[OPINION] Why are we still defining ‘mass testing’ when dengue’s about to arrive?

Pippo Carmona
[OPINION] Why are we still defining ‘mass testing’ when dengue’s about to arrive?
'As the government is still defining terms, trying to find the most appropriate alibi for their indecisiveness, the country is slowly drifting towards a more precarious situation, because another infectious visitor is about to return with the incoming wet season'

After presidential spokesperson Harry Roque suggested that the “mass” in “mass testing” implied “testing everyone,” I was left with an overwhelming sense of confusion, especially in doing my job as a scientist. If I ever get assigned to do mass spectrometry again, am I required to analyze not just my samples but also all the other ions in the known universe? How can I explain to my students the fact of mass extinctions when we’re still alive? 

Well, it shouldn’t have been an issue in the first place, but here we are, again, forced to confront another unnecessary problem. 

Days after the national lockdown was implemented, Department of Health (DOH) undersecretary Maria Rosario Vergeire announced on April 4 that the government will start its nationwide “mass testing” on April 14. She also made it very clear that “mass testing” didn’t mean “testing everyone.” “Hindi po ibig sabihin nito ay lahat ng Pilipino ay itetest natin, ang mass testing po na ating sinasabi ay isang malawakang testing ng mga taong at risk for COVID-19.

So if the operative meaning of “mass” was already understood back in April, why are the likes of Roque muddying the waters now by suggesting a different interpretation of the collective “mass?”

It was obvious from the start that this blatant misinterpretation was a deliberate political statement of intent. It was neither scientific nor semantic. It was politically honest. Roque’s explanation was true in the sense that the Duterte administration has no plans to exert extraordinary efforts to contain the COVID-19 pandemic in the Philippines. It wants to rest comfortably doing the bare minimum.

And as the government is still defining terms, trying to find the most appropriate alibi for their indecisiveness, the country is slowly drifting towards a more precarious situation, because another infectious visitor is about to return with the incoming wet season. In August of last year, after 146,062 cases and 622 deaths, the DOH declared the country to be in a dengue epidemic

But what put us in this dire position in the first place? Like Roque’s admission, it is simply politics. 

This is not to claim that the causative agents of outbreaks, the suspect pathogens, are somehow the products of a politician’s lies or of the resultant effluence from government chambers. However true it may be that listening to politicians speak can be carcinogenic, that is certainly not the case here. But to say that public health crises are political is to recognize that diseases are natural, but their eruptions are largely made possible by political actions and decisions.

Change (in meaning) is coming

But before moving further, we need to take a quick etymology side-trip to know the origins of “mass testing.” This will allow us to better grasp the political subtleties of misconstruing the intentions of such a basic demand.

Decades ago, “testing” was part of a more general epidemiological survey called “screening,” which was described by the Commission on Chronic Illness in 1957 as “the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly.” Only a formal methodological design was now lacking.

In 1968, a World Health Organization commissioned project by James Maxwell Glover Wilson and Gunner Jungner produced a seminal text on clinical methodology titled Principles and practice of screening for diseases. In it, Wilson and Jungner described the proper criteria for the conduct of screenings and the scope of their coverage. Two important categories emerged from their paper: “mass screening” and “selective screening.” For Wilson and Jungner, “mass screening” is “the large-scale screening of whole population groups,” whereas “selective screening” only covers “certain high-risk groups in the population.”

With the above definition, it’s tempting to say that Roque’s statement is backed by scientific support and that he is indeed right to question the aims of “mass testing.” But to do so is to consider concepts and ideas as stagnant across time. 

Wilson and Jungner themselves recognized that their work was subject to an intellectual culture that emphasized review and revision. In the same paper, they write, “If anywhere we have appeared dogmatic, we hope this may serve to stimulate discussion, since, in the end, real development depends on an exchange of views.” 

Today, the word “mass” in “mass screening” doesn’t necessitate the inclusion of the whole population. The Cochrane Medical Library, one of the biggest databases of medical research and reviews, now defines “mass screening” as the “Organized periodic procedures performed on large groups of people for the purpose of detecting disease (italics mine).”

Viral fear

What makes science possible and necessary is its inner logic that champions the change and challenge of ideas. But while it gives life to science, it also gives people the opportunity to confuse and abuse to forward their particular interests. The Philippines has been a consistent example in proving the truism of this relationship. And it can’t be more evident enough than in the putative allergy it has with the word “mass.”

Before “mass testing,” the Philippines was already embroiled in another problem that involved the word “mass.”

After it was revealed that Dengvaxia very slightly increases risks of severe dengue (by <0.5%) among seronegative vaccine recipients, the Public Attorneys Office, headed by Persida Acosta, launched a nationwide campaign to stop further “mass vaccination” drives. A flurry of sensational claims from Acosta piqued people’s already heightened fears. In particular was her assertion that a number of deaths was directly caused by the vaccine. While the medical community argued that there was no conclusive connection, PAO was adamant in their belief that Dengvaxia was to blame based on their own forensic investigations. When the DOH and UP-PGH offered to work together with PAO, Acosta declined the offer, saying that they already had enough specialists and there would be a conflict of interest since it was the DOH that had started the “mass vaccination” program.

The Duterte administration eventually sided with the medical experts, but the damage had already been done. According to a study by the London School of Hygiene and Tropical Medicine, Filipino belief in the importance of vaccinations dropped from 93% “strongly agreeing” in 2015 to a mere 32% in 2018. Filipinos were also less likely to view vaccinations as “safe,” as confidence dropped from 82% “strongly agreeing” that it was safe in 2015 to just 21% in 2018.

It was a resounding success for Acosta and crew. The suspension of Dengvaxia “mass vaccinations” was immediately greeted by a dengue epidemic. Thanks to a drop in vaccinations, measles also joined the applause in 2019 by infecting 12,700 and killing 203 from January 1 to February 23.

Double trouble

While the band Toto may “bless the rains down in Africa”, toto (a common male nickname in Hiligaynon) from the Philippines might bemoan the coming wet season. Heavy downpours will force people to crowd under roofed shelters, neglecting the need for distancing. Stagnant pools of rainwater and drainage will provide breeding grounds for Aedes aegypti, dengue’s winged-vectors. “Stay at home” will also be a less promising defense against COVID-19 when there are floods. Coinciding with the dengue epidemic in August last year was a torrent that flooded Metro Manila.

With no “mass testing” to let us see the extent of COVID-19’s spread, and with no “mass vaccination” to combat the threat of dengue, the approaching rains may provide some comfort as it hides the tears shed for the “mass deaths” from preventable diseases that have happened and will happen. In that at least, the government has no qualms on what “mass” means. – Rappler.com

Pippo Carmona is a biologist and historian of medicine. He writes history and science ramblings in his blog, SCALPEN.