2nd Update: August 3, 2020, 10:56 AM
Updated: August 3, 2020, 10:35 AM
Philippines
 
By Joel Pablo Salud

 

As the world slept on the eve of the Ghost Month—August—the new coronavirus swept across the archipelago and breached the 100,000 mark.

The latest Department of Health (DOH) figure reached a staggering: 103,185 confirmed cases with well-nigh 5,000 new cases added daily for the past weeks. Total active cases rose from 30,928 to 35,569, pegging a total death toll of 2,059. 

There is, however, some “good news”. The total number of recoveries stands at 65,557 in Aug 2. At first glance, the number seems to indicate that we are winning the fight against the pandemic. In spite of the raging inferno of contagion and the absence of a vaccine, it seems, a good number of patients have recovered.

In fact, a sudden spike in recoveries was pegged by the health department on July 30—a whopping 38,075 on a single day. The DOH explains the sudden spike as the result of delays in the implementation of the World Health Organization’s (WHO’s) “Criteria for releasing COVID-19 patients from isolation.”

“Criteria for discharging patients from isolation (i.e., discontinuing transmission-based precautions) without requiring retesting:

  1. “For symptomatic patients: 10 days after symptom onset, plus at least 3 additional days without symptoms (including without fever) and without respiratory symptoms);
  2. “For asymptomatic cases: 10 days after positive test for SARS-CoV-2.”

The WHO explains this as follows: “For example, if a patient had symptoms for two days, then the patient could be released from isolation after 10 days + 3 = 13 days from date of symptom onset; for a patient with symptoms for 14 days, the patient can be discharged (14 days + 3 days =) 17 days after date of symptom onset; for a patient with symptoms for 30 days, the patient can be discharged (30+3=) 33 days after symptom onset).”

The criteria, in short, does not require any further testing. But should countries decide to test, “Countries may choose to continue to use testing as part of the release criteria.  If so, the initial recommendation of two negative PCR tests at least 24 hours apart can be used.”

The U.S. Centers for Disease Control and Prevention has adopted the said WHO criteria, saying, “A test-based strategy is no longer recommended […] because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.”

The Philippines Inter-Agency Task Force (IATF) for the management of infectious diseases has approved the DOH’s recommendation on time-based reckoning of Covid-19 recoveries without testing in its Resolution No. 60.

According to the WHO, “Based on evidence showing the rarity of virus that can be cultured in respiratory samples after 9 days after symptom onset, especially in patients with mild disease, usually accompanied by rising levels of neutralizing antibodies and a resolution of symptoms, it appears safe to release patients from isolation based on clinical criteria that require a minimum time in isolation of 13 days, rather than strictly on repeated PCR results. It is important to note that the clinical criteria require that patients’ symptoms have been resolved for at least three days before release from isolation, with a minimum time in isolation of 13 days since symptom onset.”

In layman’s terms, the WHO said that it is safe for mild and asymptomatic patients to be released without PCR testing after only 13 days of isolation, given that after nine (9) days of quarantine, most mild and asymptomatic patients display increase in antibody production thereby putting an end to the symptoms.

The WHO, however, is quick to point out that this modification in the criteria should not be considered a “zero-risk approach”. 

A closer look at the WHO’s explanation suggests to me that the new criteria may have been implemented to stave off any further use of limited supplies and access to healthcare and isolation facilities by mild and asymptomatic cases. 

“Although the risk of transmission after symptom resolution is likely to be minimal based on what is currently known, it cannot be completely ruled out. However, there is no zero-risk approach, and strict reliance on PCR confirmation of viral RNA clearance creates other risks (e.g. straining resources and limiting access to health care for new patients with acute disease),” the WHO said.

If we base our conclusions on the WHO’s statement, the 65,557 “recoveries” in the country do not in any way mean that the Philippines is winning the fight against the new coronavirus. Nor does it suggest, not even remotely, that any encounter with the 65,557 patients who have “recovered” puts us or those mildly infected within the safe zone. 

The risk of transmission, albeit minimal claims WHO, cannot be completely ruled out, leaving us with the question: how much is “minimal”? 

With this new criteria, the global health body is going against its own statement in April 2020 which says that the detection of antibodies in patients cannot serve as “immunity passports” or “risk-free certificates” for travel.

“There is currently no evidence,” WHO stressed, “that people who have recovered from COVID-19 and have antibodies are protected from a second infection.” 

Proof of this are reports of reinfections even today. WHO also said in earlier statements that 80% of Covid-19 infections are mild and asymptomatic. This leaves us with a starkly grim picture: if there are, to date, 17.9 million confirmed Covid-19 cases around the world, how many more remain asymptomatic?

While WHO said that asymptomatic patients are less like to transmit the virus, such conclusions are hardly accurate given the difficulty of testing huge numbers of the population. “Comprehensive studies on transmission from asymptomatic patients are difficult to conduct, as they require testing of large population cohorts and more data are needed to better understand and quantified the transmissibility of SARS-CoV-2.”

So, the question remains: should mild and asymptomatic patients be considered “recovered” even after being quarantined for 13 days? Without testing?

The unbelievable spike in recoveries gives the public a sense of security based largely on fiction. All this seems to boil down to who must get treatment—the mild and asymptomatic or the seriously infected?

While I can fully understand what limited resources mean and how this obstacle puts a strain on healthcare facilities and medical frontliners, still there is no telling if mild and asymptomatic patients—especially those deemed “recovered”—contribute to the further spread of the virus. 

The DOH must continue testing patients and refuse the temptation to tag mild and asymptomatic patients as “recovered” if only to bolster the department’s image. 

After all’s said and done on this matter, I believe it is safer to say that the 65,557 patients under “recoveries” are mild and asymptomatic cases whose only claim to “safe passage” is a 13-day quarantine—without the guarantee of testing.

I believe that’s a more accurate way of putting it.

 

Salud is the author of several books of fiction and political nonfiction and is a member of the  Philippine Center for International PEN, Unyon ng Manunulat sa Pilipinas (UMPIL) and the Manila Critics Circle.