My five siblings and I, including my two in-laws, keep a Viber group where we often exchange memes, artworks, and videos of our nieces, and in times like these, positions about things political and seemingly otherwise. I’m putting it lightly, considering that you can plot the eight of us neatly on a Cartesian plane and no two dots would be on the exact same point, no standpoint ever being in full agreement with another. There’s always a branching out, a curve, or a tone that each one of us bends the discussion to, as I presume it is in every family, rooted mostly in the different paths we have taken or are taking. Imagine, eight people stuck with each other with roughly 250 years of life between them.
Over the last weeks of March and the dawn of these lockdowns, the arguing was mostly between my older sister and I. She was (still is) at the frontlines in this COVID crisis and she hadn’t gone home to her husband and two daughters in more than two weeks, serving as one of the emergency room doctors in one of the leading private hospitals in Metro Manila. She was resolutely not in agreement with mass testing. On the left corner, I had been entertaining the thought of mass testing as the next, logical step we could take—led by government, of course—upon reading the World Health Organization’s (WHO) campaign for it and the supposed success it heralded in South Korea and other countries. The #MassTestingNow bloc was also the only pointed segment in civil society that was visible and moving.
I was taken by my political affinities when I campaigned, albeit briefly, on Twitter for #MassTestingNow. My sister, who is seldom online, saw it and immediately brought me to court in our Viber group, asking me what I thought it meant. I replied with what I thought mass testing entailed, optimistically citing the cases of South Korea and Wuhan, as talked about in an article by the New York Times, and the best-case scenario recommended by the WHO. I did not forget to include the statement prepared by a group called Scientists Unite Against COVID-19 which defines itself as a group of “concerned scientists, organizations and other citizens,” though there are no specific signatories in the statement.
It was, of course, shot down immediately; they immediately brought up the fact that I didn’t even look at the statement’s references or its absent signatories. Out of the eight references cited in the document, only one was a journal article, the rest were fast articles from the internet. The journal citation itself also wasn’t so necessary.
My sister is also no lightweight. She was a graduate of Molecular Biology and Biotechnology from UP Diliman, eventually a UP-PGH grad, soon becoming a seasoned doctor who had finished her two residencies in Internal Medicine in New York City, and in Emergency Medicine here. At the time that she was replying to my messages, she was handling six patients positive for COVID-19 (one has, in fact, recovered and has written about it in Manila Bulletin). Sure, the weight of the argument lies on the argument alone and not on the person throwing it, but it was clear that my argument would not stand against my frontlining sister’s knowledge on and experience in treating COVID-19 patients.
Testing
She sent our Viber group Dr. Maria Cecilia Lim’s “Understanding COVID testing: A FAQ Sheet for Decision Makers and Laypersons,” which explains in detail why rapid and mass testing would probably lead to more harm than good. Dr. Lim explains in Q&A form the many ways testing is being done and how each kind of testing serves a purpose.
The reader would then see how gargantuan the task of mass testing is. Not only that, it’s that mass testing per se will not be the cure-all many purport it would be, especially when testing entails months of infrastructural preparation and a highly skilled workforce. Both of which, we don’t readily have. And after mass testing, it begs the question: will there also be a corresponding cure?
It was too idealistic for a rallying cry, and before letting the argument go, my sister quizzed me, just to see if I understood Dr. Lim’s FAQ sheet.
It became clear to me that mass testing would not be as simple as I thought it would be. It was far from a pregnancy test and was lightyears away from the thermo scan being done at checkpoints and mall gates which, simple as it is, is often done incorrectly and, perhaps, even counterproductively. It was even pointed out to me how, in the same New York Times’ article cited by the bloc rallying for mass testing, the first item on the checklist was already unfulfilled in the Philippine context—“Intervene fast, before it becomes a crisis.” Whether or not mass testing was possible in the Philippines, the topic of mass testing needed more nuancing before any viable response can be made.
One of the reasons why my sister finds mass testing a dangerous precedent in finding a solution for COVID-19 is that it would mean moving people out of their homes multiple times, exposing them to greater risks of getting infected; and since testing cannot be properly done in the first place, the results become unreliable. Imagine replicating that model on a wider scale. It might just overwhelm our systems—systems that are already overwhelmed this early. More immediately foreseeable is that persons who might not have the virus now, just might get it in the long lines for testing.
Likewise, in one of the ways testing is being done, it requires that the person being tested be healthy enough or be at that stage when his/her body is producing the antibodies against COVID because it is that which the tests are able to detect. Once that is found, then the person being tested would be categorized as “positive.” This means that many can show as “negatives,” because, while they might have COVID in their system, it might take some more time for their immune systems to produce the antibodies for COVID. They might not appear positive now, but maybe in 12 hours, they would. Without a repeat testing, this might give persons who potentially have COVID the false idea that they are free of and safe from the virus. (And we all know how low our reading comprehension scores are.)
As for the WHO, it was agreed that the WHO isn’t always correct. With some reading online, it can be traced how the WHO employs a purposeful vagueness for a very broad audience. Their recommendations, therefore, are subject to too many valid interpretations. Their recommendation for mass testing will have to go through different lenses before being applied to different local contexts. And at this point, it doesn’t take much to see that any single State claiming certainty in fighting this pandemic is simply working with branding, with assertions that are likely superficial.
I argue by saying, perhaps, it’s “more testing” not “mass testing,” a mere problem of terminology. But of course, any slight change would present a different set of problems: shortages in supply, bottlenecks in limited testing centers, unclear priorities and approaches, what to do should we find out that a particular segment—say, medical workers—is infected, what’s the threshold/breaking point, etc. etc. What’s basic for some, just isn’t basic for all. It felt like a thesis proposal defense where the slightest change in phrasing would entail an entirely new step in the subsequent theoretical framework and methodology.
The cases of the Marikina testing center, the “UP test kits,” the Chinese test kits, were then brought up, and I also asked other doctors. Unfortunately, their answers were not as rosy or as instantaneous as the pictures that media paints. It seems like we’ve already lost the war before it even began because of the decades of neglect our healthcare systems have suffered.
More concretely, these healthcare workers were concerned with how each hospital would manage COVID patients, symptomatic and asymptomatic, how the consequent traffic or algorithm of patients would be, and can changes still be made when the foundations are weak? There would necessarily be another reconceptualization, that requires reanimating into more details and approaches, baffling anyone facing this pandemic with too much information, too quickly, too soon.
My sister let me off with a stern reminder not to lose my being critical. In any case, mass testing is supposed to push through at the extension of lockdown on the 14th of April, Tuesday. How exactly that would work is anyone’s guess at this point, given the lack of clear guidelines from government. What’s certain is that nobody’s off the hook once mass testing is implemented; I’m also afraid this might become a way to give this administration a huge concession, when it’s clearly ten steps behind.
The call by the Mass Testing Now bloc included a petition to re-prioritize against VIP testing; a call for a fairer, more inclusive approach to healthcare; and a simultaneous call for the long term prioritization of health. #MassTestingNow is actually a broader, albeit simplified, call for a progressive initiative. It remains a question if any these demands, however, will be heard given the little we know of the planned mass testing next week.
The answer might still be vigilance, I guess, coupled with alertness?
Social Elements and the Powers That Be
Dr. Edsel Salvana and Atom Araullo clashed on Twitter on Friday night, March 27, to Saturday morning. They were arguing over the numbers being reported by DOH and by Salvana (who is connected to the DOH) which were both correct in essence, however, different in the manner presented and, therefore, confusing. The scuffle ended with a clarification from Dr. Salvana, and Mr. Araullo maintaining his stance which was calling out how Dr. Salvana’s presentation of data was misleading.
At that time, when the crisis was still at its natal moment, clamour for information on what government has been able to do, and where it was continuing to fail, was also only starting. The DOH, unlike many government institutions, enjoys a position where it’s perceived as a “good” agency, what with a name that’s self-explanatory. That and, of course, we’re still optimistic and would like to believe that government isn’t trying to kill anyone.
Unfortunately, the DOH, through Dr. Salvana, got itself into a mess when it decided to argue for the entire Duterte administration. Numbers were inflated to make this administration look good; repeat tests were included in the count even though these repeat tests were done on just one person, so that it would seem like much was being done. This was totally unnecessary. Reliable baseline data would also be difficult to establish now, this late, and with the well already poisoned by sinister communications not confined to Dr. Salvana and company.
There are a lot of viewpoints at work here, operating at the same time, which all in all can be traced to a sort of social anxiety and panic, or a need to do something to avert greater and greater disasters. As much as we support and honor our doctors and nurses and researchers in the medical field, it would be a loss if they consider themselves as the only ones who can move to find a solution—not just a cure—to this pandemic. The facts are clear, however: COVID-19 looms large. We are helping by staying home, and if only this administration had a plan, we’d all move in parallel lines, towards a singular direction.
Unfortunately, that just might be too much to ask when Duterte trusts too much on a systematically broken, morally bankrupt, and one-dimensional Armed Forces. All this might just be too much to ask when Duterte contradicts himself and changes directions midway through his sentences. And from this distance, we can only pray. ***