Peru bet on cheap COVID antibody tests; it didn't go well

BOGOTA, Colombia (AP) - In the early days of the coronavirus pandemic, rushed Peru health officials faced a dilemma. They knew molecular testing for COVID-19 was the best option to detect the virus - but they didn't have the laboratories, nor the supplies, or the technicians to get it working.
But there was a cheaper alternative - antibody tests, mainly from China, which flooded the market at a fraction of the price and could give a positive or negative result in minutes with a simple fingerstick.
In March, President Martin Vizcarra announced that he had completed a massive purchase of 1.6 million tests - almost all for antibodies.
Interviews with experts, public orders, import records, government decisions, patients, and COVID-19 health reports now show the country's bet on rapid antibody tests is dangerously off course.
Unlike almost every other nation, Peru relies heavily on rapid antibody blood tests to diagnose active cases - a purpose they were not designed for. The tests cannot detect early COVID-19 infections, making it difficult to quickly identify and isolate sick people. Epidemiologists surveyed by The Associated Press say their abuse produces a significant number of false positives and negatives, contributing to one of the world's worst COVID-19 outbreaks.
In addition, a number of the antibody tests purchased for use in Peru were rejected by the US after independent analysis found they did not meet standards for accurate detection of COVID-19.
Today, according to John Hopkins University, the South American nation has the highest COVID-19 death rate per capita of any country in the world - and doctors there believe the country's flawed testing approach is one reason.
"This was a multisystem failure," said Dr. Víctor Zamora, Peru's former Minister of Health. "We should have stopped the rapid tests now."
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When COVID-19 cases surfaced around the world, low- and middle-income nations found themselves in a dilemma.
The World Health Organization urged authorities to step up testing to prevent the virus from spreading out of control. One particular test - a polymerase chain reaction test - was seen as the best option. Using a sample taken deep inside the nose, the test is developed on special machines that can detect the genetic material of the virus within days of infection.
If COVID-19 cases are detected early, the sick can be isolated, their contacts tracked and the chain of infection broken.
Within weeks of the first outbreak in China, genomic sequences for the virus were made available and specialists in Asia and Europe were able to create their own tests. But in parts of the world like Africa and Latin America there was no such option. They had to wait for the tests to become available - and when they did, the incredible demand meant most were unable to secure the number they needed.
"The collapse of global cooperation and the failure of international solidarity have pushed Africa out of the diagnostic market," wrote Dr. John Nkengasong, director of Africa CDC, in Nature magazine in April when the hunt began.
Nations that had an early start to preparation or already had a relatively robust health system in place did the best. Two weeks after Colombia identified its first case, the country registered 22 private and public laboratories for PCR testing. Peru, on the other hand, relied on just one laboratory that could run 200 tests a day.
For years, Peru has invested a smaller proportion of its GDP in public health than others in the region. As COVID-19 approached, obvious flaws became apparent in Peru. Only 100 intensive care beds were available for COVID-19 patients, said Dr. Víctor Zamora, who was appointed head of the Peruvian Ministry of Health in March. Corruption scandals had interrupted numerous hospital construction projects. Peru also faced a significant shortage of doctors, forcing the state to launch a massive hiring campaign.
Even now, months later, Peru's needs are far from being met. To date, the country has fewer than 2,000 intensive care beds compared to over 6,000 in the state of Florida, which officially has 10 million fewer people.
High levels of poverty and people dependent on daily wages for informal work hampered government efforts to maintain strict quarantine and further challenged Peru's ability to respond effectively to the virus.
When Zamora arrived, he said the government had already decided that molecular testing was not a viable option. The nation did not have the infrastructure to run the tests, and it acted too slowly to try to preserve what was little available in the market.
"Peru didn't buy in time," he said. "Everyone in Latin America has bought before us - even Cuba."
Antibody tests that detect proteins made by the immune system in response to a virus have had numerous drawbacks. They had not been fully tested and their accuracy was questionable. If taken too soon, most people with the virus are negative. This could lead those infected to believe they did not have COVID-19. False positives can be just as dangerous and lead people to mistakenly believe they are immune.
Antibody testing did not require highly skilled training or a laboratory. Community workers without medical training could then be trained in administration.
"It was the right decision for the time we were in," said Zamora. "We didn't know today what we knew about the virus."

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