The national government continues to struggle with mass testing as testing capacity remains remarkably unchanged, while it has changed at least four times how it will call the testing to be conducted in the country—from mass, massive, progressive to expanded. As the label changes, so does the testing protocol or prioritization of who would be tested.
The World Health Organization (WHO) has long recommended to countries to pursue an “offensive strategy” in the outbreak by conducting mass testing.
DOH Sec. Francisco Duque III, as did other government officials, dissuaded calls for “mass testing” that they understood to mean testing all 100+ million Filipinos, the whole population. For months, they declared aversion to mass testing.
But public sentiments agreed they only simply wanted the government to conduct more tests, to conduct tests on persons under investigation (PUIs) who are classified as such as they already have severe or mild symptoms, persons under monitoring (PUMs) who has a risk of contracting the disease due to exposure of those with symptoms or confirmed cases, those who are vulnerable especially the elderly, and health workers in the frontlines.
Mass testing and massive testing
National Task Force COVID-19 (NTF COVID-19) Chief Implementer Carlito Galvez, Jr. announced on April 2 that the government will start “massive testing” on April 14. But on April 3, he said “mass testing is ongoing” with 16,368 tests conducted. The number is a high jump from the more than 5,000 tests the Department of Health (DOH) reported just a day earlier. The number would be explained later to include repeat tests.
The DOH was quick to reply that the “massive testing” Galvez referred to does not mean everyone will be tested. Massive testing is for for PUIs and PUMs for possible infection with severe or mild symptoms, as well as health workers, pregnant women and those with preexisting medical conditions, such as cancer and diabetes. These parameters are almost the same as the then-current protocols of DOH for testing, adding only frontliners and then PUMs, but still in the lowest priority if testing ever reached the lower rings of priority.
The following day, DOH USec Maria Rosario Vergeire backpedaled from previous statements that “mass testing is not needed” and said that the agency has been doing mass testing from the beginning following a risk-based protocol.
According to a post by Inter-Agency Task Force on Emerging Infectious Diseases (IATF) Consultant Dr. Edsel Salvana, “massive testing” is to test everyone who needs a test, including close contacts of known cases and some sampling in the community.
He added, “Testing people who don’t need the test is a waste and can lead to misleading data, given the limitations of testing accuracy,” as he explained his differentiation between “massive” and mass testing.
Progressive testing
From risk-based protocol, the DOH announced that it would now follow progressive testing a day before the promised day that massive testing would start.
Once the Philippines is already capable of conducting a total of 8,000 tests per day, a more expanded mass testing covering a larger population will be enforced.
“Sabi natin ang expanded testing is progressive. Kapag dumating tayo sa kakayanan ng ating gobyerno and laboratory capacity-wise na nakagagawa ng 8,000 tests per day, isasama na natin lahat ng may exposure, may history of travel na may sintomas,” Vergeire said on April 13.
[We say that the expanded testing is progressive. When we reach 8,000 tests per day that the government and laboratories can handle capacity-wise, we will then include everyone who had exposure, and history of travel with symptoms.]
Asymptomatic frontliners will also only be included in the progressive testing once the country’s laboratories are capable of conducting 8,000 tests a day–a DOH target for the end of April. However, health care workers in the frontlines numbered to 766 as of April 17, accounting for 13% of confirmed cases in the country.
“Progressive mass testing,” would prioritize those who have severe flu-like symptoms, the elderly, pregnant women, the immunocompromised, and medical workers who show respiratory symptoms. The government will no longer test PUMs. Valenzuela City Mayor Rex Gatchalian relayed the cases of 5 PUMs who tested positive in the city’s targeted mass testing on April 15, raising the question to DOH “are we not in danger of releasing potential carriers into the community that may lead to contagion.”
Various local government units (LGUs) in the National Capital Region—a region or 13 million people identified as COVID-19’s epicenter in the country—no longer waited for the national government’s mass testing as they announced the start of their own mass testing last week. These local mass testing programs, as scheduled, coincides with the national government’s efforts to start “massive testing” supposedly on April 14. LGUs tested more than the national government protocols, collecting swabs from their PUIs and PUMs. The local mass testing in Metro Manila LGUs will still be processed in the DOH-accredited labs that will be loaded onto the country’s 4,000 tests per day capacity at present.
While more swabs are collected or more tests are conducted with the local mass testing, the total testing capacity of the country has yet to increase for considerable “mass testing” to take place. From last week, only one lab was added, only 1,000 tests were added to the target capacity (now at 4,000). But the average tests conducted per day in the past week is only around 2,600 per day.
Expanded testing
On April 14, DOH Usec Maria Rosario Vergeire said that those “most at risk for COVID-19 will be prioritized for the expanded testing as prescribed by DOH Department Memorandum 2020-0151, and reiterated by Department Circular No. 2020-0179.”
The DOH identified two subgroups: (1) patients or healthcare workers with severe or critical symptoms and history of travel or exposure, and (2) patients or healthcare workers with mild symptoms, relevant history of travel or exposure, and considered vulnerable (e.g. 60 years old or older, has other illnesses such as hypertension and diabetes, or is immunocompromised).
This does not look too different from the government’s protocol in the beginning, the “risk-based” protocol Vergeire referred. The only difference is that it specified healthcare workers who has severe or mild symptoms. The expanded testing protocol now looked like a smaller net to be cast than what massive or progressive testing targeted.
On April 20, IATF spokesperson Sec. Karlo Nograles shared the revised guidelines on “expanded testing” that will only be conducted on individuals who are “at-risk of contracting COVID-19 infection.” Those required to undergo testing are suspect cases, individuals with relevant history of travel and exposure or contact, whether symptomatic or asymptomatic, and health workers with possible exposure, whether symptomatic or asymptomatic.
Nograles clarified that “indiscriminate testing beyond closed contact of a confirmed COVID-19 case is not recommended.”
The following sub-groups of are at-risk individuals were arranged in order of greatest to lowest need for testing:
- Subgroup A – Patients or healthcare workers with severe symptoms and with history of travel abroad or exposure to a confirmed COVID-19 case.
- Subgroup B – Patients or healthcare workers with mild symptoms and with history of travel abroad or exposure to a confirmed COVID-19 case, and are considered vulnerable
- Subgroup C – Patients or healthcare workers with mild symptoms and with history of travel abroad or exposure to a confirmed COVID-19 case
- Subgroup D – Patients or healthcare workers with no symptoms and with history of travel abroad or exposure to a confirmed COVID-19 case.
Subgroups A and B will be prioritized, as well as healthcare workers belonging in Subgroup C. This is similar to the what could have been the “massive testing” protocol, specifying PUMs but at the lowest priority.
Target testing capacity are still just targets
On the day the Luzon ECQ extension up to April 30 was announced, Nograles said on April 7 that the national government’s target capacity is 2,600 to 7,000 tests per day after Holy Week or by April 14. The week after, April 20, the target is 4,400 to 9,800 tests daily. Three days before the end of the extended ECQ or by April 27, the target is 13,000 to 20,000 tests per day. he DOH issued lower targets at 4,000 by April 14 and 8,000 by end of April.
As of April 14, the national government announced start of “massive testing,” there remained only 15 polymerase chain reaction labs in the country, same as the previous week and 3,000 testing capacity per day or 1,000 target tests short of the target. A week after, only one lab was added.
The country’s capacity is over 4,000 tests daily as of April 16. T
But the average tests done per day remain lower than the announced capacity, number to only 2,633 from April 11 to 17.
based on DOH data
The Philippines will be able to conduct 8,000 to 10,000 COVID-19 tests per day starting Tuesday, April 21, government officials said.
Need to push for for mass testing
While some other countries embarked on mass testing right away, in the Philippines, people had to make an uproar for it. It took months before government dropped its stance against mass testing.
The public outcry for mass testing was heeded only a week before the original month-long lockdown deadline, but has yet to start five weeks in to the enhanced community quarantine (ECQ) in Luzon.
The Filipino people’s clamor for mass testing is not isolated—as many countries who have successfully managed the outbreak has done mass testing. Even the World Health Organization (WHO) advised comprehensive testing to “test, treat, isolate, trace” carriers of the virus to prevent it from further spreading as the advised countries to do so. “Test, test, test” is the WHO’s simple message to countries. Test, so that they will not fight the disease blindly.
From the first case in the country in January 30 to the confirmation of local transmission on March 7, there were only five cases reported. The DOH was then asked if there was “underreporting” of COVID-19 cases in the country. Duque agreed with Senator Panfilo Lacson that if there was underreporting, it was unintentional and due to the country’s limited testing capacities.
Since the first week of March, the DOH and IATF insisted that “mass testing is not needed.” At times, officials would say “mass testing is not needed yet.”
But when officials said “we do not need mass testing yet because we don’t have the capacity,” then the statement becomes more elucidating. In line with this, DOH officials would then explain that mass testing is “not efficient for us right now,” “depends on resource adequacy,” and “lack of testing kits.” On the lack of kits making “mass testing impossible,” Duque once said if all indications suggest that it’s COVID-19, then don’t wait for a test, assume that it’s COVID-19. Not only testing kits, but also laboratories and experts who would process the samples are also lacking.
Given the low capacity of the country’s health system to do mass testing and treat patients, then it should follow that the capacity must be increased in this time of public health crisis, instead of limiting testing—but the Philippine government opted for the latter for more than three months since the first COVID-19 case in the country on January 30.
While the government pins its hope for curbing COVID-19 on a military lockdown and a possible cure or vaccine, the call of many Filipinos for mass testing remains. However the government wants to call it, just do it, do it for real, do it now.
