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Scramble for COVID-19 test

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Testing key to containment of COVID-19… CREDIT: MedPage Today

There are concerns of global shortage of testing capacities, Personal Protective Equipment (PPE) and ventilators, which threatens the chances of the patients to survive and nations to stop the spread of the virus.

The situation has created panic, as most people want to get tested as soon as possible. But the Nigeria Centre for Disease Control (NCDC) has said that only those with symptoms and have come in contact with confirmed cases can be tested.

However, The Guardian investigation revealed that the current setup does not allow for testing of enough people because it is based on molecular technique which is difficult to scale up.

Critics say this explains why only very few people have been screened and that the country needs a reliable rapid test kit to deployed immediately that will help decentralise testing in Nigeria. They say testing centres are needed in every state of the federation.

But the Federal Ministry of Health (FMoH) and NCDC said they couldn’t validate the results of the rapid test kits.

Meanwhile, Taiwan’s containment of COVID-19 outbreak has demonstrated importance of rapid response, including fast access to clinical laboratory tests.

According to a study published in the Journal of American Medical Association (JAMA), by taking early measures to combat the spread, Taiwan had a medical laboratory test for COVID-19 available as early as January 24, and was able to focus medical laboratory testing on the most at-risk individuals

It believed that Taiwan’s rapid response to the pandemic could provide a critical model for other countries to follow.

Until now, the World Health Organisation (WHO) and several studies have recommended several measures that can be put in place everywhere: the preparation and expansion of health services; widespread testing and tracing; social distancing and personal quarantine measures; and clear messaging.

However, the Director General of the WHO, Dr. Tedros Adhanom Ghebreyesus, had on Saturday warned: “When health workers are at risk, we are all at risk.

“Health workers in low- and middle-income countries deserve the same protection as those in the wealthiest countries.

“To support our call on all countries to conduct aggressive case-finding and testing, we’re also working urgently to massively increase the production and capacity for testing around the world….

“… The chronic global shortage of personal protective equipment is now one of the most urgent threats to our collective ability to save lives.

“WHO has shipped almost two million individual items of protective gear to 74 countries that need it most, and we’re preparing to send a similar amount to a further 60 countries.

“But much more is needed.

“This problem can only be solved with international cooperation and international solidarity.”

Director General and Chief Executive Officer of NCDC, Dr. Chikwe Ihekweazu, told The Guardian that most Nigerians are besieging the centre asking to get tested.

He, however, said the country does not have the capacity to test everybody now but is only testing those with symptoms.

The epidemiologist, however, cautioned against the use of rapid test kits saying that they have not been validated.

Contrary to reports, Ihekweazu, told The Guardian yesterday that, for now, the country has enough face masks and PPEs but not ventilators.

A ventilator is a machine that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.

For some patients who will become critically ill after contracting COVID-19 in the coming weeks and months, a ventilator could be the difference between life and death.

Ihekweazu said although the numbers of cases are rising, most infections are mild and only few patients are with severe symptoms.

The signs and symptoms include common cold and respiratory symptoms, such as dry cough, fever, shortness of breath, and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and death.

Ihekweazu told The Guardian: “If don’t have any symptoms you should not go for test. People are running around to get tested. We are testing only those with symptoms. Please stop panicking. Not everybody needs a test.

“Everybody should support healthcare workers. Stop criticising us in the middle of a war. You don’t do that to soldiers during a war. Help the health workers, encourage them and buy them food if possible, be kind to them. We need them now more than ever. They are the ones in the middle of everything.

“Yes cases are rising but most cases are mild and moderate and only few cases are severe. We are working hard trying to contain the situation. All the patients are responding to treatment. I had a telephone conference this afternoon by 2.30 pm with all the Governors and we are brainstorming on the way forward.

“At the moment there is no shortage of PPE. Ventilator is a problem globally. Every government in the world is in scarcity of ventilators not just Nigeria. We don’t produce ventilators here in Nigeria but we are working hard to get more. But so far most of the patients we have don’t require ventilators to manage them because their cases are mild.”

The NCDC noted: “The COVID-19 test reagents which Nigeria has received and procured recently can only be used for PCR tests in existing molecular laboratories. There have been important developments such as use of Gene-Xpert machines. We are also expanding our testing capacity using this technology

“No Rapid Diagnostic Test (RDT) kit for COVID19 has been validated. We are aware of validation studies going on. Until these are completed, we cannot procure RDTs, because we do not know if they work.”

The NCDC, in a post on its official Twitter page, has highlighted those that are eligible to undergo tests.

The NCDC explained that returning travelers with fever or difficulty in breathing are eligible for the test.

Also those who have had close contact with confirmed positive cases of COVID-19 are eligible to undergo the test.

The tweet read: “We have updated national case definitions for COVID19 and those that can be tested: returning travellers with fever, cough or difficulty breathing; contacts of confirmed cases with these symptoms; and those with fever and respiratory symptoms in areas of moderate-high prevalence.

Meanwhile, a virologist and Chief Executive Officer of Innovative Biotech, Keffi, Nasarawa State, and Innovative Biotech, United States (US), Dr. Simon Agwale, has called for immediate deployment of COVID-19 Rapid Test Kits across the federation, saying the kits remain the fastest method in detecting newest contacts.

Agwale, a vaccinologist and a former researcher at the University of Jos, and the National Institute for Pharmaceutical Research and Development (NIPRD), said the current molecular diagnostic approach being used in the country, although very appropriate because it measures the amount of virus in the blood, cannot proactively tackle the COVID-19 challenges.

He said: “The Rapid Test Kits differentiate between recent infections versus exposure to the various by measuring IgM and IgG antibodies respectively.

This is because any fresh recent infection would make the body generate specific IgM antibodies subgroup, which can easily be tracked. The IgM and IgM/IgG both positive suggests recent infection exposure, while IgG only positive suggests previous infection, or latent infection. The, with IgM and IgM/IgG current infections to be positive samples can then be confirmed by Real-Time Reverse Transcriptase (RT-PCR) or viral gene sequencing.”

The virologist said the fear being expressed by some concerned Nigerians is that the only three testing centres in the country, located in Lagos, Edo and Abuja are not enough to cater for over 200 million Nigerian residents. This is in addition to the fact that the current technique being used in Nigeria for detecting COVID-19 is difficult to scale up and this explains why only very limited samples have been tested so far.

He said this same fear informed the recent decision of the United States government to commence evacuation of her citizens in Nigeria over possible escalation of coronavirus.

Agwale said what might have prompted the decision of the US is because the exact number of Nigerians exposed to the dreaded virus could not be determined as possible victims mingle freely with people. He also commended some high-placed Nigerians, who have come out to state their status, adding that such would remove the stigma.

But the NCDC said it has expanded its testing capacity for COVID-19 and now has six molecular functional laboratories in the country with the capacity to test for COVID19.

The agency said it would scale up the number of laboratories to 13 in the next three weeks.

The laboratories, the centrek said, would assist other response activities, thereby reducing the number of deaths.

Agwale, however, said with COVID-19 rapid test kits, the test will become easy and can quickly be deployed nationwide for rapid screening.

The virologist added: “In the short term, we need to setup at least COVID-19 testing centres in each of the states and quickly deplore reliable rapid test kits to these centers. Positive samples can then be sent to NCDC for confirmation using molecular technique.

“Secondly, we need isolation centers in every state, preferably use the Federal medical centers so that positive cases can be isolated and treatment provided to those that need them.”

Agwale, however, said the permanent solution to the emerging global health challenges is for Nigeria to invest in local vaccine production, which would bring technological advancement and also create employment for Nigerians amongst other benefits.

Meanwhile, a study published in the Journal of the American Medical Association (JAMA), titled, “Response to COVID-19 in Taiwan Big Data Analytics, New Technology, and Proactive Testing” has identified improving the capacity to test as one of the major secret for their success in containing the virus.

Given its proximity to Mainland China and the large number of individuals who frequently travel back and forth between the countries, Taiwan was at risk of having the second-highest number of imported COVID-19 cases, according to a model developed by researchers at Johns Hopkins University and the University of New South Wales Sydney. News reports indicate that, each year, about 60,000 flights carry 10 million passengers between Taiwan and China.

But after the first reports emerged of the infection in Wuhan, China, “Taiwan quickly mobilized and instituted specific approaches for case identification, containment, and resource allocation to protect the public health,” wrote C. Jason Wang, MD, PhD; Chun Y. Ng, MBA, MPH; and Robert H. Brook, MD, ScD.

Data from Taiwan’s Centers for Disease Control (CDC) and Central Epidemic Command Center (CECC) indicate that the country has managed to contain the outbreak thanks to these aggressive actions.

As of March 19, Taiwan’s CECC reported a total of 108 laboratory-confirmed COVID-19 infections. That compares with 81,155 in China, 41,035 in Italy, and 10,755 in the US, according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University.

The World Population Review website says Taiwan’s population is about 23.8 million. But its infection rate is low even on a per capita basis: Approximately 45 infections per million population, compared with 6,784 in Italy, 564 in China, and 326 per million in the US.

The JAMA authors noted that Taiwan was prepared for an outbreak after its experience with the severe acute respiratory syndrome (SARS) pandemic in 2003, which also originated in China.

Taiwan apparently learned a lesson about preparedness from the SARS outbreak the rest of the world did not and that enabled the tiny nation to respond immediately to the novel coronavirus threat.

One noteworthy difference in the speedy response to recognition of a novel coronavirus in Taiwan, compared to recognition of the same novel coronavirus in Nigeria and most other countries, was the fast availability of clinical laboratory tests for COVID-19 in Taiwan.


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