 Good morning, good afternoon, good evening nasalman po kayo na party ng mundo. Welcome to the 79th installment of the Stop COVID-19 Webinar Series. And it's the start of our 7th season for our Webinar Series. Thank you for being part of our credible online community and to all those who have just discovered us for today. Welcome po! Sana po masian po kayo at tuloy-tuloy na po ang inyong panunod at pag-join sa Amin each and every Friday. So ang pag-usapan po natin, nakita nyo rin po sa ating mga posters is about COVID-19 testing. Testing po, it always plays an important role kapag may mga outbreak, pag may mga kumakalat ng mga sakit, may pandemya, kato'l po ngayon. And prior to the vaccination, we had to rely on testing to provide us with a little bit of information kung paano mampo kumakalat ang sakit, gano na po karami ang nakakasakit at para mas ma-tulungan din po ang mga contact tracers po natin. If someone had symptoms and tested positive, ina-isolate po natin po kagad yan. If someone was exposed at may test po siya at na-test po siya at the right time that will tell if the exposure has resulted in an infection. However, ma-apansin nyo rin po over the past, I don't know, 19-20 months po, meron po kakulangan in terms of the number of tests being done, lalo na po nung wala pa po tayong mga vaccines. Yun po talaga yung ating ginagamit po kasing guide para po magkaroon po tayong more targeted approach sa pagsupo, sa pandemyang ito. Ngayon po may bakuna na po tayo, the equation has changed. So people in the national capital region are now more than 90% are fully vaccinated that has provided some protection against the deadly COVID virus, but not an assurance that we are completely protected or unprotected. Many who have received, lalo na po ang sikat na sikat na Chinese brand are having tests done by themselves and would like to receive other vaccines based on their antibody titers, ganok po po karami ang kalalang antibodies kumbaga. So sa kakulangan po nang shall we say clear guidance on how to use and maybe interpret all of the different tests that we have right now, swab, saliva, antigen, we will continue to see irrational use of testing and perhaps unnecessary expenses as well as some sort of frustration po from testing when not needed, failing to test when needed. So for our webinar for today, if you want to learn the latest developments, kaugdaip po na COVID-19 testing straight from the most credible experts, please stay tuned and I hope you'll be able to learn more after this webinar Dr. Raymond Francis Sarmiento, director of the National Telehealth Center, National Institute of Health, University of the Philippines, Manila. Always a pleasure to be with all of you during our regular Friday lunch date and always look forward to sharing hosting duties with our beloved mentor, the president's special envoy for global health initiatives and our adjunct research faculty at the National Telehealth Center, Dr. Susie Pineda Mercado. Dr. Susie. Hi, good afternoon Raymond. Bagandang hapon po sa inon lahat saan man kayo naro and I hope you're all doing well, you're in good health and parang nakikinyan ang ngon pe although, siyempre alam natin ano to na up and down at natin atin alam kong ganoong atagal but it's good news to hear that there's some opening up. But as Raymond said, it'd be very interesting for us to talk a little bit more about testing kasi parang puro bako na yung pinagusapan. Alimutang din natin na importantin yung testing at maraming mga pagbabago sa testing so malalaman po natin ang tungkol sa mga bagong test sa pamamagitan ang ating mga experts and we do have some very good experts today who you will learn a lot from. So we're looking forward to that I'd like to greet everyone who's watching us on Facebook and on the playback on YouTube. Mabuti naman at nakakapang tipon tayo sa mga nandito for in the zoom we are here because of you so kung hindi sa inyo hindi na mga kami magkakaran ng webinar na ito at utuwalang kami na marami sa inyo talagang regularly nandito pag Friday so binabati ko kaya lahat especially those who are watching from far off places so today I could see again Isabella, Davao, Sambuanga and all of our friends in the national capital region sa ating mga DOH retained hospitals so binabati ko yung lahat and I hope that today will be a productive day and you will learn a lot from our experts about testing so nating kalimutan na habang tumatagalang panahon nagbabago rin ang teknolo hiya at naging masmahusay tayo dun sa testing so aalamin natin yan mamaya Raymond, over to you Thank you Dr. Sousy so para na rin po sa ating mga very first time na mga kasama for this webinar series we always have this very brief na video natin tago ko natin on the 3D models of the common folks po with regards to our specific topic in order to put our discussion in context at something that we really hope will be helpful as you try to learn po throughout the webinar for our person on the street interview video ang katanungan po na itatonong for today kailangan kupuba magpakuvid 19 tests para po makapasok po sa trabaho o kaya sa iskwela so TVUP take it away and hope our audience watches this may stand on this question po would be no I don't think that it is necessary to require individuals to undergo COVID-19 tests for them na makapasok sa trabaho o sa iskwela so I have two reasons why I came up with my answer first setting this as a requirement would be pricey on the part of workers and students unless po siguro if the expenses are covered by company or health insurance so we need to acknowledge po that not everyone is fortunate enough to have the financial capacity para makapapatest I think it's a necessity magkaroon ng COVID testing but yes especially na magkakaroon na nang na uproof na ay TFU limited face to face classes but I think it's very ideal kung I think it's very ideal kung like every on a daily basis pa siya gagawa yung COVID testing or like major skills but possible na maging expensive siya ilan kung magpakumintesting pa rin yung mga magagawa na papasok sa nang trabaho same time yung mga magsijantin papasok sa nang mga paralan as long as gastos ito ng saagutipan ng boss ng company at saagutaman ng iskwelaan kung gating ibigay yung gastos at nagdag-hazel pa sa mga magagama at magsijantin nil sila yung pinahirapan ng pandega ito For students po most probably they will be offered with an alternative solution po which is for them to continue siguro distance or online learning but it is more unfair I think para sa mga workers especially if work from home is not applicable to the top to the types of job that they have I think vaccination po is with very number number one solution if gusto po nating magkaroon ng community as soon as possible and yes yung safety protocols na yung ganyan and I think me bettering as an individual myself I think we should be more active we take vitamins ganyan try to live in a healthier lifestyle and so effective parang naman yung COVID testing as long as depends on yung test na yun kasi ando rin siya parang ang pag-iisip ng mga ka-trabaho rin yung lalong lala na sumang mga medyo natatakot dahil may umubu-uisi sa pagina nila na may mga kata-tanda para ka-panatagan ng loong so kailangan ng COVID testing That's why I'm not angry nakailangan pa mag-COVID-19 test para makapasok sa trabaho for practical approach siguro could be applied few of those ay to ensure na lang na individuals receive their full dose of vaccine which is totally free by the way na yung wala naman tayo sa science sa kabilan ng differences natin sa opinion ng religion man yung kung anong pinagubutan ito inihimo ko yung mga gawa at lahat ng mga kababayan na magpabakuna may basehan naman ito scientifically so sa kababagulan tayo Thank you very much TV UP it's always very nice to take the perspective of ordinary people when you ask the question obviously the big concern is cost when we look at what's going on in the rest of the world Singapore UK, Canada, Germany they're all opening up and using antigen tests for workers and for school but it's not at the cost of the individual ito po ay sinasalo ng pamahada the government pays for it or private companies I was just talking to a friend of mine in Japan private companies have to pay for it but they get tax incentives for covering COVID cost so there is a way of financing COVID tests di naman yun ang pagusapan natin ngayon pero Raymond dahil na ibanggit yan parang we can't say that we can't afford that we cannot afford it because I think we cannot afford it we need to continue to test because we will not know where the disease from a public health point of view where the disease is but they're right our young people who are interviewed are right na pagpabakuna lahat pero alam din natin na maraming breakthrough infection kahit na nabakunahan nakakaran pa rin ng COVID ang usapan ng mga experts natin yan so Raymond over to you thank you TV UP thank you TV UP and thank you Dr. Suzie we are now offering almost 600 participants in the Zoom but we hope yung pung mga nakapag-register and we'll be able to join in Zoom can join us because we are able to accommodate up to a maximum of 3000 participants if you are watching in YouTube or Facebook sana po you'll have the chance this time maybe next time to join us of our online community by joining in the Zoom please put a shout out sa comment section kung anon po kayo sa YouTube at sa Facebook pages po ng University of the Philippines TV UP and stop COVID deaths mayroon po tayong ibat-ibang para-discussions na nangyayare and there will be members of the team who will be monitoring and watching us in our live streaming channels we would also like to invite everyone to participate na sa Zooman po kayo o hindi in our fun quiz so the questions that we have for our Zoom poll are the very same questions that we have for our Mentimeter for those who are joining us for the very first time what that means is that you open your internet browser and go to www.menti.com and use the code N6872 that's 7887 6872 for you to be able to participate in our fun quiz so saan na po you'll be able to join that's something that provides us with an inkling of what you already know about the topic for those who are asking lalala po sa week in and week out nag-email the certificates of attendance will be given to those who have watched at least 50% of the webinar duration yun po please let us know we have already distributed up to webinar 77 completely I think there are still a few more that we want to be able to get out but please let us know po if you think that you should be receiving your certificate but have not received it po for those who have joined us na lalala nyo po I think it was last month a few weeks ago tayo nung ating game show na that was webinar 75 ang title po ng fact or fake B COVID-19 social media smart for the winners please expect an email from the stop covid that steam with the pick up instructions ng inyong prize at your selected UP constituent university as indicated in the google form that you have filled up na we are mentioning this because we have a lot of messages regarding those who would want to pick up po ang kanilang mga prices lalala po na ngayon na medyo maluwag na po at mga kapag labas at mga makapunta na po sa kanilang mga selected UP constituent universities if you cannot if you are not able to find it in your email inboxes baka po na sa spam folder po ninyo and please check it po para po malaman po natin kong nando na po again we would like to acknowledge San Miguel Foods the Food Division of San Miguel Food and Beverage Incorporated for the gift packages they have well essentially generously sponsored during the webinar number 75 at maraming salamat po sa lahat po ng nakilaho sa ating game show who are part of our credible online community over to you Dr. Suzy okay thank you very much Raymond for the announcements ay nagtatangong nasa na doyong kami lang mga food back okay so we are taking care of that alright so let's go to our opening speakers so we typically invite a very distinguished guest to give some opening remarks and set the tone for the webinar and I'd like to welcome Dr. Nelson Teraldino the Chair of the Department of Laboratories of the Philippine General Hospital welcome po Dr. Teraldino yes good afternoon unfortunately the webinar does not come with lunch no? so mercifully we have Raul and other experts on hand to discuss their takes on the current trends in virus testing so let me tell you it is not easy to be a virus with SARS-CoV it was able to take take root and cause so much destruction morbidity and mortality in populations everywhere because it is a newly evolved virus so I am sure that Raul is going to discuss the differences in testing that are occurring currently versus what was happening at the start of this pandemic and in the middle of this pandemic that is around the beginning of this year I have noticed from the comments that many of the issues stem from the kinds of tests how convenient it is going to be for the for the testis or for for the people in the streets for students and for workers and also many of them are aware and very apprehensive of the cost of testing but in the end for medical practitioners and for the department of health accuracy at the best doctor So for this afternoon Doctor Jonathan Rivera is going to show you some data from the Philippine General Hospital regarding how we do things since the start of the pandemic what we have been detecting in the virus strains and hopefully Doctor Distura is going to give us some more insights into what the future the very near future next month, next year is going to bring for everyone So with that thank you very much and welcome to the webinar Thank you very much Doctor Geraldino for being with us today for sharing your time with us but it's so important to have you at the webinar today Okay Raymond, over to you We are now going to our fun quiz Thank you so much Sir Nelson, it's not every day that we are graced with your presence so we really appreciate you taking the time up from your busy schedule Thank you so much sir Now move on to our fun quiz There we go, we are now seeing on the screen at least in zoom, there we go for Mentimeter also The two questions that will be posed for us for today Ang unapong katanungan Anong COVID-19 test, antingin mo ang pinakamahusa yung what COVID-19 test do you think is the best The first option is RT-PCR swab Second option RT-PCR saliva Rapid antigen and fourth option rapid antibody We are seeing almost 200 participants at least in the zoom joining in, 76 in Mentimeter Hopefully mas marabi pa po ang mag-join sa ating fun quiz, hindi namang po ito graded so please let sana po makasali po kayo sa ating Mentimeter po and zoom poll po who are joining us from Benigno V, Aldanya National High School in Pozo Rubio Pangasinan, Commission on Population and Development Region 3 in San Fernando, Pampanga the Provincial Health Office, Provincial Epidemiology and Surveillance Unit in Tresim, Marteres City and Cavite Corazon, Loxin, Montilibano Memorial Regional Hospital in Bacolod, Noigros Occidental and the Ministry of Health in Barm, the Mangsamoro Autonomous Region in Muslim Mindanao Finally, we are also being viewed po we have already greeted those from Algeria but we hope to greet those who are joining us from Chunin Hospital in Taipei, Taiwan Hock Polyclinic in Vietnam Penang Malaysia, Dubai United Arab Emirates, Taif Saudi Arabia, Lunichi Aleb University of Lida II University of Liji, Laotoka and Stockton, California bago po yon si Stockton, California For question number 2 kapag nag-positive ako sa COVID-19 test, makakabayay pa rin po ako so for the benefit of those who are watching us internationally, if I test positive for COVID-19 test will I still be able to travel? It's a true or false question we are seeing 78 participants in Mentimeter answering the questions and a little 400 in the zoom poll so please let us know if you are encountering any problems po that's why you are choosing to put it in the chat but anyway, we will not be closing the poll as we move on to our main speaker Doctor Susie It's really cute I really like that I still have a lot so thank you for participating and it's my honor to present our first speaker we are always happy to have him on the webinar he is known to you Simulat sa po, sinasaman na namin sa discussion he is one of our world-class Filipino scientists and we are very proud of him because he was the first one to develop a Filipino COVID test napatagay natin sa poll question so I'd like to welcome Doctor Raul Destura Professor of the UP College of Medicine he is also Deputy Director for Strategic Initiatives and Emerging Programs Director of the National Training Center for Biosafety and Biosecurity at the University of the Philippines National Institutes of Health so welcome Raul Thank you ma'am Susie for the very generous introduction so will I proceed now with my lecture go ahead excited masyado oh excited oh game thank you for having me here at the TPUP webinar and I will present to you everything about the highlights about COVID-19 testing and perhaps will provide you some of the nuances around the test para mapilis natin may tindihan bakit itong test na ito ay hindi appropriate sa ganitong condition and vice versa so can you see my slides yes sir go ahead so we will be discussing about SARS-CoV Doctor Raul medyong putul sa sasababa ah pat putul hold on let me gumagawa sa sarili na naman siyang isip hold on I think I know the problem na it's my computer let me alright here we go one more time putul pa din ba yes sir it's still cut off cut off sa baba okay on the right side para siyang naka ibayong dimension sir okay so atnyaran na ito sa akin in one of my lectures well so let me see if I can yun there we go perfect thank you sorry about the technical because hindi tayo hindi magiging ang digital experience pag hindi tayo makaka experience ang digital glitches yun ang aking paluso sa so basically we'll focus on the viral dynamics discussions on the different platforms for COVID-19 testing and some of the platforms that are not practical in its implementation sense but can be useful on specific need no but not really for general need and some discussions on what are the unmet needs of the current diagnostics and some issues that I'm glad na raised na kanina sa opening salvo na webinar namin so this is how it looks like right now as of 4 27 PM November 18 2021 clearly we're still the COVID virus is still raging on in most parts but take note that this are the degree of intensity so far based on cumulative number of cases so pagpinina natin ito, ito yung intensity ng picture, ng COVID how it affected the world as we speak and there are about 5 million deaths already globally and 64 million confirmed cases since the start of the pandemic and it's actually distributed in this area from the Americas down to the Africa region sometimes the number is not because they don't have much cases sometimes the number is because they don't have access to diagnostic to confirm cases so those are some of the UNS in terms of interpreting data for reporting to the global community this is where we are as of this morning from the COVID tracker of the Department of Health website we had a total of 2,821,753 cases plus 1,297 added on November 18 23 active cases more than 2 million recovered 46,422 died if you look at the diagnostic based on reporting to the national data you are seeing a significant drop in the number of positive cases in this area which means that our vaccination program may have a lot of impact in what's happening right now at the same time there are still a lot of people conscious about protecting their community and their family members who continually wear their masks and do protective and do social distancing despite the vaccination may be these are some of the reasons why we are able to reduce further the number of cases although when you see again what's happening in the malls may juman inergus ka ng kont about the number of cases in the malls but I would understand because more than almost 2 years of repeated lockdowns and restrictions there is hunger for people to be out there because humans are social beings now we just need to be very conscious about there may be some consequences but I hope that the speed and the degree of vaccination and the spread will have an impact in mitigating these events that usually triggers as a spreader events in the past so right now we are looking at number of samples that has already been tested 23 million has been tested and our current positivity rate up to 13.4 but the current positivity rate is actually lower than 13 this is just a cumulative over the years now let's go to viral dynamics of the SARS-CoV-Virus and this is where diagnostics comes in in terms of usability and this is where also some of the the failures of the acknowledged actually so in terms of the viral transmission and how it behaves it's divided into two period latent and infectious period in this case between zero to the third day from exposure normally the biological burden is not that high so when you would request for a diagnostic test sometimes we would ask when we would consult a doctor to say I am exposed to a positive case I would like to test immediately and the doctor would say let's wait at least on the fourth day or the fifth day to test because it might be a waste of time because it might be in a latent period and your testing would likely be negative so in order to protect yourself while waiting for the appropriate time to be tested you isolate yourself and then because if you isolate yourself at that you develop symptoms on the third and fourth day you are now under the infectious period but since you already anticipated that you already protected your loved ones and your friends and your peers and your community to get exposed to what you have in this case the infectious period is between three to day seventeen but we all know that this actually has changed over time that the degree of infectious disease has decreased to less than two weeks of the illness but there are special situations where in the virus remains viable especially those that are severely immunocompromised or do not have the ability to develop an immune response since the virus are actually thriving longer than they should in the body but generally if your immune system is intact the duration of infectivity is a little bit lower but the degree of positivity of your test could be longer than your infectiousness so these are the ones that are a little bit challenging kasi paginagamit natin yung PCR test to determine infectivity so maraming gray zone doon sa area in terms of clinical presentation you will see here during the incubation process mayroon dito part na hindi ka pa dag di develop ng sintomas nakakahawa ka na and then if you develop symptoms kaya tayo nakakaroon ng contact tracing and that's the reason why we do contact tracing kasi ito yung mga na-exposed at wala silang nararamdaman at nakakahawa sila sa iba until it's time that your symptoms are actually resolved which means that you're no longer infectious so now I hope that you guys remember this slide set because it gives us a nice representation of how diagnostic technologies can actually be useful and which type of analytical samples are actually useful in identifying the right technology for the right sample if you notice here between minus one and minus two weeks before the onset of symptoms there is already some form of elevation of the virus but it may not yet still be detectable by existing technology so far because you need a critical number of inoculum size for it to be detected by your by your assay so if you notice here the solid blue and red line represents nasa pharyngeal swab, PCR blue line detectability between week two week one, week two and starts going down on the third week but we've seen cases that remains persistently positive over the four, five or six weeks kaila pagtitinan mo yung paninang cycling threshold values patas ang patas na yung number meaning patas ang patas yung number pababaan ng pababaan ang viral copies na yung PCR technology remember, PCR positivity does not discriminate live and dead viruses so importante pa rin na pag may nakikita kayong risulta to ask your doctor about it get the appropriate interpretations based on your clinical presentation in relation to your onset of symptoms and the host condition that tested positive so iti lang siya parang you rely on the test right away because that's one of the most nonstop text consults I receive from my colleagues about this information so I try my best to provide as much as I can information pa hindi ko alam, hinahan na po nalang yung sa kakakut para makatubang so the increase in the probability of detection by polymerase chain reaction is likely between week one and week two, pinakamakas at antibody detection test ni normally nakikita siya doon sa second towards the second week of illness medyo mas matas yung kanyang likelihood to be detected than the first week of illness in terms of isolating the virus the likelihood of viral isolation for them to grow is within the first week of illness towards the early part of the second week and beyond that hindi na sila tumutubo which makes you ask PCR positivity versus viral viability are two different entities in interpreting infectivity so that's why PCR positivity alone may not be enough to make decisions that you are infectious or not on a clinical standpoint but when you're talking about public health at standpoint sometimes the interpretations will be different because you now include public health risk mitigation planning and that way some decisions are applicable for public health control some decisions needs to patient-based interpretation by your attending physician normally sometimes hindi nagmamatchin dalawang approaches and that's why you have to also respect the interpretations of our public health specialist on the utilization of this technology for antigen detection it's almost concurrent with the ability of the virus to be detected directly so if you do antigen detection the indication is almost similar with PCR in the weak one of the disease and it goes down meaning the diagnostic accuracy drops also over time these are some of the areas where the indications for diagnostic testing can actually be used for clinical decision for test developers for policy makers and clinicians that would need to consider that each of the diagnostic use case needs to be done with the intention of testing and the population being tested in terms of the decision process for example in this case are there technologies that we can use to screen a symptomatic patients because they are still incubating are there technologies that can be used for monitoring contacts during the incubation process so these technologies if available can actually be useful for active and passive surveillance and fortunately there are no perfect tests screening of symptomatic individuals because some of them may or may not test positive by PCR because of the curve I have shown you a while ago but doesn't mean that they will not have the potential to infect other people from a public health standard it's not just test but it's also isolate and keep yourself this these are the principles why the other thing utilization for indications for diagnostic testing is for increasing screening of symptomatic patients and establishing the diagnosis which is the most common indications for the diagnostic tools in some cases it's being used for treatment initiation decisions but basically because of the nature of the disease the decision tools for treatment for diagnostic testing is not mainly to establish a diagnosis but actually to determine the dynamics of the disease so in this case, PCR technologies may have very little role in initiating treatment decision but will have a huge role in establishing the diagnosis during the symptomatic phase of illness the next indication is are there technologies that can help us de-isolate our patients or can be used for monitoring of shedding of course there are but the problem is from a public health standpoint the best de-isolation tool is really determine viral viability which means viral cultures and just using the word viral cultures is like a crazy idea because it's very expensive it's very tedious and requires a high containment facility to do all of these procedures that's why it's very important that studies done on viral infectivity on a clinical setting established so that you can make decision based on the duration of your isolation days and the need for a repeat testing or monitoring of shedding over time with the knowledge coming in are no longer being required so the timing of the diagnostic testing in relation to the infection is critical actually the inaccuracy of COVID-19 diagnosis there are three major platforms that I will be discussing with you today and then a new one that's always been from experience being asked to me all the time so might as well parang isang sabihan natin para mabawasan yung phone consoles okay lang naman so it's based on molecular testing serological testing and the non-invasive procedure in this case so when you say serological testing it's actually divided into three major groupings you have the enzyme link immunosorbent assay platform you have the lateral flow immunosorbent assay platform and the chemiluminescent immunosorbent assay platform now this is a systematic review of the pool sensitivity of enzyme link immunosorbent assay platform that is affected in terms of the dynamics of the disease process from the first week to the third week now if you remember the curve kanina so you can really see that the antibody generation is happening towards the later part of the disease that's why when you do ELISA for antibody testing in the first week of illness you will really have a very poor poor sensitivity it's not because that the test is bad it's simply because of the natural dynamics of the immune response so talagang may critical value by critical limit ang mga assay on its ability to pick up minuscule levels of the antibody response in the first week of illness hence the sensitivity is that low no? can attempt tumbling, combining capture ELISA and all of these days methodology to increase and highlight even minuscule levels of the antibody to be able to pick up as early as basically it's still a challenge for tech developers to make serological testing or antibody testing useful for acute case detection it's always like in the if you notice the sensitivity gets higher and higher on the third week so if your purpose is active case detection this may not be the test that you need but if your purpose is seroprevalent study how many in that population are actually serologically positive which mean has been exposed in the past then this can be a useful tool to determine the seroprevalence of that particular population so based on the nine pooled studies between infected and non-infected the pooled sensitivity is 84.3% and the pooled specificity is 97.6% beyond several weeks of testing now so they really accumulate cumulatively ang gi-increase ang kanilang sensitivity now the other one is lateral flow immuno assay similar behavior kasi whether it is ELISA or lateral flow immuno assay they are actually working on the same challenges in the diagnostic arm which means they are dependent on the intensity of the antibody response over time and knowing that based on the curve again the antibody is lower on the first week and continues to increase on the second and the third week so naturally your lateral flow immuno assay will pick up more of the antibody as the days pass from the time the patient started having symptoms so the pooled sensitivity for lateral flow is significantly lower than ELISA and that's of course it's not unique to COVID yung degree of reactivity generally must higher ang ELISA based platform than the lateral flow although in specific diseases halos pareho na sila like HIV and all the others the other one is luminescent immuno assay that combines fluorescent signals and chemical reactions that are being detected by a unit that measures luminescent technology so this one has the highest pooled sensitivity of 97.8% and the pooled specificity of 97.8% as well but again it is this is a pooled sensitivity on the third week tumataas talang yung kanilang diagnostic threshold over time so but based on the systematic review of studies on the higher quality clinical studies assessing the diagnostic accuracy of serological tests for COVID-19 are still needed up to now currently available evidence is not support to continued use of existing point of care serological tests for acute case detection let me clarify that for acute case detection now there is another ongoing technology now which is the neutralization antibody detection test developed by GenScript I think it's called the C-PASS SARS code 2 neutralization antibody kit this is like a sorogate version of the standard neutralization testing which is either a plaque reduction neutralization test or a micron neutralization test or the pseudo viral neutralization testing which are the ones actually being used a standard diagnostic tool to determine vaccine efficacy studies or neutralizing antibody this particular technology developed by a team in Singapore National University of Singapore developed the neutralization antibody by copying a certain portion of the virus so in this case the sorogate virus utilization test S1 is the spike protein and then this is the active binding domain of the spike protein and this is the detector and then they also copied the most common receptor on on tissue culture cells or respiratory cells that makes the viral entry into the virus more active more efficient this is the ACE2 receptor in the surface of the respiratory epithelium actually there are two of these receptors the ACE2 and the TEMRIS but I think they have utilized the most commonly identified wholesale receptor so the receptor plus the antigen portion of the virus which is the spike protein and the purpose of your antibody is to stop the binding of the ACE2 with the spike protein the problem however is it measures neutralization but the issue here is how much neutralization is protective of you because it has not been standardized and these are the ones and what kind of cut of are you going to use so these are the ones that that gives them sometimes a false sense of security that oh it's really high up to the high heavens and I think I protected and all of a sudden they will call me and say how come I develop breakthrough infection so I have to explain to them that the spike protein designs based on the most common binding sites of the reactive binding domain of the COVID virus unfortunately the spike protein and the reactive binding domain of the COVID-19 virus is also one of the most area that pertains that's why we have variants that has different versions of the reactive binding domain that may be unrecognizable to the neutralizing antibiotic so it still happens and then it identifies the protected mechanism from that and the value now tells us whether are all of this really neutralizing in the net so I think there was this article that was released in Journal of America of JAMA 2021 about the problems with the antibody testing for SARS-CoV-2 immunity because of the lack of the sorogit that are actually well established understandably it's really a challenge for diagnostic test developers I could feel the frustrations also but this is one thing because even the developer of the technology states that customers should not interpret the results of these tests as an indication or degree of immunity or protection from re-infection so I keep telling them that having the virus is nice but whether do you really have significant protective antibody you have neutralizing antibody but is it protective enough for you and that's the one that needs to be childhood because how high should the type there be to tell you with certainty that that particular value is the cut-off for immunoprotection or is this a cut-off to determine the degree of exposure but is it protective enough or for you or is it what are the cut-offs and expectations in terms of the different variants since variants mutations are classified based on the mutations of the reactive binding domain of the spike protein so this is some of the questions that were raised that's why every time that is actually being asked I give them a cautionary advice that the technology may still have its utilization but not as a tool to lower down your guard so that's my useful advice to them now in terms of molecular diagnostics you are all familiar with PCR technology the one here in the middle but there are other molecular-based tools such as the antigen-detection-based assay here and then the isothermal technology here which is a colorimetric tool and then some are using combinations of lateral flow and CRISPR technology to identify the SARS-CoVirus but it all starts so kung mali yung pag-collect mali na lahat pag-ontan dito and in the most the ones that I take has gained more recognition now because of our constant monitoring of the circulating variants at the Philippine Genome Center is the sequencing technology here which can actually be divided into several sort of sequencing platform either a nanopore-based sequencing or sequencing by synthesis and of course the preparation is very tedious because you have to do PCR amplifications and library preps before you actually do the actual sequencing technology which is not very practical in the daily utilization rates not okay so from for most virological testings to determine active viral presence in the host cell the gold standard has been PCR technology so nocleg acid based testing that falls under that category use nocleg acid amplification and product detection targeting the SARS-CoV-2 genes and these are divided into the RT-PCR or the reverse transcriptase polymerase chain reactions or DD-PCR digital droplet PCR that can actually pick up small copies of the virus under droplet technology which really has much higher sensitivity than RT-PCR the problem is the machine needed to convert them into a droplet platform is also very price limiting so when you do the calculation and you do the math for general use the other one is the reverse transcript loop mediated isothermal amplification platform which amplifies the nocleg acid technology with just single temperature transfer so this is the technology that we used for our dengue technology we also have our versions of the COVID using the lamp but we're still working on its timing because right now everybody prefers the RT-PCR but it's just there the antigen test is a detection of viral antigens by specific binding to antibody followed by optical, magnetic or electrochemical-chemical visualizations of the interaction the targets for most of these antigen tests targets portions of the virus such as the nucleocapsid the spike protein the envelope protein and the membrane proteins which are the four most common targets for antigen detections in any virus tech development for antigen detection test now your RT-PCR and your antigen has the same intended use it can detect current infection for both but it's detected by the RT-PCR is the viral RNA product after extracting using the nucleocapsid extraction technology whereas the antigen test you just have to process the sample to express the antigens in the solution and now it can be used directly by the antigen test the specimen type for the RT-PCR could be swab, sputum saliva bronchial viola lavage for the antigen test it was mostly intended for a swab technology the sensitivity is high for the RT-PCR and of course moderate for the antigen but both of them has a very high specificity and in terms of test complexity depends on which RT-PCR platform you are using if you are doing single step one step, double steps RT-PCR platforms that makes the technology a little bit more complex or if you have those cartridge type it can now be easier to use and then for the antigen test relatively easy to use because most of the time the platform is point of care in platform for RT-PCR test some are still struggling to convert them into a point of care platform but there are now micro-PCR technologies that utilizes high-end ceramic technologies for much controlled temperature sample processing the turnaround time ranges depending if it's a digital droplet PCR that's 15 minutes to two days depending on how efficient is the management of your laboratory but for the antigen test is about 15 minutes and the cost is a little bit different RT-PCR test has a moderate price tag and the antigen test is generally low price compared to the RT-PCR now in terms of the analytical performance of PCR based study out of 13 studies involving 2255 has an average sensitivity of 95.2% at the confidence interval of 86.7% to 98.3% so pa may naririnig kayong the sensitivity is 100% and the specificity is 100% no such thing those are laboratory performance sensitivity report because there are no 100% diagnostic test in the world right now because there are external factors affecting the integrity of the results kaya paganda yung test mo bangit yung pagkakulay kaya maganda yung test mo inappropriate yung time and time of collection paganda yung test mo pero yung processing ng preanalytical sample hindi maganda ba ba ba pa din yung sensitivity so that's why they look at the clinical diagnostic sensitivity not the laboratory performance diagnostic sensitivity makaibap uyan so in terms of the analytical performance of the antigen test it has an average sensitivity based on 8 studies of about 56.2% with confidence interval of 29 to 79.8% and the average specificity is about 99.5% which means positive ka you are 99.5% sure that you have the COVID antigen in your body if you test negative there is still a chance that you may still be positive that's why you have to advise patients that even if you test positive if you had significant exposure can you wait it out for a few days if you will develop symptoms or lack of care and that's the utilization of the advice instead of saying but these are intrinsic challenges of existing diagnostic platform so no plague acid based platforms such as RTPCR remain to be the gold standard for COVID-19 testing improve primer and probe design and control over pre analytical variables suspected to improve its clinical performance although antigen detection test limited by its low accuracy they remain as a promising cost effective platforms for population-wide mass screening and point of care use but there are a lot of unmet needs in COVID-19 diagnostics the scaling of access to diagnostic testing has become a challenge in the past but I think we are learning from that experience and we are revising and streamlining some of the regulatory requirements as we speak to useful specimen types collection devices and transferred media are needed still requires for clinical validation of the utility of non-respiratory specimen like urine stool and all the other samples but I think for this particular illness the respiratory sample remains to be the most ideal in this situation a short and medium term pipelines for de-isolation decisions is also unmet need in diagnostics so there is a need for a more accurate screening of a symptomatics and determination of live viral shedding ito talaga yung pinaka powerful if there is a technology that can determine live viral shedding accurately that would be a good de-isolation technology and I hope someone can develop such technologies there is also a need for the standard quality assurance protocols for all for us to have our own wide scale independent evaluation of the emerging test to empower our laboratories because they are actually handled by very able technologies are actually trained on validating and establishing quality assurance protocols for emerging technologies in their lab laboratories access by low resource setting as well you need for long term scaling up manufacturing and efficient supply chain to become a disruptor and make the technology that used to be very inaccessible to most people is now being democratized and improving access to the marginalized sector so I guess one of the question kanina yung ang pasok sa skwela I like the comment of that young 18 year old lady mohan kway di siya maging doctor or policy developer or politician the way she handles herself now there is the technical working technical advisory group for schooling during COVID-19 take note this is from the European setup so everything that is stated here should be taken with a grade of salt and determine its applicability in the Philippine setting the way I always look at it is what is the minimum requirement that will allow opening of the schools without adding to the risk of transmission if you ask my opinion opening the school is actually one way also of protecting our children from social pressures of doing online schooling and if there is a way we can help make it safer for our children to have the right environment for learning that's the goal that we should be setting so if you ask my personal opinion it does not represent the institution that I am representing right now but my personal thoughts about it is that I really want the school to be open even in the presence of COVID provided that all of the measures are actually in place and the strongest measure that we can actually have is vaccinating everyone around our children until the indications for vaccination which actually being done now in other parts of the world we already downloaded our kids here in the Philippines so the COVID testing the technical advisory group supports the above and advices the value of PCR and rapid diagnostic antigen test in school settings in opening schools and controlling transmission needs to be evaluated based on their effectiveness cost effectiveness and visibility personally I do not want this as a requirement I would rather have targeted PCR testing for those who actually had very vulnerable family members at home but as a full testing every so often I find that very impractical testing should be prioritized for symptomatic children with acute respiratory infection in any of the severity if they belong to a vulnerable group risk group or are in a special situation with a high risk with further spread but a symptomatic high risk exposure or close contact cases should also be considered for testing so meaning in this test all targeted testing method should consider diagnostic test accuracy the need to test if infection spread whether the student is isolated frequency of testing material for testing support for testing and follow up measures for a positive test but I agree it's easier to be implemented in countries that are actually subsidized or supervised but is it really testing really technically if you ask yourself if I have the money and I don't have the money is the finances the only reason why I will not advocate regular testing regular testing in the in the school set my mind I would probably recommend targeted testing and not past testing in school whether you have the money or do not have the money for it vaccination has been the most useful tool in preventing test a positive test result or a negative test result doesn't mean that the child will not develop symptoms five days later and continue infecting because the previous test was already was negative to start with and you cannot test naman children every day and that's impractical that's out of the question and that's even ridiculous so cluster investigation in children's school setting should be organized in a way that enables continuity of learning and that routine temperature or symptom checking in schools should be avoided as no evidence is available to support their use because you can be infectious even if you are asymptomatic and if you look at asymptomatic rates you don't know how much of that is actually needed how many students you have to test to be able to pick up percent asymptomatic cases so the cost benefit of that over standard measures for control needs to be balanced for testing and opening school so there are a number of diagnostic platforms that currently exist from to use depends on the availability diagnostic accuracy and timing of infection novel diagnostic techniques are continuously being introduced adoption of these technologies in the future will depend on the regulatory policies which are currently inadequate so to navigate the maze of COVID-19 diagnostics a multi-dimensional point of view should be adopted by test developers policy makers and clinicians and these views should include the technicality of the test the population to be tested the intention for testing and the regulatory monitoring of the test thank you very much thank you very much let's talk to Raul Destura na kung napakalino ng kanyang paliwanag and I think well I can see some of your questions so please put your questions in the chat box and later we will have Raul in our panel discussion and we will answer some questions so thank you very much I think we are always enthralled by your presentations okay so let's go to the next our next speaker it's my honor to introduce a colleague at the Philippine Red Cross who I've had the chance to work with and wala kung masasabi wala pang masipag dito she is the head of the Blood Blood Services National Blood Services National Blood Services Director and she's internationally known for her work in the International Federation of the Red Cross Red Crescent Movement because the Philippines has 88 or even more I don't know if I have the right number but more than 88 blood banks all over the Philippines and she has been doing screening, testing and using an RPPCR for the longest time so we thought we would invite her to give a reaction to Raul's presentation to talk a little bit about what the Red Cross is doing, has been doing and just to share her thoughts and her experience with us so I'm very honored to welcome a friend who day and night anytime in the day or the night if you need blood she's able to get it and to move it along through the organization of the Red Cross so Dr. Kristy Monina M. Narita Monina, welcome to the webinar Thank you very much for the kind introduction Dr. Susi and the invitation po actually it was Dr. Susi she's very instrumental so in concept developing our molecular laboratory when the pandemic happened she was one we asked in setting up yung ating a molecular laboratory excuse me while Dr. Distura reported about the diagnostics different diagnostics for the SARS-CoV-2 infection yung applicability naman ishishir ko particularly with the antibody testing because we've been operating also a convalescent plasma center in a port area manila but before that of course you all know that the Red Cross has RTPCR swab test and we've been very active since the very beginning of the pandemic and right now we have 14 molecular laboratories and aside from the swab test we engage with ating salive test and that's also RTPCR and it was through the leadership of a chairman na Gordon when he contacted actually Dr. Ranola of the University of Illinois in and she's a fellow together with Dr. Pau and Dr. Michael T of UP they presented our study, the Red Cross study for the HTAP to approve the RTPCR saliva test of the Philippine Red Cross which we started in February this year and from February to up to date we already had more than one million saliva test and this is very important since at that time in February the RTPCR swab test was a high racket in the testing fee as high as 4,800 and when we introduced this we offered it at 2,800 but right now it is more affordable at 1,500 and it's the RTPCR technology and the public really save or the government really save a lot with this saliva test the RTPCR about a billion pesos savings for this saliva test now going back to my topic regarding the convalescent plasma and the antibody testing for SARS-CoV-2 just a brief introduction that the convalescent plasma for COVID-19 it's a passive antibody therapy taken of course covered SARS-CoV donor and it contains neutralizing antibodies against the said infection and it's still an investigational product usually transfused for severe to life threatening cases and it was given a compassionate special permit for its use and in the Red Cross we were able to operate and be given with a certificate of compliance last year of July 2020 that's when we started our operations and of course aside from the basic eligibility requirement as a blood donor these are also hematological and serological requirements we do subject the blood samples of our blood donors to of course CBC with platelet counts because the manner in which these plasma donors donate in the Red Cross is either through whole blood donation and aferesis donation or aferesis donation and of course it's mandatory to test our donations to the five TTIs like hepatitis B hepatitis C, syphilis malaria and malaria and should be non-reactive and for our CP donors red cell antibody screening and as what was mentioned earlier SARS-CoV antibody test and it should be at a tighter level of 1 is to 160 so moving forward we employ the use of a quantitative test for antibody testing for SARS-CoV-2 and it is automated a chemiluminescent microparticular immune assay test it's a quantitative IgG determination specifically to the spike protein of SARS-CoV-2 earlier doctor Destora mentioned about this particular assay and its sensitivity is about 98.3% and specificity of 99.4% based on the study conducted by UK as published in the journal of clinical microbiology actually we were able to use 1-2 I mean the SARS-CoV-2 IgG determination just this mid May until now because prior to that this hasn't been available and we were still using then the qualitative method of IgG antibody determination and this qualitative method is directed towards the nucleocapsid and it can only detect the presence of antibodies that are active or natural infection versus this quantitative method that which can detect both the humoral response to a vaccine and the response to natural infection so with the test that we are using it was actually compared to the plaque reduction neutralization test that's the PRNT again Dr. Distura mentioned this one and they compared the quantitative as a values this one over here to your right versus the titers the PRNT dilution by way of a study at the Broad Institute and the subjecting about 86 samples and positive samples and the positive the PPA or the positive percent agreement to the test that we are using is about 100 percent but as a requirement to a CP donation convalescent plasma donation we need about 1 is to 160 titers equivalent to the quantitative value of 3200 to neutralize and infection okay so just to show you the number of test done by the Red Cross using this quantitative IGG test for SARS-CoV-2 from May 26th up to November 15 we were able to do about 228 test and those that qualified based on the requirement the cut of requirement of 1 is to 160 is only was only 107 okay so 24 of which were due to less than 1 is to 160 or low IGG by the way a person is positive using this method to an antibody if the value is 50 50 arbitrary units per ML but of course we need more to neutralize the SARS-CoV infection and that is more than 3,000 or 3,250 so 24 were deferred due to low IGG and this were the results of the quantitative IGG assay for SARS-CoV-2 the total number of donors with breakthrough infection meaning they've been vaccinated then they acquired infection that's about 90, 90 donors so out of the 90 donors we get about donors who had 1 is to 160 14 1 is to 250 that's 14 and a lot were more than the required cut of and that is 1 is to 640 and those results of those unvaccinated donors with natural infection were only 17 and those gave 1 is to 160 2 donors 1 is to 250 that's 4 donors and 1 is to 640 it's also quite a lot that's 640 donors for those breakthrough infection because we've been very active in vaccinating here at the NCR rather than those donors who passed who were unvaccinated and passed the antibody testing the required antibody cut-off value okay just to show you that the the Red Cross has been active in a Convalescent Plasma program and since the time it we operated we were able to dispense about 1,162 units until yesterday and we serve about 1,025 patients and hospitals who access the Red Cross basically here in NCR, in Region 4 in Region 3 and some of our units were still a ship or was accessed by people or patients in our hospitals in the Visayas it's 113 hospitals serve and for this year we were able to serve almost 500 units and of course there's also a recommendation by the PSMID NAT of course, NAT and they are against the use of Convalescent Plasma in patients with COVID-19 infection okay but actually even if there's this recommendation during surges we still get a request on a monthly basis 100 to 200 units that was in April and May and lately during the surge in August and September about 100 units and daily a few of them still access for Convalescent Plasma products for their patient and when they do access of course our infectious disease specialist communicates with us asking for the tighter of the products that we will be issuing and they are really very strict that we comply with the minimum antibody tighter of 1 to 160 so this was the report of the Department of Health National Voluntary Blood Services program currently we are still on a status quo we do still operate a Convalescent Plasma Center together with the different hospitals and the Philippine Blood Center and even if there's a recommendation by the PISMID and we will continue for as long as the DOH says so actually the NVBSP are about to speak or coordinate and communicate with the expert technical panel on how we move way forward because the request has been reducing and we're actually spending a lot in regards to the operation of Convalescent Plasma so that's all for my presentation thank you very much to all thank you so much Dr. Naloopta very very welcome updates coming from the Philippine Red Cross on testing for blood products and really something that we should look forward ma maya sa our Q&A panel discussion we hope you'll be able to stay on Dr. Manina next up we have our next speaker who will provide a perspective po he is a pathology consultant at the Department of Laboratories of the Philippine General Hospital please welcome to the webinar Dr. Jonathan P. Rivera Dr. Rivera Hello sir, good afternoon everybody attending this webinar I'm Jonathan P. Rivera and a pathology consultant in the Department of Laboratories in Philippine General Hospital and on behalf Department of Laboratories so he was able to cover to cover most if not all of the most vital and important details when it comes to SARS-CoV-2 testing and he was also able to related to the clinical and public health standpoint so that is actually quite very important so my job here as a reactor I think I will not be able to add additional info to what Dr. DeStura has already provided but instead I will present to you our experience here in ECH what we were since the pandemic what we were doing and the number of tests that we've been able to do in the hospital so let me just share my slides to you this is just a quick very quick presentation so for the first slide so since May 2020 up to the present you can see that there is an uptrend in the number of tests done for SARS-CoV-2 in PGH in Philippine General Hospital represented by the orange bar graphs you can see there is a constant uptrend peaking till September 2021 which most likely represents represented the the recent search that we experience in a country and then it slowly dropped down in October and deep down to the lowest to a low end November 2021 you can see also from the graph the blue colored bar graphs which represents the positivity rate so the positivity rate as it speaks on April 2021 around August and around September and the lowest positivity rate is today within the month of November is from around 3-4% so the data that we have in PGH the number of tests that we done in the positivity rate seems to reflect the DOH reports that we see in the news during our testing we've been able to send some of the positive samples to PGHC to be sequenced and from those positive samples we were able to identify the different variants of SARS-CoV-2 in the hospital so the most frequently identified as the delta variant followed by the beta and the alpha variant in the hospital we have several platforms but all of them use the NA 80 or they are all nucleic acid tests and they are either a plate based platform or a cartridge based PCR tests and we try to achieve a very acceptable turnaround time so for our plate based or routine runs we usually are able to release results within 6-8 hours after receiving the samples in the laboratory for urgent cases or patients needing immediate reaging so we can usually provide results within 2-4 hours by using our plate based platforms in the form of gene expert at the same time the pricing in the hospital follows the circular provided by the DOH so our tests are quite affordable now on the horizon we have already submitted our parallel testing with regards to saliva RTPCR when parallel to our routine mesofaryngeal swab RTPCR to RITM and we are just waiting for the validation and if we are deemed qualified to perform saliva RTPCR testing then we will decide and think where to put that modality in our existing workflow so as Dr. Distura presented earlier each modality has its own pros and cons and you have to think carefully where to to their fullest potential we are also eyeing in the horizon pool testing so as we get a more stable supply of PCR kits I think in the future we can now start testing or validating pool testing in the hospital unfortunately with regards to antigen testing this did not pick up in the hospital although there has been a previous donation of antigen test kits request from physicians did not really pick up so antigen test kits they are mostly beneficial in areas or regions in which your nucleic acid test kits or PCR tests are not available or if they are available the turnaround time is quite long so patients that needs immediate attention and management will benefit from antigen test kits while still waiting for the PCR test but given in the hospital that we have at a very acceptable turnaround time and our current PCR modalities and platforms meet the needs of the hospital the antigen test kits did not pick up in practice so that is just my presentation and hopefully I have shared I've given you an insight on what we have been doing in PHH Thank you so much Dr. Rivera for giving us a glimpse of your work at the Philippine General Center we hope that's something that you could also delve a little more in detail mamaya po sa Q&A panel and then for our last reactor and speaker but not the least he will be sharing perspectives coming from the private sector please welcome to the webinar the general manager of the Lord's Grace Medical Industrial Clinic Jesse Diatre Jess Good afternoon doc Good afternoon everyone I would like to share with you my slides so in views of this experience and testing ilan na yung na test dito sa laboratory namin so I'm Jesse Diatre I'm the general manager of the Lord's Grace Medical Industrial Clinic company here in Pasaypo so according to the data of the DOH nagsimula kami we started our laboratory last week of September 2020 up to the November 10 we accumulated our process about 266,500 and about that about 29,523 positive namin so we gathered 11% positive iterate throughout the year na so here's the sample tested we offer the RTPCR rapid antigen antibody we have the rapid eclia we have also the RSVD or equivalent or similar to neutralizing antibody for RTPCR so September 2020 to November 10 you already processed sample 266,500 and for the antigen we have processed the 24,000 samples for the antibody we have 6,000 samples and for the SRVD we have 400 samples so aside from the evolution of the technology we also have challenges in the laboratory specifically the reaction of the patient or some client so na since na na topic na ni Dr. Distura ang scientific cases and si Dr. Nalukta in terms of convalescent si Dr. Jonathan sa youth na may public sector sa our encounter na namin is the patient tend to do laboratory hopping for shopping for COVID-19 testing on one of the biggest challenges na encounter sa laboratory due to different results obtained in the PCR so ang nangyari after that pag-once na nag-release ng positive mag-travel sila di going to another laboratory then later on if nagkaroon sila ng negative results di going to backlash the laboratory who release the positive result and here are some dilemmas that we also encounter sa our laboratory so one point na na encounter na namin is patient highly expect the laboratories to interpret the result instead of consulting their own physician for medical advice so they are usually when they receive the results they are always asking the laboratory to interpret the results and give some advice so we usually advise them to consult their own physicians or the infectious control doctors so the second dilemmas that we encounter is in their test results for positive cases which lead to multiple complaints sometimes legal demand social bashing and hassle so na encounter na namin sa social media na namin pag nagkaroon ng positive results sa kanila and then we going to another laboratory tapos nag-negative sila they are always complaining into our website the third dilemmas that we encounter patient undergone multiple RTPCR test with different institution will turn out negative and eventually baklasyong the laboratory could give out the positive results so lage talaga yan as in hindi lang tatlo early mga basis na nangyari sa isang aral minsan they are always complaining and then may minsan nag-detreat talaga so in yung mga nakikita namin na medyo nakaka kindren sa pag move forward ng laboratory because of the complaints of the patient next is the patient relying on the laboratory to conduct proper test instead of consulting their position for the proper test needed so bupun na lang yung mga paciente just because they wanted to know their status pero pa tinatantanong sila ko ang reason kong bakit sila magpapa laboratory test sabihin lang nila na gusto lang nila so yung yung mga bago ngayon na nakikita namin sa molecular compared doon sa routine laboratory or clinical lab natin because if you going to give them the result in the clinical laboratory setting pagkatapos nila nga receive yung result nila automatically the consult the doctors ngayon mga paciente if you going to give the result to them ang gagawin nila is tatanungin agad nila yung laboratory ko ano yung interpretation of course sa laboratory hindi namin nila ah hindi namin ah hindi interpret the results and that would be the end of my presentation thank you for the free one thank you so much jess as we try to move on to our panel discussion may we call on each of our speakers to open up their videos po as well we are seeing the poll being flash on the screen right now pero hindi lang po natin mag open po ng kanilang camera okay so okay before we go into our Q&A we'll take a very very quick break lang po na for our special public service announcement for today take it away tv up mukhang malalib yung iniesin mo ka mula ka magpaso ngayon malap ko may disinfection po siya grocery ah gan ba hindi ba pa rin ka yung paso kahabong pa tinong isang nga sana makabalik na ako sa trabaho oh siya siya hindi na muna kitay store po yung nakukamang malalim hindi isig mo magpabakuna na kaya tayo wala ang problema po magpabakuna mo lang ako dahil malku kayo magpapabakuna ako thank you so much tv up the COVID communication public service announcement is one of many outputs of the UP research and title communicating COVID-19 in post quarantine Philippines headed by our UP vice president for public affairs doctor Elena Perna and funded by the department of science and technology PHRD and the department of health through its ahead HSPR project over to you doctor Susie thank you very much Raymond and thank you to all our speakers na ko very good presentations and I will go into our panel discussion we're going to get some questions from the audience but let me start with a with a situation question and anyone can answer it but I think Raul may be know we know that many people received sign of act and you know they're thinking is that they received sign of act and they want to know if they are protected and so what they do is they want to get an antibody test to see if they have antibodies so what's your advice in this situation because even our health workers are asking that question I get that question almost every day from my colleagues regarding the antibody test and whether it is a immunoprotection unfortunately the existing test we have at the moment for lack of standardization cut-offs to determine immunoprotection are not useful enough to provide that information at the moment the talents there is we kind of use the number as a basis that oh it's high enough that's why we think we are protected and in all of a sudden we have had a breakthrough infection in one of my patients the problem with testing measurement the antibody levels it is a total antibody measurement in most of this test serologically it does not discriminate how much of that antibody level is neutralizing and how much is non-neutralizing so just getting the tighter is not a direct measurement of immunoprotection it just tells you your intensity of response to the infection that's why the variability in the levels of immunoprotection is a big challenge because what would be your cut-off because the data of immunoprotection is still in a flux as data comes in in the future we will be able to identify the critical threshold level to say that at this particular level that particular cut-off set is immunoprotective enough obviously with the current cut-offs that some of the tech developers are putting out are based on in vitro data but doesn't translate to herd immunity levels or immunoprotective levels for lack of the standardized test these are just sorogate markers that provide you the measurement of the degree of the immune response we know that even if you have high elevated antibodies for certain viral diseases that doesn't mean that you are protected example if you measure your antibody levels against influenza it's high but where do you get influence again that particular day well that particular year because of the rapidly changing antigenic response to that particular virus because of mutations so kaya nag-revaccinate sila di pa almost every year despite of that the coronavirus is also one of those virus that during the replicative state mutates every two hours and sometimes the mutation is non-consequential and sometimes the most dangerous part is if it becomes consequential because we are not dealing with the variants so measuring the levels of antibodies to a specific disease like COVID virus doesn't mean that you are protected from all of these variants so sometimes this is now there is a transitioning between two areas of concern one is the epidemic of the variants affecting both vaccinated and in the epidemic of the non-vaccinated which is the scarier portion here so what do we have so far to base our level of confidence on vaccination and reduce the level of vaccine hesitancy what we have as data is that though you may have breakthrough infections coming from the if you are vaccinated the protection level for the severe form of the disease is still high up there so kung magkadevelop pa rin ng COVID on an individual basis the risk of you from dying from the disease dramatically lowers dramatically goes down if you are previously vaccinated but the problem is if you have someone in your household vulnerable to vaccine sila ang pwede makaroon ng disease na matinde hindi ikaw kaya kahit vacunado hindi advise pa rin natin ang mga tao to do the social distancing the wearing of the face mask to protect the vulnerable population especially those that you love the elderly ones who may have problems developing immunoprotective activities so to use at a biological level as a basis of confidence that I am protected can be misleading at this point kung nirerequest yon dapat sa sabihin palagi ng advice na this is actually a basis that you develop at immune response from your vaccine but this is not the basis for you to say that you are protected forever from the virus which means that you need to be cautious about it and think about the people around you who have contraindications to receive the vaccine or you have the host profile that makes vaccine intake a little bit less than those that are that have intact immune system these are the elderly the receiving immunosuppressive drugs just had chemo receiving high dose steroids for autoimmune diseases so these are the ones that a little bit of a concern that may not have more effective vaccine protection than those who do not have this kind of risk factor so bottom line is the current serological measurements to determine protective antibody levels are still very limited not because the kit is wrong it's just because of the nature of the virus when the spike protein segments of the virus which is the one utilized to target measurements of the antibody levels changed that it recognized total antibody levels pero yung protective levels of the targets are not there because it's a different variant of the virus you can still have breakthrough infection two things either a breakthrough infection of the virus or in your case you have a rapidly waning immunity compared to other individuals so it can be either or a combination of both reasons so if patients would still request for those tests it's best that the doctors provide them the proper advice on what to think about when they have those results this is what you call managing expectations but otherwise social media bashing doctor ganito ganyan laboratory ganito ganyan so i think it's really a failure of communication sometimes on the pros and cons of these technologies that is being offered to us take note we are dealing with a pandemic and the need for rapid technology availability is always up there that sometimes even if it requires months and months tested, validated, reevaluated and reevaluated again you don't have that luxury so sometimes you have to do it what we have but the most important thing are the caveats of this technology that we need to be able to translate effectively in a language that is understandable by the non-medical community or even some medical community so ito yung challenge with all of these tests thank you very much doctor distura i think doctor doctor nelson thank you raul doctor nelson had his hand up yes i want to add a little bit to what raul had said now classically when you get infected by something you have two branches of immunity one is antibody mediated immunity another one is cytotoxic or cell mediated immunity now when you get infected by a virus in general i think there is evidence and people will hear me out on this that ang cell mediated immunity is more important in viral diseases than antibody mediated immunity so ang minimized sure ng antibody levels these are effector arms of humoral or antibody mediated immunity and we do not know kung ano ang kanyang cell mediated immunity which is also important because hindi isya minimized sure the other item that i would like to stress is when this particular virus enters your respiratory trap ang unan niyang encounter na structure is going to be the surface muco sa it is a surface that is covered by muco secretions and in such a situation ang antibody that is responsible for immunity there is secretory IgA at hindi IgG or IgM so therefore pag may minimized sure na IgG from the bloodstream from the circulation it could be different from what is occurring in the muco sa the real contact with the virus happens so hindi kasigurado kung meron kang ang IgG in the blood pero wala ka naman sufficient antibodies that are present in the muco sa layer ay mukhang antibodies in the circulation do not tell the whole story so that is the reason why we refuse to rely too much on antibody levels to say that you are protected or not protected or slightly protected from this particular virus because there are so many factors in the immune response na hindi na may make sure in this particular illness it's only IgG and early in the disease also IgM and secretory Ig and IgA na minimized sure walang secretory IgA yan so the antibodies that we are measuring are not exactly the ones that first come into contact with the virus as soon as it enters the respiratory tract so that is the reason why it is difficult to say that you are protected based on antibody IgG levels thank you okay thank you very much Dr. Nelson for that explanation I think we have one question that we will take from the audience because we are nearing the topic please go ahead Raymond so the two questions I'll just choose the one that's most uploaded the question reads what's the laboratory quality assurance that is in place for COVID-19 testing I think she's asking the protocols to make sure and it's also very much what is echoed in the chat with regards to RTPCR testing has an error all of that maybe we can ask Dr. Nalukta and then Dr. Heraldino afterwards actually in the Red Cross in our molecular laboratory of course I think every year they do are being subjected to proficiency testing that's on the technical aspect of our operations for the molecular laboratory or medtex and definitely every day they do preventive maintenance and quality check we have a laboratory supervisors who really make sure that they do monitor the operation and doing quality assurance procedures every now and then and even we have quality assurance auditors that goes around those 14 laboratories once or twice a year so they really need to double check if they are compliant to the procedures set forth by the government aside from the monitoring done by the Department of Health to each and every laboratory Red Cross because lately we were actually visited by the Department of Health so Mr. Jesse Tietre actually mentioned the laboratory so it really is a very problematic practice that you do haping when the timing of the collection is really different so with all of those problems at least somehow the Department of Health have reported that with the incident that happened to the Red Cross it's really within the standards by the government Thank you Dr. Manina Rae, Raul wants to say something about lab haping Dr. Sura because this is a common problem people think that when you test at one point in time you're in that particular state frozen the whole time so that's why you do lab haping choose the best menu that can provide you the test that you want for yourself and not the actual test for example if you test negative now and then you can doubt it because you may feel a little bit of something and then later on you go to another lab and you have it repeated and you tested positive remember the viral the viral reflective process is a viral dynamics process meaning your levels will be too low kaya negative ka doon sa lab A a few days later nag positive ko na doon sa kabila bako doon bakit ako positive dito on the reverse side nag positive ka, hindi ka happy sa result e'in doon ba ba siyong result mo a day after or two days later you go to another lab, negative ka na and in past pa pa ninyawalaan mo yung gusto mong result kung gusto mong result na negative doon ka sa negative the answer to that is you are wasting your money the specificity of the test is 99% which means that if you test positive at a particular point in time you have the genetic markers for that but later on pag mag-negative ka it means either you rapidly shed the virus and the pickup is already low then you will test positive so unless you really into the scientific model you have yourself tested simultaneously all at the same time same time same sample at sa kaiba-ibang laboratory kasi minsan isa pang dahilan is yung pag-collect pangalawa yung pag-transport pangatlo yung so there are pre-analytical processes that can affect the behavior of diagnostic technology so if you do laboratory hopping ibilimu na lang na cheeseburger yung gasto sa test sayang yung paulit-ulito thank you very much okay, i think we don't have any more time we would like to thank all our guests and we're going to give you a minute or two to formulate your parting words to our audience our audience are mainly front-line health workers as you can see from different parts of the country hospitals, clinics, health care centers so we'll give you a minute or two to do that meanwhile Raymond's gonna file what's this show our evaluation poll to answer to the questions yes, yes okay, can we do that team okay, there we go so this question comes from well actually i'll just read it anong COVID-19 test antingin mo ang pinaka mahusay so what COVID-19 test do you think is the best? the options are RTPCR swab, RTPCR saliva rapid antigen and rapid antibody we'll call on Dr. Distura to reiterate his message for this item still the most powerful tool for diagnosing COVID-19 is the RTPCR swab technology followed by RTPCR saliva technology followed by the rapid antigen and lastly by the rapid antibody it's not because they're really bad of course the intrinsic limitation of the platform is the one that keeps it a little bit of a challenge okay and then for our second question kapag positive po ba ako sa COVID-19, nakakabiyahit pa rin ako so that means if I'm positive for COVID-19, I can still travel is that true or false? go ahead ayah, false you shouldn't travel if you are positive or the virus because travel agency or the facility have no way of differentiating whether your positivity is in the infectious state or if your positivity is in the post-infectious state so ito yung public health decision kung gusto mo kumawantra you consult an attending physician have yourself evaluated and take care of your health rather than your drive to travel thank you so much doctor distura team, can we have the evaluation poll? there we go so we usually have this 5 question evaluation poll during this time our panelists will be well, gathering themselves to come up with their final messages to our audience, I'll read the questions and it's a 4-point likert scale, first is the panelists demonstrate the thorough knowledge of the topic, second the panelists were well prepared and organized third, the panelists spoke clearly and audibly fourth, the panelists used appropriate language with technical medical jargon adequately explained and number 5, the panelists contributed to new perspectives and knowledge on managing virus key COVID-19 health issues so we will continue to leave it open and like we mentioned walapong separate evaluation poll, eto na po yun answers and inputs po for this evaluation poll over to you doctor susie okay, thank you very much Raymond so we're going to ask our panelists to give their parting words for our audience and we're going to start with jessie diatre go ahead jessie thank you doctor susie my final remarks it's always better to consult and collaborate with other healthcare provider to make sure that the patient is very important in order to perform appropriate laboratory procedures again, do not be complacent because complacency could cost life, stay safe and God bless thank you thank you very much we're now going to call on doctor Jonathan Rivera hello ma'am for my parting words it's quite interesting to be invited in a webinar in which we don't only see the scientific side of things or the clinical side of things so as the questions reflected na very ang important din yung public health standpoint, yung mga later yung mga patients natin so it reflects on their questions directed to us and I hope in the future we can have more webinars like this na hindi lang yung polit-ulit na minimension natin yung mga different modalities and how it may help or impact the public health standpoint okay thank you very much doctor Jonathan, we'll go to doctor Monina na look down the Philippine Red Cross Monina thank you very much pa so as we unmask these SARS-CoV-2 let us continue to work together and we have all of our chairman Richard Gordon our secretary general together with doctor Susie she is still a part of the Red Cross the international federation of the Red Cross maraming-maraming salamat pa for the support and the trust you've been giving to the Red Cross we offer you our services in molecular laboratory RTPCR SWAP saliva and the different services that we can offer in response to COVID-19 infection thank you very much Monina for those words okay Raul, your turn yeah thank you so much for having me here today and the chance to explain the pros and cons of all the technologies available but the bottom line here is diagnostic testing for COVID-19 is not the only solution to control the pandemic it is a mere tool in providing us information for proper decision-making on what the next best thing to do in so far as the overall scheme of controlling it is a much a responsibility of the clinical laboratory diagnostician as also the doctors requesting for the test as well as the individuals receiving the results of the test this particular tools allows us to provide decision-making for clinical management at the same times gives information to the country how far we are in terms of controlling this pandemic again no matter how well established and well played well played the plans are where the battle plans for controlling it will never run on autopilot it means that each of us has a responsibility to do and to protect our country so that we can open our economy faster and that's so that our kids nieces and nephews can go back to school and that the economy will start growing and create more jobs again vaccinate vaccinate and vaccinate. Thank you Thank you very much. We'll go to Dr. Nelson. Is Dr. Nelson here? I think he got disconnected. Okay so we'll now move to our synthesis and closing remarks and it's our honor to have the deputy director for health operations at the Philippine General Hospital Dr. Stella Marili-Gaspi Jose Stella the floor is yours. Hello, good afternoon everyone this has been a very illuminating conference and Dr. Raul Destura presented his talk and actually this graph that he showed was shown several several times in this TVUP even at the start of the pandemic so this is just like a review for our followers in this webinar series so zero to third day you have the latent phase and then you have the infectiousity and then he said that in the clinical presentation from zero to five days is the incubation period and the patient becomes symptomatic up to the 14th day and what we are seeing here is in fact TBP so what is important is the timing of the PCR test now we are in the PGH if you think that this is a delta variant we get the swab the RT-PCR on the third day but it is just non-variant so we get it on the fifth day and the PCR test does not discriminate between a live virus and a dead virus so even after the patient has recovered from the COVID-19 infection the RT-PCR can still be positive but what is important here is your clinical assessment of the patient as you know now there is what we call the long COVID or the patient will manifest the symptoms of COVID even it is not infectious anymore so the antibodies if you want to test for antibodies should be tested on the second week of illness antigen is concurrent actually with the RT-PCR but more studies are needed to validate this now about neutralizing antibodies when you get your neutralizing antibodies they will give you a level but we do not know exactly how high it should be so that you will be prevented from having a COVID infection but I would like to reiterate that it is really vaccination which is important for those of you who go shopping from one test center to the other what is important is if the patient is symptomatic and when the test was done okay so in conclusion to Dr. Raul's lecture the RT-PCR is the gold standard I think he mentioned it again and the antigen testing is very promising now for Dr. Christy Monina Nalukta I admire her work in the Philippine Red Cross saludo ako sa inyo mam at marami kayong natutulungan okay so nasubukan ko magpasalay ba test sa Red Cross sa alamang and magaling very efficient at napakalini so wala ako masabi for Dr. Jonathan Rivera he presented the PGH data and so we see that it's going up going down we had already researched so far and now there is a search in Europe and so hindiyan maglalawon baka magcasurch naman tayo dito but if we are vaccinated as many have spoken even if you get the disease it will be mild or moderate but the death are very low or minimal now from Jesse Diatre he presented the dilemas in managing laboratories you know I sympathize with you at mahirap na talaga yung binabash tayo sa social media dapat nga masamaman pero gusto mo rin tulay mong bash ng tao pero wag bak natin gagawin nyo hindi yung tama we just have to enlighten our patients okay thank you very much for this opportunity to give the closing remarks thank you so much thank you so much Stella so that's our deputy director for operations to Philippine general so this brings us to a close and before we say goodbye I just want to encourage everyone to be with us next week na ko ganda ng topic natin sabi nito stay safe stay home down pero nakita natin itong pandemia antaas ng rates po ng domestic violence and pagaabuso ng mga bata so we will have some experts who will talk about this what to do how to prevent it where to report it ano ang mga kailangan tulong ang gagawin natin kasi kung meron kayong mga nahikitang mga dinadalang mga bata or mga kababaihan na mukhang sinasaktan sa kani lang mga tahanan dahil nag-lockdown din ay medyo na maraming naaburido but that's not a reason so we are going to talk about violence at home and COVID-19 so be with us next week Raymond over to you I can see people are answering the evaluation on the chat we were having trouble with the with launching ending restarting sharing the results of the poll we hope that's something that we'll able to address after this webinar po thank you so much to each and everyone of our expert panelists everyone really learned and you'll be able to see that not just in the in their answers to the evaluation poll na nasa chat ngayon but also in their comments po na when they were putting it in the chat so maraming-maraming salang po sa inyong lahat before we conclude our program let's first acknowledge the very hardworking team we understand COVID-19 that's web in our series without each and everyone of you hindi po talaga mangyayari etong ating credible online community very very thankful po kami sa inyong lahat and finally all stop COVID-19 webinars are archived for viewing at the TV UP YouTube channel at your convenience meron napong 78 webinars na naka-archived po doon ngayon after this webinar magiging 79 na po you can also view that in our other channels po in Facebook as well so this formally closes our webinar for this week magkita kita po tayo ulit next week same time same channel Friday from 12 noon to 2pm we look forward to your company again next Friday it's a date together we can stop COVID-19 so keep safe keep healthy and see you online the other Spain before my piece the other lives before my timp but right behind the mask I look into myself a mask do I have strength to carry on my god oh lord what's this go on I need you here to keep me strong I'm here to hold the line I'll keep my until my It's named to realize, it's fine to be afraid Just hold on to the word he gave This time we'll come to pass Cause this salvation makes a last You'll carry you to see the break of day The others pained from my fears The others lashed before my tears But right behind the mask I look into myself and ask Do I have strength to carry on? My God, how long was this gone? I need you here to keep me strong I'm here to hold the line I'll keep my head till my head's dying On my fears, the others lashed before my tears But right behind the mask I look into myself and ask Do I have strength to carry on? But if you're here to keep me strong I'll keep my word There's pain before my tears But pushing on the spite of tears Leads things through another day