Omicron this, Omicron that!

Published January 18, 2022, 12:05 AM

by Raymundo W. Lo, MD, FPSP

UNDER THE MICROSCOPE

Dr. Raymundo Lo

Just about everything has been said about Omicron. My son, Richie, was so sick of it he asked we not discuss COVID at lunch even just once. But it won’t go away if we wish for it, so here goes.

It seems almost everyone we know has caught it or is in quarantine for exposure. My COVID RT-PCR testing duties have been keeping me sleep deprived much of the week, with the majority of the tests turning out positive. I’ve had to counsel family after family what to do with affected ones and how they can prevent further spread. That’s how I practically spend the rest of my waking hours, other than still doing other pathology duties like histopath sign-outs and managing the staff depletion due to COVID infections.

I’ve read about calls for mass testing. At this point in time, when there’s widespread community transmission, mass testing is no longer a viable option. As med techs, encoders, and other staff fall to the virus and have to be isolated or quarantined, we can no longer do as many tests as we usually can.

Mass testing is useful if done early in the outbreak, when we can seek out the infected in the community before it becomes generalized. That’s how other countries have controlled it: lockdowns, population testing, contact tracing and isolation. The mass testing involves pooling samples to achieve economy of scale yet is still accurate so as not to miss cases.

We in the Philippine Society of Pathologists Inc., have pioneered the use of pooled testing successfully and had it recognized by the DOH, which has issued guidelines for its use in low-incidence populations.

I advocated this approach early on in the Delta outbreak, calling for localized lockdowns, followed by pool testing the entire barangay or district. Local governments were contacted, but they were too busy with vaccination drives; and resources for testing were not prioritized. I wonder how it could have changed the trajectory of the Delta surge had we done the mass testing at that time. But with Omicron, the explosive increase in cases has precluded pooled testing.

Now, with so many asking to be tested, and the few available RT-PCR labs and their decimated staff overwhelmed by the test volumes, many have turned to antigen testing. We know it is less sensitive than RT-PCR, but when it turns out positive, at least with validated kits, it is very accurate. But positive antigen tests are not reported alongside RT-PCR results, since the DOH has not developed pathways for its reporting. Neither is it used for contact tracing. This is a shame, for this option prevents us from knowing the full extent of the outbreak.

Validation of kits, RT-PCR, and antigen, is assigned exclusively to the Research Institute for Tropical Medicine (RITM), which is admittedly overwhelmed by the sheer number of brands being applied for validation. Some have been sitting there waiting up to now. Not that it is fully RITM’s fault, since the DOH insists that the RITM do the validations by itself. Let’s recognize the public health emergency situation and not have the usual bureaucratic approach to doing business. Other COVID testing labs can be deputized to perform the validations with the supervision and guidance of RITM, thus freeing it for more pressing matters.

There are many antigen test kits being marketed to the public, validated or not. They are sold left and right, and supplies have run out for many distributors, much to their delight. The FDA has labeled those validated as “For use only by medical professionals” yet we know any Juan can purchase a box and test themselves with it. The FDA apparently has no police powers to control this, much like the rapid antibody fiasco early in the pandemic. Yet, DOH insists that antigen kits should not be for home use.

There are antigen kits designed for home use that have applied for emergency use authorization (EUA), but which again have fallen through the bureaucratic cracks. I’ve been asked my opinion on this and I think we should allow its use, even if only for the sake of the consumers knowing their COVID status and hopefully isolating if positive to spare housemates from getting sick.

We’re not alone in this dire lack-of-testing situation. The USA, despite all its wealth and more robust health and testing network, is now in the throes of an acute testing shortage. The Biden administration is going to ship 500 million antigen kits for home use. That says a lot about what their health authorities think of antigen tests.

Now the advice is to prioritize testing for symptomatic cases who are elderly and/or with co-morbids, and for health care worker surveillance. All others with mild symptoms or exposed should quarantine ASAP and monitor for symptoms/progression. Sensible considering our current testing scenario. But it doesn’t address the acute need for travel clearance, now that LGUs are once again demanding negative RT-PCR tests before accepting non-residents into their jurisdictions. Neither does it address the concerns of business trying to keep open despite thinning ranks due to COVID infections.

Ok, Richie, I’ll stop talking about COVID now.

 
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