COVID-19 TESTING | HOW RELIABLE IN MANAGING THE PANDEMIC?

COVID-19 TESTING | HOW RELIABLE IN MANAGING THE PANDEMIC?

Ordinarily, the importance of accurate diagnoses cannot be overemphasized. Testing for COVID-19 is important for diagnosis hence, the right and timely treatment. However, the efficacy of the methodology, time factor, test kits, and its availability are perhaps among the most widely discussed topics.

COVID-19 testing is necessary as it provides valuable information that guides public health decisions about measures to contain the outbreak and preventable death. There are other illnesses (differential diagnoses) that present with symptoms in the spectrum of the COVID-19 syndrome.

These include pneumonia, asthma, flu, malaria, etc. Owing to this, the need for accuracy is of utmost importance.

As seen recently, there was panic over a trending video that showed an ambulance belonging to Warri Central Hospital, picking up a sick patient from her residence.

The patient who was previously diagnosed of pneumonia back in 2004 recounted her ordeal on how she was ignored by doctors and nurses on reaching the said general hospital because she was coughing badly. Thinking she had coronavirus, the doctors were said to be confused.

Days later, the Chief Medical Director (CMD) of Central Hospital, Warri, Delta State, Dr. Paul Okubor, dispelled rumors of a suspected case of coronavirus in Warri. Still, the fact remained that she was poorly treated, grossly mismanaged, and apparently, the treatment protocol for pneumonia was not followed.

What is COVID-19 testing all about?

COVID-19 testing

The primary specimen is a throat or nose swab, collected by a healthcare professional. Under certain clinical circumstances, a lower respiratory tract specimen should be obtained and tested. If there’s a productive cough, non-induced sputum should be tested. In the case of invasive mechanical ventilation, a lower respiratory tract aspirate or bronchoalveolar lavage sample would do.

Presently, two methods deployed in the course of COVID-19 testing are molecular and serological testing.

Molecular testing, using Reverse Transcription – Polymerase Chain Reaction (RT-PCR) for example, detects a present or ongoing infection. Detection of antibodies as a result of a previous or past infection is known as serological testing.

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Antibodies usually take 1-3 weeks after infection to form. Thus, serological tests indicate how many people have had the disease already, inclusive of those with mild symptoms or no symptoms at all. This method is helpful for diagnosis and population surveillance.

While the collection of samples can occur almost anywhere, testing is carried out in designated laboratories with strict protocols. In either case, the basic thing remains to avoid contamination of the specimen and observing standard precautions to avoid contracting the disease.

Depending on the type of test and/or location, time varies from 15-30 minutes to a week.

What are the popular COVID-19 tests?

The tests carried out for COVID-19  confirm if you currently have the virus (PCR – Polymerase Chain Reaction) or have made antibodies against the virus (serology). Regardless of the kind of test, actionable Information from these tests is important to help us return to work, reopen schools and relax restrictions. These are all dependent on the outcome of public health decisions or measures to contain the outbreak.

  • What does an RT-PCR test detect?

The PCR test detects the virus, using swabs from the nose and/or throat. It has a high accuracy rate, but seldom does not pick up all infections or may detect a similar infection such as common flu.  Most countries utilize this method of testing but limit it to the very ill due to the paucity of test kits and other logistics. Needless to say, it is a herculean task to scale-up testing for large proportions of the population, especially in largely populated countries.

Not minding a PCR test isn’t 100% dependable, it is important for early detection. This, in turn, helps to isolate infected persons and contain the outbreak. PCR testing is also crucial much later in the outbreak because it demonstrates how the virus navigates the population. A calculus or percentile summation of data may indicate those that develop serious complications. Consequently, this reveals how dangerous this virus is for different sets of people – young, pregnant, old, or terminally ill.

  • How is serology testing helping with the pandemics?
COVID-19 testing

Serology testing becomes necessary when one desires to find out if they have been exposed to the virus, and developed antibodies (immunoglobulins). Antibodies merely exert their effect by blocking virus attachment to target cells (neutralizing antibodies), making them useless. Not much is known about COVID-19 antibodies especially with regards to protection against re-infection.

Another uncertainty is how long they persist in the blood to confer immunity or meaningful protection. Supposing the virus behaves like other kinds of infections, serum could be synthesized after recovery to help others boost their immunity.  Some countries in Europe are understudying serology results as an “immunity ticket” to return to work.

Nonetheless, there are downsides to antibodies too in COVID-19. Antibodies can provoke a cytokine storm by overstimulating the immune system. Also, it has been reported that antibodies can activate immune cells which cause collateral damage in the lungs.

What are the challenges with COVID-19 testing?

Ideally, testing for an acute case of COVID-19 doesn’t have to take days — considering the number of persons yet to be tested and the need for timely intervention. Time is of the essence during a global epidemic such as this. In most areas, the supply of coronavirus test kits continues to drop.

Thankfully though, more tests are ongoing and more types of testing are slowly becoming obtainable. One of such is the antigen test.

It is quite disturbing that nations around the world continue to grapple with identifying who can get a COVID-19 test and where to locate the closest testing site amongst other struggles.

Also, pending what method is employed, sometimes, false positives occur. In the case of RT-PCR, the primary cause of false-positive results is that the test has detected antibodies, but they may or may not be antibodies to COVID-19. They are antibodies to another substance or infection.

Test reagents are not meant to react towards other types of antibodies, but it sometimes happens. This is why (sometimes) using this method in clinical diagnosis is frowned at.

This leads us to the most challenging aspect of the fight against coronavirus.  In the face of dwindling supplies around the world, there are cases of “wide variations” in the performance of some test kits reportedly gotten from China.

Recently, the Chinese embassy in India slammed a decision by Indian government medical research agency to suspend the use of Chinese rapid testing kits for COVID-19 on the grounds that they are faulty. 

Well, it turns out this is not peculiar to Asia only. US Vice President, Mike Pence, while speaking during the daily briefing on the novel coronavirus, said those “slow, lab-based tests” that are typically conducted by the CDC and the state’s public health labs would “never have been able to meet the testing in this coronavirus epidemic.” 

For third world countries reliant on donations from other countries who are also struggling at this time, what many can do is hope against hope.

What does taking a COVID-19 test feel like?

For a nose or throat swab, it is okay to close your eyes while suppressing the urge to sneeze till after the procedure. Sneezing will cause injury to the delicate membrane lining your nose and mouth. It also puts caregivers in grave danger.

Though this is a simple and mostly well-tolerated procedure, some conspiracy theorists make it seem so profound by using such expressions as ” it feels like carving out your brains,” just to scare people and further propagate their conspiracy theory.

First off, the swab stick is merely turned twice inside the nostrils or oral cavity (mouth) during sample collection just to expose the swab stick to a wider area for a better sample. Secondly, the swap stick is wrapped with fluffy cotton which gives it that cotton bud appearance. Thirdly, there also isn’t the risk of swallowing as it is of moderate length.

Although a subset of people may find this procedure a little irritating, the swab is barely pushed an inch into the mouth or nostrils. The sample has to be taken at the back of the nose, at a region called oropharynx – where the mouth meets the nose (the roof of the mouth). This region is highly supplied with nerves and blood. Above all, it is highly sensitive especially to smell and touch.

What is the importance of COVID-19 testing?

At the moment, over 1.6 million people have already recovered out of over 4.3 million confirmed cases worldwide. This represents over 85% recovery rate. The mortality rate is not totally insignificant either. The coronavirus pandemic has claimed about 15% of those infected and particularly hit senior citizens the hardest.

The world itches for normalcy but the reality staring us in the face says otherwise. No definitive cure is ready and the next 18-24 months, may or may not see the release of several drugs and vaccines which are currently underway. In spite of this, scaling up diagnostic tests for COVID-19 would help avert looming human and economic crises.

How? Well, all things being equal, early identification and treatment of acute cases would ultimately increase the recovery rate. Following this, if this virus behaves like other viruses with a stable genetic sequence, those with acquired immunity can return to work. 

Agreed, most countries were ill-prepared, and some totally unequipped to do battle against Coronavirus. The shortage of Personal Protective Equipment (PPE), test kits like the swab, sample bottles, reagents, etc. were and still are a few of the difficulties encountered.

In spite of this, a combination of molecular and serology tests with a well-outlined triage will go a long way in understanding how the disease evolves and prevent a second-wave.

The need for political commitment cannot be overlooked. It is necessary that resources are pooled and strategies peculiar to each set are executed. With these, we are sure to adapt to the new world normalcy.

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Further reading

https://www.vanguardngr.com/2020/03/covid-19-central-hospital-warri-debunks-rumors-of-suspected-case

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