A closer look at DOH’s triage system and why politicians, officials are getting tested for COVID-19

March 19, 2020 - 5:03 PM
File photo of laboratory testing
Undated file photo of a person conducting tests in a laboratory. (Philstar/File photo)

Health Undersecretary Maria Rosario Vergeire recently explained why some public officials were tested for COVID-19 infection, citing a triage system but the previous triage system she was referring to didn’t suggest they should be tested.

In a radio interview over DZMM on Tuesday, Vergeire said that they were tested when the “decision tool” of the health department has not yet been revised.

“Nung mangyari ang mga test na ito, especially ‘yung sa ating higher officials, hindi pa natin na-revise ‘yung decision tool nation… So pumasok pa rin sila sa criteria natin as PUI (persons under investigation),” she said.

Based on reports, a number of senators who underwent COVID-19 detection only found out they were exposed to an infected person on the evening of March 11, Wednesday.

Senators Sherwin Gatchalian and Nancy Binay then announced that they would impose a self-quarantine after they discovered that a resource person at the Senate hearing of the Committee on Basic Education, Arts and Culture last March 5 tested positive for COVID-19.

This prompted other public officials such as President Rodrigo Duterte, Executive Secretary Salvador Medialdea and Senate Minority Leader Juan Miguel Zubiri, among others, to get tested as well.

The Department of Health, however, released an “updated” algorithm for the triage of patients with possible COVID-19 infection the day before Binay and Gatchalian discovered they were exposed and then tested.

It was shared on their Facebook page late March 10, Tuesday.

DOH triage system as of March 10, 2020
The triage system of the health department as of March 10, 2020. (Photo from the Department of Health via Facebook)

It indicated that people experiencing symptoms related to respiratory acute illnesses shall be classified as either persons under monitoring or investigation, depending on the travel history, exposure or preexisting health conditions.

A person who does not have any symptoms, or are asymptomatic, can only be considered “under monitoring“—the lowest level in the triage system—if he has “appropriate exposure” to an individual infected with COVID-19.

People who fall under that category, based on the triage system released March 10, “should undergo home quarantine for 14 days to monitor for the development of symptoms.”

They should inform the Regional Epidemiology Surveillance Unit and fill out a case investigation form.

“NO NEED for testing,” the DOH said in the post.

Reports noted that officials such as Binay and Gatchalian had no symptoms when they decided to undergo self-quarantine and eventually had themselves tested.

An older version of DOH’s decision tool dated Jan. 30, 2020 is also available on its website but not on its Facebook page.

Under that version, a person is “under investigation“—the same term that Vergeire used to describe the public officials who underwent testing—if he has at least a history of exposure and has respiratory infection symptoms.

The older decision tool also indicated that those with a “history of exposure” is when someone had close contact with those who took care of an infected person, have visited or worked in a live animal market in China or have direct contact with animals in China with COVID-19.

It specifically defined what a close contact means which includes “working together in close proximity or sharing the same classroom environment with an nCoV patient.”

They could also be considered a PUI if they have traveled to China in the past 14 days and have displayed symptoms of respiratory infection, among others.

If a person only had a history of exposure or travel history to China in the past 14 days but do not have any fever or respiratory infection symptoms, they are only considered as “under monitoring.”

Reports noted that most public officials cited “instances they were exposed to (a) possibly infected person or their travels to places with known cases of transmission” as reasons for their decision to test.

The older decision tool indicated that those “under monitoring” should self-quarantine. It did not mention that they should get tested for the infection.

The DOH made the same clarification on Wednesday evening, a day after one of its senior officials tested positive for COVID-19.

“DOH clarifies that as long as you were not in close proximity—at least 2 meters distance —with the said official, you are not considered a close contact,” the state health agency said.

Prioritize those with symptoms

The questions about asymptomatic officials’ testing were raised by the local online community after some of their family members were tested despite displaying no symptoms related to COVID-19.

Some Filipinos claimed that those who are working in the frontlines of the pandemic and people labeled as “under investigation” should avail of the test kits first, considering the DOH said it is limited in the first place.

RELATED: Politicians and their families get tested for COVID-19, but some people are not having it

An associate publisher from a news outlet shared that one of their reporters “exposed to a senator on quarantine” was not given the same opportunity as the public officials who underwent testing despite being asymptomatic.

“Earlier, we tried to ask if our reporter exposed to a senator on quarantine (could) get a test but was told no coz of protocol to test only those w/symptoms. Yet our senators even get to be tested twice. They are our leaders so they are (important) yes, but do we ordinary people deserve less?” she tweeted.

Last Friday, Manila Mayor Isko Moreno, his chief of staff Cesar Chavez and other city hall officials who accompanied him in a business trip to London sought testing from DOH, despite not having symptoms.

They tested negative for COVID-19 but voluntarily placed themselves under self-quarantine.

Aside from Binay and Gatchalian, almost all of their colleagues at the Senate have also undergone testing except for opposition Senators Kiko Pangilinan and Risa Hontiveros who declined to be tested due to scarcity of test kits.

The two lawmakers cited the current policy of the health department that states only symptomatic patients, those with travel history to confirmed countries or those in close contact with an infected individual can get tested.

Pangilinan and Hontiveros have imposed a self-quarantine instead.

The country is currently facing a shortage of testing kits to detect COVID-19. Recently, provinces in the Visayas region have expressed concern about obtaining it due to restrictions on domestic travel.

On Thursday, the Food and Drug Administration announced that it approved a list of COVID-19 test kits donated by South Korea and China for commercial use. It added that these PCR based reagent kits are to be used in laboratories and not point-of-care or do-it-yourself kits.
Based on the DOH tracker, there are only 1,172 individuals tested for infection since January 30 as of 12 noon on March 19. Of which, 298 are cases with pending results.