Still on COVID-19: A closer look at DOH mass testing

THE COVID-19 pandemic may have caught the world off-guard, but with the right combination of resources and sound policy-making, some countries have addressed the peril more effectively than others. South Korea is often cited as a model in mass testing, without having to impose a strict lockdown.

In the Philippines, the national government enforced a region-wide “community quarantine.”  Even with the highly restrictive policy, the public remains afraid of contracting the disease, unsure that the measures adopted include enough checks on asymptomatic carriers, persons who would not be tested given the existing criteria.  

The Department of Health (DOH) had insisted on the use of the confirmatory polymerase chain reaction (PCR) test. Secretary Francisco Duque had said at first that government did not have resources to acquire enough of these tests. He also said that the test required high safety infrastructure to protect those working in the laboratories.

On April 14, the DOH said it was now ready to do “expanded testing” which covers “1) suspect cases or 2) individuals with relevant history of travel and exposure (or contact), whether symptomatic or asymptomatic, and health workers with possible exposure, whether symptomatic or asymptomatic.” Testing beyond close contacts of confirmed cases is still not recommended by the DOH.  Are the people’s fears and anxieties unfounded? 

CMFR cheers Rappler for looking into the capacity of the country in addressing this public health issue. Carmela Fonbuena’s “How poor is the Philippine health system? Many hospitals not qualified to test for coronavirus”  on April 21 identified the problems besetting the implementation of confirmatory testing of COVID-19 cases, which can ultimately be traced to belated responses from the national government.

Fonbuena reported the following keypoints of information:

1. Few government-run hospitals are equipped to conduct the confirmatory polymerase chain reaction (PCR) test, as this requires laboratories to meet certain biosafety levels and have staff with training in handling viruses.
2. The Research Institute for Tropical Medicine (RITM) was the sole facility to process samples in the early days of the pandemic, initially only capable of doing 300 tests daily. It only started accrediting other laboratories after the enhanced community quarantine was implemented.
3. Out of 17 laboratories accredited, only five are outside Metro Manila: two each in Luzon and Visayas, and one in Mindanao. Many more hospitals are trying to meet accreditation requirements. (As of this writing, one more accredited facility in Metro Manila has been added to the list.)
4. In Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), not a single hospital qualifies for testing. It’s most advanced hospital only qualified as a referral center. BARMM looked to Zamboanga City for help, but even the city had no testing center of its own. Suspected cases have died in Sulu province without getting tested.

These points paint a rather grim picture of the progress or lack of it in the much touted roll-out of DOH’s so-called mass testing. Questions about speed for getting the results as well as the reliability of results are major issues of efficacy.

Fonbuena also described efforts of local governments, such as the cities of Valenzuela and Marikina, to address the pandemic early on, such as building their own laboratories, procuring test kits and making arrangements with private facilities still undergoing accreditation. Valenzuela is among the first cities to conduct a “localized targeted mass testing,” after much painstaking work. Marikina itself had to contend with delays in the accreditation of its laboratory.

Fonbuena said mayors criticized the national government’s failure to ramp up the country’s testing capacity during the month-long lull between the first reported case contracted through foreign travel and the first reported local transmission. She added, “local officials continue to demand more, calling for true mass testing as concerns grow over asymptomatic cases, who may not be included in the national government’s criteria for testing.”

Fonbuena did not elaborate on the “true mass testing,”but many doctors and experts have called for mass testing through the use of rapid antibody test kits. There was no description of these kits in the report, however, and how it differs from the PCR testing.

The report would have been more pointed if the rationale for their use was discussed, especially since the government has only announced the evaluation of rapid test kits last April 20. As of April 24, the Food and Drug Administration has approved 22 rapid antibody test kits, which after RITM’s evaluation may be used for asymptomatic patients, along with those who have recovered, and everyone else who may not fall under the current standards of testing.

Other media would do well to follow this lead. People need to know that despite the restrictive quarantine, if there is no widespread use of rapid antibody testing, the gains of the quarantine can be lost by the failure to check more widely infectious carriers among the population.

The DOH has mistakenly seen only the usefulness of the PCR for diagnostic purposes. But unless these are supplemented by rapid tests, the government will have no clue about the spread of contamination in the populace.

Former Health Secretary Manuel Dayrit shared the local executives’ sentiment, telling Rappler that there was a failure to think ahead on the part of the current DOH. Dayrit said that the Philippines remains in the “caveman days” of testing, citing long turnaround times for test results, which can further be delayed by issues such as transport of samples. He pointed out South Korea’s learning curve from the Middle East Respiratory Syndrome (MERS) in 2015: expanded production of PCR tests kits with government support, and renewed interest of physicians to specialize in molecular biology.

Dayrit added that the Philippines has no choice but to improve on the current system, and that the government’s priorities require re-evaluation once the pandemic is over. His observations reinforce the view that all kinds of testing should have been explored from the very beginning when there were only a few cases, and that the health system itself needs priority attention from government, including the necessary allocations to improve its capacity to promote the health of those who have no means of paying for private hospitals. The gaps cited in Rappler’s report must remind everyone that as punishing as the lockdown is, so much more needs to be done by government to curb COVID-19. Beyond reporting cases, the news must call attention to such inadequacies for these to get immediate response.