MMDA: Metro Manila to restrict movements, activities of unvaccinated
Philstar.com
January 3, 2022 | 10:20am
Makati residents receive the first dose of the Sinovac vaccine at the Makati Coliseum.
Krizjohn Rosales, file
MANILA, Philippines — Metro Manila's mayors have agreed to pass local
ordinances that will restrict the movements and activities of
unvaccinated people in the National Capital Region while the region is
under Alert Level 3 or higher, the Metropolitan Manila Development
Authority said Monday morning.
The local legislation will restrict unvaccinated people to their
homes and will bar them malls, restaurants and other public areas, MMDA
Chairman Benhur Abalos said in a briefing. He said that the mayors of
Metro Manila have already agreed in principle to the sweeping
restrictions although there may be differences among the ordinances that
local governments will pass.
Unvaccinated people are supposed to stay at home except for essential
trips like buying food, water and medicine. They will be allowed to
engage in individual outdoor exercise "within the general area of
residence" but will not be allowed to do much else.
Although going to work is among the valid exceptions, Abalos said
that unvaccinated people will have to take RT-PCR tests every two weeks
at their own expense and must present a negative COVID-19 test result
before being admitted to on-site work.
This requirement will cover people who don't live in the National Capital Region but work there.
Unvaccinated people will also be barred from eating at food
establishments and will not be allowed to go on leisure and social trips
to malls, hotels, event venues and sports and country clubs. They will
also not be allowed domestic travel on public transportation.
"This is like [Enhanced Community Quarantine] but only for the
unvaccinated, and for their own protection," Abalos said, referring to
the strictest form of lockdown under a previous system that the
government used from 2020 to part of 2021.
"It will be hard for us to go into lockdown again," he said earlier
in the briefing. "We must learn how to live with the [Omicron] variant."
The Palace announced on December 31, 2021 that Metro Manila will be
under Alert Level 3 from January 3 to 15 because of an increase in
COVID-19 cases and the threat posed by the Omicron variant of the
coronavirus. — Jonathan de Santos
Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.
Anakbayan USA, a national organization of Filipino youth and students dedicated to advancing democratic rights, sends this response:
In the viral Atlantic article,
“My Family’s Slave,” author Alex Tizon tells his account of Eudocia
Tomas Pulido, who was to Tizon’s family both “Lola” and slave. Behind
the heart-wrenching storytelling is a reality we must face: the
oppressive class structures and culture that brought forth Eudocia’s
enslavement and trafficking, and the need to change them in order to
address the root of modern day slavery within the Filipino community.
The use of underpaid and overworked katulong, utusan, and kasambahay—the
kind of servitude Eudocia was forced to perform—is common practice
among many Filipino families. It is an unjust practice that stems from a
violent history of colonization and exploitation of the Filipino
people. In the Philippines, thousands of Filipinos are brought to the
cities, suburbs, and wealthy households in the countryside as domestic
help. These domestic helpers are very often young women who must face
exploitative conditions. No matter their destination, they are
undoubtedly a product of the massive landlessness and joblessness
brought about by feudalism in the Philippines.
Feudalism
is primarily an agriculture-based economic system where most farmers or
peasants don’t own land and are forced to work for a landlord who
profits off excessive land rent rates, exorbitant loan interest rates,
and very low crop prices, among others. Over decades, this setup has
become dominant across the Philippines. In effect, it has left 9 out of 10 farmers landless today and has forced peasants and families to sell their labor to landlords, in urban areas, and abroad.
Equally important to this economic system is the backward haciendero,
or feudal, culture needed to maintain it. Oppressive religious
practices combined with the lack of access to quality education produces
a culture in which people internalize unquestioning obedience and utang na loob
(debt of gratitude). It produces a society where exploitation is
downplayed as a temporary state worth bearing to prevent any collective
resistance and thoroughgoing change. In a feudal society, bahala na (come what may) becomes a guiding principle, just as Eudocia was forced to internalize.
Domestic
feudalism also plays a role in the forced migration of millions of
Filipinos every year. Along with imperialist interests from countries
like the U.S., feudalism helps to maintain an economic structure in the
Philippines that is export-oriented and import-dependent. On one hand,
agricultural products like sugar and coconuts produced on feudal
haciendas (with one of the largest haciendas
in the Philippines located in the same province Eudocia hails from), as
well as other natural resources like minerals, are exported to other
countries. On the other hand, finished consumer goods—like electronics,
clothes, and cars—are largely imported and sold to the Philippines at
high rates rather than made domestically. This is due to unequal trade
agreements with imperialist countries that seek to dump excess products
on foreign markets to earn profit. In essence, Filipino peasant farmers
who work long days to produce goods that feed and supply the rest of the
world face the harsh contradiction of being unable to provide for their
own families.
The result? Lack of domestic industry and
widespread landlessness—conditions that have pushed Filipinos into
poverty, and subsequently out of the country to find work. Facilitated
by Philippine laws and institutions, and dictated by foreign demands,
Philippine migration has supplied the world with at least 12 million
Filipinos, four million of whom are in the U.S., with one of those
families being the Tizons. Beyond the reality that Filipinos are forced
to migrate abroad due to lack of economic opportunity at home, many are
actually trafficked and forced to work in different countries. Indeed,
Eudocia is one of hundreds of Filipinos who are trafficked into the U.S.
every year as teachers, bakery workers, shipyard workers, and more.
Tizon’s
confession opened the eyes of many to an unjust social practice
occurring in the Philippines and abroad. It is a practice stemming from
feudalism, imperialism, and a government in place that facilitates this
exploitation and oppression of its people. This does not exonerate the
Tizon family’s abuse and exploitation of Eudocia. But in seeking justice
for Eudocia, we should seek justice as well for the millions of
Filipinos pushed into poverty and out of the country by feudal
landlessness, joblessness, and the lack of opportunities. We invite
those seeking to channel their justified rage, sadness, and desire to
act to meet with or join a local chapter of Anakbayan-USA or other BAYAN USA
organizations near you. Only through collective action and organizing
can we ensure that no other person must live their life as someone
else’s servant.
The
Lenox Hill Greenwich Village emergency department, where patients have
been charged extraordinarily high prices for coronavirus tests. This
photo was taken in mid-March; the blue parts of the signs advertising
coronavirus testing have since been removed.Credit...Steven Molina Contreras for The New York Times
Lenox
Hill Hospital in Manhattan advertised its “Covid-19 Testing” on a large
blue and white banner outside its Greenwich Village division’s
emergency room. The banner said nothing about cost.
But cost turned out to be the testing’s most noteworthy feature. Lenox Hill, one of the city’s oldest and best-known hospitals, repeatedly billed patients more than $3,000 for the routine nasal swab test, about 30 times the test’s typical cost.
“It
was shocking to see a number like that, when I’ve gotten tested before
for about $135,” said Ana Roa, who was billed $3,358 for a test at Lenox
Hill last month.
Ms.
Roa’s coronavirus test bill is among 16 that The New York Times
reviewed from the site. They show that Lenox Hill arrives at its
unusually high prices by charging a large fee for the test itself —
about six times the typical charge — and by billing the encounter as a
“moderately complex” emergency room visit.
In
one case, a family accrued $39,314 in charges for 12 tests this winter,
all taken to fulfill requirements for returning to work or school. In
another, an asymptomatic patient walked in because she saw the banner
outside and wanted a test after traveling. Her insurance was charged
$2,963.
Federal legislation last year mandated that coronavirus testing be free for patients,
so individuals are typically protected. None of the patients tested at
the Lenox Hill emergency room were billed directly for the service. But
eventually, American patients bear the costs of these expensive tests in
the form of higher insurance premiums.
Patient bills show that at least one additional hospital owned by Lenox Hill’s parent group, Northwell Health, has charged emergency room fees to patients at a mass testing site.
“It
felt like deception, and an effort to try and get money that they are
not entitled to,” said Ute Tabi. She was reviewing her family’s
insurance claims and saw a $2,793 charge for a drive-through coronavirus
test her husband got at a Northwell hospital
in the New York suburbs, Huntington Hospital on Long Island. The
hospital pursued the family for a share of the bill, which Ms. Tabi has
so far refused to pay.
The Times has been asking readers to submit bills
so that we can understand the costs of coronavirus testing and
treatment. So far, more than 600 patients have participated. Their bills
have revealed high charges and illegal fees, as well as patients who face substantial medical debt for coronavirus treatment. If you have a bill for coronavirus testing or treatment, you can share it here.
Northwell Health, a nonprofit, operates 23 hospitals in the region, and received about $1.2 billion in emergency health provider funding in the federal CARES Act last year.
The chain recently came under scrutiny after The Times revealed it had sued more than 2,500 patients for medical debt during the pandemic. It has since dropped those cases.
Northwell,
which defended its coronavirus testing charges as appropriate, has
since removed the blue signs at the Greenwich Village division
advertising the service.
Officials
said patients tested at the emergency room received more advanced care
than they would elsewhere. They declined to comment on specific patient
cases but said their protocols involve notifying patients that their
test will come with emergency room fees. A sign with the information is
taped to a plexiglass shield at the registration desk.
“I don’t think of the emergency room as a testing site,” said Barbara Osborn, Northwell’s vice president for communications.
But
the Lenox Hill in Greenwich Village has tested 15,000 patients for
coronavirus over the course of the pandemic. Patients interviewed by The
Times said they went there because of the banner outside, not to seek
emergency care. They were asymptomatic and seeking tests as a precaution
before traveling or socializing.
Ms.
Roa spotted the emergency room fee through an unusual circumstance. Her
wallet had been stolen, and she was checking her bills. She feared her
identity had been stolen because she had no memory of visiting an
emergency room.
“I
called my insurance and was freaking out, asking who has my identity,
what will this bring,” she said. “After maybe 45 minutes, I got
transferred to someone who was able to tell me that this was all about a
Covid test.”
Congress inadvertently encourages expensive tests
Americans have taken about 370 million tests during the pandemic. The price of each — as with most services in the American health system — can vary widely from one hospital or doctor’s office to another.
State-run
testing sites in New York do not charge patients or collect health
insurance information for the coronavirus nasal swab tests. A study published last year found that a swab test at a hospital can run from $20 to $850. Some independent laboratories have charged more, billing $2,315.
The Lenox Hill Greenwich Village center bills $671 for its coronavirus test, six times what major labs such as LabCorp and Quest charge. The rest of the price discrepancy comes from the emergency room fees.
Doctors
and hospitals that bill higher prices for testing can rely on new
federal protections to ensure they are paid. Congress passed a law last
year that requires insurers to fully cover coronavirus testing costs and not apply any patient co-payments or other fees to the service.
Insurers
must also pay for services that are necessary to obtain the coronavirus
test, such as a doctor’s visit or, in the case of Lenox Hill, an
emergency room facility fee.
“This
is such a gold mine for hospitals because now they can charge emergency
fees for completely healthy people that just want to be tested,” said
Renee Hsia, a professor of emergency medicine at the University of
California, San Francisco, who researches medical billing. “This is what
you’d expect from a market-oriented approach to health care. It’s the
behavior our laws have incentivized.”
Emergency rooms in the United States typically charge patients something called a facility fee, the price of walking through the door and seeking care. The fees have risen sharply in recent years, and can cost about $200 for a simple visit or $1,800 for the most complex cases.
Hospitals
like Lenox Hill often defend these costs as necessary to fulfill
federal laws that require them care for all patients regardless of their
ability to pay.
“If someone does not
have insurance, we still provide the same level of care as we would to
someone who has insurance,” said Rich Miller, Northwell’s chief business
officer.
Emergency room fees are
common in the American system but rare in the world of coronavirus
testing. At The Times’s request, the data firm Castlight Health analyzed
insurance claims for 1.5 million coronavirus tests.
It
found that less than 4 percent of coronavirus tests are billed through
emergency departments. The vast majority of those tests are associated
with large claims that have many charges, suggesting the nasal swab was
incidental to a more complex visit.
Only
about 5,000 bills out of the sample of 1.5 million — about 0.3 percent —
were billed in a way that looked similar to Lenox Hill’s fees, the
Castlight data shows.
At
the Lenox Hill site, Mr. Miller explained, there are actually two
separate coronavirus testing processes. Patients who arrive with a
doctor’s order for a coronavirus test are routed to a service center
that does not charge emergency room fees.
Patients
who come in without that prescription are sent to the emergency room
for an evaluation, where they will incur the facility fee charges. About
75 percent of coronavirus tests at Lenox Hill Greenwich Village are
routed through the emergency room, a practice Mr. Miller defended.
“Anyone
who would have been billed for an emergency room visit would have been
assessed accordingly to see if other things were wrong with them,” Mr.
Miller said. “We believe we’re adequately disclosing that this is an
emergency department visit, and will be billed as E.R.”
Short visits, surprising bills
Founded
in 1857, Lenox Hill has long served a wealthy clientele at its main
division on the Upper East Side of Manhattan. It is where Beyoncé gave birth in 2012, and is the subject of an eponymous Netflix documentary series that shows the hospital’s inner workings.
It
would stay open 24 hours and provide care to patients regardless of
their ability to pay. But unlike traditional emergency rooms, it is not
physically attached to a larger hospital.
Free-standing
emergency rooms have proliferated in recent years, across the country
and across New York City. Montefiore, Northwell and N.Y.U.-Langone have
all opened them within the last decade.
Supporters
have praised them for expanding critical care access without building
an entire hospital, a potential boon to underserved urban and rural
areas.
But they have also faced
criticism for how they price care, especially for simple visits. One
analysis conducted by the health insurer UnitedHealthcare found that the
average cost for a visit related to a common condition like a fever or
cough was 19 times higher in free-standing emergency rooms than in urgent care centers.
“Free-standing
emergency departments simultaneously represent the best, innovative
side of American health care and the pure profit motive,” said Dr.
Jeremiah Schuur, chair of the emergency medicine department at Brown
University’s Alpert Medical School.
The
prices at Lenox Hill’s free-standing emergency room caught the eye of
local government officials shortly after it opened. New York City’s
Community Board 2, which has jurisdiction over Greenwich Village, held a meeting
in 2016 to discuss several cases. One patient was charged $1,000 to
have a bee sting looked at, and another faced fees of $3,000 related to a
sprained ankle.
Sarah Nathan was not
looking for emergency-level care when she was tested at Lenox Hill
Greenwich Village. She just needed a test to return to her job as a
nursery school teacher.
The bill for
her visit came to $3,194, which her insurance negotiated down to $2,084.
She recalls asking a front desk representative whether she would be
billed for an emergency room visit. She said she was told she would not
be.
It’s
‘scientifically meaningless’ and all false positives, some have claimed
about the current polymerase chain reaction (PCR) test for SARS-CoV-2
infection or its disease, Covid-19. False-positive means that the positive result of a test is false, so it’s picking up a signal when there’s none.
The inventor of PCR said it could not detect infectious viruses.
It has not been compared to a gold-standard, definitive test.
It’s a qualitative test, not quantitative.
The cycle threshold (Ct) value used is too high, so it’s detecting coronavirus genes when there are no real viruses.
There’s no proof that the detected genes belong to SARS-CoV-2 since this coronavirus has never been purified.
This
article will look at each of these points — evaluating if they are
correct or not. Actually, however, most of the above points are in the
grey area that is not outright wrong, which is why they can be
misleading if not interpreted properly.
In brief, PCR works
by using specific primers to attach to both ends of a gene segment. An
enzyme then amplifies that primers-marked gene until its detectable by
genetic dye or marker. The type of PCR used to detect SARS-CoV-2 is
real-time reverse transcription PCR (RT-PCR). Specifically, the RT-CR test detects the E and RdRp genes coding for the viral envelope and RNA polymerase enzyme, respectively, unique to SARS-CoV-2.
1. It can’t detect infectious viruses?
PCR tests “cannot detect free infectious viruses at all.” a quote attributed to
Kary B. Mulis, Ph.D., a biochemist who invented the PCR test worthy of
the Chemistry Nobel Laureate award in 1993. He died on 7 August 2019.
Dr. Mulis did notsay that quote, however. Instead, it came from a 1996 article by John Lauritsen, award-winning American reporter.
Anyhow,
that quote is not entirely false either. Lauritsen intended to clarify
that the PCR test does not detect the whole virion but genetic pieces
unique to the virion.
So,
it’s true that the PCR test “cannot detect free infectious viruses.” It
can be likened to the analogy that finding dog fur in a location
doesn’t mean the dog is still there. Similarly, detecting genetic pieces
of SARS-CoV-2 doesn’t mean that the complete SARS-CoV-2 virion is still
there. Maybe SARS-CoV-2 was already destroyed by the immune system,
leaving dead viral fragments. This is undoubtedly one major flaw of the PCR test.
“It
is important to note that detecting viral material by PCR does not
indicate that the virus is fully intact and infectious, i.e., able to
cause infection in other people,” the Public Health England spokesperson
told Reuterson
November 2020. “The isolation of infectious virus from positive
individuals requires virus culture methods. These methods can only be
conducted in laboratories with specialist containment facilities and are
time-consuming and complex.”
Indeed,
there’s a discrepancy between the positive PCR (specifically, RT-PCR)
test and culturable SARS-CoV-2. In virology, culturable virus means that
the virus can replicate in cells in a lab dish — indicating that the
virus is infectious. After all, viruses can’t survive without a cell
host.
An editorial in the International Journal of Infectious Diseases reviewed
various studies and stated that SARS-CoV-2 is often not culturable
after the 8–10th day of illness, despite on-going positive RT-PCR test
results. This is because SARS-CoV-2 may have disseminated deep into the
lungs or elsewhere in the body to be sampled from the nose.
Therefore,
persons who tested positive for SARS-CoV-2 by RT-PCR may not harbor
infectious viruses. The RT-PCR test can’t conclude but can only tell
that there might be active or infectious SARS-CoV-2 in the body.
2. It has not been compared to a definitive test?
The
accuracy of a particular pregnancy test, for example, is determined by
comparing its results to a gold-standard, definitive test. In this case,
the definitive test is the visible pregnancy itself. By comparing a
particular test to a definitive test, we can discern how accurate it is,
such as its false positive and false negative rates.
Admittedly,
this comparison has not been made with the current PCR test. But that’s
because there’s actually no definitive test for Covid-19 or SARS-CoV-2.
Why?
Covid-19 or SARS-CoV-2 can be detected in at least two other ways, although they are not definitive as well:
A
chest CT (computerized tomography) scan showing lung abnormalities
typical of Covid-19. But infected people can still spread the virus to
others even before symptoms develop and the lungs start showing
abnormalities observable with chest scan. About 59% of SARS-CoV-2 transmissions are caused by infected persons who had no symptoms — asymptomatic.
An
attempt to culture viruses from the respiratory samples. But the
absence of culturable SARS-CoV-2 doesn’t indicate that the patient is no
longer sick. As mentioned, SARS-CoV-2 is not typically culturable after
the 8–10th day of illness from nasal swabs, but Covid-19 lasts for a few weeks.
This is because the virus may have reached deeper parts of the body,
such as the lungs or air sacs, to be culturable from nasal swabs.
Thus,
infected persons might not develop an illness, yet they can transmit
the virus to others. And sick patients might not harbor culturable
viruses. These reasons are why there’s no definitive test for Covid-19
or SARS-CoV-2.
The
PCR test may be the best cost-effective option we have to detect
possible SARS-CoV-2 infection. It’s only ‘possible’ because the detected
SARS-CoV-2 genetic material might be dead, and not culturable or
capable of causing Covid-19.
3. It’s qualitative, not quantitative?
Yes,
the PCR test is qualitative as it only indicates either the gene of
interest is present or absent. Thus, “they don’t show how many viral
particles are in the body,” journalists wrote elsewhere.
But the type of PCR test used to detect SARS-CoV-2 is RT-PCR, which is semi-quantitative. One added functionality of RT-PCR is the cycle threshold (CT) value that indicates the number of amplification that occurred from the PCR.
Therefore,
the higher the CT value, the more amplification was needed to detect
the gene of interest — indicating that this gene is found in low amounts
in the clinical sample. Likewise, the lower the CT value, the less
amplification was necessary since the gene of interest is abundant in
the sample.
While
the RT-PCR test for SARS-CoV-2 or Covid-19 doesn’t indicate the exact
number of viruses present, it tells us its abundance. So it's
semi-quantitative that offers value in semi-quantifying viral load.
Indeed, the Ct value can predict Covid-19 duration, severity, or death, but such clinical utility remains debated since the Ct value can vary between RT-PCR protocols.
4. The Ct threshold value is too high?
As
follows, too high of a Ct value indicates minuscule SARS-CoV-2 genetic
material in the sample, which might mean that it’s clinically
meaningless. Yet, it’s still a positive result.
Anthony
Fauci, MD, the director of the National Institute of Allergy and
Infectious Diseases and medical advisor of the White House, admitted
that the Ct value of >35 most likely indicates “dead nucleotides,” which means harmless virus fragments. Some even consider that the Ct value of over 30 is too high. Indeed, a review of multiple studies concluded that SARS-CoV-2 is usually not culturable at a Ct value of >30 or >33.
“Most
[RT-PCR] tests set the [Ct value] limit at 40, a few at 37. This means
that you are positive for the coronavirus if the test process required
up to 40 cycles, or 37, to detect the virus,” the New York Times reported.
Apparently, the FDA did not set the Ct value limit for a positive
SARS-CoV-2 test, and that “commercial manufacturers and laboratories set
their own.”
Hence, setting the Ct value up to 40 may have overestimated the true number of SARS-CoV-2 cases. If the New York Times is correct in that most RT-PCR tests did that, then the majority of tests might have detected some false positives.
To
give an idea of how frequently is the ‘some false positives,’ the
Wadsworth Center in New York has kept records of their Ct values. In July 2020,
Wadsworth Center detected 872 positive RT-PCR tests for SARS-CoV-2 with
Ct value set at 40. However, about 43% and 63% of those positives were
no longer positive if the Ct value cutoff is set at 35 and 30,
respectively. This means that if the Ct value was set more appropriately
at 30–35, we might have recorded about 43–63% fewer SARS-CoV-2 cases
today. This is in line with the estimation that 49% of SARS-CoV-2 cases are asymptomatic.
But, newly infected people
might show a high Ct value of 37, for example, which may reach 30 or
less in the following days as the virus replicates. Recall that higher
Ct values mean lesser viral load. Alternatively, the nasal swab may not reach
deep enough to sample sufficient viruses. So, the RT-PCR test can pick
up every single ‘potentially’ infectious or contagious case.
It’s
indeed a dilemmatic situation — to minimize risk by counting every
single ‘potentially’ infectious case as true cases or to take some risk
by setting the Ct value lower and miss out on some true infectious
cases.
Some experts have suggested that persons with high Ct value upon RT-PCR test be tested again
soon. Even a rapid test — such as the rapid antigen test — with lower
sensitivity can be useful in identifying the most infectious cases,
rather than every single potentially infectious case. Indeed, the rapid
antigen test works best in high viral load cases with a Ct value of <25.
5. Detected genes don’t belong to SARS-CoV-2?
Opponents of the RT-PCR test have claimed that there’s no proof that the detected gene belongs to SARS-CoV-2. Because nobody has ever purified
SARS-CoV-2, to begin with. They went on to argue that SARS-CoV-2, the
causative agent of Covid-19, does not exist because it doesn’t fulfill
Koch’s postulates for a pathogen.
However, viruses exist following the revised Koch postulates
since the original postulates were formed when researchers didn't know
viruses exist. As pathogen-host interactions are complex, not even every
bacteria can fulfill Koch’s postulates.
Also,
unlike bacteria or fungi, viruses can only survive and replicate inside
a living cell. Viruses can’t survive in the environment outside cells,
except for a brief moment when viruses propagate from cell to cell. In
this sense, viruses can’t be purified purely alive like bacteria or
fungi, but they can be cultured in a set of living cells.
Therefore, SARS-CoV-2 existsas proven
via culturing it in living cells in a lab dish. Electron microscopy can
then reveal viral-like particles in SARS-CoV-2 infected cells.
Alternatively, SARS-CoV-2 can be separated from the cells before
visualization. Genetic material inside infected cells or viruses can
then be sequenced to derive the full genome of SARS-CoV-2. SARS-CoV-2
replication inside cells can also be inhibited with drugs or reacted
with antibodies. Plus, SARS-CoV-2 can be transmitted among susceptible
animal species, causing Covid-like diseases. So, yes, SARS-CoV-2 is
real.
Since
the full genome of SARS-CoV-2 has been sequenced, we can compare it to
the other sequenced viruses in genomic databases. The PCR or RT-PCR test
can then be designed to amplify a gene unique to SARS-CoV-2.
Short abstract
Given
the topic complexity, it’s expected that there are misunderstandings.
People can be misled into believing that the RT-PCR test for SARS-CoV-2
is a fraud. Indeed, reasons for believing the fraud are not entirely
wrong either:
It’s true that the RT-PCR test can’t detect infectious SARS-CoV-2, but it can detect genes specific for SARS-CoV-2.
It’s
true that the RT-PCR test has not been compared to a gold-standard,
definitive test. But that’s because there’s no such definitive test.
It’s true that the RT-PCR test is qualitative, but it’s also semi-quantitative with a cycle threshold (Ct) value.
It’s
true that the Ct value set is high, making the test very sensitive that
it might pick up signals from dead viral fragments. This may have led
to SARS-CoV-2 overdiagnoses. But setting the Ct value lower also comes
at the risk of overlooking probable infectious cases.
It’s
not true that SARS-CoV-2 has never been ‘purified’; however, that term
may mean. SARS-CoV-2 exists, and there are genes specific to SARS-CoV-2
that can be targeted with RT-PCR.
Overall,
the RT-PCR test is reliable, although it’s not perfect and may have
overestimated the true SARS-CoV-2 case numbers to some extent. Rather
than fixating on its flaws, however, proper use and interpretation of
RT-PCR tests should be the focus. Public education and correcting
misinformation, while easier said than done, also matters.
Thanks to Philip George Hayward for informing me of the concerns surrounding the RT-PCR coronavirus test’s scientific validity.
If you have made it this far, I appreciate it. Subscribe to my Medium email list here. If you want to become a member to get unlimited access to Medium, you can use my referral link and I will receive a small commission.
The Department of Health (DOH) recently gave Philippine Red Cross
(PRC) the green light to use saliva tests in detecting Covid-19.
This means the cheaper and less invasive saliva-based Covid-19 test –
an alternative to the real-time reverse transcription-polymerase chain
reaction (RT-PCR) swab tests – can already be offered to the public.
PRC’s saliva Covid-19 test costs P2,000 while the RT-PCR test costs around P3,800 to P5,000.
Countries like the United States, Singapore, Hong Kong, Taiwan, and
Japan have either approved or have been using this method of using
saliva samples to test for SARS-CoV-2, the new coronavirus that causes
respiratory illness Covid-19, as an alternative to RT-PCR test, which is
still considered the gold standard in coronavirus detection.
How is it done?
Compared to the nasopharyngeal swab, wherein a sterile swab is
inserted through a nostril and into the nasopharynx, the saliva test is
considered less invasive, therefore, less painful if not totally
painless.
Patients only have to spit into a sterile vial that will then be
submitted to a PCR laboratory for analysis. According to Senator Richard
Gordon, who also chairs PRC, the result of a saliva Covid-19 test just
takes few hours.
But Gordon reminded the public there are some guidelines that should be followed before undergoing the saliva test.
“Do not drink any liquid…eat, brush teeth, gargle, smoke tobacco half
an hour before the test,” he said in a television interview over
ABS-CBN News Channel.
How accurate is it?
According to PRC lead researcher Michael Tee, the saliva Covid-19 test’s accuracy rate is 98.23 percent.
In an earlier statement, PRC biomolecular laboratories chief Paulyn
Ubial said their study showed that the saliva-based test was 98.11
percent accurate in testing for coronavirus.
On the other hand, the RT-PCR swab test has a 99-percent accuracy rate.
“Sa calculation po namin, although nagtatalo pa ang mga statistician
at mga doctor at this point—mamayang hapon namin ipe-present sa Covid
lab expert panel ng Department of Health—meron pong accuracy ang saliva
versus the swab of 98.11 percent,” Ubial said over ABS-CBN’s Teleradyo
on January 20.
(Based on our calculation, although it is still being debated by
statisticians and doctors at this point, the accuracy of saliva test
versus swab test is 98.11 percent. We will present these findings to the
Covid lab expert panel of the DOH later in the afternoon.)
On August 15 last year, the U.S. Food and Drug Administration (FDA)
issued an emergency use authorization (EUA) to SalivaDirect – a
saliva-based method of Covid-19 testing developed at the Yale School of
Public Health.
According to Yale, the procedure is “ideal for large-scale testing
and offers a number of advantages over traditional testing methods.”
Where and how to undergo saliva tests?
People can now avail themselves of the saliva-based test by booking
an appointment on the PCR’s official website. The tests can be carried
out either at the PCR’s headquarters in Mandaluyong City or their
molecular laboratory in Port Area in Manila.
Prior to booking an appointment, a patient should first answer and submit an e-CIF Form.
Payment for the saliva Covid-19 test should be made online: GCash via PayMongo or GrabPay via PayMongo.
Booking an appointment and filling of E-CIF form is done through the Dashlabs platform.
COVID-19
test kit developed by experts from the Philippine Genome Center and the
National Institutes of Health of the University of the Philippines
Manila.
Manila HealthTek Inc., Facebook
MANILA, Philippines – Senators belonging to the minority bloc urged
the government to allow the use of Filipino-made, world-class
coronavirus disease 2019 (COVID-19) test kits, especially at a time when
resources are scarce.
In a joint statement, Senate Minority Leader Frank Drilon and Sens.
Francis Pangilinan and Risa Hontiveros questioned what was holding
Health Secretary Francisco Duque III and the DOH back from giving the
go-signal for the use and mass production of this Filipino-made, quality
yet less expensive test kit.
“Is there someone making money from expensive and imported
test kits? The savings that could be generated from this kit are crucial
in augmenting our COVID-19 response especially at a time when resources
are scarce,” the senators added.
The senators said Filipino scientists and doctors started developing
the test kits as early as December last year when reports about the
coronavirus surfaced.
“The country is ramping up COVID-19 testing, but locally
manufactured, world-class P1,320 PCR test kits are gathering dust in
laboratories due to the inaction of Health Secretary Duque,” the
lawmakers said.
Developed by the University of the Philippines National Institute for
Health and funded by the Department of Science and Technology, the
Filipino test kit continues to face hurdles even as imported brands
coming from China and Korea, costing more than double at between P4,000
and P8,000, enter the country without difficulty.
The kits have undergone trials and tests, with an interim report
showing that they have up to 93.96 percent sensitivity and up to 98.04
percent specificity, at a confidence interval of 95 percent, ranking
among the world’s best and performing better than some of the imported
kits.
“Is there someone being favored here at the expense of
Filipinos who every day face the dangers of getting infected, or who
could already be carriers of the virus but are not yet being tested?”
they asked.
With the number of COVID-19 cases continuously rising, the senators
said the DOH could not afford more missteps in handling the situation
because lives are at stake.
1.
For asymptomatic close contacts of probable or confirmed COVID-19
cases, RT-PCR testing shall be done 5 to 7 days from exposure. If
limited test kits are available, the following conditions shall be
prioritized:
Age is >60 years old and/or they have a comorbidity,
There are sufficient RT-PCR testing kits
Enough human resources for additional contact tracing
2.
For mild or moderate suspect or probable COVID-19 cases, RT-PCR test
shall be done immediately if RT-PCR test is available in a nationally
accredited laboratory. If not and a rapid antigen test is available,
rapid antigen test shall be performed.
3.
For severe and critical suspect or probable COVID-19 cases, patients
must first be stabilized prior to testing. Once stable, RT-PCR test
shall be done if RT-PCR test is available in a nationally accredited
laboratory. If not and a rapid antigen test is available, rapid antigen
test shall be performed.
