Medical experts recommend ‘7 Commandments’ health protocol in public transport


Aside from the thousands of Filipinos affected by the Covid-19 virus, the Philippine economy has been severely affected by the pandemic. With the current community quarantine guidelines, gradually, the country emerges from the recession that has severely impacted livelihoods. Many Filipinos are currently braving the pandemic with the urgent need to revitalize the country’s economy.

However, the economy cannot build back without increasing public transport capacity. As of today, public transport has been operating at only 20-30% of pre-pandemic levels due to understandable fears of outbreaks arising from congested public transport spaces.

With this, an expert panel of doctors with diverse backgrounds, including public health, epidemiology and infectious diseases, all with the intention of seeing the country get back on its feet as safely as possible, released a statement recommending strict health protocols in public transport. Presented to members of the Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID) on September 15, 2020, this is just part of a more comprehensive set of recommendations to aid the country in reviving the economy while adhering to comprehensive public health standards.

The medical experts advocate strictly implementing what is called the 7 Commandments, for all public transportation:

  1. Wearing of proper face masks
  2. Wearing of face shields
  3. No talking and no eating
  4. Adequate ventilation
  5. Frequent and proper disinfection
  6. No symptomatic passengers
  7. Appropriate physical distancing

The panel consists of former DOH secretary Dr. Manuel M. Dayrit, UP Manila College of Public Health dean Dr. Vicente Belizario, Jr., national task force against Covid-19 and former DOH Usec. Dr. Teodoro Herbosa, UP Manila Environmental and Occupational Health department chair Dr. Michael Hernandez, Philippine College of Surgeons Cancer Commission director Dr. Manuel Francisco T. Roxas, former DOH secretary Dr. Esperanza Cabral, founder and CEO of Eye Bank Foundation of the Philippines Dr. Ma. Dominga Padilla, and infectious disease specialist Dr. Rontgene Solante.

A result of the team’s consultation with international experts, the panel believes that with the strict implementation and monitoring of the 7 Commandments gradual relaxing of social distancing rules, in order to double or even triple our current public transport capacity, without compromising public health can be achieved.

For example, the panel cites a recent study from Duke University which shows that surgical masks reduce droplet transmission by up to 99%, and that the simple act of not talking can reduce droplet counts by up to 4x. In addition, a meta-analysis published on June 22, 2020 in The Lancet, a leading international medical journal, shows that face masks and face shields can independently reduce the chance of viral transmission by up to 5-fold and 3-fold, respectively. In China, Japan, Korea, Singapore, Taiwan, Vietnam, and other countries, passengers wear face masks while sitting side-by-side in trains, while COVID cases remain manageable.

With regards to appropriate physical distancing, the World Health Organization recommends: “To the extent possible, keep a distance of at least 1 meter from other passengers when purchasing tickets, waiting to board public transport, and moving around public
transport stations.”

As per panel, while WHO recommends keeping a distance of 1-meter from other passengers to the extent possible, it allows for adjustments based on context. With this, the medical experts recommend to slowly reduce physical distancing norm in public utility.

“Given our other recommended health interventions, we propose the gradual reduction of the physical distancing norm during transit to 0.5 meters or lower. Based on the panel’s review of the scientific literature and the policies and experiences of neighboring countries, evidence shows physical distancing can be maintained below 1-meter, so long as other health measures are also implemented.”

The panel also shared that there are more details to their proposal that they are hoping to further discuss in detail with the IATF and the stakeholders.

“We would like to engage in further dialogue with the IATF, medical and transportation experts, and other stakeholders, about our proposal. We also encourage a discussion of other groups’ thoughts on health and other matters, including the overall increase of the supply of safe public transportation such as rail, buses, jeepneys, motorcycle taxis, and Transport Network Vehicle Services (TNVS), and the use of other options such as cycling, walking, and private shuttles.”

The panel also pointed out that the prolonged recession is far devastating than the manageable risks in the expert proposal.

“We believe that there is a way forward that carefully balances a careful reopening of public transport capacity, with public health, while allowing purposeful flexibility to re-adjust measures based on actual and evolving data from the ground.”

In closing, the panel mentioned that proper implementation and enforcement of these measures are key in order to maintain safety in public transport. More so, education of the public is also vital as everyone must be responsible to religiously comply with the 7 Commandments. Continuous monitoring and data-driven evaluation by public health experts will also be critical in this plan’s success.

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