House Ways and Means Committee chair, Albay Rep. Joey Sarte Salceda has urged authorities to shift to “exhaustive” testing and tracing as the country gears towards easing up the stringent enhanced community quarantine (ECQ) lockdowns after May 15, 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.
Apart from areas still considered critical, the government is now inclined to modify ECQ and switch to general community quarantines (GCQ), or lift lockdowns in some areas all together, if warranted. “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 Duterte and the Cabinet recently, which also tackled the system-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 and really be exhaustive with 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.” He stressed further that “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.”
“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%. Our modeling shows that a 50% reduction in mobility and a 90% isolation tendency for the infected, yield the highest impact. It’s likely we reduced mobility in the workplace by as much as 70% during ECQ and as much as 80% in transport. We can adjust up, so that reduction only becomes 50%, provided that we keep isolation tendency at 90%,” he explained.
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 first case. Testing and tracing need to be more efficient,” he added with emphasis.
He also noted that “the given the minimum number of tests needed to control the crisis is about 60 (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).”
He suggested that this is also 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 worse by a DOH bureaucracy that is “pretty successful in undermining the acquisition of PPEs and test kits.”
In his report, Salceda wrote: “At this point, however, with a fuller sense of the costs and benefits of public health policy options, we can justifiably say that the country is now better prepared for the consequences of general quarantine with better testing and tracing, for the impacts of more ECQ extensions on the economic ecosystems with the Q1 GDP now at -0.2% in only two weeks of lockdown and likely -6.8% after almost seven weeks of lockdown in Q2, and revenues falling by -1.8% which could either deplete resources for recovery and further push the demand for such resources with deeper demand destruction.”
“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% levels will decisively flatten the infection curve,” his report added.
Salceda also 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 systems — transport, 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 pointed out.
The lawmaker had advocated for a national system to deal with COVID-19 as early as January, when he filed HB 6096, which would have created a Center for Disease Control and a pandemic response framework. He has also submitted several proposals for social relief, many of which have been approved by the executive. As co-chair of the House Economic Stimulus and Recovery Plan, Salceda is a principal author of the country’s economic stimulus program.