The Scientific Coalition of Puerto Rico, appointed by Governor Pedro R. Pierluisi, today presented to the executive branch and the Department of Health an analysis and recommendations on diagnostic testing strategies for COVID-19 to be performed in Puerto Rico during this second year of the pandemic. One of the recommendations is not to use serological or rapid tests in any context as a diagnostic test for COVID-19.
“Science has come a long way in the past year, including virus detection strategies. In accordance with Implementing Decree OE-2021-001, where Governor Pedro R. Pierluisi directs the Minister of Health to create, design and execute a program that results in the massive administration of tests to detect COVID-19, we present an analysis of where is Puerto Rico on the issue of testing, how the science has progressed and we make specific recommendations to create robust systems that allow us to diagnose the virus’s behavior during the reopening processes in the coming year and avoid possible spikes in infections detect, ”said Marcos López, PhD, member of the Puerto Rico Scientific Coalition.
Coalition members understand that strategies need to be adapted to achieve three goals: 1) greater accessibility to diagnostic tests, 2) distribution and use of tests at key points during the reopening processes, and 3) adjustments in the use of tests and strategies scientific studies to track the virus and its variants.
“We begin our analyzes by examining what tests were done in Puerto Rico during the pandemic, the opportunities and the challenges, in the context of where science is today. There have been tough times of test shortages in Puerto Rico, and times, like the one we are going through today, where there is an abundance of testing, but people don’t get enough testing. That supply and demand, and that accessibility, must be stabilized, it being understood that, unlike when the pandemic started, more than 300 tests have already been approved for use in the United States and Puerto Rico. There is no reason why someone who wants to have a test should not do this. One of the unique aspects in Puerto Rico is the number of private laboratories we have all over the island and how this increases accessibility for the population. In fact, more than 1.7 million molecular diagnostic tests have already been performed, ”said Barbara Segarra, an associate of the Puerto Rico Scientific Coalition.
The coalition emphasizes that 84% of the total number of tests conducted in Puerto Rico during the pandemic were conducted in private clinical laboratories or academic centers. The moments of ‘shortage’ of tests, which affected the citizens so badly, were partly due to administrative barriers that prevented access to reagents or the execution of tests in these private laboratories. Some of these barriers still exist and limit access to tests, barriers such as, for example, the requirement in some contexts for a medical order to take a test, misinformation about the type of test to be performed or the one for certain is not allowed. test a recovery, on the part of the medical plans, on the taking of samples. The coalition recommends removing these barriers and strengthening partnerships, as has been done in most jurisdictions in the United States and elsewhere in the world, between the Department of Health and the private sector to expand access to health services.
The coalition understands that the type of evidence to be emphasized must change as the access to the evidence and the scientific knowledge associated with it have changed.
Serological tests are not diagnostic tests. We do not recommend the use of serological tests as a diagnostic tool in any context.We understand that some vaccinated citizens undergo serological testing to determine post-vaccination immunity. We emphasize that these tests do not necessarily measure the neutralizing antibodies that develop after vaccination, and we recommend avoiding such a practice, ”said Mildred Lozada, member of the Puerto Rico Scientific Coalition.
“On the other hand, we recognize the existence of new variants and the need to have systems with which to identify them. We recommend the implementation of molecular epidemiology-based surveillance programs targeting COVID-19 variants that make it possible to contain community infections and evaluate their transmission dynamics, ”said Dr. Kenira Thompson of the Scientific Coalition. “Programs should include virus isolation and neutralization analysis of serum libraries from vaccinated patients, by age ranges and plasma from recovered patients to determine whether the neutralizing antibodies our population produces can neutralize the variants or circulating strains. Surveillance and research projects resulting in the construction Sera libraries from vaccinated patients and the performance of pre- and post-vaccination IgG / IgM serological tests in at-risk populations should also be supported to understand the extent to which humans produce anti-SARS-CoV-2 antibodies. We understand that these strategies are the right and rigorous way to monitor immunity in Puerto Rico and in the context of the variants ”.
In addition, the coalition recognized that there are other new ways to integrate science into virus monitoring that have not yet been used in Puerto Rico, and that they need to be integrated to strengthen surveillance systems. For example, the coalition has recommended aligning test distribution and strategies with the context of openings, including their strategic use in airports, schools, government agencies or the private sector. He recommended the integration of methods, such as sample grouping or pooling, for monitoring in group contexts, such as school reopening. He also recommended the implementation of new wastewater environmental epidemiology programs to monitor sources of infection and identify possible outbreaks by detecting the presence of the SARS-CoV-2 virus in these samples. The process may even include tracking mutations of some variants, as well as determining their relative concentration.
The pandemic isn’t over yet, but in Puerto Rico we have the scientific knowledge to monitor the virus’s behavior and make the necessary adjustments to protect the population.A year after this pandemic, we are recommending new surveillance so that we do not find ourselves again in circumstances where there is a shortage of resources or access to tests that do not allow us to understand the virus’s behavior and make scientific decisions. take. We urge the Ministry of Health to implement these new programs, which will increase capacity and access to testing by citizens. We also urge the public to continue with precautions to protect themselves from infections and to continue testing when available or when they have symptoms. This will allow us to identify the sources of potential infections and protect lives during the reopening processes, in the context of the variants and as we achieve immunity to the herd, ”concluded Daniel Colón Ramos, president of the Puerto Rico Scientific Coalition.