Virus testing, tracing, isolation to escalate
GOTCHA - Jarius Bondoc (The Philippine Star) - April 8, 2020 - 12:00am

A two-week extension of the Luzon lockdown is cramped. By end-Apr. government will strive to flatten the pandemic curve. That is, lessen COVID-19 infections, notably deaths that are double the recoveries. The World Health Organization’s prescription stays: test, trace, isolate, and treat all cases possible. Yet basics like test kits and labs, hospital beds and ventilators are short. People need to be informed and fed too, as homes are the first line of defense against the new coronavirus.

Frequent hand washing, physical distancing, and stay-in remain crucial. But those are tough in waterless shanties in crowded slums. Bulk of the 84,000 curfew violators since the humid lockdown began mid-Mar. had merely strayed outdoor for fresh air. They need free facemasks until taught to make their own and as livelihood. People will grasp that masks complement spacing. As Johns Hopkins Hospital noted, Taiwan, Korea, and Japan curbed outbreaks by universal masking, which Europe and America failed to follow.

Simpletons need educating. Stoning the houses of infectees and lynching frontline health workers do not decontaminate. Officials who lock food or medicine in their locales, and lock out health or returning overseas workers need disciplining.

Most prone yet least likely to survive infection, the elderly and ailing can stay home. Still people will go out for food. Best if government can bring it to them. The P200-billion Bayanihan fund is only for Apr. and May. If outbreak resurges or in just partial free-up, P100 billion more a month must be doled – P5,000-P8,000 each to 18 million poor families. Forecast normalization is Nov. at best. Congress might have to realign up to P600 billion more from the P4.1-trillion national budget. Retain only the salaries and operating expenses of government employees.

Micro, small and medium enterprises – the country’s main employers – will need cash aid too to keep going. Or else, joblessness and hunger will ensue.

Government needs accurate data. Of late only severe and critical cases are reported daily, along with deaths and recoveries. Analysts are thrown off. Mild and moderate cases remain undetected due to shortage of test kits and processing labs.

The Dept. of Health will double its 150,000 kits on hand by mid-Apr. Only then will every person under monitoring and under investigation will be tested. (PUM: confirmed exposure and comorbidities; PUI: both plus symptoms.) The kits are expensive, P6,000-P8,000 apiece, and take long to process, at least  two days. Called RT-PCR (reverse transcriptase polymerase chain reaction), DOH prefers it for ability to identify the SARS-CoV-2 virus. Patients need to be tested up to thrice each to confirm recovery. WHO-Philippines anticipates 75,000 infectees. Four days ago the Food and Drug Administration licensed a domestic variant by the University of the Philippines-National Institute of Health and a private pharmaceutical, at half the price. 

Yesterday DOH consented to use as well the alternative serologic test, said Dr. Anthony Leachon. It is cheaper, P500 apiece, and faster, 15-20 minutes, according to the special adviser to National Action Plan COVID-19 chief implementer, Sec. Carlito Galvez Jr. The test counts the antibodies that combat the virus. DOH has tens of thousands ready for distribution to hospitals, Leachon added.

DOH previously belittled it for being only 60-percent accurate. As the first antibodies can appear only on the fifth day of infection, and specialized ones as late as 11 days, the peril of false negatives is high; meaning, people wrongly cleared would be walking around infecting more. But the RT-PCR could be no different. The Journal of the American Medical Association said different methods in taking of specimen result in huge inaccuracies too (see https://jamanetwork.com/journals/jama/fullarticle/2762997).

The antibody tests would now be used to complement the RT-PCR. Confirmation of recoveries can be done by serologic. As well, for patients dying of TB, chronic obstructive pulmonary disease, pneumonia, and other respiratory ailments, which are among the ten causes of mortality. And for screening health workers, soldiers, policemen, food processors and bank employees who are frequently exposed for long periods. To screen as well potential donors to the Philippine General Hospital’s call for blood donations from recovered patients, to test if their antibodies can save critical ones.

Contact tracing needs to be digitalized, like in South Korea and Taiwan. Apps can be replicated. Filipinos may be unwilling to surrender freedoms and personal data like in China, where each citizen is rated on mobiles as green or safe, yellow or exposed, and red or positive. But it would help to adopt Korean and Taiwanese apps that pinpoint through smartphone the whereabouts of positives and thus ensure quarantine.

Isolation and treatment are to be improved. Being refurbished are state-owned Rizal Memorial Sports Complex in Manila, and Philippine International Convention Center and World Trade Center in Pasay as quarantine centers for PUIs and PUMs from slums, to avoid infecting families and neighbors. Provinces and cities, churches, and private groups can follow suit. Marikina mayor Marcy Teodoro, Caloocan Catholic bishop Pablo David, and Popburri (organic popsicles and burritos) restaurant owner Camille Dowling Ibanes have shown the way. Camille provides not only free food, but also rooms, baths, sleeping mats, medicines and laundry facilities for the homeless.

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Catch Sapol radio show, temporarily moved to Fridays, 10 a.m.-12 nn, DWIZ, (882-AM).

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

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