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CORONAVIRUS

Testing the weak link in Covid-19 fight

It is the entry point for Covid-19 control and must be prioritised.

In Summary
  • Different testing strategies are needed within the country in order to contain and control the spread of the virus.
  • Door-to-door testing in population-dense areas where there is doubling of reported cases over 3-4 days period will likely have better test yields.

Why is testing for Covid-19 important? Testing leads to quick identification of cases, immediate isolation to prevent spread and early treatment of those identified. Although there is no specific treatment or cure, the treatment and care provided may improve speed of recovery and reduce mortality.

Testing also helps to identify early anyone who came into contact with infected people so they too can be monitored and tested. Testing is also important in the mitigation efforts, helping characterise the prevalence, spread and contagiousness of the disease.

Kenya has, simultaneously, counties with no reported Covid-19 cases and counties with community circulation of the virus. Given the important role of testing for Covid-19 control, what are the strategies for optimising testing in the country?

For counties where there have been no reported Covid-19 cases so far, the objective for a testing strategy is to “test all suspected cases in an effort to detect first cases as rapidly as possible, and take immediate contact tracing measures to prevent further spread in the county”. The objective for the testing strategy for counties with community transmission is to “slow transmission, reduce case numbers and end community outbreaks.”

Thus, different testing strategies are needed within the country in order to contain and control the spread of the virus.

It has been publicly acknowledged that the levels of testing in Kenya, despite an installed capacity of over 50,000 samples per day, are still seriously inadequate to meet the need. The testing capacity in Kenya continues to grow from the initial two labs in Nairobi, to 20 laboratories in 10 counties, including two private sector laboratories.

Two additional private sector laboratories as well as two mobile laboratories are due to come onboard. The global supply chain is currently the challenge to meeting the increasing demand for testing, limiting the availability of reagents and kits for testing. The falling prices for the reagents and test kits offer hope that with increased affordability, supply and access will increase sufficiently to meet most of the demand.

 

Testing is the entry point for Covid-19 control and must be prioritised in counties with community transmission and in settings where testing capacity does not exist or meet needs. This prioritisation should focus on the early identification, protection of vulnerable patients and healthcare workers. Focused testing in healthcare facilities ensures that infection prevention and control measures can be correctly implemented such that vulnerable patients who do not have Covid-19 are protected from nosocomial (facility setting) transmission of infection.

Although in the national response, selected national facilities and nominated facilities in the counties have already established isolation and treatment facilities, through integration into service delivery in all the health facilities, sample collection and testing of those eligible is yet to be universally achieved.

This is the situation even in counties with community transmission hotspots. County governments have the responsibility to ensure the uptake, rapid roll-out and sustenance of Covid-19 testing is integrated into all health facilities for all symptomatic patients and for symptomatic healthcare workers. Testing of healthcare workers has been initiated but coverage is still very low.

Testing among vulnerable populations (elderly, those in nursing homes) and risk groups (healthcare workers, frontline care workers, security personnel, transporters, etc) will be important for early identification and treatment to minimise progression to severe disease. Results of testing of specific populations (like asymptomatic healthcare workers) can give a rough estimate of the size of the outbreak in the area and be used to monitor trends and effect of containment measures.

Targeted mass testing, although it increases awareness and demand for testing, may have very low yields that may not justify resources diverted and deployed. In my opinion, targeted approach of door-to-door testing in population-dense areas where there is doubling of reported cases over 3-4 days period will likely have better test yields.

Infectious disease control physician and public health specialist