Scaling up COVID-19 testing

As the world grapples with the COVID-19 pandemic, two practices—one ancient, another modern—have emerged as essential to any plan to contain it. The ancient one is that of quarantine, which comes from the “40 days” (quarenta) of isolation during medieval plagues. Long before the advent of germ theory, let alone virology, people knew that physical—not social—distancing could prevent the spread of epidemics.

The modern one, meanwhile, is that of diagnostic testing. As with other infections, the rationale for COVID-19 testing is clear: At the individual level, it allows for informed clinical decisions; at the community level, it can guide policies concerning contact tracing and quarantine. At the national and global levels, meanwhile, testing gives a clearer picture of the full extent of the pandemic, and allows us to measure real progress in containing it. As WHO chief Tedros Adhanom Ghebreyesus said, “You cannot fight a fire blindfolded. We cannot stop this pandemic if we don’t know who is infected”; thus, he has called on governments to “test, test, test.”

Beyond its epidemiological functions, I would add that testing also has “symbolic efficacy,” soothing the anxieties of a panicked public and reassuring them that the government is in control.

Despite these clear rationales for testing, our country has lagged behind in terms of testing, owing to a number of problems, including a very limited testing infrastructure. Dr. Edsel Salvaña, who advises the government on its pandemic response, has stated that while testing everyone is “an ideal strategy,” as with other countries we have to follow a protocol that as of March 16 limits testing to persons under investigation (PUIs) who are elderly or with underlying conditions, and admitted PUIs in severe or critical condition.

Unfortunately, even this restricted protocol has been undermined by politicians, VIPs, and their families who have seemingly gotten preferentially tested. “What hurts me the most is that here we are, risking our lives, getting exposed to COVID-19 and we can’t even get ourselves and our patients tested,” a medical frontliner told me. Already, some PUIs have died without knowing their COVID-19 status.

The lack of human resources to do contact training and specialized laboratories to do the tests, not to mention bureaucratic delays, have also prevented the Department of Health (DOH) from scaling up. Adding to the challenge is the fact that LGUs are not directly under its control, and some coordinate better than others.

The consequences have been catastrophic. Without knowing where the cases are, authorities are resorting to increasingly draconian measures that are leading to unintended consequences, particularly among the poor and elderly. Moreover, held against the mirror of other countries, the lack of testing is adding to people’s doubts and fears.

Which is probably why many have resorted to, or counted on false hopes raised by, home-based tests with results within minutes. These tests, however, detect only the antibodies to the virus and not the virus itself, and can thus yield many false negatives and positives. For this reason, we need the more sensitive nucleic acid (RT-PCR) tests, which require not testing kits, but specialized laboratories and people to run them.

Thankfully, the DOH is responding to this gap, despite its initial underestimation of the pandemic. More kits are arriving or are being validated (e.g., the one developed by UP-NIH at a fraction of the price of foreign ones), and more laboratories are being accredited or activated to do the tests. More people are also being recruited for contact tracing. As with the call for “volunteers” for COVID-19 hospitals, the DOH should compensate them, for accountability and fairness.

Communications efforts are also being mounted, with the DOH tapping various sectors for assistance. Amid an epidemic of fake news and faux expertise, credible information must reach an anxious public, even as actions—such as scaled-up testing and an end to VIP tests—would comfort better than words.

All of the above actions would only be enough if done strategically, with the utmost urgency, efficiency, and transparency, and with the full force of our national resources. The COVID-19 threat has put our government and health care system to the test, and failure is not an option.

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