Widespread testing can limit pandemic
GOTCHA - Jarius Bondoc (The Philippine Star) - March 25, 2020 - 12:00am

Cavite Gov. Jonvic Remulla publicly has apologized for COVID-19 testing even if asymptomatic. He regretted skipping “protocol and triage algorithm set by the Dept. of Health.” Yet it illustrated that political elitism reigns even in pandemic. Amid shortage of kits the DOH limits tests to those with acute symptoms, existing ailment, and contact with infectee. All others are sent on home quarantine. The Research Institute for Tropical Medicine cleared Remulla of the killer virus after a meeting where an attendee acted ill despite thermal-scanning. Forthrightness no doubt won him admiration. Circulating online meanwhile is a scorned list of pols, Cabinet men, bureaucrats, family members and aides who allegedly pulled rank at RITM. Though half of them are elderly and all fulfilled public duties, VIP status is no cause for test. More deserving are frontline health workers who minister daily to COVID-19 patients, self-quarantine only when exhausted, and yearn to be with worried loved ones. Of four doctors who have succumbed to COVID-19 as of yesterday, the test result of one came too late. Philippine Medical Association president Jose Santiago appealed to government for priority testing for PUIs, patients under investigation. Health Usec. Maria Rosario Vergeire said the VIPs were tested when the rules still covered mild signs, history of unsafe travel, and possible exposure. They have since strictened it. Forthrightness is key too to public cooperation. There wouldn’t be an issue if test kits were in abundance.

Equality will contain the pandemic. Testing all suspected cases focuses the isolation and breaks the chain of infection. World Health Organization director general Tedros Adhanom Ghebreyesus cited the experiences of China, Korea, and Singapore. Widespread tests enabled their health officials to understand the novel coronavirus, then track and concentrate resources in hotspots. Thence lockdowns were relaxed where possible and socio-economic costs minimized. WHO-Philippines anticipates as many as 70,000 Filipinos to be infected. Ample tests would plot the rise and hopeful plateauing, said Health Sec. Francisco Duque. But the 100,000 kits donated by China last weekend still are inadequate. The virus still randomly is spreading. At exponential rate there would be 26,000 cases by end-Mar., data scientists Christopher Monterola and Erika Fille Legara analyzed for Rappler.

There are two kinds of tests: genetic and serologic. The first pinpoints the SARS-CoV-2 pest that causes the COVID-19 infection. Developed by genomic sequencing weeks after the Wuhan outbreak, it reveals the invader’s RNA. This is then reverse transcribed to DNA for processing, thus the official name: reverse transcription polymerase chain reaction (RT-PCR). Specimens are taken deep from the nose or throat, often inducing coughing, a risky exposure for the swab taker. Fairly accurate, it takes six hours to run with results completed in 48 hours, and costs about $120 (P6,000). Asian and European pharmaceutical firms now mass-produce it.

The other test identifies the antibodies (immunoglobulin) dispatched against the invader. In layman terms, a med explained, the antibodies first on scene are the quick reaction teams (IgM), followed by the specialized reinforcements (IgG). Blood samples are taken by needle prick. The presence of the antibodies indicate battling with SARS-CoV-2. Test results are out in 15-20 minutes, and cost less than $10 (P500). But specialist Dr. Edsel Maurice Salvaña is not too keen about it. The problem is IgM can be detected five to ten days after infection, and IgG up to 21 days, he wrote in Esquire Philippines. Since symptoms begin to show five days after infection, many patients will test negative for IgM and all negative for IgG. Those false negatives – there is disease but undetected – can mislead. Same with false positives caused by other viruses, like colds.

Director General Eric Domingo, Food and Drug Administration, shares Salvaña’s doubts. Several pharmas have applied for antibody test approval. Domingo says no local labs can yet validate their claims. Besides, their first hurdle is to show proof of use in their home countries, not just certificates of overseas application. If the false negative rates are improved, IgM/IgG can be used for confirmatory tests of recovery, and mass screening of frequently long exposed soldiers, policemen, barangay watchmen, factory and hospital workers.

The FDA has approved eight genetic tests as of Friday. Still being validated but very promising is one culled by the University of the Philippines-National Institute of Health from the best features of several prototypes. Cost will be brought down to P2,000 per test, said developer Dr. Raul Destura, deputy executive director of the Philippine Genome Center.

To speed up processing, WHO accredited, in addition to RITM, four more labs: San Lazaro Hospital, Manila; Baguio General Hospital and Medical Center; Vicente Sotto Memorial Medical Center, Cebu City; and Southern Philippines Medical Center, Davao City. Testing capacity is 950 to 1000 cases a day.

An alliance of scientists petitioned Friday Mar. 20 for widespread testing to complement physical distancing and community quarantine. Consisting of more than a thousand microbiologists and health experts, Scientists Unite Against COVID-19 is inventorying labs with qPCR testing machines. Costing several million pesos apiece, the machines can further speed up mass-testing. “Not only is mass-testing a crucial public health measure; we can curb collective anxiety brought about by the fact that we are blindly fighting an unseen enemy and affirm the right of all Filipinos to be treated equitably in access to diagnosis,” they said.

Malacañang has allotted P27 billion for the emergency. Congress is re-aligning P200 billion more. More test kits can be produced or purchased, along with ventilators and respirators for severe cases. A DOH inventory of the latter equipment is also long overdue.

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Gotcha archives: www.philstar.com/columns/134276/gotcha

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