Restricting mobility is meant to give government the time to build its capacities to stop the spread of the virus. But what happens when a government only resorts to a lockdown and nothing else?
By JANESS ANN J. ELLAO
Additional research from Dawn Peña, Amalyn Anacio, and Jon Ernst Pascual
Graphics by Dawn Peña
MANILA – Under the world’s longest and strictest lockdown, the Philippine government’s own data show that it has yet to reach its ideal testing capacity which health advocates have long been pushing since the pandemic broke last year.
“We have not been proactive in looking for COVID-19 cases. Whether a person is exhibiting a symptom or not, tests should be made available to them,” community medicine advocate and co-convenor of the Coalition for People’s Right to Health Joshua San Pedro said.
The country currently has more than 1.3 million COVID-19 cases, of which 4.5 percent are active cases based on the health department’s latest bulletin. There is also increasing number of cases in the regions, with the cities of Dumaguete and Koronadal having 206-percent and 96-percent increase, respectively, in new cases from May 31 to June 6.
The Department of Health’s (DOH) Data Drop revealed that the testing capacity only increases and reaches government targets whenever there is a surge in new cases.
The World Health Organization (WHO) said that physical distancing and lockdowns can decrease the transmission of the dreaded COVID-19. Lockdowns, however, may seriously affect impoverished individuals and communities as these bring “social and economic life to a near stop.”
Governments, the WHO said, must use the time to “build their capacities to detect, isolate, test and care for all cases; trace and quarantine all contacts.”
In the Philippines, however, the government only implemented restrictions on mobility. The capacities needed to defeat the pandemic, particularly on mass testing, remain far behind the universally accepted benchmarks.
Mass testing and surveillance
San Pedro noted that the number of individuals being tested for COVID-19 usually declines after a surge. This means, he added, that our testing capacity is dependent on the number of patients or suspected patients who are exhibiting symptoms of the virus who want to be tested.
In March, amid another surge of cases in the National Capital Region (NCR), the government said it aims to conduct 100,000 daily COVID-19 tests per day. Of late, however, daily tests on individuals range from 40,000 to 60,000. This is the case even if government should be testing as much as 130,000 daily to bring down the positivity rate to the WHO-recommended five percent.
Positivity rate refers to the percentage of individuals who tested positive to the virus in relation to the total number tests conducted.
San Pedro said the government should also revisit how it is conducting its disease surveillance and ensure that it is carried out consistently. “We want to see how far this virus has gone, whether or not people are experiencing symptoms. The government can do sampling. And if there are symptoms, this can already be addressed early instead of waiting for it to aggravate.”
To do this, funding is very crucial.
However, under the Duterte administration, the budget of the DOH’s Epidemiology and Disaster Surveillance program has been decreased from $5.4 million in 2019 to $2.4 million in 2020. The budget was further decreased this year to $2.3 million.
Mass testing and its accessibility
To evaluate the country’s testing capacity, San Pedro noted that testing centers are increasingly only available in highly urbanized cities. Privately-owned COVID-19 testing laboratories, particularly in the NCR and Region 7 (where Cebu City is included), run more tests compared to the government.
As of June 8, DOH has accredited only 260 laboratories. Of these, about one-third are in Metro Manila, proving San Pedro’s point that the country has an uneven public health care system.
The devolution of health care (i.e., the transfer of managing and financing of regional government hospitals from national to local government as pushed by multilateral bodies including the World Bank) shows how testing capacity depends on the investment of regions and provinces on equipment, cartridges and human resource to do so.
Increasing the number of laboratories that can conduct tests in the provinces is crucial, given the surge in cases outside NCR. For one, only two accredited testing centers are operating in the Bangsamoro Autonomous Region of Muslim Mindanao even if Cotabato City has a 62-percent increase in new cases from May 31 to June 6 alone.
There are currently 29 provinces that are still without a COVID-19 testing center. Some of them like Northern Samar and Bukidnon are among the poorest provinces. Other regions, on the other hand, only have one or two accredited laboratories.
These testing centers also vary in capacity, with supply problems on test kits still hounding them. In these instances, samples are sent to the nearest possible laboratory, and the long and arduous process keeps the government from getting real-time results.
“Even before the pandemic, two-thirds of the hospitals in the country are privately owned. It seems the same trend is happening for our COVID-19 testing centers,” San Pedro said.
Mass testing, contact tracing and vaccine roll-out
Health advocates stressed the importance of contact tracing to curb the spread of the virus. WHO said this is a key component in public health response to infectious disease outbreaks.
In a resolution dated January 14, the Inter-agency Task Force for the Management of Emerging Infectious Diseases ordered the strengthening of contact tracing by expanding to third-generation close contacts in light of new COVID-19 variants detected in the country.
Government officials admitted that contact tracing remains the weakest link in the pandemic response. Its contact tracing czar and Baguio City Mayor Benjamin Magalong originally targeted 30 to 37 close contacts of patients in urban areas and 25 to 30 contacts in rural areas. But he said in a House inquiry in March 2021 that “technically, there is no contact tracing” because only members of the household are being identified.
Marian (not her real name), a contact tracer hired by the Department of Interior Local Government for the city of Taguig, told Bulatlat that human errors usually hinder efficient contact tracing. These include writing wrong details in contact tracing forms or the erroneous data encoding.
Marian said that, on the average, they are able to identify one to two close contacts per individual who tested positive. These close contacts usually belong to their immediate household.
The only time they get more than two close contacts, Marian said, is when it involves a big, extended household. She added that even if patients volunteer where they have been, contact tracers from DILG do not have access to their respective contact tracing forms.
The sad state of the country’s contact tracing affects testing capacity. San Pedro said that it is important to test all close contacts of those who tested positive to curb the spread of the virus, especially outbreaks in communities. “The more we find the positive cases through wider testing, the more we can trace their contacts to quarantine them and stop the spread of COVID-19.”
Amid a vaccine roll-out, San Pedro said that mass testing should still be a government priority. This should be continued until the country has reached herd immunity, which, by the looks of the current vaccine roll-out, can take years if not decades.
In one vaccine center in Pasig, a health worker told Bulatlat that they are only able to accommodate a maximum of 500 residents a day. Other cities like San Juan can inoculate 3,000 daily.
Mass testing and government accountability
Instead of mass testing, the Philippine government resorts to technicalities. For example, government officials claim that no country in the world has been able to test 100 percent of the population.
San Pedro added that it is also easier to put the blame on people, including the criminalization of health protocol violations, than fund programs that could have lasting impact not just to end the pandemic but also to rebuild the country’s public health care.
Meanwhile, with the government not building sufficient capacities to deal with the pandemic, the lockdowns have only resulted in loss of livelihoods for many people, hurting the poor most especially. In April, the country’s unemployment rate rose to 8.7 percent which means that there are now 4.14 million jobless Filipinos.
Kadamay Secretary General Mimi Doringo said that urban poor shy away from being tested for COVID-19 as the government has no assistance to those would test positive. “Who will look after their family? Where will they isolate? These are some of their unanswered questions.”
Instead of putting the blame on Filipinos, Doringo challenged the government to finally get its act together and have concrete programs for those suspected of COVID-19 and those who tested positive, as well as their respective families.