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May 21, 2020

Salita Nang Salita? Duterte’s Adviser Apologizes After Berating Doctors Opposed To Rapid Testing

Salita Nang Salita? Duterte’s Adviser Apologizes After Berating Doctors Opposed To Rapid Testing A woman undergoes testing for coronavirus disease 2019 on May 20, 2020 as the city government of Marikina required it for employees in the private sector before work resumes during the modified enhanced community quarantine in Metro Manila. Photo by Walter Bollozos, The Philippine STAR

Reacting to several medical groups’ objection to the use of rapid antibody testing kits to detect the coronavirus disease 2019 (COVID-19) in employees returning to work over accuracy concerns, Presidential Adviser for Entrepreneurship Jose Ma. Concepcion III  lashed out at medical doctors he described as being all talk and no action.

But last night, Concepcion apologized if his statements were perceived to criticize doctors in general. He called for unity in the fight against COVID-19, which he described as "the common enemy" in a statement he posted on his Facebook page.

Concepcion’s strong reaction in defense of rapid testing, which he thought was key to avoiding another lockdown that could further cripple the economy, drew the ire of medical practitioners who sacrificed a lot at the frontlines of a still raging pandemic.

During Wednesday’s Laging Handa press briefing, Concepcion said: “Ang problema nitong mga doctor, salita nang salita, wala namang ginagawa; complain nang complain (The problem with these doctors, they talk and talk and do nothing; they just complain and complain).”

Ang mangyayari dito, magsasarado ulit ekonomiya ng Pilipinas, maraming mawawalan ng trabaho (What will happen here is the Philippine economy will be shut down again and many will lose their jobs),” Concepcion added.

Itong mga grupo na ito, ingay nang ingay, wala namang ginagawa. So anong gagawin ng buong private sector, mag-lo-lockdown tayo ulit?... Masisira iyong stimulus package nila kasi hindi umaandar ang economy, so we cannot afford another lockdown (These groups just make and make noise and do nothing. So what should the whole private sector do, go on another lockdown? Their stimulus package will be ruined because the economy is no longer moving, so we cannot afford another lockdown),” he said.

Concepcion, also the president and chief executive officer of listed food and beverage company RFM Corp. and the founder of nonprofit Go Negosyo, has initiated Project Antibody Rapid Test Kits (ARK), which will distribute some 500,000 rapid testing kits (RTKs) to more than 200 companies for the screening of their employees.

In a statement on Sunday, May 17, he said the RTKs have arrived in the country and are expected to ramp up COVID-19 testing in the country.

RTKs detect the presence of antibodies in an individual’s blood or serum and can give results in as little as 15 minutes. The presence of antibodies may imply that the body is trying to fight an infection, but such test kits do not directly detect the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.

Medical groups recommend real-time reverse transcription polymerase chain reaction (RT-PCR) tests as the gold standard. This is done by taking nasal and throat swabs, so the sample can be sent to the laboratory to detect the presence of SARS-CoV-2 and measure its viral load.

The RTK may result in a “false negative” if the body has yet to develop antibodies, or a “false positive” if the detected antibodies developed due to other viruses or bacteria. Department of Health Undersecretary Maria Rosario Vergeire said the RTKs should not be used as stand-alone tests and results should still be validated using the RT-PCR tests.

In a May 19 press briefing, Philippine Society of Microbiology and Infectious Diseases (PSMID) president Issa Alejandria said as many as two-thirds of rapid antibody tests could yield false positive results that may needlessly force workers into self-isolation and compel contact tracing.

It was not like the medical groups were not mindful of the economic effects of rapid antibody testing. Philippine College of Occupational Medicine president Phil Pangilinan lamented that “companies that are trying to recover from economic devastation are forced to suffer further by paying for costly and potentially misleading tests.”

In response, Concepcion said businesses were forced to rely on RTKs because of the country’s laboratory capacity for RT-PCR tests remains low.

Ito lang ang puwede naming gawin, itong rapid test. Kung mayroon silang ibang test na puwedeng gawin, eh di gagamitin namin (This is the only thing we can do, this rapid test. If they have another test that we can do, we will use it),” he said.

Concepcion argued that even Duterte’s health was being protected by rapid tests conducted on those visiting Malacañang. He argued that the confidence of Duterte, the Presidential Security Group and top entrepreneurs in RTK should show that “it does work.”

“My appeal to all of these doctors, if you have a better alternative, why don’t you tell us that better alternative. You want us to get the capacity of the PCR test? Well, there’s none eh. What can we do?” Concepcion said. “So if I were you, I mean I would tell them, ‘Look, let’s save the livelihoods of these people as well as the health.’ And the reason why we are doing this testing is because as we open up the economy, we want to be sure that the health is not affected and that’s the only method.”

“It’s better to test than not to test,” he stressed.

Many Filipinos online were furious about Concepcion’s latest controversial remarks, weeks after an April 29 business forum in which he claimed, without any proof, that the poor “are so used to so much exposure that they have a better immunity than us, who are sheltered in a well-protected environment” amid the COVID-19 pandemic.

Commission on Population and Development Commissioner Dexter Galban said: “Sir, with all due respect, this is an insult to all the doctors risking their lives on the front lines of our pandemic response. A little tact & show of respect can go a long way.”

Molecular biologist Joshua Miguel Danac, a member of the Scientists Unite Against COVID-19, asked: “Does Presidential Adviser for Entrepreneurship Joey Concepcion think he knows better than medical doctors and scientists when it comes to medical issues?”

The comments of Concepcion also did not sit well with doctors. Dr. Lyndon Cosico, a consultant at the San Juan de Dios Hospital, posted on Facebook on May 20: "Ayos ito ah. Wala daw kami ginagawa??? The nerve!!!! Presidential Adviser for Entrepreneurship Joey Concepcion, Where were you sir when (doctors) were dying saving lives of our countrymen?"

"I lost my wife last year. My kids only have me. But i still take the risk to go on duty at the ER (emergency room) despite my age and risk factors. You just don't know how stressed and anxious we are everytime we wake up and go to work. We don't even get to see our families for fear of infecting them. Alongside your photo sir in this post are our MODERN DAY HEROES who sacrificed their lives at the frontlines, in case you don't know.....and many more who got sick, intubated but who fortunately recovered," Cosico wrote.  

St. Luke's Medical Center interventional cardiologist Rodney Jimenez asked on Facebook: “Learning activity. What do we do when we are faced with someone who derogates us in a very bad light? Anyone?”

Perpetual Help Medical Center cardiologist Naya Cordero said she wished detractors would remain healthy so they would not end up being their patients. She also questioned if the government has done enough against violators of health protocols. 

Kung trabaho lang tingin namin sa propesyon namin, anytime sana nag-quit na kami. Eh namamatay na nga mga kasama namin (If we only see our profession as a job, anytime we could have quit. But, our colleagues are already dying),” Cordero said, noting that her opinions do not reflect those of the hospitals she is associated. 

Sana lang di kayo maging pasyente naming mga makukudang doktor. Pinapanalangin ko rin maging healthy kayo para di namin kayo makita (I just hope you will not become patients of us talkative doctors. I also pray that you become healthy so we will not see you),” she added in the post that she took down to lessen the negativity. 

“Okay. I just want to cry,” Belle Buenaflor said, lamenting that despite the sacrifices of doctors, “wala pa din pala kaming ginagawa (it turns out we have not been doing anything).”

Buenaflor said she understood the concerns about the flagging economy and the plight of entrepreneurs who have been “hitting rock bottom.” But she pointed this out: “As a doctor, it is also our responsibility to give our advice if the health of the people is at stake. May ginagawa kami. Hindi lang kami kuda (nang) kuda (We are doing something too. We are not just talking and talking).”

University of the Philippines School of Economics teaching fellow JC Punongbayan said the problem with Concepcion is that he is too “out of touch and tone-deaf.”

This was not the first time that the sacrifices of doctors were repaid with heartbreak. During the end of March, the DOH was forced to reconsider the meager P500 daily pay that it offered to volunteer health workers; this was equivalent to the daily minimum wage in the National Capital Region.

The Philippine Overseas Employment Administration on April 2 suspended the deployment of health care workers to other countries, which could give them better pay and resources. The ensuing uproar led to the partial lifting of the ban on April 13 to exempt those with perfected and signed overseas employment contracts as of March 8.

Meanwhile, the Duterte administration has sought to shift the burden of checking the status of workers to the private sector. Presidential spokesman Harry Roque on May 19 said the Philippine Health Insurance Corporation would not pay for RTKs for the testing of people who do not show any symptoms unless they came from abroad or were in close contact with a confirmed COVID-19 case.The government’s refusal to check for possible asymptomatic virus carriers who could be unknowingly spreading the disease comes even as Cebu City Mayor Edgardo Labella said 95 percent of the cases there showed no symptoms.

It may be noted that the Philippines only began “enhanced target testing” on April 14 with a daily capacity of 3,000 tests. The government aimed to increase this to 8,000 by the end of April, but by the second week of May, President Duterte reported to Congress that only an average daily rate of 7,809 was achieved. Roque said 11,127 tests were finally conducted on May 15.

As of May 15, the country still has a supply of 829,982 remaining available tests, which can last about a month if government reaches its target daily capacity of 30,000 tests.

In  a press briefing on Wednesday, May 20, the DOH also assured that the country has sufficient supply of test kits to check people suspected of having COVID-19.

"What we are having problem right now are the other logistics for the laboratories that we use together with the test kits like the re-agents," Vergeire said.

Vergeire explained the government is having difficulty sourcing re-agents because of the high demand worldwide.

Target testing effective

Amid calls for mass testing for COVID-19, Vergeire noted that 85 percent of confirmed COVID-19 cases came from or transmitted by symptomatic patients.

Read more: Are we on our own? Furor over lack of mass testing for COVID-19

This is the reason why the DOH is not pushing for testing of asymptomatic or those individuals not manifesting symptoms of COVID-19.

"Testing asymptomatic may give us false sense of security or it might give false result,"  Vergeire said.

According to Vergeire, symptomatic patients has a high 85 percent probability of  transmitting the infection to others, unlike the asymptomatic.

She emphasized that the RT-PCR test, which is highly sensitive, can only detect the virus from the infected individual two days prior to showing of symptoms.

"And when you test (for) example an asymptomatic individual today and then tomorrow he or she got another exposure, will you repeat the test. That's is why testing the asymptomatic is not cost effective and irrational," Vergeire said.

She added that experts had admitted that even RT-PCR is not 100 percent  accurate and can still miss out on one-third of the population.

"We don't want it used for asymptomatic unless that asymptomatic has proven history of exposure. Asymptomatic individual with exposure should be differentiated from those without any exposure at all," Vergeire said.

At this time, Vergeire underscored the country's COVID-19 positivity rate is at 7.9 percent, which is lower than the 10 percent benchmark being used by the World Health Organization to determine if the efforts being undertaken is on the right track.

She said various trials are being undertaken but until now, the world is still awaiting for a new vaccine against COVID-19.

"All over the world, the vaccines undergoing clinic trial are still under 2b or 3 phase . So when President Duterte said there will be vaccine by January 2021, it’s the clinical trial that Philippines intends to join," Vergeire explained.

Meanwhile, Vergeire said, the use of the test kits developed by the University of the Philippine (UP) has been delayed due to technical issues.

"The test kits have to be recalled because the technical issues have to be corrected, but hopefully next week (they) can already be validated," she said.

In March, the Food and Drug Administration decided to allow the use of test kits developed by UP to help increase COVID-19 testing amid the pandemic. – With Mayen Jaymalin

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