Coronavirus: Types of COVID Tests & Costs in the Philippines

The idea of writing this article was initially to help my business owner friends to have one-point reference on Types of COVID Tests & Costs in the Philippines. Because at the time of writing this, there is actually no information available on the internet. Whether on Google or on Facebook. If there are, the data are not consolidated and hard to process. Thus, the birth of this post. In hopes of helping SMEs or even us regular folks to have a point of reference.

Scroll until the end of the post to see all tests and costs of COVID-19 in the Philippines

*Article will be updated with new information as received.

Technical Advisory from DOH (Department of Health Philippines)

Antibody-based tests for COVID-19 may yield false negative results leading to wrong discharge

Scientific Basis:
Viral SARS-CoV-2 mRNA detection by means of RT-PCR is still the screening tool of choice. Checing the igG/IgM antibody response may yield false negative results in patients that are in early stages of infection. Antibodies cannot be detected until much later after infection starts.

What Does it Mean:
False negative results from antibody-based tests may cause to be wrongly discharged even as they are still infected and capable of spreading COVID-19

COVID-19 Test Comparison

RT-PCR Test – Real-time Polymerase Chain Reaction

• SAMPLE: Swab sample from inside the throat and/or nose
• TEST SITE: The specimen is evaluated in a specialized laboratory
• EVALUATOR: Only licensed and trained health workers
• QUALIFIED PERSON TO TEST: Person with or without symptoms
• RELEASE PERIOD: 24-48 hours
• PURPOSE: Detects virus genetic material

Rapid Antibody-based Test

• SAMPLE: Blood sample
• TEST SITE: The specimen is evaluated in a hospital or licensed facility
• EVALUATOR: Only licensed and trained health workers
• QUALIFIED PERSON TO TEST: Person with symptoms (5th to 21st day upon the first sign of symptoms)
• RELEASE PERIOD: 15 minutes
• PURPOSE: Detects antibodies formed by the body in reaction to the COVID-19 infection

COVID Tests & Costs in the Philippines

Mary Mediatrix – Lipa Batangas

• Rapid – 700 PHP
• Swab – 7,000 PHP

Cardinal Santos Medical Center

• Rapid – 1,500 PHP
• Swab – 6,000 PHP

From Dr. Edsel Maurice Salvana on “clearance prior to going back to work”

There seems to be some confusion on what needs to be done to clear an employee for work. DOH released DM 2020-020 which outlines Interim Guidelines on the Return to Work.

The most pertinent items are:

1. You need to check EVERYONE for SYMPTOMS before they can be allowed to work.

The rationale for this is that >80% of transmission of COVID-19 is from SYMPTOMATIC disease. The DM says that employers SHOULD ask all returning workers about FEVER AND RESPIRATORY SYMPTOMS in the last 14 days.

If they have had this COMBINATION of symptoms, they should be tested with an RT-PCR if suspected to have COVID-19. Because even RT-PCR can be false negative in up to 1/3 of patients, the SAFEST thing to do is to isolate all symptomatic patients for 14 days REGARDLESS of RT-PCR result. If RT-PCR is positive, they will need to be cleared with a repeat test per DOH protocol. If RT-PCR is negative, they can return to work after 14 days of isolation provided they no longer have symptoms and feel well.

2. There is NO REQUIRED LABORATORY TESTING to clear asymptomatic workers for work.

THERE IS NO GOOD TEST FOR AN ASYMPTOMATIC CARRIER. Rapid antibody tests WILL ALL BE FALSELY NEGATIVE in a patient who is incubating COVID-19 and will only become positive about 7 days or more from the time of symptoms onset. If you find an IgM+ or IgG+ in someone who is ASYMPTOMATIC for more than 14 days, he/she is either a RECOVERED CASE or a FALSE POSITIVE. Either way, that patient is UNLIKELY to be contagious. Even if you do RT-PCR in an asymptomatic carrier, it will only pick up people who are 2-3 days away from developing symptoms. It takes 5 days or more to incubate COVID-19 so you will MISS half of those carriers. It isn’t cost-effective to screen everyone.

Bottom line is that you CANNOT RULE OUT asymptomatic COVID-19 with testing, and so the SAFEST thing to do is to prepare your workplace as if everyone is a potential asymptomatic carrier: mask for everyone (can be cloth or surgical mask), physical distancing, handwashing, frequent disinfection, capacity controls, staggered shifts, etc. You also need to check symptoms and temperature on everyone daily and isolate people who are symptomatic along with close contacts.

Employers CAN but are NOT REQUIRED to do SAMPLING of their workforce for asymptomatic carriers, but this won’t be cost-effective and will not screen out potential carriers as stated above. The BEST test to carry out at BASELINE is an RT-PCR, but this can still miss asymptomatic carriers. After every 14 days, a validated Rapid Antibody Test CAN be used (again not required) on a sample of workers if you want to check for anyone who developed asymptomatic COVID-19 recently. This cost will be borne by the employer also since it is not required by DOH.

Testing all asymptomatic workers is NOT cost-effective and is a significant financial burden for employers. It will not screen out asymptomatic carriers even with RT-PCR and is NOT required by DOH.

3. Not all antibody tests are created equal, and validation is ongoing. Proceed with caution if you decide to use them and try to use kits that have high sensitivity and specificity if you elect to test.

A lot of rapid antibody test kits have poor sensitivity and specificity as assessed by FIND-WHO (https://finddx.shinyapps.io/COVID19DxData/). None work very well at <7 days from symptom onset. Ideally, you want a >85% sensitive and >95% specific test. There is an ELISA that is coming that is purportedly 99% sensitive and 100% specific, although this needs to be done in a laboratory. WHO currently does not recommend use of rapid antibody tests for clinical decision-making as a standalone test. The use of rapid antibody tests is still evolving. No doubt they will have a role, but it is important to use them with their limitations in mind so that one can act properly on the results.

The bottom line is that we are going to have to live with this virus for a very long time. Even if you test appropriately once and are negative, you can still get infected the next day. Appropriate testing is PART of the solution, and it has its limits. We need to assume everyone is a potential carrier, and we need to minimize our risk by changing our daily habits to limit transmission. This is the best way forward.

Sources:

• Unilab
• DOH
• Mary Mediatrix Hospital
• Dr. Edsel Maurice Salvana