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[OPINION] A plea to the DOH for urgency and transparency

'We need health officials who share our sense of urgency, who do not dismiss our concerns and answer complacently, providing very little information'

4/10/2020 1:20:00 PM

'We need health officials who share our sense of urgency, who do not dismiss our concerns and answer complacently, providing very little information.' COVID19PH

'We need health officials who share our sense of urgency, who do not dismiss our concerns and answer complacently, providing very little information'

Updated 5:35 PM, April 10, 2020I am not an epidemiologist by any stretch, though my degree was in a field of public health. But I study how agencies act and communicate during extreme events, like the one we are in now.Agencies are often risk-averse, meaning that, when put in a situation, their tendency is to play it safe. But, too often, avoiding risk to the agency (e.g. the risk of making extraordinary decisions that go outside one's routine) can result in increased risk to the public (e.g. the risk of an epidemic growing exponentially).

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Take, for example, how the DOH has reacted to opinions that it is not doing"mass testing," which other national health agencies are doing. Bureaucracies can respond defensively. Secretary Duque might say something like:"I'll test what, 104 million Filipinos?

Hindi yata tama 'yun." (Actually, he did say this on March 10.) And this is a way of changing the topic, because that is not what"mass testing" means.What it means is: increasing the numbers of people tested by having more inclusive criteria for testing, not limiting testing to just a few categories like the severely ill, and it means including those with mild symptoms. It means scaling up the tests done each day by a factor of 10 to a hundred. This is what all the other health agencies (Taiwan, South Korea, Hong Kong) are doing. As late as March 20, Undersecretary Vergeire said we do not need mass testing. (But I believe they are, in fact, scaling up testing as we speak – if they are, that is to their credit.) (READ:

[ANALYSIS] 3 ideas on mass testing: Where, how, and why?)Another example: when asked,"Why not use rapid antibody-based tests to supplement what DOH is doing now," the response is to go with routine (e.g.,"PCR is the gold standard"). But these are not routine times.

One wonders, if these rapid tests are good enough for agencies in Korea, Taiwan, and other areas where they have flattened the curve, if it is good enough for the White House, why not use them here? The conventional response: we are wary of false negative results. But here is the point: since so few of the suspected cases are actually tested, then there must be thousands of infected people with non-severe symptoms being turned away. Each of these who goes untested is a false negative. If you think of this like a machine, the"machine" has a 100% rate of false negatives. And each infected person that goes untested can go on and infect, say, 3 other people, which means continued exponential growth. (Having a tested person wait a week to get results is almost as bad.)

Agencies, when they play safe, can become less transparent. But these are extraordinary times, and Filipinos demand to know everything that is going on. South Korea's foreign minister said,"The key to our success has been absolute transparency with the public."

As some journalists astutely pointed out, the numbers appearing in the DOH's COVID Tracker were much different from what was being verbally reported (more than 100% off, which should be front page news). If you look at the website today, it only reports the bare minimum: total cases, recovered cases, mortalities. Much information is no longer being posted, such as number of tests conducted that day, PUIs, numbers of patients in area hospitals, etc.

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But the public demands to know what is going on, especially reporting on how many samples were taken in a day and how many test results were obtained. Are we getting a few hundred test results per day or a few thousand? What are the numbers? And what are current testing times; are they decreasing?

You see, if we are, in fact, still under-testing, another problem is that the"epidemic curve" (i.e. the graph showing daily new cases over time) tells us nothing, because the great majority of infections are not being captured. It cannot tell us if it is trending upwards, downwards, still exponentially growing, etc. And so, decisions about lockdowns that the government has to make in real time are being informed by little data. The public cannot even tell how many tests were done each day.

Agencies need to claim victory. I have heard how the DOH is touting early success because infections in the Philippines seem to be only two in a million. But if the DOH is under-testing, can we really say anything? To exaggerate the point, if I test zero people, could I then say infection rates are zero in a million? (Plus, excuse my math, but it seems two per million times 105 million equals 210.)

And what about surge capacity analysis? Other health agencies are doing this in real time. This is what New York City does when it determines the need for 15,000 more ventilators. Where is our analysis? And what advice are people getting? What does a household do when they have 9 people living in the same small structure, and one of them might be infected but cannot get tested?

I do not pretend to see inside Secretary Duque's and Undersecretary Vergeire's minds. I don't know if they are exhibiting classic risk-aversion. Perhaps there are other reasons – they are the experts, not me. I suspect they are taking heroic actions behind the scenes, but I only know what I read. I know that the DOH is under great stress and under-resourced, and they are trying to address a situation that, a few months ago, was unimaginable. We need health officials who share our sense of urgency, who do not dismiss our concerns and answer complacently, providing very little information.

And where is the President in all this? These are, after all, his appointees. Why do we not see him everyday, pushing them? Read more: Rappler »

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thank you. hoping you'll reach more readers with this. these were my thoughts too. they promised ncovtracker will be back the 14th. hoping for more data like supply and capability projections. that's what I'm afraid of, hospitals overwhelmed after a few days of MORE testing

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