Dr. Edsel Maurice Salvana, Director at University of the Philippines Manila and Clinical Associate Professor at University of the Philippines-Philippine General Hospital has taken to socmed dissecting what the 4 confirmed new covid-19 cases means to Filipinos.
In a Facebook post, Salvana urged netizens to take a deep breath before he proceed to share his analysis of the situation in the Philippines amid the new reported cases of covid-19 in the country. “Deeper breath. Four new cases in the Philippines. Let’s dissect what this means for us.”
Basically, Salvana answered 4 commonly pressing questions asked in light of this new developments.
1. Does this mean there is sustained community transmission?
As far as Salvana is concerned, it will not lead to that yet because it was clear to him the new transmissions happened because the two Filipinos who turned positive for covid-19 had contact with a confirmed case. “No it doesn’t. Two of the four new patients had travel history, while the other two had contact with a confirmed case. There is still a clear epidemiologic exposure and so hopefully we still have a chance to control with quarantine and contact tracing.”
2. Is DOH underreporting cases?
Salvana denied the DOH is underreporting cases but the most logical question he said is, ‘are we missing cases?’ “If you look at the timeframe between testing and reporting, it is no more that 24 to 48 hours. DOH is reporting as soon as it can, with some lead time for contact tracing so that people can quarantine themselves as soon as possible. So there is no underreporting. The more relevant question is are we missing cases.”
3. Are we missing cases?
Salvanan did not categorically say it but judging his response, the DOH missed some cases however, despite the technical limitations of the country, Salvana is confident with the two surveillance systems, one from WHO and the other one called SARI have picked up case #5 out of 10. The UP doc credited the excellent clinical judgment of a private practitioner who decided to test his patient based on SARI principles. “The best surveillance systems in the world miss cases. The US CDC have tracked cases with no travel history after cryptic community transmission over 3 to 6 weeks. There are WHO protocols that we follow. We have two surveillance systems. The first one is the one that identifies PUIs and PUMs based on travel or contact with a known case. A second one, SARI, looks for unexplained pneumonias and clusters of pneumonia in the community. This is how DOH picked up case #5 out of the 10. This was due to the excellent clinical judgement of a private infectious disease physician who decided to test based on SARI principles.”
Salvana stressed that testing is being done and the 10 cases detected means the DOH isn’t sleeping on the job as critics suggest. “The fact that DOH DETECTED the 10 cases means that TESTING IS BEING DONE. More than 700 people have been screened according to established WHO protocols. Due diligence is being observed.”
4. But why don’t we test more if we are concerned of missing cases?
Salvana defended the DOH from not doing more test because of missing cases. It is the cost that is why we still need to prioritize testing to the most probable because we cannot test everyone at this time. “Each test costs the government (aka you) 5,000 to 8,000 pesos. Testing is complicated and not many places are capable of doing the test well. Even the CDC in the USA had a major error in their test. Capacity is being expanded. A Filipino kit is being validated. These are all happening as we speak. However we still need to prioritize testing to the most probable because we cannot test everyone at this time.”
5. What happens next?
Salvana ended the FB post urging Filipinos to stay away from doing any of our social activities if we hoped to defeat the covid-19 outbreak by learning from the China experience and that social distancing is effective in stopping the virus from further infecting other people. “Based on the Chinese experience, the only thing that seems to have a major impact on transmission is social distancing. We do not want to wait until we have a case load as high as Wuhan because even they had a hard time controlling and they have much more resources than we have. We need to think of preemptive social distancing now if we want to have a chance to contain. If this happens. PLEASE follow instructions and understand that a sacrifice is being asked of everyone FOR THE GREATER GOOD. Now is the time to help each other by putting our individual impulses aside and being proactive. Filipinos have shown tremendous resilience through the years, be it typhoon, earthquake or volcano. No virus can defeat us.”
Source: Edsel Maurice Salvana