On Testing and Vaccines

Published September 15, 2021, 12:12 AM

by Raymundo W. Lo, MD, FPSP

UNDER THE MICROSCOPE

An opinion column I read Monday cites a massive testing and treatment program which is patently FALSE. Majority of testing occurs in private labs that operate more efficiently and are paid for by individuals being tested since PhilHealth will not reimburse non-admission cases. Even some government hospital labs have more private cases than government-funded. Heck, government labs insist on upfront payment too.

COVID treatment is likewise done in many private hospitals which up to now are not being reimbursed by PhilHealth causing these hospitals to ask patients to pay out of pocket first and when PhilHealth reimburses the hospital, the patient will be refunded. But that’s a big IF.

So what massive program is the column talking about?

He goes on to say those who have symptoms should not be tested anymore. REALLY? Can you imagine your father being admitted in the COVID ward without being tested and he turns out to have another viral infection? Well, he will certainly catch COVID there for sure and perhaps die of it because he wasn’t tested before admission. In Medicine, we have the dictum: “Primum non nocere,” Latin for “First, do no harm.” That’s why we need to confirm our diagnosis before treating a patient. Wrong diagnosis, wrong treatment. Patient doesn’t get well and dies needlessly.

Imagine how that will affect our epidemiologic data? No testing, just assume a case is COVID. Public health policies rely on accurate data, so how on earth will this approach help? As it is, we are simply not testing enough based on WHO standards. To adequately gauge the extent of the pandemic and isolate most if not all positives to prevent further spread, our positivity rate must be at most 10 percent, or if using a population measure, we must test 10 percent of our population every day.

So, how are we doing testing wise? We haven’t even approached 100,000 tests a day (conservative population estimate 100 million). If you consider that we have 20,000 cases daily, we must test at least five of their close contacts, which incidentally, is also 100,000. Scale down testing? No, sir. We actually have to increase testing. The government early on bought millions of PCR kits and these should be used to test for free, since most of our government COVID testing labs were set up with equipment donated by the private sector thru GoNegosyo. Besides where are the Bayanihan funds earmarked for COVID response? Ah, but that’s another whole kettle of (rotten) fish entirely.

In war, the first dictumis: Know thy enemy. In this case, the enemy is an invisible virus hiding in plain sight in symptomatic and asymptomatic individuals. If we don’t know who the enemy is, how do we even fight it? While it is true only about two percent of infected persons need hospitalization, we must identify them first to provide the medical care they need. The asymptomatics are more likely to spread the virus unknowingly since they don’t feel a thing and can go around and infect tens or hundreds of people they come in contact with. Is it important to test them? Of course! Or else we’ll never see the end of surges like we’re having now.

Vaccines are definitely important to keep you from landing in the hospital with severe COVID that ups the risk of dying. It may not prevent infection but that’s not the intent of vaccination.

Unfortunately for us, we don’t have enough vaccines yet for everyone who wants the jab. There’s a worldwide shortage but that’s not reason for not having prepared early to get our share of the supply. We may have also bought vaccines at a higher price but how are we to know if there’s a shroud of secrecy there.

Vaccination roll outs are also problematic. Our government insists on bureaucratizing everything including the pandemic response. There’s always a form to fill up here, an interview there, doctors required to take vital signs and endless waiting in line, sometimes for hours. This is from personal experience being a volunteer vaccinator at our village vaccination activities. Contrast that with getting a shot in the USA where all you have to do is log in online which schedules you at a date and time, then you show up and get a shot after you show an ID card. It doesn’t matter if you’re an American citizen, illegal immigrant or just a tourist. Fast and easy. No sweat or time wasted. I should know since I got my Pfizer shot there.

Why should there be a choice between testing and vaccines? If funds are the problem, that’s a government concern. With trillions of pesos in foreign loans, there should be enough for both. Why must we choose between one or the other? It’s a false dichotomy being foisted by those who stand to earn big, no, huge bucks by siphoning off COVID funds to other lesser priorities (see recent headlines and weep) and of course, the C word.

There is so much to do to ramp up COVID responses which must definitely include TESTING and VACCINES, not to mention good contact tracing (at which we suck), and putting up isolation and quarantine facilities, field hospitals and increasing hospital staffing.

 
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