Project Title: SOLIDARITY Treatment Trial: Multicenter Randomized Trial of Additional Treatments for COVID-19 in Hospitalized Patients Project Leader:Marissa M. Alejandria, MD, MSc Implementing Agency: National Institutes of Health- University of the Philippines Manila Duration:12 months
Despite worldwide efforts to develop a treatment against COVID-19, there is still no evidence-based medication proven effective to fight the virus.
To compare the effects of major COVID-19 treatment outcomes among hospitals globally, the World Health Organization (WHO) organized a solidarity treatment trial aimed at unifying efforts to assess any effects and provide reliable estimates of these treatments on COVID-19 cases. As one of the participating countries, the Philippines is conducting a study among 24 hospitals from Luzon, Visayas, and Mindanao. The study will test the safety and effectiveness of four repurposed drugs in treating COVID-19 compared to the standard of care being practiced in all participating hospitals.
The project is expected to provide evidence-based clinical practice guidelines for the care of COVID-19 patients and, eventually, provide evidence-based medicine against the virus. Funded by the Department of Science and Technology through the Philippine Council for Health Research and Development (DOST-PCHRD), the project has been approved for implementation last April 11, 2020 and has started enrolling patients.
The public can now access latest updates on coronavirus research, news, library resources, and other related information in one site through the COVID-19 CORe (Communication, Ongoing projects, Research) Portal developed and managed by the Department of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD).
Aiming to strengthen the country’s pandemic information dissemination efforts, DOST-PCHRD compiles all available evidence-based information on COVID-19, including local and international research, local innovations, pandemic analysis and policy papers, webinars, and local healthcare facilities.
The portal also provides access to COVID-19 trackers and useful links to official advisories and recognized library resources of various health organizations and the academe such as the World Health Organization, John Hopkins Libraries, and the University of the Philippines (UP).
“We need to boost the generation of solutions against the coronavirus pandemic, and building an open-access portal to related resources will aid our researchers and the public with legitimate and evidence-based information on COVID-19, ” said Dr. Jaime C. Montoya, Executive Director of DOST PCHRD.
DOST-PCHRD expects to add resources to the portal as more information becomes available to the public. The portal is free and can be easily accessed at http://covid19.healthresearch.ph/. Meanwhile, the Council is also managing HERDIN Plus (www.herdin.ph), an online portal that provides easy management and access to health research and related information.
Transfer of RT-PCR units from DOST-Food and Nutrition Research Institute to RITM
Transfer of RT-PCR units from MSI Dr. Conaco Team and PCHRD to San Lazaro
To increase the country’s COVID-19 testing capacity, quantitative real-time polymerase chain reaction (qRT-PCR) machines, a crucial technology for detecting viral infections, are being lent and distributed to various testing laboratories as part of the Department of Science and Technology's initiatives to fight the coronavirus pandemic.
Prior to the Department of Health’s request to borrow qRT-PCRs, DOST, its attached agencies and several Universities with DOST-funded projects have already deployed units that matched specific requirements for COVID-19 testing to the following laboratory facilities: Lung Center of the Philippines, Philippine Genome Center, Davao Regional Medical Center, and Western Visayas Medical Center.
Transfer of RT-PCR units from Dr. Sevilla's team at University of Sto. Tomas to Baguio General Hospital aided by Dr. Dharmatov Albano. DOH-CAR and Lifeline Diagnostics Supplies Inc. for the dismantling and re-installation at BGHMC.
Transfer of RT-PCR units from DOST-Industry Technology Development Institute to RITM
Additional units of qRT-PCRs were lent and transferred to the following laboratories: Research Institute for Tropical Medicine, Baguio General Hospital and Medical Center, Lung Center of the Philippines, and San Lazaro Hospital.
The said qRT-PCRs are originally being used for research and development projects of DOST-attached agencies and some Universities. The machines are lent by the Department through the cooperation of different proponents and institutions supported by DOST, with assistance from its Research and Development Councils and select regional offices.
“By using the resources we currently have, we are adding value to the laboratories’ existing operations. We at the science community will always find means to assist our healthcare workers with necessary tools in this battle with the virus,” said Dr. Jaime C. Montoya, Executive Director of DOST-Philippine Council for Health Research and Development (PCHRD).
The qRT-PCR machine, which is currently the most widely used method for detecting coronavirus, is essential as it amplifies the viral RNA from swab samples taken from suspected patients.
The distribution of qRT-PCRs is based upon the assessment and request from the DOH. The Department plans to focus future R&D initiatives on COVID-19 programs and pandemic information dissemination projects.
As the cases of the novel coronavirus in the country continue to rise, the Department of Health (DOH) seeks for additional medical equipment such as ventilators and respirators to help severely ill COVID-19 patients confined in intensive care unit (ICU).
To answer this call, a research team consisting of pulmonologists and biomedical engineers, led by Dr. Abundio Balgos of UP Manila, developed GINHAWA, a compact, safe and effective ventilator that can be used for both children and adults. The project started in 2012, in collaboration with biomedical engineers from De La Salle University and then proceeded with the redesign phase in 2019 with the help of biomedical technicians led by Mr. Glenn Tuazon.
GINHAWA costs 42 percent cheaper than similar portable ventilators intended for use in ICUs, emergency rooms and ambulances. The technology has an embedded software protocol for self-diagnosis, protocol for cloud-assisted troubleshooting, repair and patient data analytics.
To date, bench testing using Michigan Instruments Pneuview Test Lung and animal studies testing were done, proving its safety and efficacy. Initial human trials were also conducted, with six patients included in the human safety and efficacy studies.
The locally-developed GINHAWA is made possible through funding support from the Department of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD).
With the increasing number of COVID-19 cases in the country, a study from the University of the Philippines Manila predicts that the worst case scenario for the healthcare system is the surge of patients exceeding available healthcare resources to the extent that “critical care may have to be rationed.” This brings about issues on the standard of care provided to patients leading to ethical implications. To address this, a research team led by Mr. Peter Sy of the University of the Philippines Manila came out with the “Ethics Guidelines on COVID-19 Crisis-Level Hospital Care,” a document healthcare providers may adapt and adjust according to their institution’s needs during the pandemic.
Last April 13, 2020, the University of the Philippines Manila held an online conference which served as a venue for the project team and healthcare stakeholders to discuss the guidelines, how it can help the healthcare providers, and what improvements can be made to the document.
Dr. Belle Siasoco, a co-investigator of the project, cited five ethical elements considered in the creation of the guidelines, namely procedural fairness, urgency, duty to care, equity, and to minimize harm. The document aims to help healthcare providers answer the question, "How should decision-makers balance between saving as many lives as possible or relieving as much pain and suffering as possible, on the one hand, and, on the other, aiming for the best possible quality of life as well as as seeing through the cases of patients they have come to care for?”
The “Ethics Guidelines on COVID-19 Crisis-Level Hospital Care” contains the following sections: ● Principles- Elaborates the ethical elements in which the rest of the document is based from. ● Admission triage- Provides guidelines on patient admission and the type of care to be provided to the patient ● Communication of care- Focuses on ensuring communication of care to the patients’ families ● Therapeutic interventions- Provides guidelines on the use of available alternative therapeutic interventions for treatment ● ICU allocation- Provides guidelines on patient admission to the ICU and its processes ● Care for non-COVID-19 patients- Provides guidelines on providing care for non-COVID-19 patients ● Information management- Elaborates on the information healthcare providers may attain and discloses ● Research- Provides guidelines on conducting research in time of the pandemic ● Personnel rights and obligations- Provides guidelines on healthcare worker rights and obligations ● Working committees- Elaborates tasks of committees within hospitals and the establishment of the patient liaison committee ● Post mortem care- Provides guidelines on post-mortem care of suspected and confirmed COVID-19 case
Some features of the document include the establishment of the patient liaison committee and provision of alternatives such as palliative care to the patients. The patient liaison committee will be the authorized body to decide “on withholding or withdrawing ventilator support for any given case, based primarily on the criteria-based assessments of the attending physicians.” Once a patient cannot be provided ventilator support according to the criteria set by the committee, the patient may opt for palliative care. It was also pointed out that engagement with the family of the patient must also be a priority for crisis-level healthcare.