ECQ and limited testing insufficient to stop Covid-19

IT was with disbelief that I read in the news that Health Secretary Francisco Duque 3rd during a Senate hearing said there was no evidence that asymptomatic Covid-infected persons could infect others. While the World Health Organization may not have conclusive scientific evidence that asymptomatic persons are contagious there is more than enough scientific studies and research telling us that asymptomatic persons are likely spreaders of Covid-19.

Isn’t this why we isolate all Covid-positive or exposed persons, symptomatic or not? It has been very clear since January, when cases were piling up in Wuhan, that the severe cases only constituted a fraction of all positive cases.

Covid-19 is fought with “prevention and control rather than treatment,” Peking Union Hospital’s Du Bin — who was in the frontline in Wuhan — told the in March. “With a substantial proportion of pre-symptomatic transmission, measures such as enhanced personal hygiene among the general population and social distancing would likely be the key instruments for disease control in the community,” Dr. Eric Lau and colleagues concluded in a study from March (“Temporal dynamics in viral shedding and transmissibility of Covid-19,” May 2020,

And this could be where we should focus now, rather than on mass testing. I have been an advocate of mass (polymerase chain reaction or PCR) testing but I think at this point, weeks of community quarantine and 200,000-plus PCR tests notwithstanding, the virus has spread beyond what we can test. First, it was just the Chinese tourists who were infected. Then, it was prominent members of the community who got infected on their foreign travels. But at this point the virus has penetrated crowded urban poor communities and reached even small towns in the provinces. Testing facilities were until recently only found in a few regional centers. PCR testing has been beyond the reach of most local government units (LGUs) with only very sick persons who ended up in hospital having been tested these past months. Results have often taken up to two weeks to be released to the concerned LGU. While aggressive contact tracing and isolation of close contacts now seem to follow every positive case, how many positive cases remain under the radar? The high cost of medical treatment plus the incredible inconvenience, even stigma, of quarantine is probably keeping some symptomatic individuals from reporting themselves.

While transmissions that would have occurred without community quarantine were prevented, others have likely happened, in particular within households and in crowded communities. Aggressive mass testing, contact tracing and isolation would probably have been more effective two to three months ago when there were fewer people infected in fewer places. But now, at this point, such a strategy would be too expensive. In addition, our resource base has shrunk. Social Weather Stations on May 21 reported a doubling of the number of Filipino families who go hungry, from 2.1 million last December to 4.2 million now. Dwindling government funds must be spent wisely and where they make the most impact for the largest number of people.

Rapid diagnostic testing (RDT) of employees and students have been proposed, but it would be costly, aside from the fact that RDTs are not a reliable tool in determining active Covid-19 infections. So, while cheaper and faster than PCR tests, RDT tests’ unreliability makes them a risky investment. Said Davao City Mayor Sara DuterteCarpio after more than 200 residents in Barangay 23-C, the city’s hardest hit tested negative in the rapid test: “

is false negative asymptomatic

catch” ( May 21). And whether PCR or rapid test, they would have to be repeated regularly and frequently as workers and students could get infected at home or during commuting.

Nearly three months under various degrees of community quarantine and almost four months without flights from China and South Korea have taken an enormous toll on the economy. The rise in the hunger rate is an indicator of things to come unless we allow people to earn a living, tests or no tests. This is where the prevention comes in — the above-mentioned “enhanced personal hygiene” and social ( or physical) distancing must be continued and embraced in all aspects of life and for who knows how long. From urban poor neighborhoods to students, from farms to commercial establishments, every process or activity has to be redesigned, every community empowered, to live with and survive Covid-19 and other disease outbreaks. If we cannot community-quarantine or masstest ourselves out of the pandemic without committing economic suicide in the process, then physical distancing and enhanced personal hygiene must become our new way of life. We just can’t wait for a vaccine that may never come.