Let docs lead, but Duterte must decide

The feedback I received for last week’s column—on a rambling, undisciplined, fatalistic President Duterte as the government’s weakest link—included some reluctant or rueful recognition from members of the diplomatic community and even from government officials. (Yes, there was a lot of hate, too, from the usual suspects.)

And while it was a real breather not to hear from the President over the holiest days of the Christian calendar, we would need the same rambling, undisciplined, fatalistic President to decide on the crucial next step in the country’s handling of the worst health emergency since the Spanish flu of 1918. Do we follow the successful example of South Korea, Taiwan, and Germany in conducting mass testing using rapid antibody tests, or do we conduct more tests but using only the “gold standard” of testing, the RT-PCR diagnostic panel?

The Philippine College of Physicians (PCP) and the Philippine Society for Microbiology and Infectious Diseases (PSMID) have issued a joint statement discouraging the use of rapid antibody tests for COVID-19.

As I understand it, the doctors’ consensus is based on their “thorough review of the evidence,” that these antibody tests are in fact poor tests. They make four recommendations; each of them seem counterintuitive, in the light of the successful experience of South Korea, Taiwan, and Germany in “flattening the curve” of COVID-19 infection. But it is our doctors speaking:

Let me highlight only the first: “We do not recommend clinical use in the first 14 days of illness because of the high false positive rates and false negative rates. False negative rates are particularly worrisome, because they may lead to false reassurance and inadvertent exposure. They pose a threat to healthcare workers, the patients themselves and the households they belong to. In addition, pending results of ongoing trials, management remains the same for COVID-19 and non-COVID-19 respiratory illnesses.”

This is easy enough to follow: False positive means a healthy person has failed the test; more worryingly, false negative means an actually sick person has passed the test. Hence, “false reassurance and inadvertent exposure.”

But other doctors, including Dr. Tony Leachon, one of three senior advisers to the Department of Health, have continued to call for mass testing as conducted by the Koreans, the Taiwanese, the Germans: That is to say, using rapid antibody tests with quick turnaround times.

Leachon has approvingly referred to the New York Times article on “How South Korea Flattened the Curve,” which identifies the four key elements of the Korean response. Element No. 2 is “Test Early, Often, and Safely.” The tests, which can be done in as little as 10 minutes in over 600 testing centers, including drive-through stations and walk-in booths, must be of the rapid antibody type.

Are the antibody tests available to the Philippines of markedly inferior quality to those used by South Korea, Taiwan, and Germany? (The first two have donated or are ready to donate test kits to the Philippines.) Did the “thorough review” conducted by the PCP and the PSMID factor in the successful use of the same tests by the three countries?

Here’s a layman’s question. Can’t the testing protocol for the rapid tests require repeated negative tests before a patient can be pronounced negative of the coronavirus? That’s already the protocol for RT-PCR tests. Another layman’s question: Even if the antibody tests are only 41-percent sensitive, wouldn’t that mean that a still significant plurality of those potentially sick with COVID-19 can be isolated, thus reducing the pool of potential carriers?

I realize that deciding on a matter like this cannot be decided by pure science alone. Because it is quite literally a matter of life and death, the decision must include nonscientific factors, including financial resources or the lack of them, and the political will to endure yet another extension of the quarantine. We aren’t at the same stage as the Philippines during the Spanish flu pandemic, where (we learn from Francis Gealogo’s scholarship) at least 80,000 people died, out of a population of roughly 10 million. But we must decide whether to use rapid antibody tests at all.

Who decides? We are—despite the deliberate blurring of the Constitution’s red lines under this administration—still a representative democracy. That means that the buck stops with President Duterte. I hope he overcomes his sense of fatalism, which is really a surrender to one’s circumstances, and acts instead like our fate is still in our hands.

On Twitter: @jnery_newsstand, email: jnery@inquirer.com.ph