OPINION: Why our country is likely losing the war against COVID-19

Dr. Jun R. Ruiz

Posted at Aug 26 2020 10:44 PM | Updated as of Aug 28 2020 12:04 AM

One day before we entered August, we breached the 4,000 daily new cases mark—a new record as we suddenly doubled the rate of new cases from the previous week. On August 10, records were broken again when 6,958 new cases were reported by the Department of Health (DOH). The Philippines is definitely not winning the war against COVID-19.

I have my own personal thoughts why our country has not been able to turn around the direction in controlling the pandemic. Europe became the epicenter of the pandemic after China was able to control its contagion through aggressive measures of strict quarantine and lockdown. The European Union leaders accomplished the herculean task by regularly meeting via video conference during the peak of the COVID-19 crisis. They closed its external borders to non-essential travel, mobilized resources to support the emergency response among its member countries, ensured supply of protective equipment, and promoted research for treatments and vaccines. Subsequently, these strategies led to a victorious decline of the pandemic in Europe in May.

Despite having one of the longest and strictest lockdowns in the world during this pandemic, the Philippines is losing the war against COVID-19. The strictest Enhanced Community Quarantine (ECQ) was implemented on March 15 till May 15 in the National Capital Region. The restrictions were gradually eased in the metropolis, as requested by the mayors and the business sector due to concerns in the economy. Despite these measures, the national government fails to contain the pandemic as the country continues its downward spiral.

Doctors appeal for timeout

Eighty medical societies and associations made a public appeal on August 1 to the government to place Metro-Manila and the surrounding areas under ECQ for 14 days to give medical workers a “timeout” to recalibrate strategies to stop the record-surge of the pandemic from worsening. The reality is that the healthcare system has already been overwhelmed, as several hospitals again closed its doors to patients with COVID-19. President Rodrigo Duterte implemented MECQ again in Metro-Manila and the surrounding provinces from August 4 till 18.

Stopping the spread of COVID-19 requires finding and testing all suspected persons so that the confirmed cases are promptly and effectively isolated. Testing was the cornerstone of COVID-19 control in Italy, Germany, South Korea, and New Zealand. The close contacts of all confirmed cases should be rapidly identified so they can be quarantined and medically monitored for the 14-day incubation period. In early March, it was just the Research Institute of Tropical Medicine (RITM) that was doing the testing using RT-PCR swab tests, the gold standard in diagnosing acute infection. There were long backlogs in the lab as doctors waited for more than a week for the results of their patients from all over the country to be available. The lack of testing kits early on handicapped this strategy, as asymptomatic and mild cases were not recommended to be tested and were advised to stay home. Months later, the government compensated by pushing for more testing and are now conducting more than 30,000 tests a day.

Rapid Antibody Test

The Rapid Antibody Test (RAT) detects antibodies that are proteins made in response to an infection. These start to develop only after 1 to 3 weeks after the infection, and are negative early on the disease. The RAT should not be used to diagnose acute infection. The sensitivity of the test is affected by the timing: only 30% in the first 7 days of infection, and increases after 14 days of infection. Because of this poor accuracy, there is a high rate of false positives and false negatives. A false positive test occurs when a person who does not have COVID-19 is diagnosed to be positive, while a false negative test occurs when a person who has COVID-19 is tested negative. With a false positive test, the person is unnecessarily quarantined and stigmatized. A patient with a false negative result gets a false sense of security and can start spreading the infection to several people.

As the government was easing the lockdown to gradually re-open the economy, there was pressure from the business sector to bring the workers back to the workplace. The DOH repeatedly warned the public that use of the RAT for clearance to work may result in infected individuals being cleared and inadvertently spreading the virus. Despite these clear policies against using RAT, its advantage as a cheaper alternative was promoted by some influential businessmen, local government units (LGUs), private companies, and certain organizations, leading to its misuse as a diagnostic test for acute COVID-19 infection. Even the national government programs, like the Hatid Probinsya, used this as a screening test with disastrous results. Several thousands of stranded and returning workers to the provinces who initially tested negative on RAT turned out to be positive by RT-PCR test. They became “super-spreaders” and further infected more communities. Using the wrong test in this pandemic can be catastrophic.

No effective contact tracing

Quarantine and isolation prevent transmission of infection, especially when implemented in the early stages of the pandemic. Although there were efforts by the government in building quarantine facilities for the COVID-19 positive and suspect cases, the extent of the usage of these large facilities were not clear to the public. It can be assumed that the majority of affected patients with mild symptoms ended up in home quarantine, potentially affecting members of their household. Those patients who needed isolation should have been brought to these facilities by the LGUs. 
 
Contact tracing is a key disease control strategy for preventing further spread of COVID-19. After testing and isolation, early contact tracing was implemented in most of the successful countries that controlled their epidemic. This past week, we found out that the DOH no longer has a contact tracing team, and Tracing czar Mayor Benjamin Magalong admitted that “only 4 of the 614 LGUs have a good contact tracing team in place”. In all of these months, there was no effective contact tracing happening in the country. There is also a likely failure of Filipinos to maintain social distancing and wearing masks appropriately at all times. Even at workplaces, including the hospitals, employees would eat together without any physical distancing and this has been associated with clusters. In the densely populated areas of Metro-Manila, the congestion and overcrowding of people in their homes lead to likely household transmission.

I am hopeful that the 2 weeks of “time-out” and the additional restrictions imposed during the MECQ in Metro-Manila would bring the Philippines to the right direction in fighting against COVID-19. The increased participation of leading medical experts, specifically the leaders of the Healthcare Professionals Alliance against COVID-19, in the meetings with the DOH and Inter-Agency Task Force (IATF) would provide guidance and the much-needed shot in the arm for these government agencies, where scientists should take the lead instead of politicians. It also time to step up in the basics of pandemic control which are early testing, quick isolation or quarantine, and extensive contact tracing to mitigate the COVID-19 pandemic in the country. We all need to work together, other than waiting for the vaccine to be available. By changing our game plan, only then can we start winning the war against COVID-19.

About the author: 

Dr. Jun R. Ruiz is a gastroenterologist at The Medical City and an author of several peer-reviewed medical journal articles, international book chapters, and health features. He has contributed several articles on digestive disorders, fitness, travel, and social issues in newspapers and magazines. He is a strong advocate for colorectal cancer screening in the country.

Disclaimer: The views in this blog are those of the blogger and do not necessarily reflect the views of ABS-CBN Corp.