Mass confusion over mass testing

MASS testing now! The cry literally screams off the page in miles-long threads on social media, and it makes sense that it should, because without even being told by health experts — and the leadership of the World Health Organization (WHO) has told everyone, repeatedly — anyone with even a modest grasp of what is happening understands that testing for the presence of the coronavirus disease 2019 (Covid-19) is the first logical step in stopping the Covid-19 pandemic. But, as just about everything about this unexpected, unwelcome and thoroughly unpleasant plague sweeping the globe has been, “mass testing” is not so simple as it sounds. That does not, however, mean that it cannot or should not be done.

The testing process

The subject of mass testing cannot be properly addressed without an understanding of what is actually required. According to an apolitical medical source (the University of New Zealand Department of Medical and Health Sciences, specifically), there are essentially just two steps to the process, neither of which is simple if thorough testing is the goal.

First, a sample must be taken. There are four options here: a simple mouth/throat swab; collecting coughed-up mucus; a nasal swab (which requires those long swabs), which is a bit trickier to do properly; and something called a bronchial lavage, which involves inserting a tube through the nose or mouth into the lungs, injecting a small amount of fluid, and then drawing the fluid and any nastiness that has collected in it back out again. This obviously requires much more skill and equipment than any of the other testing methods.

Here’s the rub: In order to absolutely confirm whether a person is infected (or not) with the coronavirus, both types of samples – from the nose and throat, and from the lungs – should be taken. Some patients have had negative results from a swab test, but are positive for the infection when the bronchial sample is tested.

Nevertheless, the swab testing can eliminate or identify a great majority of potential Covid-19 patients, and given enough supplies and organization, the sampling can be carried out on a mass scale, and goes a long way toward arresting the spread of the disease. This is what countries such as South Korea, Singapore, and Taiwan have been doing, and why they are regarded as having gotten the Covid-19 epidemic under control, although none have entirely eliminated it yet.

The second step is the actual testing, which is done by a process called a nucleic acid amplification test. That requires the use of specialized equipment and chemical reagents, and of course, trained personnel to conduct the process. At present, the fastest equipment available can complete the process in about five minutes; at peak efficiency, the entire process from sample preparation to receiving a result takes about 10 minutes, according to the Kiwi medical experts. The fast, five-minute machines (first developed by Abbott) are not yet widely available, so for most testing using what various labs already have, the process takes about half an hour. That means that a single machine, operating with no hitches and with skilled technicians tending it, can process from about 50 up to a maximum of 150 tests per day.

What to do with the infected?

The ideal procedure, since it appears that anyone carrying the virus can spread it regardless of his or her condition, is to isolate the patient and carry out contact tracing, i.e., identifying anyone the person has been within six feet of over a period of at least two weeks and possibly up to five weeks prior to the positive test result. This requires a large number of adequate isolation facilities and an army of health workers to both monitor patients and conduct contact tracing.

It appears China was eventually able to do this, but the circumstances have been less than ideal everywhere else, and so the methodology being used currently is a compromise. Department of Health ( DoH) guidelines right now are that asymptomatic patients or patients with mild symptoms should “self- isolate” at home for at least two weeks after any symptoms have disappeared.

Based on the rapidly growing amount of data from detected cases worldwide, on average about one in six patients requires hospital care for breathing difficulties, and of those, one-third to one-half will require intensive treatment.

How many people may become infected in any given population is uncertain, and depends on too many factors — sanitation, the behavior of the population, steps taken to limit the spread of the virus — to determine for sure, but the consensus worst-case scenario among studies done so far suggests about 40 percent. That provides at least an anecdotal scope to the problem the Philippines may have to solve. If no preventive steps were taken, out of our population of 107 million up to 42.8 million may become infected, of which 7.1 million may require hospitalization, with as many as 3.6 million in intensive care.

Preventive steps have been taken, of course, which has reduced that 42.8 million figure substantially, but, whether the DoH or anyone else likes it or not, reduced it to a number that cannot be known in any other way except through comprehensive testing. And, as at least one supposed political leader, who should probably not only be thrown out of office but tarred and feathered for being such a poor example to the public has demonstrated, “self-isolation” is a poor strategy for preventing transmission of Covid-19, so proper, managed isolation of infected patients is also required.

Quit making excuses

The bottom line is, the only way the Philippines will get on top of the epidemic here is for policymakers – the DoH and the still-baffling Interagency Task Force on Emerging Infectious Diseases (IATF) – is to spend less time explaining why they can’t do things, look up “sense of urgency” on Wikipedia or some other easy- to- access source of knowledge for the dull- witted, and put forth their full efforts into acquiring massive amounts of testing materials and equipment, as many skilled personnel as can be recruited (which, of course, also requires vast quantities of protective gear to allow them to work safely, as well as proper accommodations and decent pay), and creating a large volume of isolation space, then carrying out testing on a massive scale.

We have all had three months of clear object lessons from here and elsewhere that anything short of that effort is woefully inadequate, and we are all fed up with being driven into boredom-induced madness and poverty by the half-measure of “enhanced community quarantine.” It is high time the government demonstrates there is a purpose for everyone’s sacrifices large and small, and start doing its damned job.