Speed and scale can win the COVID-19 war
COVID-19 is not going away soon, this much we are told.
Companies are racing to come out with vaccines, but actual vaccination of the world to achieve herd immunity would be a challenge and cannot be done overnight.
Some wealthy nations might be able to do it faster, but poorer countries may not even have the resources to do it.
Despite scientific findings and information sharing, new coronavirus disease (COVID-19) remains a puzzle, even to scientists. Sadly, only some nations—Taiwan, Vietnam, Germany, to name a few—seem to be able to control the virus, although they say it is too early to tell, while most continue to struggle with the virus.
In a recent interview, former Health Secretary Esperanza Cabral opined, “We are doing the right things; we just need speed and scale.”
Bill Gates was more forthright, “Any test result after forty-eight hours is garbage; we (the United States) are just not doing enough testing.”
Translation: speed and scale are keys to winning the war against COVID-19.The enemy
COVID-19, SARS (severe acute respiratory syndrome)and MERS (Middle East respiratory syndrome) are all corona viruses (like cousins) which, at times, could manifest severe, acute respiratory syndromes.
Unlike its cousins, though, COVID-19 reportedly could precipitate blood clotting which generally attacks the heart and other vital organs.
It is also generally reported that for the vulnerable, COVID-19 could be deadly; while for most, it could be benign.
Most experts agree: To control the enemy, separate the infected (symptomatic and asymptomatic) from the rest of the population. In other words, test, contact trace and isolate the infected swiftly and decisively.
Speedy tests
Cabral clarified that there is no perfect test.
A test could achieve 100-percent sensitivity (truly positive) and 100-percent specificity (truly negative) in a clinical trial under a controlled environment. In real life, though, things could go awry—improper taking of swab samples, deterioration of samples, mishandling, technical problems, etc. that could result in false positives and false negatives.
Unfortunately, a single test does not seem to be enough, especially for health workers. One could be well today, sick tomorrow.
There are three test platforms for the virus, with varying modes, results, advantages and disadvantages.
First, the PCR (polymerase chain reaction) antigen test: the gold standard; identifies the virus for diagnostics and treatment; expensive; slow results (3 to 6-hour chain reaction to detect the DNA); but long approved by FDAs (food and drug administrations).
Next, the antibody test: identifies the antibodies (not the virus); indicates the patient was infected in the past due to the presence of antibodies; results in 15 minutes or so; relatively cheaper; with US FDA emergency use authorization; needs PCR test confirmation for diagnostics. Given a high specificity (low false negatives), it can efficiently separate the non-infected which anyway represents 90 percent or more of the population.
Lastly, the saliva antigen test: US FDA just gave its emergency use authorization; detects proteins of the virus; results in three hours or so; has higher chance of false negatives and should be confirmed by PCR test; can be used for repeated tests at home or at the workplace due to simpler design and affordable cost.
The experts can confirm if all these three platforms could identify the infected (positive) or the non-infected (negative): PCR test—recommended for diagnostics and treatment, given the costs and delayed results; antibody test—for rapid pretest and principally identify the non-infected, with confirmatory PCR test, if tested positive, given the faster results and relatively lower costs; and saliva antigen test—for factories, offices, other facilities and homes that need repeated testing, with confirmatory PCR test, if tested positive, given its affordability and convenience.
Speedy contact tracing
Manual contact tracing, although thorough, is tedious, slow, expensive and can never keep up with the highly contagious virus.
The contact tracing czar, Baguio City Mayor Benjamin Magalong, after his assessment, recently reported that only 1 percent of the local government units have effective contact tracing. Some say this is not surprising, given slow budget releases, difficulty in recruiting and training contact tracers and the accredited mobile contact tracing application reportedly still has to report significant positive test results.
No doubt, an effective mobile contact tracing application is a must to pursue the virus that infects swiftly and exponentially, if unfettered.
Speedy isolation
This should be done ASAP through effective self-quarantine at home; otherwise, PUIs, PUMs and the infected should be quarantined in appropriate facilities.
Likewise, penalties should be imposed for quarantine violations.
We should do target testing, or go after the symptomatic and asymptomatic persons. Mass testing could be expensive and is probably unnecessary.
The US Center for Diseases Control and Prevention indicated that the asymptomatic is estimated to represent about 40 percent of the infected.
Assuming this and allowing for statistical errors, we can triple our confirmed cases, recently estimated at 150,000 to 450,000 for adequate testing and contact tracing.
Conclusion
In fighting the COVID-19 war, speed and scale are keys to win the war but we must not forget the following tested principles:
• A nation acting as one, with public and private sector involvement.
• Swift, decisive and trustworthy leadership.
• Comprehensive, timely and relevant national action plan, professionally and effectively implemented.
• One voice that is clear, honest, useful and timely; and finally,
• Science precedes politics. INQThis article reflects the personal opinion of the author and does not reflect the official stand of the Management Association of the Philippines or the MAP. The author is a
member of the MAP Inclusive Growth Committee and the chair of OMNIPAY, INC. Feedback at [email protected]. For previous articles, please visit map.org.ph.
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