Test, trace, treat: Finding the weakest link in PH's COVID-19 response

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Metro Manila (CNN Philippines) — The Philippines government's core target of the pandemic response revolve around the 3Ts: Testing those who might be infected, tracing that person's close contacts who might also have the virus, treating those who are showing symptoms and isolating those who might be infected.

And the process goes on, and on, and on.

By testing and isolating those who need to be, health experts say, the virus can no longer spread. The government and the pandemic response task force (IATF) have already ramped up testing. From zero laboratories that can detect coronavirus infections back in January 2020, the country has opened 228 laboratories that have testing capabilities.

There are also 1,272 isolation facilities nationwide, including modular hospitals.

Yet, a year and a half into the pandemic, the country is reporting the second highest daily COVID-19 case count in Southeast Asia.

The Ateneo School of Government’s recent analysis states that the “Duterte administration failed to provide a more responsive approach to the ongoing coronavirus pandemic.”

For one, political science professor Carmel Abao says the government missed its initial target of going back to normalcy by December 2020, and flattening the curve. She also noted the administration’s communication problems.

“Ang response ng gobyerno ay mababaw, magulo at mabagal. Hindi na-konekta na ang pandemya ay primary health problem,” she says. 

[Translation: The government's response has been shallow, chaotic, and slow. It did not regard the pandemic as a primary health problem.]

Rather, she says the government treated the health crisis as a law and order problem.

The weakest link

As of July, over 300,000 people are being tested for COVID-19 every week through swab RT-PCR testing. This number still doesn’t include saliva or antigen testing. Yet, this remains insufficient.

While many have criticized the government for its failure to do mass testing, health professional groups say this is not really the problem.

Both the Health Professionals Alliance Against COVID-19 (HPAAC) and the Philippine College of Physicians (PCP) point to inadequate contact tracing as the culprit.

"This is the missing link," HPAAC steering committee member Dr. Aileen Espina tells CNN Philippines. "All of the things that we've been doing, bineef up na natin ang testing...We're building mga facilities, ang dami na. 'Yung gitna, ang contact tracing, doon tayo medyo nagkulang."

[Translation: We've beefed up testing. We have many isolation facilities already. The mid-point — contact tracing — is where we're lacking.]

PCP president Dr. Maricar Limpin believes the government will not be able to test, treat, and isolate enough if they're falling short on finding those who might have contracted the virus.

"Isolation and testing will depend doon sa contact tracing. Kung ang contact tracing mo mahina, lalabas ang susunod magiging mahina rin," she tells CNN Philippines. "Ang may symptoms nagagawa natin na matest yan e, pero ang exposed sa may Covid-19, 'yun ang hindi natin mahabol, and they are the ones who need to be tested. Kung hindi natin sila mate-test tapos positive sila, it just so happens wala sila nararamdaman now, they are transmitting the virus to others."

[Translation: Isolation and testing will depend on contact tracing. If your contact tracing is weak, the rest of the elements that follow will also be weak. We are able to test those with symptoms, but those who have been exposed to COVID-19, we cannot identify them. They are the ones who need to be tested. If they're not tested and it turns out they're infected but asymptomatic, they will be transmitting the virus to others.]

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Contact Tracing czar and Baguio City Mayor Benjamin Magalong has set the ideal contact tracing ratio between 1:30 and 1:37. This means contact tracers should find 30 to 37 close contacts of an infected individual in the past two days, within 24 to 48 hours.

Still running behind months into the pandemic, the government set a new target contact tracing efficiency ratio of 1:15.

Despite the adjusted target, the DOH says the national average close contact tracing ratio is at 1:6 as of June 18.

Even at the height of the surge back in March and April this year, Magalong admitted, contact tracing was basically non-existent.

Linking it all together

Doctors Limpin and Espina agree, the main problem is the lack of inter-operability in the government's process. Each local government has its own contact tracing system in place, whether it is a written health declaration form, a logbook, or an app.

"The contact tracing itself, di masyado maganda pagkakagawa. Hindi natin natrace agad ang maexpose. Ang contact tracing na ginagawa natin ngayon, it takes them one month or two months bago magtawag doon sa nagkaroon, pero ang importante (mahanap) 'yung na-expose doon sa nagkaroon ng COVID-19," Dr. Limpin said.

[Translation: The contact tracing system was not developed well. We cannot immediately trace those who have been exposed. It takes one to two months before they are able to reach out to those infected. It's important to trace those who were infected.]

In a Congressional hearing on March 3, Magalong said many local government units are not using the data collection tool suggested by the national government despite the fact that this had already been shared with them.

The government acquired contact tracing app StaySafe.PH from developer Multisys at the height of coronavirus cases in March — one year into the pandemic. This will be the primary contact tracing nationwide. But until June, it was still being tested. By end of June, the use of StaySafe.PH was made mandatory among all public utility vehicle operators and passengers. The Department of Trade and Industry is also pushing its use in business and public establishments. But it’s still being tested for local governments.

Aside from having a primary contact tracing system, Dr. Espina says information from the contact tracing application should be linked to other key facilities in the pandemic response.

"It just a matter of putting it all together. We have been lobbying for these systems to inter-operate. So, our tracing is linked to testing, and linked to treatment facilities. We have been advocating for this since October last year and we're hoping that maybe this time ma-realize ng mga tao that this is the missing link [We're hoping people will realize that this is the missing link]," Dr. Espina says.

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