Opinion Opinion Feature

Beyond the curve

In the past month and a half that enhanced community quarantine measures have been in place, calls for increased testing have remained ever present, if not grown steadily stronger. Although the increase in COVID-19 cases seems to have stabilized in recent days, as well as newly reported recoveries outnumbering new fatalities, this cannot beget complacency.

Case in point: when Valenzuela City began its own mass testing program earlier this month, the local government unit reported last April 16 that five residents were found positive for the virus. That these individuals showed no symptoms suggests a severe underestimation of the true number of COVID-19 cases. What makes the virus so potent—and early detection all the more important—is that many infections can manifest as asymptomatic to mild cases, seemingly harmless. With asymptomatic individuals excluded from the Department of Health’s (DOH) latest testing and classification scheme, many unaware carriers can still be spreading the disease.

Focusing on the more visible, and arguably more severe, cases may perhaps be due to resources being insufficient until recently, with the national government unable to emulate the way that South Korea, for example, has executed mass, indiscriminate testing to combat the crisis. Health workers, who are more exposed and at a greater risk of contracting the virus, were in fact only added to DOH’s testing protocol at the end of March, after more than a dozen doctors had already died from COVID-19 complications. The perceived inefficiency has led to a persisting dread that we are doing too little, that we have not acted fast enough.

When the local outbreak escalated in early March, the Research Institute for Tropical Medicine (RITM) was the only facility licensed to handle samples and confirm positive cases, resulting in a large backlog of untested samples. The five-stage accreditation process for testing centers takes a lot of time and resources to comply with, and understandably so, to ensure accurate detection and prevent further transmission of the virus. It is not just about having enough COVID-19 test kits: at the minimum, a laboratory would require the RT-PCR machine itself; biosafety cabinets and protective gear; materials for DNA extraction, the first phase before PCR; and trained personnel.

To give credit where due, though, the number has since expanded from six last March 30, to 18 fully operational facilities as of April 24, raising the total capacity to 4,500 tests daily. Still, it is fair to criticize that increasing testing capacity should have been prioritized and accomplished earlier, even before the cases surged and the quarantine began.

Additionally, RITM’s recently-reported scaling down of operations due to several infected staff has renewed worries and apprehensions. Not to mention that the institute already reallocated its resources toward COVID-19 efforts, suspending HIV testing last April 6 and even now considering turning its facilities exclusively for COVID-19 testing to aid the country’s response to the pandemic.

Obtaining the data needed to make the right decisions may also call for contact tracing and examining clusters, or specific communities where there are high densities of people and positive cases. This way, proper resources can be allocated to those most susceptible to the disease, with randomized testing prioritized for these high-risk sectors.

Apart from the testing aspect, it is clear that the local health sector is still under a lot of strain. With medical centers becoming overloaded, special quarantine facilities like sporting venues also entered the picture to provide a space for the afflicted to self-isolate and stave off the spread of the disease.

Just last April 22, when the national tally climbed to 6,710 confirmed cases, 422 physicians were among the 1,062 health workers infected with the virus—15.8 percent of the total cases in the country, much higher than the Western Pacific region’s average infection rate of two to three percent for healthcare providers. To put this into perspective, the Philippines’ doctor-to-patient ratio is a staggering 1:40,000; for 422 doctors incapacitated from serving at the front line, close to 16.9 million Filipinos would potentially be deprived of medical attention.

The COVID-19 death toll fails to recognize the true extent of damage done on a much larger scale. Consider the unsustainable prospect of extended quarantine measures: condemning several thousands, if not millions, of families without proper aid provided. The poor most especially live in the gray area of either succumbing to COVID-19, or succumbing to starvation and other complications. If the latter, their realities will be shunned from the narrative, excluded from the data—similar to how patients of other illnesses, if stripped of medical care during this period, will be overlooked by the COVID-19 statistics.

As a consequence of years of inadequate support for local research and health infrastructure, the already-overwhelmed healthcare system seems ill-equipped to mitigate the disease’s ravaging impact. Conceivably, the quarantine period should have been used to buy enough time for the healthcare system to be reinforced. It is almost a certainty that when the quarantine is finally lifted, there will be a surge of cases—the question then becomes whether the health sector can not only handle the COVID-19 outbreak, from detection to isolation and treatment, but also continue to provide medical services to all others who need it—without collapsing upon itself. The solution is not just about keeping one’s distance and practicing hand hygiene to minimize spread; it is building the capacity to survive these measures.

Beyond testing per se, beyond flattening the curve, there is a need to raise the bar—to increase the maximum load that the healthcare system can feasibly manage. And later, when all this is over, investments must continue to be made where needed most, so that we are better equipped in the future, rather than left to scramble against time when facing a crisis of such magnitude.

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