House Ways and Means Committee chairman Albay Rep. Joey Sarte Salceda has urged authorities to shift to “exhaustive” testing and tracing as the country eases up the stringent enhanced community quarantine measures today relative to the COVID-19 pandemic.
The strategy would require rapid contact tracing and testing of some 1.4 million individuals within 30 days, or about 48,000 tests a day, said Salceda, who also co-chairs the House Economic Stimulus Cluster’s Defeat COVID-19 panel.
“The ECQ seems to have worked in reducing the number of potential infections by slowing down the virus,” he said in a 70-page report submitted to President Rodrigo Duterte and the Cabinet recently, which also tackled the systems-based approach in handling and managing the pandemic.
One of the studies Salceda cited says that “the observed dynamics of the pandemic in various countries shows that the growth rate of new infection cases has the tendency to decrease linearly when the quarantine is imposed in a country (or a region) until it reaches constant value, which corresponds to the effectiveness of quarantine measures taken . . .”
He pointed out, however, the “need for tools other than ECQ extensions" as well as exhaustive testing and tracing,” adding that “the national strategy has to shift to one where we leave no stone unturned when it comes to testing and tracing.”
Salceda, who led the call for a Metro Manila lockdown at the onset of the pandemic, and whose proposals for ECQ extensions have since been adopted by the government, noted that “the tradeoffs, at this stage, seem to point to a shift to GCQ, given that lockdown extensions without a comprehensive plan moving forward will cause very deep cuts in the economy.”
"We need to make sure there is exhaustive testing and tracing since the moral and economic calculus changes if you don’t have exhaustive testing," he said.
“By exhaustive, I mean to say, find every positive case actively. Test every possible contact, then find the positives among the contacts, and the trace, ad infinitum, until isolation of hypothetical cases exceeds 90 percent. Our modeling shows that a 50 percent reduction in mobility and a 90 percent isolation tendency for the infected yield the highest impact. It’s likely we reduced mobility in the workplace by as much as 70 percent during ECQ and as much as 80 percent in transport. We can adjust up, so that reduction only becomes 50 percent, provided that we keep isolation tendency at 90 percent,” he added.
Salceda said the most important figure is the number of tests per case.
“Testing per case as of May 2020 shows that the top five countries that have received global praises for having been able to control the COVID-19 pandemic were also those that conducted the highest number of tests per case. The secret of Vietnam is 1,000 tests per case which was enforced within two weeks after the first case. Testing and tracing need to be more efficient,” he said.
"Given that the minimum number of tests needed to control the crisis is about 60 per case (based on South Korea’s experience), and with worst case estimates of 24,000 cases at peak in the Philippines, we may need to prepare to perform at least 1.4 million tests over the next 30 days (or around 48,000 tests per day)," Salceda added.
He said this is an opportunity to deploy 240,000 displaced workers to do tracing, with four tracers per barangay, and more for areas with bigger populations and larger infections.
He likewise noted that the use of digital technology to contact tracing is most appropriate but would be "challenged by weak telecom systems” and would be made worse by a DOH-bureaucracy that is “pretty successful in undermining the acquisition of PPEs and test kits.”
“Moving forward, our in-house analysis shows that at this stage, given that the initial exponential stage of COVID-19 has passed, the isolation factors (testing, tracing, and isolating/treating) will have a more positive impact on lowering the infectivity of COVID-19 than mobility factors (an extension of the ECQ). Our analysis appears to validate that the ECQ was a necessary first step.”
“To be very effective in isolating all cases, we must begin by actively finding where the cases are, as opposed to waiting for the symptomatic to suspect infection and report themselves, even as self-reporting has become less likely. No thanks to the widespread stigmatization of COVID-19 suspects. Our estimates indicate that the best regime is a reduction in mobility and an increase in isolation to near 100 percent levels will decisively flatten the infection curve,” he added in his report.
Salceda pushed his advocacy for a “systems-based” approach as opposed to relying on individuals to behave well, or communities to be able to contain the pandemic on their own.
“We need significant investments in good systemstransport, healthcare, labor, and communications. The whole shift to ‘a new normal,’ with the expectation that people will behave well, shifts to individuals the burden of defeating the disease. As is obvious in the international comparatives, COVID-19 spares countries with good systems,” he said.