna siya. Maski na nga ang mga gumaling na sa COVID19 ay kailangan pa ring mabakunahan muli.

TANONG 8: Di ba dapat mga nakatatanda lamang ang bakunahan, dahil sila ang delikadong magkasakit nang malubha o mamatay mula sa komplikasyon ng COVID-19?

SAGOT 8:

a) Hindi lamang ang mga nakatatanda ang naaapektuhan ng COVID-19. Kailangang maprotektahan ang lahat. Mayroon pa ngang mga kilalang doctor at medikal na propesyonal na namatay dahil sa sakit na ito, kahit na bata pa sila.

b) Nakakahawa rin ang mga bata kahit hindi sila nakararamdam ng sakit. Ang mga nakababatang pumapasok sa trabaho, nakikihalubilo sa maramihan at nalalantad sa COVID-19 ay maaaring mag-uwi ng virus at makahawa sa kanilang mga kasama sa bahay. Baka nga dapat mauna pa silang mabakunahan kaysa sa mga nakatatandang kamag-anak dahil lumalabas sa mga pag-aaral na kadalasan ay sila ang nag-uuwi ng virus sa kanilang pamamahay at pamilya.

Kusang loob, kagandahang loob at pagtitiwala

Dapat nating pag-isipan ang kahalagahan ng pagbabakuna, hindi lamang para sa ating sariling kalusugan, kundi bilang kagandahang loob para sa ating pamilya at mga kapwa tao. Dapat din nating isaalang-alang ang mga problemang kasalukuyang nararanasan ng halos lahat nang tao dahil sa kinakailangang lockdown at quarantine. Ang posibilidad na makaranas ng pansariling kaligtasan mula sa sakit ay nakasalalay din sa pagkakaroon ng panlipunang kaligtasan mula sa COVID-19.

Kung nag-iisip tayong magpabakuna dapat unawain natin ang maaaring panganib. Timbangin natin kung angkop at sulit ang mga panganib kung ikukumpara sa benepisyong gusto nating makuha para sa ating sarili at mga mahal sa buhay. Ang desisyon ay magiging maluwag sa atin kung magagawa natin ito nang kusang loob. Kung mayroon tayong mga pagdududa komunsulta muna tayo sa pinagkakatiwalaang doktor na makapagbibigay sa atin ng lakas ng loob para gawin ang karapat-dapat.

Source: https://ethics.healthresearch.ph/index.php/2-uncategorised/415-etika-ng-bakuna-laban-sa-covid-19

How a racing heart may alter decision-making brain circuits

Anxiety, addiction, and other psychiatric disorders are often characterized by intense states of what scientists call arousal: The heart races, blood pressure readings rise, breaths shorten, and "bad" decisions are made. In an effort to understand how these states influence the brain's decision-making processes, scientists at the Icahn School of Medicine at Mount Sinai analyzed the data from a previous study of non-human primates. They found that two of the brain's decision-making centers contain neurons that may exclusively monitor the body's internal dynamics. Furthermore, a heightened state of arousal appeared to rewire one of the centers by turning some decision-making neurons into internal state monitors.

"Our results suggest that the brain's decision-making circuits may be wired to constantly monitor and integrate what is happening inside the body. Because of that, changes in our level of arousal can alter the way that these circuits work," said Peter Rudebeck, PhD, Associate Professor in the Nash Family Department of Neuroscience and Friedman Brain Institute at Mount Sinai and the senior author of the study published in PNAS (Proceedings of the National Academy of Sciences). "We hope that these results will help researchers gain a better understanding of the brain areas and fundamental cellular processes that underlie several psychiatric disorders."

The study was led by Atsushi Fujimoto, MD, PhD, an Instructor in Dr. Rudebeck's lab who previously studied how the brain controls risk-taking.

For years scientists have described the relationship between arousal and decision-making performance as a "U-shaped curve." Basically, a little of bit of arousal -- such as that experienced after a cup of coffee -- might produce peak performance. But too much or too little arousal increases the chances that the brain will make slow or incorrect decisions.

Initial results from this study supported this idea. The researchers analyzed data from a previous set of experiments that tested the ability of three rhesus monkeys to decide between receiving two rewards: either a lot of tasty juice or a little. Dr. Rudebeck performed these experiments while working as a post-doctoral fellow at the National Institute of Mental Health. As expected, the monkeys consistently chose to have more juice, and on average they made this decision faster when their hearts were beating faster, supporting the idea that an aroused state fosters better performance.

Next, the researchers analyzed the electrical activity recorded from neurons in two of the brain's decision centers called the orbitofrontal cortex and dorsal anterior cingulate cortex.

They found that the activity of about a sixth of the neurons in either area correlated with fluctuations in heart rate. In other words, if an animal's heart rate changed, then the activity of these cells would also change by either speeding up or slowing down. This activity appeared to be unaffected by the decisions made about the different rewards that the monkeys were receiving. Meanwhile, the activity of the remaining cells in each area appeared to be primarily involved in the decision-making process.

"Brain scanning studies have suggested that bodily arousal alters the activity of these decision-making centers. Our results both support this idea on a cellular level and suggest that the sole job of some these neurons is to track the body's internal, or interoceptive, states," Dr. Fujimoto said. "The next question we had was: 'What might happen during the type of heightened arousal states seen in patients who suffer from anxiety, addiction, and other psychiatric disorders?'"

To answer the question, the researchers analyzed the data obtained after the amygdala, the brain's emotional center, was surgically turned off in each animal. This raised heart rates by up to 15 beats per minute. Now, in this higher arousal state, the faster the animals' hearts beat, the slower they were to choose a reward. This suggests that when the animals' arousal state was heightened, it actually hampered the decision-making process.

When the team looked at the neural activity, they found something even more interesting. The heightened arousal state appeared to alter the roles that the neurons played during decision-making. In both brain centers, the researchers saw evidence of a decrease in the number of neurons involved in the decision-making process. Moreover, in the dorsal anterior cingulate cortex, the number of neurons that appeared to track internal states rose slightly. This altered the balance of information represented in this area, as if the neural signals for decision making were "hijacked" by arousal.

"Although not definitive, our results suggest that a heightened arousal state degrades and takes control of the decision-making circuits in the brain," Dr. Rudebeck said. "We plan to continue studying how arousal can influence higher brain functions and how this contributes to psychiatric disorders."

This study was supported by the National Institutes of Health (MH110822), the NIH's BRAIN Initiative (MH117040), the NIH Intramural Research Program at the National Institute of Mental Health (MH002886), the Takeda Science Foundation, and a Brain & Behavior Research Foundation Young Investigator Grant (#28979).

Source: The Mount Sinai Hospital / Mount Sinai School of Medicine. "How a racing heart may alter decision-making brain circuits: Body-state monitoring neurons can hijack the decision-making process." ScienceDaily. ScienceDaily, 30 August 2021. www.sciencedaily.com/releases/2021/08/210830140224.htm

Minimizing the impact of the Delta variant in the Philippines

The Delta variant is the most closely watched coronavirus mutation yet, and with good reason: it’s twice as transmissible as the original virus, with one positive person potentially capable of causing infection in another nine to 13 persons.

Community transmission largely attributed to the Delta variant is causing an increase of reported cases on daily basis including unfortunately hundreds of reported daily deaths. Even countries that previously contained COVID-19 transmission are seeing a rapid rise in cases partly driven by this more transmissible variant. What can the Philippines do to strengthen its response?

To minimize the impact of the Delta variant, the World Health Organization (WHO) encourages the government, local government units (LGUs), employers, and all Filipinos to act proactively and together to break the chains of transmission and prevent its further spread in households, communities, and workplaces. We need to work together to successfully address this evolving challenge.

“The coronavirus has mutated to spread quickly to more people. We also must adapt our own mindsets and behaviours – to adapt quickly to this new reality so we can minimize the impact of the evolving pandemic both as individuals and as a community,” said Dr Rabindra Abeyasinghe, WHO Representative to the Philippines.

Pandemic fatigue behind poor adherence to minimum public health standards

Nearly 20 months into the global health crisis, pandemic fatigue is contributing to and creating risks as the mental distress of losing jobs, keeping families safe, or the sweeping uncertainty of the future takes a toll on many Filipinos.

“People are taking risks to earn a living despite the threats of Delta and other variants or even simply getting together with their loved ones,” said Dr Abeyasinghe. “These are understandable, but in the face of a more transmissible variant, we need to be extra vigilant and adopt ways to be safe in these settings. The minimum public health standards when complied with due diligence are still very effective in preventing transmission and interrupting chains of transmission.”

Aside from wearing masks and physically distancing, WHO emphasizes the need for avoiding closed and crowded settings and ensuring good ventilation. Opening windows at home or in workplaces prevents people from inhaling air carrying very small droplets or aerosol particles that contain infectious coronavirus.

Physical distancing could be more challenging in public spaces like public transport, indoor dining spaces, some workplaces, wet markets and groceries. “We encourage safety or enforcement officers to be on alert and remind people to keep their distance from others,” said Dr Abeyasinghe. “It is not just about telling them what to do, however, but also pointing out why they still need to do it – to keep themselves and others safe.” These behaviours and practices are equally important for the non-vaccinated and the vaccinated. This is because we are seeing breakthrough infections that are usually less severe even among the vaccinated.

Less social mixing, fewer risks

Although it’s not universally clear that the Delta variant itself causes more severe cases, such reports have come from several countries. The higher transmissibility of the Delta variant leads to a larger pool of people getting infected. Unfortunately, this also includes increased numbers among children and unvaccinated elderly persons. The larger number of people infected results in higher numbers of persons developing severe disease and seeking hospital critical care, potentially overwhelming the healthcare systems in many affected countries, especially in countries with low vaccination coverage among elderly and comorbid populations.

“Compared to the SARS-CoV-2 wild type, the highly transmissible Delta variant which causes higher viral loads in the respiratory tract spreads faster and infects more people, potentially affecting every individual in a household if one person gets infected.

In the Philippines, the early lockdown in the country’s capital and areas with increasing COVID-19 cases have decreased the movement of people and somewhat delayed the surge of cases. However the decrease in mobility in the most recent Enhanced Community Quarantine (ECQ) was noticeably higher compared with previous lockdowns.

As the National Capital Region continues in MECQ. we need to all limit our movement to essential errands and turn to online tools for work and social engagements as much as possible.

Vaccination protects the community

Social mixing also poses greater risks to vulnerable people who are unvaccinated. The increase of cases seen by WHO in countries around the world is largely among unvaccinated.

Senior citizens and people with underlying conditions will be gravely affected if the Delta variant spreads far and wide in the country. “Before Delta cause surges everywhere in the Philippines, those at high risk of severe disease and death due to COVID-19, the elderly (A2) and comorbid populations (A3) must be fully vaccinated as soon as possible,” said Dr Abeyasinghe.

“It is not enough to meet population protection in a few areas. Inoculating people in the A2 and A3 priority groups all over the country can create the most impact in decongesting hospitals and saving lives.”

WHO also welcomes the idea of NCR cities “vaccinating as one,” allowing residents of one local government unit (LGU) to get their jabs in another. “We support this localized dose sharing for the elderly and people with comorbidities. It is a resourceful and timely suggestion and addresses the urgency of our situation with the Delta variant.”

Vaccines not only protect elderly and persons with comorbidities, they help reduce severe infections in families preventing the need for out of pocket expenditure, they also protect the hospitals from being overwhelmed contributing to economic recovery of the country. Recent data shows that all vaccines are highly effective in preventing severe disease and death. Vaccines are not 100% effective in preventing infections with the new variants, but fully vaccinated people experience breakthrough infections that are often mild. Additionally, vaccinated people shed the virus for a shorter duration of time potentially reducing the risk of others being infected.

Save beds for severe cases to save lives

WHO has been supporting the expansion of the health care system through the setting up of step-down facilities and expansion of ICU capacities. As the number of cases increases and the health care capacities come under pressure it’s important to better manage the existing capacities through referral and back referrals. Infected persons with no or minimal risk can be managed at home or in isolation facilities, reserving hospital space for high risk and severely ill patients.

Temporary treatment and monitoring facilities (TTMFs) are an important part of the COVID-19 response as they help prevent infection at home and congestion of hospitals. They could be facilities to isolate mild and asymptomatic COVID-19 patients, or step-down facilities for recovering patients.

“The Philippines can learn from countries that stringently implement suggested triage algorithms and save hospital beds for severe cases,” said Dr Abeyasinghe. “We encourage home-based care for those who meet the following criteria: Patients at low risk, those who have a separate isolation room with toilet and good ventilation and can have their daily needs delivered at home.”

If home isolation is not possible, access to TTMFs must be facilitated by LGUs to lessen transmission in the household. Based on PhilHealth’s home isolation guide, health care providers and patients must have daily check-ins for at least 10 days to ensure monitoring of symptoms and immediate action if inpatient care is needed.

Investing in and ensuring telemedicine services are in place facilitates better adherence to infection and prevention control (IPC) measures at all stages of care, and protects care givers from unnecessary exposure.

“The collective health of the nation is based on individual actions,” said Dr Abeyasinghe. “The simple precautionary measures you take for yourself and your family also protect your communities. Now more than ever, we need to see and embrace the bayanihan spirit to overcome this public health crisis together and heal as one.” (Rocel Ann Junio, Communications Officer, WHO Philippines, This email address is being protected from spambots. You need JavaScript enabled to view it. )

Source: https://www.who.int/philippines/news/detail/31-08-2021-minimizing-the-impact-of-the-delta-variant-in-the-philippines

Reducing sugar in packaged foods can prevent disease in millions

Cutting 20% of sugar from packaged foods and 40% from beverages could prevent 2.48 million cardiovascular disease events (such as strokes, heart attacks, cardiac arrests), 490,000 cardiovascular deaths, and 750,000 diabetes cases in the U.S. over the lifetime of the adult population, according to micro-simulation study published in Circulation.

A team of researchers from Massachusetts General Hospital (MGH), the Friedman School of Nutrition Science & Policy at Tufts University, Harvard T.H. Chan School of Public Health and New York City Department of Health and Mental Hygiene (NYC DOH) created a model to simulate and quantify the health, economic, and equity impacts of a pragmatic sugar-reduction policy proposed by the U.S. National Salt and Sugar Reduction Initiative (NSSRI). A partnership of more than 100 local, state and national health organizations convened by the NYC DOH, the NSSRI released draft sugar-reduction targets for packaged foods and beverages in 15 categories in 2018. This February, NSSRI finalized the policy with the goal of industry voluntarily committing to gradually reformulate their sugary products.

Implementing a national policy, however, will require government support to monitor companies as they work toward the targets and to publicly report on their progress. The researchers hope their model will build consensus on the need for a national-sugar reformulation policy in the US. "We hope that this study will help push the reformulation initiative forward in the next few years," says Siyi Shangguan, MD, MPH, lead author and attending physician at MGH. "Reducing the sugar content of commercially prepared foods and beverages will have a larger impact on the health of Americans than other initiatives to cut sugar, such as imposing a sugar tax, labeling added sugar content, or banning sugary drinks in schools."

Ten years after the NSSRI policy goes into effect, the U.S. could expect to save $4.28 billion in total net healthcare costs, and $118.04 billion over the lifetime of the current adult population (ages 35 to 79), according to the model. Adding the societal costs of lost productivity of Americans developing diseases from excessive sugar consumption, the total cost savings of the NSSRI policy rises to $160.88 billion over the adult population's lifetime. These benefits are likely to be an underestimation since the calculations were conservative. The study also demonstrated that even partial industry compliance with the policy could generate significant health and economic gains.

The researchers found that the NSSRI policy became cost-effective at six years and cost-saving at nine years. The policy could also reduce disparities, with the greatest estimated health gains among Black and Hispanic adults, and Americans with lower income and less education -- populations that consume the most sugar as a historical consequence of inequitable systems.

Product reformulation efforts have been shown to be successful in reducing other harmful nutrients, such as trans fats and sodium. The U.S., however, lags other countries in implementing strong sugar-reduction policies, with countries such as the UK, Norway, and Singapore taking the lead on sugar-reformulation efforts. The US may yet become a leader in protecting its people from the dangers of excessive sugar consumption if the NSSRI's proposed sugar-reduction targets are achieved. "The NSSRI policy is by far the most carefully designed and comprehensive, yet achievable, sugar-reformulation initiative in the world," says Shangguan.

Consuming sugary foods and beverages is strongly linked to obesity and diseases such as type 2 diabetes and cardiovascular disease, the leading cause of mortality in the U.S. More than two in five American adults are obese, one in two have diabetes or prediabetes, and nearly one in two have cardiovascular disease, with those from lower-income groups being disproportionately burdened.

"Sugar is one of the most obvious additives in the food supply to reduce to reasonable amounts," says Dariush Mozaffarian, MD, DrPH, co-senior author and dean of the Friedman School of Nutrition Science and Policy at Tufts University. "Our findings suggest it's time to implement a national program with voluntary sugar reduction targets, which can generate major improvements in health, health disparities, and healthcare spending in less than a decade."

Major funding for this study provided by the National Institutes of Health.

Shangguan is an attending at MGH and an instructor of Medicine at Harvard Medical School. Mozaffarian is dean of the Friedman School of Nutrition Science and Policy at Tufts University. Thomas Gaziano, MD, MSc, is associate professor at Brigham and Women's Hospital and assistant professor of Medicine at HMS. Renata Micha, PhD, is research associate professor at the Friedman School of Nutrition Science and Policy at Tufts University and associate professor at the University of Thessaly in Greece.

Source: Massachusetts General Hospital. "Reducing sugar in packaged foods can prevent disease in millions." ScienceDaily. ScienceDaily, 27 August 2021. https://www.sciencedaily.com/releases/2021/08/210827082431.htm

DBM lauds DOST-PCHRD for achieving all performance indicators in 2020

The Department of Budget and Management (DBM) commends the performance of the Department of Science and Technology (DOST) and its attached agencies for attaining its targets and major outputs despite the limitations brought by the COVID-19 pandemic in 2020.

Of the 19 DOST agencies, DBM lauded the Philippine Council for Health Research and Development (PCHRD) for achieving all its performance indicators committed for 2020 with an accomplishment rate of 100% to 377%, and for attaining an almost 100% budget utilization rate.

“The government appreciates the efforts of DOST in delivering its commitments in terms of the performance indicators, particularly for being an active agency in curbing the effects of the virus through its scientific intervention in medicine as well as its promotion of a better-designed, well-prepared programs and projects for the agency,” said DBM Undersecretary Tina Rose Marie L. Canda in a DBM summary report sent to DOST.

In 2020, the Council supported 36 research and development (R&D) projects implemented in response to COVID-19 and maintained its support to 138 ongoing research projects under its nine R&D priority areas, of which 22 have completed implementation in the said year. The Council also welcomed a total of 332 R&D research proposals, where 46 new projects were approved for funding and implementation.

In terms of capacity building, PCHRD has supported 53 MD-PhD in Molecular Medicine scholars in 2020, welcomed 12 new Balik Scientists, and approved 22 projects in addition to the 37 ongoing projects being supported under its Regional Research Fund Program. More so, the Council also provided important inputs to 17 legislations, filed 76 intellectual property applications, and co-organized 40 health-related webinars, among many of its information, communication, and technology transfer services.

“Our ultimate goal as the country’s lead coordinating body for health research has always been the same for the last three decades: to make life better for the Filipinos through health research-based solutions and innovations. We thank the DBM for recognizing our efforts to address the needs of our country’s health system amid major crises, including the COVID-19 pandemic. We share this recognition with our Filipino researchers, partners, and stakeholders who strive to create research-based solutions to our pressing health needs,” said PCHRD Executive Director Jaime C. Montoya.

The DBM report also highlighted that DOST supported a total of 1,267 projects in 2020, out of its target of 954 projects, and all agencies surpassed their targets including PCHRD with 207 projects implemented under the Grants-In-Aid (GIA) program. DBM also reports that all DOST agencies posted “very impressive” obligation rates under their operations.

“I believe that we have accomplished much more than what the financial and physical performance indicators present. We have put in place pioneering and strategic programs that respond to national problems particularly the COVID-19 pandemic. Our interventions have long and enduring positive impacts on the economic development, poverty reduction, and social transformation as affirmed by our various clients and stakeholders,” said DOST Secretary Fortunato T. de la Peña.

The physical performance is measured in terms of the outcome and output performance indicators committed in the Performance Informed Budget for FY 2020, while the financial performance is measured in terms of budget utilization rate both in obligation and disbursement and income performance.

Source: https://www.pchrd.dost.gov.ph/news/6704-dbm-lauds-dost-pchrd-for-achieving-all-performance-indicators-in-2020