THE Philippines announced its first A(H1N1)-related fatality on Monday, but stressed that the primary cause of the 49-year-old woman’s death is a lingering heart disease, complicated by other illnesses.

Director Yolanda Oliveros of the National Center for Disease Prevention and Control said in a news briefing in Malacañang the fatality involved an undocumented A(H1N1) case who died in her residence on June 19 due to acute myocardial infarction or congestive heart failure.

“[We are] very sure that the cause of death, as the autopsy showed, is acute myocardial infarction because basically this particular case has multiple chronic illnesses. She has many other illnesses,” said Oliveros.

At a separate briefing at the Department of Health (DOH), Secretary Francisco Duque III said the 49-year-old woman revealed the flu-like symptoms on June 17 and died on June 19.

Two days before her death, she experienced dry cough, fever and chills, and difficulty of breathing; however, she still went to work on the day the symptoms surfaced and took Bioflu instead.

The family was prompted to call for medical help two days after, but she died at home an hour after the doctor came.

“We condole with the family of the patient as we mourn her untimely death,” Duque said in a press conference at the DOH office in Manila.

Since there is no travel history, her condition was only reported to the DOH a day after she died.

“A(H1N1) is not the cause of death, but the virus could have exacerbated the situation,” Duque said.

According to the post-autopsy findings, her death was caused by congestive heart failure secondary to acute myocardial infarction aggravated by severe pneumonia, either bacterial, viral or both.

“For this particular case, she was attended to by a physician but she died at home. We have to get some details on that. But the cause of death signed out by her attending physician is acute myocardial infarction. She really had heart disease, congestive heart failure, she also had liver disease. So this is really a complicated case,” Oliveros said at the Palace briefing.

Oliveros stressed that the woman, whose location she declined to specify, did “not necessarily” die of A(H1N1) and her case should not be a cause for alarm for the public.

High-risk populations watched

“You have to understand that as we have been saying, generally the virus is mild but we have to make sure that the high-risk populations are protected because this is where some severe complications or even death would occur,” Oliveros said.

She said the health officials are checking how the woman caught the A(H1N1) virus, if she had a history of travel or contact with people who had traveled or exhibited flu-like symptoms; and are doing contact tracing to give prophylactic treatment to the concerned people.

Asked whether her A(H1N1) infection contributed to her demise, Oliveros said this has not been established. “It can be that she had a concomitant flu but she was really sick because of the illness. We have said that those with medical conditions are more prone (to infection) because they have weak resistance,” Oliveros said.

Bracing for mutated virus

The DOH has prepared for the possibility of a second wave of a mutated A(H1N1) virus hitting the country.

“We are happy with how DOH is handling this crisis that were facing. Eighty-four percent have recovered already. Our cases are mild, by the grace of God,” Oliveros said.

The Philippines has 445 confirmed A(H1N1) cases to date, including 17 new cases composed of 15 Filipinos and two foreigners, and that 84 percent of the total number of cases had recovered and discharged from the hospital.

She stressed that the Philippines is “not yet heading for a second wave” of A(H1N1) infections but is preparing for it nonetheless.

She said the second wave is described as “more virulent and more fatal if there will be mutation of the current virus,” based on the experience with the Spanish influenza pandemic in 1918, which killed at least 50 million people worldwide.

“Now towards that, we are now preparing our health facilities. If there will be a second wave, the most important component is the risk communication to reduce panic. Second will be health infrastructure to make sure that all our hospitals and health facilities are prepared to address the severely ill cases that will be coming to hospitals,” she said.

Oliveros said private medical practitioners and medical and nursing schools will be tapped to augment manpower in government hospitals, if necessary.

No takeover of private hospitals

In a public health emergency, the DOH will take the lead in managing a public health crisis, but this would not involve the takeover of private hospitals. The DOH can only “coordinate with private facilities and we will mandate them to follow the guidelines and cooperate with the government,” she explained.

“We have some regulatory power within DOH that can mandate private institutions to follow standard guidelines and protocols if warranted,” Oliveros said.

She said members of the National Disaster Coordinating Council (NDCC), including the military and the police, “have their own contingency plan on how to assist the government to respond in case there will be a lot of cases.”

She said preparations also include ensuring the continued provision of basic, essential services outside the public health system such as communications, transportation and business services.

“We are encouraging all the companies to have their business continuity plan,” Oliveros said.

She reiterated that A(H1N1) cases will continue to climb if the public ignores public health measures repeatedly encouraged by the government, such as observing personal hygiene; and for those with flu-like symptoms, to remain at home and avoid crowded places and seek medical attention.

“What we fear is they will (infect) high-risk individuals. . . . That’s where we’re going to see severely ill cases or fatalities,” she said.

Oliveros said the DOH is finalizing its mitigation response plan and is revising the school response plan for the Department of Education (DepEd).

When asked, she said the DOH has spent an estimated P93.5 million out of its P150-million A(H1N1) response fund, including expenses to prepare state hospitals.

Employers’ responsibility

The Department of Labor and Employment (DOLE) urged employers and workers groups to take precautions against A (H1N1) and formed a task force to strengthen measures to avoid workplace outbreaks.

“The task force would serve as the DOLE focal point on H1N1 matters affecting workers and employers,” Labor Secretary Marianito Roque said.

The task force will monitor the implementation of the DOLE advisory in all companies. Employers are tasked to regularly provide their workers information on the flu including its transmission, disease outcome and treatment options.

“Companies are also reminded to regularly clean their work areas and make sure that water, soap and disinfectants are available in washrooms and toilets. Delegation of company focal persons who would monitor and ensure that measures against H1N1 are strictly followed at the workplace is highly encouraged,” Roque said.

He appealed to employers to exercise flexibility and compassion in granting additional leave with pay to workers suspected of having, or already infected with flu.

DOLE Undersecretary Lourdes Trasmonte said the task force should include capability-building seminars for H1N1 focal persons in establishments.

“The OSHC has started the conduct of learning sessions on H1N1 in coordination with the Employers Confederation of the Philippines, People Management of the Philippines, Philippine Chamber of Commerce and Industries, Trade Union Congress of the Philippines, Federation of Free Workers, Trade Union of the Philippines and Allied Services and other stakeholders,” she said.

She said the labor office will provide information on the treatment of leave of absence of an employee who is asked to stay at home or is served a quarantine order for reasons related to A(H1N1).

Philhealth benefits

Meanwhile, public and private health workers diagnosed with A(H1N1) may avail themselves of the P150,000 PhilHealth hospitalization benefit, an addition to company healthcare benefits.

Nonhealth workers such as managers, call center agents, teachers, clerks, etc., and their dependents who are diagnosed with A(H1N1) may access PhilHealth hospital benefits amounting to P75,000.

A worker who contracts A(H1N1) in the performance of his or her work is also entitled to sickness benefits under SSS and employees compensation benefits under PD 626 or the ECC law.

Public hygiene reminders

The DOH advised the public, especially high-risk groups, to immediately see a doctor once they have the flu symptoms.

“They should not wait for their symptoms to worsen because they are prone to many infections other than the novel virus such as our seasonal flu strains. These are patients with uncontrolled diabetes, frank cardiovascular disease, COPD, organ transplant recipients, those who are immunocompromised, those with chronic liver and kidney disease, people suffering from other infections like HIV/AIDs and TB, pregnant women and the very young and the elderly,” Duque said.


Meanwhile, he advised the public to continue proper hand washing, cough etiquette, and other hygiene practices.


“The best defense against A (H1N1) and other diseases is to boost your immune system. Most people can fight off this virus without special medications or hospitalization. You can stay at home and take supportive care like plenty of fluids, vitamins and bed rest,” Duque stressed.

The DOH also reported 35 persons more have fully recovered from the novel virus, thus bringing the total count of the fully recovered to 374, or 84 percent.