Monthly Archives: August 2020

Rapid Tests from a Perspective of a Seller

It is with some amusement (sometimes sadness) that there are calls for, literally, the hanging of sellers of rapid tests. And we have a populist government ready to cater to anyone who shouts loud enough, or shouts louder than our president. We now have MECQ (Modified Enhance Community Quarantine), which, from my perspective of going out every day for work, will cause more suffering to the general populace than Covid 19. The restaurants where I took (forced) my family to eat every weekend to support businesses have their people working five days in a month, rotating those who stayed on to have some income to survive.

Yet as some blame us sellers of rapid tests for the latest MECQ, nobody has really checked the claims of private hospitals that they are overflowing with Covid patients, and if the allocation of beds requested of them had been made real. Surely there is truth to front liners being overwhelmed and exhausted, but nobody asked how many front liners were added in the four months we were in lock down, how many portable xrays and ventilators were added by all the private and public hospitals during the lock down. Sure, PCR machines were (are? really? which one?) all the craze, but I am not sure there is anything beyond PCR that were being pushed as the “gold” standard, in spite of many reports of false negatives, and (let’s say it already) even false positives. You mean there is no economic interests behind all the push for PCRs? (Note: we also have PCR machines being sold by our company, so do buy from us, as we have economic interests in this too! Although I have never believed it is a “gold” standard test, it is a legitimate and helpful and expensive yet necessary tool to fight and understand Covid 19.)

I feel lucky that as a seller of rapid tests, our brand being the Abbott Panbio, very early in the process, before we got approval from FDA, which is when we were allowed to import, we already pledged publicly, to friends and DoH and even Abbott, all income from this endeavor will go to charitable health care initiatives. At least it gives me a certain ability to write about this, with less baggage of being accused of making tons of money: there are so many cheap and substandard tests out there ahead of the curve, making those tons of money is an illusion for us, and an impossibility, unfortunately.

The initial plan was to form some kind of think tank for health care, as I admit being impressed with the knowledge I saw on the internet that groups in the US were producing, but I consulted people like Kenneth Hartigan Go, MD of AIM, who matter-of-fact pointed out, the shortage of talent will be a very difficult hurdle. I also asked Acting Neda Secretary Karl Kendrick Chua if he had a speaker in mind from abroad we could connect the economic team to help understand the pandemic’s impact on the economy, and sadly when contacted, of course the resource person was afraid to travel. I also visited San Juan De Dios, thinking of what they need, and internally we even thought of doing a partnership with them for say their MRI or their ventilators, and the income can generate funds for projects for the Catholic Church. Earnings from the Abbott Panbio Rapid Tests will make it easier to be adventurous in exploring non-traditional businesses at scale, with profit the least of the worries.

I wish I could say this impulse is simply because our people in the company want to live our Catholic faith, and this is certainly part of it. But there are other reasons: likely the pandemic made many of us want to win some points on the Karma score board. But really, for me, it was listening as a boy to old Tsinoy businessmen discussing this or that business opportunity, and it struck me when an old man, successful in business, said he would never go into the funeral homes business, or pawnshop business, which are lucrative, but it benefits from the misfortune of people. That idea has never left me. To not benefit from the misfortune of other people.

Now that the anti-rapid tests movement and hysteria are on hyper drive, let me share my perspective as a seller. During day one of April, when the PCR campaign was at its high, and whatever else tests were there, echoing the global call, especially in the US, for testing: I sent a message to friends and customers, saying at that time that we were beyond testing. I am sure some of my good friends like Dr. Harvey Uy will be able to retrieve that message somewhere in their phones. All the hospital directors we served will have it in their phones and emailbox.

Why were we beyond testing April at the height of the panic? I thought we should all be sheltering, educating the public, and if there are funds, building bed capacity, learning and buying ventilators, making sure portable xrays are in the right places, especially isolation hospitals that should have been built as a 2nd and 3rd waves seemed likely even then. We should be social distancing at that time, and even then, after 30 days, I was already arguing the lock down was too long. There was no example yet of Vietnam in the Philippine consciousness in April.

Actually, because we are today in the post-lock-down stage, we should be testing however we can. April 1, I was already sending the link of the interview with Jay Bhattacharya, M.D., Ph.D. with the conservative and pro-market think tank Hoover Institute in Stanford University.
( https://www.hoover.org/research/questioning-conventional-wisdom-covid-19-crisis-dr-jay-bhattacharya )
One compelling argument is only antibody testing can give us a denominator to the numerator of positives coming out of PCR machines. We will get an idea the population’s infection rate if we have a numerator and a denominator, the number of people who already have the antibody within a given population. But I also pointed out in April, that to declare Filipinos negative, or immune, or of having antibodies will be counter productive, because no explanation of the situation, no education campaign was able to conceptually explain social distance yet in the vernacular. At hindsight, one could say, there was no viral video and song yet, on wearing masks, social distance, and the washing of hands; which they had very early, at hindsight, in Vietnam.

Imagine my surprise when a very good friend, a medical director, told me businessmen like myself whose overwhelming economic interests in rapid tests are giving Filipinos a false sense of security, thus the spread of Covid 19 today. (Of course medical doctors and their medical doctor kids never have economic interests – wink wink, let us not go there, please). Even he has my message about this “we are beyond testing” via text messages and email from me in the first week of April. I was surely aware of this problem before Abbott even reached out to us to distribute the Abbott Panbio Rapid Tests, and I have been very vocal about this false sense of security, whatever the tests, because the Philippines as a country just has no culture of science and of planning (certainly not at the level of scenario building). And finally, people who test negative in the PCR do not have the false sense of security that they can go out and have parties and basketball tournaments that rapid tests people do? Because they spent more? Because cross contamination never happens in the preferred laboratory? Education is the problem, not testing. Hardly anyone wants to educate, but everyone is pushing this or that “gold” standard. Most of the “gold” standard hardly qualify for bronze by the month of August.

I even have a month of April SMS to friends who write in Filipino to translate, in Filipino, the concept of social distancing.

But I was clear, to all friends and customers, and we have the emails and text messages for it: during the lock down, we should be in the capacity building and education stage: now that we are in the post-lock down stage, we should be opening the economy, we should be using all the tools available to test, to get the economy going.

In our belief that rapid tests are useful, the very first shipment of the 50,000 tests of the Abbott Panbio, we delivered 4,700 to the Department of Health as our support for its efforts, in support of the work of Secretary Francisco Duque, and then Undersecretary Rolando Domingo, now of the FDA as Director General. We also donated, at more modest quantities, to PGH and individual health workers and friends.

The claim of Abbott in its brochure is for finger whole blood, sensitivity is 96.2% and specificity is 100 %. These are, we just assumed, laboratory-controlled tests, and so let us give it a minus 10 % at least in actual use. Anecdotally, it has enabled our team to serve well in our work, installing and repairing medical equipment, and in moments of very scary situations when we feared exposure, or false negatives, and false positives in the PCR, the Panbio enabled us to have some kind of guidance on whether to keep the office open or closed. Assuming someone was exposed in the office, but the office people all 100 percent tested negative in the IgM, without these tests, we could have closed our office many times. So far, the swabs have shown that our decisions have been correct. One of the multinational companies we deal with had their engineers shelter for three months, without going out to help hospitals, and in July when they came out, three of their engineers tested positive; while our engineers, wearing masks, gloves, and face shields, worked every day in five months, have zero cases so far.

We should move as a community and society away from fear, and towards more understanding of the situation. The hysterical anti-rapid tests shouts are not helping anyone, except making those who shout feel good about doing something, but actually bringing us back to the stage of fear and confusion, and the 2nd Metro Manila and surrounding areas’ MECQ is part of that fear and hysteria.

There is no doubt there are flawed, imperfect, and even sham rapid tests: but the call to just totally push out or ban rapid tests is another emotional, flawed, hysterical reaction that brings darkness, not clarity. It is a misunderstanding of what stage we are in, and I argue, in the post-lock-down stage, we need a cheap, quick, mass testing capability that rapid tests offer. This moment of temporarily bringing us back to MECQ will prove to be a mistake, it mis-educates the public, and I have no doubt, it just killed hundreds of jobs that will just not come back. They just won’t. Being an entrepreneur, I also built a business from absolute zero, and the many restaurants and stores and other businesses pushed over the edge by this MECQ will condemn many people to years of poverty and hardship.

I have to say: every business, small or big, it breaks my heart to see them close. I know the blood, sweat, and tears to get a small enterprise going; never mind to get one earning. It is hell.

The LGU that uses the Abbott Panbio in all its checkpoints, including the airport, have as of today 30 Covid positive citizens, all in isolation, all part of the balik-probinsya program of the national government, and their health workers interviewed on the ground claim their decisive and imaginative leadership was helped by the Abbott Panbio. Other LGUs have more infected people in their communities and are glorified in media for their showbiz efforts. The PCR tests allocation of this LGU is used wisely, as they are not overloaded and blind, so they can allocate these expensive and limited PCR tests to those going back to their home province from Metro Manila, but also for health workers, political leaders, law enforcers who are needed to be serving, planning, and educating. (The photo at the very top of this essay of a child getting tested is from that LGU).

A former congresswoman/medical doctor in her facebook said LGUs just wasted their time contact tracing those who dealt with positives in rapid tests. Assuming these to be IgM positive, with what we know now, we isolate, and with the availability of PCR machines, we swab. We are assuming of course, they got an Abbott Panbio, or equal it. Assuming IgG, then there is nothing to fear, and with the Abbott Panbio, we have found near 100 percent reliability on those that also test positive in the immunology machines.

We adapt, we learn, we improve.

I get addressed as medical doctor sometimes in my dealings with people in the medical community, and I always have to, embarrassed, correct them: I am not a medical doctor, and humorously (I hope) add that although I do have a doctorate, it is a Ph.D in literature, and I have never been addressed as a doctor in my previous life, but I now write out medical prescriptions (haha! a lame attempt at Woody Allen humor). But with all the hysteria and shouting over rapid tests, one even proposing to hang a noose around my neck, I am just glad to have specialized in literature, more than any other subject that I eventually built a passion for, and I do have a passion for science and medicine now (I have read Siddhartta Mukerjee’s Emperor of Maladies on Cancer with great focus and enjoyment).

Albert Einstein is a convenient and respectable way to end this essay: “Imagination is more important than knowledge.” Why did this genius say that?

Indeed, in these times of Covid 19, our lack of imagination as a society and as a health care community is just plain obvious. Imagination, in fact, it is our only way out of this rut. Indeed, I cannot resist mentioning, it is the novels of national hero Dr. Jose Rizal that finally gave the fatal blow to the colonial foundations of Spanish Philippines: it is not his knowledge of medicine.

(please consider read reading these articles:

https://harvardmagazine.com/2020/08/covid-19-test-for-public-health

https://www.nytimes.com/2020/07/14/health/coronavirus-hair-salon-masks.html )