South Africa’s scaling up of the Covid-19 testing in recent weeks appears to have resulted in severe capacity constraints at public sector laboratories, with doctors reporting that it is often taking a week or longer to get results.
“The current turnaround time for Covid-19 tests in Gauteng is around seven days for outpatients and three to four days for inpatients,” said Dr Tom Boyles, an infectious diseases specialist at the Helen Joseph Hospital in Johannesburg.
He said that doctors in the Eastern and Western Cape have reported similar delays.
A doctor who works at an emergency unit in a public hospital in Johannesburg confirmed to Spotlight that they are also waiting seven days for the test results. The doctor, who asked not to be identified, said this was very frustrating for clinicians.
In some of the worst cases, tests sent from their hospital were lost and results took as long as three weeks after initial testing.
The doctor said that testing delays were contributing to congestion in wards since they are not getting the results delayed the discharge of patients.
The doctor also suggested that the testing backlog may explain why the number of confirmed cases in Gauteng was not rising quicker at the moment. “I think it’s simply because we are not testing enough,” the doctor said. “Our numbers reflect a week ago.”
Spotlight has also received information that Covid-19 test turnaround times at another Johannesburg hospital is currently 11 days.
Questions Spotlight sent to the National Health Laboratory Services were not answered by the time of publication, but Business Day on Friday quoted NHLS chief executive Kamy Chetty as saying that the key constraint was the supply of test kits.
“The suppliers for the high throughput machines do not have enough stock to meet demand and are trying to ramp up production,” she was quoted as saying.
This appears to contradict earlier reassurances given by NHLS board chairperson Eric Buch.
Early last month Buch confidently told Spotlight that the NHLS could do 15 000 tests a day.
“The NHLS has also secured supplies to maintain the 15 000 testing capacity over the next three months and further increase it if required,” he said at the time.
Buch also said then: “The NHLS cannot generate demand, and in fact would welcome an increase in the number of patients who are referred for testing.”
Over the last week, the NHLS and private sector labs have together done between 10 000 and 15 000 tests a day – a substantial increase from much lower levels two weeks ago.
Even so, the information provided in Health Minister Dr Zweli Mkhize’s daily Covid-19 updates suggests that the NHLS has not yet done anything near the 15 000 claimed daily capacity.
Impact on services
Boyles said the delays were having a huge impact on service delivery “particularly as there are currently no isolation facilities to house people who cannot self-isolate due to crowded living conditions”.
“Therefore, an outpatient with mild symptoms may go back to a crowded living space or even to work and only be informed that she/he is positive seven days later when she/he has most likely already transmitted the infection,” said Boyles.
“There are similar problems for inpatients as there are not enough single rooms to isolate them all. While awaiting results, positive and negative
patients must share wards. While every effort is made to prevent cross-infection, the greater the turnaround time the greater the risk.”
DA shadow MEC for health in Gauteng, Jack Bloom, shared these concerns.
“I am alarmed by delays in providing test results in Gauteng which means that many Covid-19 infection figures could be a week old and infected people could be infecting others instead of being quarantined,” said Jack Bloom in a media statement released this morning.
“I fear that the Covid-19 infection figures in Gauteng are understated because of testing backlogs. If public testing cannot cope then private tests should be commissioned by the provincial government as is being done in the Western Cape.”
Questions sent to the Gauteng department of health were not answered by the time of publication.
At a media conference on Thursday Dr Keith Cloete, head of the Western Cape department of health said that in some instances the testing turnaround time in the province was seven days, but indicated that it was now down to around two days.
He said that the Western Cape had decided to use private-sector testing capacity. He also said the province’s premier and MEC for health had written to President Cyril Ramaphosa and Mkhize about the province’s concerns around the country’s testing capacity.
Cloete said that the recent scale-up in testing exceeded the NHLS’ capacity to keep up with demand.
Boyles made a similar point, saying that the NHLS was “clearly being overwhelmed at the moment”. He also questioned how transparent the NHLS was being about their capacity challenges.
What to do?
While Chetty told Business Day that the NHLS was “working hard” to address the supply issues, the limited testing capacity may in the meantime require a rethink of South Africa’s testing strategy.
Boyles suggested three things:
- Stop community testing of asymptomatic people – the yield on results is very low, and it floods the systems with tests that it cannot handle. This can be restarted when laboratory capacity improves. Alternatively, in such circumstance, samples should be pooled such that a single Polymerase chain reaction can be used for five to 10 patients. This is already standard practice in other countries.
- Prioritise inpatient samples, they should go to the front of the queue in the laboratory, meaning that the turnaround time would be less than 24 hours.
- Provide isolation facilities for outpatients who live in crowded conditions, to be safely housed while awaiting results.
Cloete hinted at a somewhat similar prioritisation of testing in the Western Cape.
- Persons under investigation in an acute hospital setting;
- Healthcare workers;
- Members of the public who present with symptoms;
- People identified through community screening; and
- Workplace clusters.
* This article was produced by Spotlight – health journalism in the public interest. Find us at http://www.spotlightnsp.co.za/
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