UNDER THE MICROSCOPE

On May 5, 2023, the WHO declared an end to the Covid-19 health emergency. While this is reason to celebrate, having endured three years of various restrictions, we have to pause and consider the repercussions on the testing labs.
To combat the pandemic, over 300 Covid-19 testing laboratories were set up at great cost in terms of equipment and staff training. We couldn’t have weathered the pandemic without the voluminous testing that these labs did. Their medical technologists and pathologists labored night and day, 24/7, to deliver results that guided the doctors in their patient management, the government bureaucrats in crafting policies either to restrict or relax emergency provisions, and the public to know their health status and take appropriate steps to avoid infecting their family members.
In the past year or so, some of these laboratories closed down, no longer able to support their operations due to decreased testing volume.  Undoubtedly, there were some that were financed with an eye to making a quick buck out of the situation, and these were the ones that packed up and left. However, there are still a sizable number that continue to operate at greatly reduced censuses, and herein lies the rub. These are molecular laboratories with advanced equipment and now well-trained staff in molecular techniques, spread out all over the country. It can be said that prior to the Covid-19 pandemic, the Philippines was a laggard in the molecular sciences, with just a few major hospitals performing various clinical testing using molecular techniques. (Disclosure: the author, in his capacity as clinical pathologist at St. Luke’s Medical Center, had been conducting molecular tests since 1992, including paternity testing.) So, the country was virtually dragged, kicking and screaming figuratively, into the molecular age in a very short amount of time, which is actually a good thing.
In case we come across another pandemic, which, in this day and age, can happen in years rather than in decades, we now have the capacity to perform the required testing in volume. It can even be applicable in certain epidemics, to forestall further spread of infectious diseases.
Yet, even at this point in time, the Department of Health (DOH) has not moved to capacitate these laboratories, which are licensed exclusively to test for Covid-19, to perform other molecular testing in infectious diseases, cancer detection and management, and inheritable genetic diseases. With the end of the pandemic situation, we will see such a rapid decline of Covid testing that these labs will be forced to close down, becoming unviable operations with staff salaries to pay, and rent and maintenance costs that will not be supported by the income from testing for Covid-19.
In fact, at the last Philippine Society of Pathologists convention DOH Hour, the guest speakers from DOH said they are still eliciting recommendations from our specialty society on how to proceed with this situation. The DOH, in its draft administrative order, considers molecular testing to be so advanced and esoteric that it requires special licensing. Sadly, this is not the case. Modern medicine has advanced, such that molecular testing can be performed in the regular clinical lab like other tests. Molecular testing is now essential in cancer treatment, infectious-disease detection, blood banking, and practically all branches of medicine.
Enacting restrictive requirements for molecular testing in clinical laboratories will only retard development of new technologies that are now de rigeuer in clinical laboratories worldwide. This was essentially the same scenario back in 1988 when the DOH required medical technologists to undergo two-week training before granting them special licenses for HIV testing. But, in fact, the immunologic test for HIV is just a routine immunologic technique in clinical labs. The offshoot of this was to hinder widespread testing for HIV. It also spawned a black market for HIV-licensed medtechs, since there were not enough HIV trainings offered by the DOH to satisfy the demand. The additional requirement of counselling likewise deters many from getting HIV tests, which may be why HIV is rapidly spreading in the country.
What the DOH needs to do is to open up molecular testing for other diseases in the Covid labs as well as in other clinical labs already offering or intending to offer molecular tests. Let the professional societies have a hand in ensuring quality measures. If this is not feasible, have their reference labs offer periodic testing challenges to determine how the labs are doing. Unfortunately, the laboratory staff of the Research Institute for Tropical Medicine (RITM) has been suspended, unjustly, in my opinion, for the Pharmally mess; whereas the main characters in the purchase of the Covid-19 RT-PCR kits have not been charged or were able to leave the country without being charged.
There is such a thing as over-regulation. Please don’t fall into the trap again, DOH.