Wednesday, June 3, 2020

COVID-19 Testing Doesn’t Prevent Infection: Puerto Rico Government’s Answer to a Question No One Asked

By on March 27, 2020

Dr. Juan Luis Salgado and Gov. Wanda Vázquez (Courtesy)

Contact Tracing is Key to Controling Pandemic, WHO Director-General Says

By Rafelli González Cotto

“The tests are important, but the tests do not prevent transmission, what prevents the transmission is social isolation.” That has become the constant refrain of Puerto Rico’s government when asked about the pace in processing the first 1,000 molecular tests of patients suspected of having contracted the novel coronavirus disease (COVID-19) on the island.

Similar statements, which were echoed during the special program broadcast on state television and press conference Thursday, contrast with the recommendation of the World Health Organization (WHO).

“Test every suspected case” with COVID-19 symptoms, WHO Director-General Tedros Adhanom Ghebreyesus recently told the world media. “If they test positive, isolate them and find out who they have been in close contact with up to two days before they developed symptoms, and test those people, too,” Ghebreyesus stressed. 

“Puerto Rico and the Task Force is testing, testing, testing. All those who have the condition and their doctor referral will undergo the tests,” Gov. Wanda Vázquez Garced said in the press conference she gave at La Fortaleza grounds a week after not holding any media briefings with her coronavirus task force.

Hours earlier, a patient with a referral, symptoms and negative tests for mycoplasma and influenza had to resort to social media to finally get tested. Other patients have faced similar issues in the past few weeks.

“We want the press to understand that we are transparent, we are trying to get test kits from where there are none, and the test will not cure you, it will tell you if you have the condition or not,” Dr. Juan Luis Salgado, a task force member, told reporters Thursday. The doctor then asked the “many people in the press” to “call us and tell us I have a million test kits” to buy them immediately.

Where are the rapid test kits?

On March 13, then-Health Secretary Rafael Rodríguez Mercado assured that 1,000 molecular tests would arrive. Nearly two weeks after said announcement, the reason why kits from that same order are still available is not clear.

On March 19, Vázquez Garced announced that she ordered the purchase of another type of test. With a $10 million investment, a total of 200,000 rapid test kits were expected to arrive on an unspecified date, from an unknown location and supplier. These tests, which are less accurate than a molecular test, would reduce the wait time for the result to 30 minutes. Nine days have passed since that announcement.

“The tests are important, but the tests do not prevent transmission, what prevents the transmission is social isolation. We are competing in a global crisis with other countries such as Europe, Asia and the United States, and sometimes it is difficult to get a commitment from the supplier,” explained the head of the task force, Dr. Segundo Rodríguez, regarding the slow pace at which rapid test kits arrive, the exact number of which and where they have been delivered is unknown.

“The molecular test is more accurate than the rapid test. Therefore, if I already have these patients who underwent the test, I am not going to use up these rapid tests, which are a less effective test for them than the one already administered. We are trying to get the CDC [Centers for Disease Control and Prevention] to activate another laboratory in the Medical Center [the island’s main public hospital] to continue doing the tests,” Dr. Salgado replied to Caribbean Business regarding whether rapid tests would be administered in cases pending molecular testing, which totaled 336 at the conclusion of the press conference, for faster results.

Task force protocol

During the press conference, Dr. Rodríguez said his group of doctors had given the governor a “manual and the protocols” to address the pandemic. “What we want is that there be transparency and…uniformity throughout this process,” he said.

Given that protocol has been established, should it be assumed that there is an epidemiological estimate of the number of deaths expected as a result of the virus, CB asked.

“If nothing was done, if nothing had been done in the epidemiological study in a country like Puerto Rico, and from what is being estimated is happening in Italy, in Spain, in the United States, it could have been 20,000 people,” replied task force member Dr. Salgado, who praised the actions that the governor carried out, which are contrary to what President Donald Trump and the vast majority of state governors have done.

However, the estimated 20,000 possible deaths is not what the task force expects. 

“We believe that the [case number] curve, in which we are now on the part…that is rising, is now going to tell us if all this has really worked, and we believe that would be the worst scenario but it will not be the worst scenario. We are sure we are headed toward the best scenario,”  predicted Salgado.

While measures such as social distancing, closure of non-essential businesses and the establishment of a panel of medical experts have been wise decisions, these initiatives alone will not directly affect the curve because the numbers fed to produce the corresponding graph is the number of confirmed cases, data that can only be obtained via testing, whether molecular, rapid or a combination of both methodologies.

In addition, testing is required to properly collect contact tracing data, the task force itself acknowledged.

The governor assured CB that the manual and protocols that the task force gave her will be made public this weekend on a website that will contain statistical COVID-19 data and other related information.

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