By Argyll Cyrus Geducos
With the approval of the use of rapid test kits for COVID-19, the Inter-agency Task Force (IATF) for the Management of Emerging Infectious Diseases has released new guidelines on the conduct of testing in the country.
Cabinet Secretary Karlo Nograles (Photo from Karlo Nograles / Facebook page / MANILA BULLETIN)
In a press briefing, Cabinet Secretary and IATF spokesman Karlo Nograles said COVID-19 Expanded Testing is the testing all individuals who are at risk of contracting the disease that includes the following:
Suspect case
Individuals with a relevant history of travel and exposure or contact, whether symptomatic or asymptomatic; and
Healthcare workers with possible exposure, whether symptomatic or asymptomatic
The IATF, however, does not recommend indiscriminate testing beyond close contacts of a confirmed COVID-19 case.
At-risk individuals
The IATF has categorized individuals into four subgroups arranged in order of greatest to the lowest need for testing.
Subgroup A are patients or healthcare workers with severe or critical symptoms, history of travel, or contact with a confirmed COVID-19 case.
Subgroup B are patients or healthcare workers with mild symptoms, history of travel, contact with a confirmed COVID-19 case, and are considered vulnerable.
Subgroup C are patients or healthcare workers with mild symptoms, history of travel, or contact with a confirmed COVID-19 case.
Subgroup D are the patients or healthcare workers with no symptoms but have a history of travel to countries or places with community transmission, or contact with a confirmed COVID-19 case.
Rationalize testing
Due to the global shortage of testing kits and limitations in local capacity for testing, Nograles said there is a need to rationalize available tests and prioritize subgroups A and B.
However, in view of the expansion of testing capacity and to ensure healthcare workforce safety, subgroup C will be tested and health workers prioritized.
All sub-national laboratories are directed to allocate between 20-30 percent of their daily testing capacity for health workers and the remaining for patients.
Testing kits
According to Nograles, real-time polymerase chain reaction (RT-PCR) testing is the confirmatory test or test kits approved by the Food and Drug Administration (FDA) and validated by the Research Institute for Tropical Medicine (RTIM).
While rapid antibody-based tests can be used, Nograles said these test kits should not be used as stand-alone tests to definitively diagnose or rule out COVID-19.
"These must be used in conjunction with RT-PCR, care must be exercised to not unduly consume RT-PCR test kits for the sake of confirmation," he said.
"Reporting of confirmed and recovered cases shall continue to be based on RT-PCR testing, in accordance with Administrative Order 2020-0013," he added.
Nograles likewise said that only rapid antibody-based test kits approved by the FDA and locally validated by the RITM or the Department of Science and Technology (DOST) may be used.
The disposal of test kits, including personal protective equipment (PPEs) and other materials used in testing, shall adhere to existing guidelines on the management of healthcare wastes.
Meanwhile, the expanded use of point-of-care rapid antibody-based test kits through validation and seroepidemiological studies shall be explored for Subgroup D, as testing all asymptomatic contacts of confirmed cases using RT-PCR is not recommended until there is surplus testing capacity.
According to Nograles, the results of such validation and seroepidemiological studies shall be submitted to the Department of Health (DOH) and to the Health Technology Assessment Council (HTAC) for their review and consideration.
"This should inform future prospects of financing of DOH and PhilHealth since both agencies may only finance or reimburse COVID-19 test kits that have been positively recommended by the HTAC as required by RA No. 11223," he said.
Revised guidelines for healthcare workers
Based on the new IATF guidelines on Expanded Testing for COVID-19, only licensed medical doctors may request and administer antibody-based tests.
Healthcare workers showing no symptoms for the diseases but had unprotected exposure to confirmed cases should be isolated and tested using the RT-PCR. If no RT-PCR kits are available, antibody-based tests can be used to test them every 14 days. The said healthcare workers should be cleared before returning to work.
Revised guidelines for symptomatic non-healthcare workers
According to Nograles, the testing of all symptomatic patients who are close contacts of a known or probable case must be conducted by health workers equipped with proper PPEs. The patients must be isolated at all times.
However, the testing of symptomatic patients who are close contacts of a known or probable case with rapid antibody-based test kits alone is not recommended.
"If there is no available RT-PCR, validated rapid antibody-based testing that detects both IgM and IgG may be used. However, regardless of results, patients should remain isolated for 14 days or until asymptomatic, whichever is longer," he said.
"All symptomatic patients should be referred for RT-PCR testing and isolated accordingly," he added.
Revised guidelines for asymptomatic non-healthcare workers
All asymptomatic non-healthcare workers who are close contacts of confirmed cases need to complete 14 days of quarantine from the date of the last contact with the confirmed case either at a temporary treatment and monitoring facility or home quarantine if with a solo room and toilet, regardless of the rapid antibody-based test result.
If symptoms develop at any time, samples must be collected for RT-PCR testing.
Rapid antibody-based testing may be used for asymptomatic non-healthcare workers who are close contacts of confirmed COVID-19 cases, provided that rapid antibody-based kits are validated.
Testing may be done twice if there is sufficient availability of rapid antibody-based testing kits and PPEs. The first must be done at the time of isolation, but preferably at least five days from exposure, and another on the last day of quarantine.
For settings with limited availability of rapid antibody-based testing kits and PPE, testing may be done once only, during the 14th day from contact with a confirmed case.
If there are no available rapid test kits and/or PPE, patients can be released from quarantine after 14 days as long as the patient remains asymptomatic.
The testing of asymptomatic people should be performed with proper safety precautions, including hand hygiene, use of appropriate PPEs for conducting the test, respiratory hygiene, waste disposal, and patient care equipment.
Overseas Filipinos
Nograles said overseas Filipinos (OFs) returning to the country should undergo the mandatory 14-day quarantine. They can be tested twice using the antibody-based test kits twice, the first one when they enter the quarantine facility and the other once the quarantine period ends.
Community-based transmission
Based on IATF guidelines, the expanded testing in areas with suspected COVID-19 community-based transmission can be performed at the household, purok, and barangay level with a proper sampling methodology in collaboration with the Epidemiology Bureau and local health officials. A properly validated antibody testing kit should be used for this purpose.
Validation studies
Pending availability of PRNT (Plaque reduction neutralization test) validation by RITM, Nograles requested all who intend to conduct their own validation studies to do the following:
- Register their studies through [email protected] (including an update on the status of ethics approval),
- Use the protocol for local validation study for asymptomatic contacts provided, and
- Report testing results