PGH team: Mass testing attractive but not feasible

MANILA, Philippines — Since the spread of COVID-19 in the country early this year, various groups have urged the government to conduct mass testing to help contain the disease.

But based on the experience of the Philippine General Hospital (PGH), mass testing as conducted, for instance, among health-care workers has proven to be not as helpful as it was thought. Not only did it turn out to be resource-intensive, but it also failed to detect infections that were still in the early stages.

In an 11-page policy paper recently released, the state-run hospital’s COVID-19 Crisis Team said routine mass testing twice a month in the hospital was “not feasible,” as it took them “over four weeks” to finish testing some 5,000 healthcare workers.

The team added that if the materials they used for mass testing weren’t donated, PGH would have spent at least P18.5 million in that single round of test.

“Given the cost, operational and logistical limitations of testing health-care workers every few weeks, the mass testing for all health-care workers is not sustainable in our institution at this time,” said the team composed of doctors Regina Berba, Eric Berberabe, Bill Veloso, Rodney Dofitas, Lilibeth Genuino and medical director Gap Legaspi.

They added that “this massive manpower requirement for a routine testing will be taxing to a system with competing needs. Instead these huge resources can be channeled to proven and cost-efficient preventive measures.”

FRONT LINE The government’s premier medical facility, the Philippine General Hospital —MARIANNE BERMUDEZ

Targeted testing

As a COVID-19 referral facility, PGH currently handles 181 patients confirmed or suspected to be infected with the SARS-CoV-2 virus that causes the respiratory disease.

Since testing for COVID-19 is “time sensitive,” doing it for no reason would not prove beneficial to the tested individual, Berberabe said in an Inquirer interview on Friday.

“We have findings that … if you get exposed on Day 1, you will be symptomatic on Day 5. Your test will be positive only on Day 3. So the first two to three days, your test result will return negative even if you have COVID-19,” said the physician, who heads the PGH health information education and communications division.

Dr. Jonas del Rosario, the PGH spokesperson, said this was the reason hospitals put out testing guidelines because of the need to understand that “we have to test based on science.”

Instead of mass testing, PGH advocates targeted testing, wherein front-liners are tested when they are symptomatic, when they have been unduly exposed to a COVID-19 patient, when they have been exposed without wearing proper protective gear, or “whenever they feel they need to be tested.”

“In PGH, we listen to them. If exposure is really there, we tell them this is the best time to have you tested,” Del Rosario said. “We know that you are scared but the test will be wasted if it comes back negative, and possibly the timing was off.”

‘Attractive ideas’ dropped

Apart from mass testing, the use of rapid antibody tests was one of “two attractive ideas” that PGH took out from its COVID-19 operations as the premier government hospital ultimately found it unhelpful.

Using donated rapid test kits, PGH found that of the 60 health workers who tested positive using the standard reverse transcription-polymerase chain reaction (RT-PCR) test, only 12 were positive in the rapid test.

“If we were to rely on the rapid antibody test as the screening tool, and then swab only those with positive results, then we would have missed 48 out of 60, or 4 out of every 5 positive COVID-19 cases,” the PGH team said in their paper.

They added: “The level of sensitivity at 20 percent for PGH is too low to be of any value. The number of potential missed cases of 80 percent is too dangerously high to even consider rapid antibody test as a screening tool.”

In an interview, Berberabe explained that “if you use it to diagnose the presence of the disease, that’s wrong. We’re not saying that it has no use, but we hope that it is used for the intention it was meant to.”

The PGH team also emphasized the need for contact tracing in communities.

“To cut the transmission, persons with high-risk exposure need to be identified, alerted and voluntarily go for strict isolation as soon as [they have] symptoms. COVID patients are most infectious from one day before and up to the first three days of start of symptoms,” the PGH team said.

“Contact tracing loses its impact if initiated one day, one week, one month after the case is identified. Quarantine must start upon identification of a high-risk exposure. If we wait for the COVID-19 test results, as many persons usually do, it might already be too late and many persons may have already been exposed,” they said.

Virus case update

On Saturday, the national caseload climbed to 157,918 as the Department of Health (DOH) recorded an additional 4,351 cases.

Of the new cases submitted by 96 out of the 103 accredited laboratories, 2,460 came from Metro Manila. This was followed by Laguna (232 cases), Cavite (211), Cebu (187) and Rizal (184) provinces.

Majority of the new cases, or 3,469, fell ill between Aug. 2 and 15, and 618 in July.

There are now a total 83,109 active cases, of which 91 percent are mild, 7.5 percent are asymptomatic, 0.6 are severe and 0.9 are critical.

Time-based recovery protocol

The number of active cases is expected to drop today as DOH is set to tag thousands of mild and asymptomatic patients as having recovered from COVID-19 under its time-based recovery protocol.

A total of 72,209 patients have recovered, with the addition of 885 more patients.

The death toll, however, jumped to 2,600 as 159 patients were reported to have succumbed to COVID-19: 57 this month, 61 in July, 37 in June, three in May and one in April.

Central Visayas had the most number of fatalities at 71, followed by Metro Manila (61), Calabarzon (16), Central Luzon (2), Zamboanga (2) and Ilocos, Soccsksargen and the Bangsamoro Autonomous Region in Muslim Mindanao, with each having one recorded death.

To date, more than 1.8 million persons have been tested. The national positivity rate stands at 10.23 percent, more than double the less than 5-percent benchmark of the World Health Organization.