RATs
SKETCHES - Ana Marie Pamintuan (The Philippine Star) - August 12, 2020 - 12:00am

From the start, the medical community was divided on the usefulness of the rapid antibody test for COVID-19.

I don’t remember any strong objections, however, from the Department of Health on the use of the test it has now dubbed as RATs in screening for COVID. What I remember is the city government of Marikina complaining that the DOH was sitting on Mayor Marcelino Teodoro’s initiative to open the city’s own COVID testing facility using the gold standard in virus detection, the real time reverse transcription-polymerase chain reaction (rRT-PCR) GenAmplify test kit developed by University of the Philippines scientists and mass produced by a local pharmaceutical company, Dr. Raul Destura’s Manila HealthTek Inc.

Other countries such as South Korea quickly mobilized their local companies to produce PCR test kits at the start of the pandemic. In contrast, we focused on importing test kits, most of which turned out to be RATs.

We listened to a segment of the medical community plus members of the Inter-Agency Task Force on the Management of Emerging Infectious Diseases (IATF) who said that because of the lack of PCR tests, something was better than nothing and RATs would have to do for the moment.

People had the impression that IATF members, mostly Cabinet secretaries, as well as the close-in security of President Duterte were subjected to RATs each time they met with the Chief Executive.

When the Manila city government offered free drive-through COVID tests to the public, the test was for antibodies, not the SARS-coronavirus-2 (SARS-CoV-2) itself.

So government agencies and private companies subjected their employees to RATs as businesses reopened and people returned to work. Scores of people in Metro Manila who were allowed to go to their home provinces were cleared for travel using RATs.

Now we are being told that the DOH never endorsed RATs for screening for SARS-CoV-2, because it produces too many false-positive and false-negative results.

The scientific explanation is that it takes from one to two weeks before an infected person produces antibodies against SARS-CoV-2, so RATs may be administered too early and the result will be a false negative. Or else the antibody detected is in response to a different pathogen.

On the other hand, the rRT-PCR swab test detects SARS-CoV-2 itself, while the latest one, the antigen test, detects the proteins attached to the spikes in the coronavirus.

The DOH says RATs can still be useful in screening PCR-confirmed COVID cases, to determine if they have sufficiently recovered to allow them to safely end quarantine.

RATs is about a tenth of the cost of the swab test. To save on costs, pooled PCR swab testing is being piloted this week.

Still, the DOH warning has raised the question: did the use of RATs as the economy gradually reopened contribute to the community transmission of COVID?

*      *      *

This is on top of the initial confusion over the home quarantine of mild or asymptomatic COVID cases.

Certain local government executives have groused about the belated advisory from the DOH on the guidelines for allowing home quarantine: the COVID case must have his or her own room with its own toilet and bath, and there must be no person in the household vulnerable to infection, such as young children, the elderly, pregnant women and persons with comorbidities.

By the time the advisory was issued, many COVID cases were already on home quarantine, including Filipinos who had returned from abroad as well as locally stranded individuals in Metro Manila who had returned to their home provinces.

Considering the weakness of our contact tracing capability, and even the weakness in ensuring that all COVID cases including the mild and asymptomatic remain in proper quarantine, you can see why the infection numbers are surging. Contact tracing has been aggravated by incomplete or inaccurate data.

In Taiwan, a smartcard allows authorities to track all the places visited by the card holder, making contact tracing quick and accurate. We have a lot of tech-savvy people, especially among the millennials. Perhaps one of them can develop a similar system for contact tracing during a pandemic.

*      *      *

Even with the return of Metro Manila and four neighboring provinces to the stricter modified enhanced community quarantine or MECQ, a record 6,958 new cases were reported last Monday, with 633 recoveries and 24 deaths.

With government coffers nearly empty, and even our great-great grandchildren now buried in foreign debt, the administration has rejected proposals, mostly from health workers and data crunchers, to extend the MECQ by another two weeks.

But you can sense what President Duterte thinks of the carping health workers. In the pandemic response, he keeps referring to “my soldiers,” “my police” – leading people to wonder if they are his private army. Since state forces are on the people’s payroll, how about saying “our soldiers,” “our police”? And how come he doesn’t refer to health workers as “my frontliners”? Because they threatened him, in his dreams, with “revolution”?

*      *      *

As we muddle through our pandemic response, much hope is pinned on the speedy release of a vaccine.

The government has vowed that the first beneficiaries of any vaccine will be the 20 million poorest Filipinos.

Aware of concerns over newly released vaccines especially those made in certain countries, Duterte has offered to serve as a guinea pig in case vaccines from Russia arrive in the Philippines. He has made no similar promise so far in the case of vaccines from his adopted land, China.

Those who can afford to pay are instead waiting for vaccines from the US and Europe. Dr. Anthony Fauci, the top US disease expert, says definitive results of studies on Massachusetts-based biotech firm Moderna Inc.’s COVID-19 vaccine are expected in November or December, but the efficacy could be only 50 to 60 percent, so public health protocols are still necessary.

This means we urgently need to improve our T3 (test, trace, treat) capabilities. The improvement should start in the messaging. There should be no repeat of the common question in the case of the rapid antibody test and home quarantine: Ano ba talaga, ate, kuya?

COVID-19
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