We need better COVID response

Coronavirus disease 2019 or COVID-19 beds in government hospitals in NCR and Cebu are starting to fill up. The poor are now getting infected, disproving one observation that they seem to have immunity to the virus, or we are only finding out now because more testing is being done. 

Dr. Anthony Leachon, resigned COVID National Task Force consultant, said last Tuesday that we ought to “regroup” in our response effort. He said the health secretary needs the help of  a “guiding coalition” composed of representatives from academe and the private sector. The DOH Secretary needs a new vision, a new strategy for the next three months. 

Dr. Leachon observed we now have two epicenters, NCR and Cebu City, and we cannot fight too many big battles given our limited resources. The Palace spokesman also expressed hope the prediction of UP scientists of 40,000 cases by end-June will not happen. We have overtaken the UP professors’ June 15 prediction of 24,000 cases when DOH announced 26,420 cases.

But maybe we just have to work smarter. For instance, a source said, there are now 42 licensed COVID-19 RT-PCR laboratories across the country, but we are far from meeting the 30,000 daily tests targeted by the government. Why?

The problem, I am told, is operational. The focus should be on how to run each site efficiently. The source pointed out the bottlenecks.

“For a laboratory to meet its daily target, such as, for example, 1,000 tests per day, they need to be familiar with the PCR “workflow,” from sample preparation to sample extraction, to amplification to reading. Each step involves different sets of materials and procedures. One missing material or misstep will lead to test failure, wastage of patient sample and test kits, and reporting delays.

“Incompatibility of the machine and reagents. The DOH is providing COVID-19 test kits, but not necessarily the equipment. Both must be validated to ensure operational compatibility. Otherwise, the results are questionable.

“The DOH has stockpiled COVID-19 test kits, but not extraction kits. These go together. For “workflow,” there is a need to extract the sample from RNA to DNA for amplification. This takes time, especially when done manually.

“If one item is missing, staff cannot proceed to the next step. All materials must be available and all equipment must be calibrated prior to moving along the process.

“The sample (swab of patient) is just as good as the COVID-19 test. Majority of samples are coming outside the laboratory, and the laboratory has no control over its quality (temperature, quantity, material, spillage, incorrect labelling, etc).

“Results interpretation. Encoding. Reporting. The more automated the procedure, the faster and more reliable the recording. Majority of sites are not automated...

“The efficiency grading of each laboratory is equal to how it performs against its daily testing capacity. Overall, based on the DOH Testing Tracker, the efficiency of all laboratories doing COVID-19 testing is below 40 percent of capacity.

“During the interim, during the crisis, the DOH should manage the COVID-19 real-time PCR laboratories the way McDonald’s or Jollibee functionally operates, with a focus on supply chain management and the use of a performance-based model, where each branch or franchise has to meet its target sales (number of tests per day), provide the required tools (personnel, equipment, reagents, consumables, etc), and adhere to quality control and operational guidelines.

“The supply chain manager has a very critical role to play in providing for the needs of each site quickly and on time. Looking at the DOH Testing Tracker, it is clear that resources and supply are unevenly distributed and unused among sites. Over the next several months, the slow and uneven utilization of resources will result not only in slow testing, but also in waste of resources (due to reagents’ expiring, lack of or poor transport and storage)...

“But what is the situation at the DOH? Items being procured are not matched or compatible with the machine available at the laboratory. Against the daily testing target, the procurement of key items (UVT media/swab, extraction kits and RT-PCR kits) are not done on one to one basis. Since April 8 to June 12, DOH has already procured 404,200 extraction tests versus 8,534,744 RT-PCR tests. A huge mismatch in numbers (current 9,600 actual daily testing, and DOH announcement of testing 1.63 million Filipinos by end of July 2020 using RT-PCR). 

“Based on the DOH-DBM procurement record, the government has already procured around seven million COVID-19 RT-PCR tests on top of around one million donated tests. With the current actual testing of 9,600 per day, it would take 1,066 days to consume these tests, which have an average shelf life of only six months and need to be stored below 21 negative degree centigrade. Therefore, it is imperative that we scale up our testing to no less than 50,000 per day, not only to control the spread of the virus, but also to avert unnecessary waste of resources.”

So we don’t only need doctors running our COVID  response, but also good managers. Perhaps good supply chain managers can be assigned by some companies to help DOH do a better job, and the numbers specialists at the statistics office should take over the handling of data. An all-hands-on deck approach is needed. 

DOH needs help, as Dr. Leachon pointed out, and the DOH leadership and bureaucracy must seek and use such help. Let the UP professors help. The nation’s health security is at stake. Defending bureaucratic turf should not happen. 

Malampaya 

Last Wednesday, we published a letter from Energy Secretary Alfonso Cusi expressing his reservations about a column item I wrote about plans to buy Malampaya shares from Dennis Uy’s Udenna. But let me disabuse his mind that I accused him of anything improper since nothing has yet happened that warrants that. The deal was put off. 

But since he said he plans to revive it at the proper time, I felt it my duty to warn him and protect him from making a mistake by citing considerations he might have overlooked. My main point is simply,  there is no need to buy those additional shares. PNOC-EC already owns 10 percent and that’s enough to have access to consortium data for better government regulation. 

His past close business ties with Dennis Uy is publicly known. I made no insinuation of irregularity, but the optics are bad. I only intended to warn Sec. Cusi of the problem and it is best he avoids any significant transaction with Uy that can be misinterpreted. Bad optics reduce public trust, something a public official cannot afford. It is not enough to say the plan was approved by the PNOC board because it did so on his prodding.

Finally, I apologize if I hurt his feelings or gave  a wrong impression of wrong doing. I hope Sec. Cusi realizes that he and I are really working for the same public good.  Indeed, Sec. Cusi should be commended for bringing up the plan to public knowledge. It could have been kept secret. It shows he believes in being transparent.

As a public official, he cannot be onion skinned because public discussions and even criticisms of official acts and programs are part of a public official’s job description in our democratic setting. Unfortunately we are now so polarized that it is easy for officials to be offended. 

I have nothing against Sec. Cusi. I don’t know him that well. Nothing personal. Just a normal public threshing of a matter involving the use of taxpayer money at a time when our Treasury had been emptied by expenses related to fighting the COVID epidemic.

Boo Chanco’s email address is [email protected]. Follow him on Twitter @boochanco