"Detect. Isolate. Treat. Reintegrate"
"Detect. Isolate. Treat. Reintegrate"
Rearranged, the above spells “dirt”—which is what’s now filling our mouths as our faces hit the ground from the force of the virus epidemic. Or, what it must feel like you’re inhaling as your lungs struggle for oxygen amid the viral haze of a seriously infected patient.
What the above letters mean, though, are something more hopeful. They’re an acronym for the strategy design that our government—through an interagency task force (IATF)—has decided to follow as it struggles to beat back the virus. If we want to lift, or at least relax, the extended expanded lockdown by end of this month, it’s a strategy we should all learn by heart, and in which we should find our respective roles to play.
In short: Detect. Isolate. Treat. Reintegrate. Many of its components may already be familiar to us, but the whole picture maybe not yet. It’s our road back to recovery.
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Detection starts with testing. Unfortunately, this is an area about which there are even more differences of opinion among the medically ignorant, than there are among the doctors themselves. Truly, ignorance is more infectious than knowledge.
The flavour du jour is lateral assay flow testing. It’s the only test that doesn’t need to be done in a lab, and it reportedly takes only 15 minutes to get results back. It’s currently beloved not only by those hooked on instant gratification, but also by certain business and economic leaders who like to get results quickly and who really ought to be more respectful of the limits to their mastery of the universe.
Unfortunately for them, this test method can be as low as only 40-percent accurate. That means it is even less accurate than a 50/50 toss of the coin. Why bother to test, in that case? Better for us to just toss a coin every time.
The other methods available are lab-based and thus require more time to yield results. The method officially preferred by the interagency task force is RT-PCR, the only one that actually looks for the detritus of the virus itself. It’s a lab-based test that can yield results in 1-2 days. By itself, the test is at best 70- percent accurate—hardly the “gold standard” that even health officials have labelled it. But 70 percent is still a lot better than 40 percent, or 50/50, especially if combined with actual patient examination that is the only way to seal a truly reliable diagnosis.
The good news is that we’re about to take delivery of a lot more RT-PCR test equipment that should push up our testing capacity to 8,000 tests per day as early as this week. This seems to be the minimum number of tests whose results our doctors will be comfortable enough to use as a guide in deciding whether we can relax the extended lockdown by end of this month. The next three weeks, in short, are critical.
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The second part of Detection is contact tracing. All that testing isn’t just in order to find out who are infected—especially those who aren’t showing any symptoms—and either isolate or treat them as the case may be. More important from a public health point of view, it’s to track down people who may have been infected by contact even with just a possibly infected person. This allows us to put a geographic face on the spread of the virus, which will later let us lift, or relax, the lockdown in some places but maintain it in others.
The telcos are helping by allowing the authorities to track where your cellphone has been. As well, the presence of a large number of cellphones moving about in a given area tells us there’s a high rate of potentially infectious contact taking place among those cellphone users. Don’t expect the lockdown to go up anytime soon in those areas.
Because of the importance of contact tracing, the IATF recently decided—after a long and heated debate—to relax the standard rules on patient confidentiality and share the names of (symptomatic) PUIs and (asymptomatic) PUMs with the police and other authorities. This will make it easier to track down their contact histories.
What isn’t about to happen, though—perhaps not ever—is sharing those names with the general public. When even heroic frontline health workers are being harassed by their communities, it’s clear that the public can’t be trusted with that kind of information. With so many now hooked on fake news, average citizens—like children—just can’t be expected to behave responsibly with too much information.
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The third part of Detection is social distancing. The basic rules by now are well-known: Wear your face mask (gloves would also be helpful). Maintain your distance (at least one meter from each other, although recent tests have seen the virus travel by air as far as four meters). Observe personal hygiene scrupulously, like frequently washing your hands, coughing into disposable tissue paper, not touching your eyes or nose through which the virus can gain entry.
Unfortunately, social distancing in many of our communities simply has to be forcibly enforced. We’ve seen videos of public markets, or cockpits, or religious processions where everybody merrily carries on practically cheek to jowl. But there simply aren’t enough policemen or barangay watchmen to do the job. And in certain cities, like Quezon City, the leadership doesn’t seem to have the energy or interest to keep people in line.
A new idea has come up that might be worth considering by the IATF. That is to make every single household as a quarantine point. The head of family serves as barangay tanod over his filial flock.
The guidelines for this still have to be worked out, but the list of what needs to be enforceable wouldn’t be long. It would obviously include basics like making your family wear masks outside the house, making them wash hands before entering, disinfecting clothes and other personal accessories brought in from outside, and in some cases, properly isolating a family member who’s a PUI or PUM, especially from elderly other family members.
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And that’s just the “D” in DITR. More on the rest of it next week.
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