As of 15 May, South Africa has a total of 12 739 confirmed Covid-19 cases and 238 confirmed deaths. The SA Coronavirus website’s latest media release indicates that by 14 May, more than 403 000 tests had been conducted in the country. News24 also recently reported that the Solidarity Fund approved funding for 400 000 Covid-19 test kits costing R250 million to support increased testing for the deadly virus across the country.
However, a guidance document – published on 13 May by the Colleges of Medicine of South Africa’s (CMSA) Covid-19 Evidence-based Guidance Task Team and CMSA’s CEO, Professor Eric Buch – advises limiting testing in the country for two reasons:
- Reducing unnecessary testing means that we can preserve test kits for those environments where it is needed most.
- Limiting testing means reducing the burden on laboratories, which will ultimately ensure more rapid turn-around times.
According to the document, which references an article by Spotlight, the National Health Laboratory Service (NHLS) aims to conduct 15 000 tests daily. However, it has been difficult to achieve this due to logistical issues, as well as a lack of test reagent and viral extraction kits. In recent weeks, however, testing has been ramped up - and more than 21 000 new tests were reported to have been conducted on Sunday.
Testing in a setting with limited resources
The World Health Organization (WHO) identifies testing and tracing people infected Covid-19 a vital measure in order to reduce the spread of the new coronavirus (SARS-CoV-2). However, delays in receiving test results, the authors of the CMSA document mention, greatly hampers the ability to follow this recommendation. Currently, the average turn-around time for laboratory sample results can range from two to seven days. Earlier this month, Bhekisisa reported that a national backlog has meant that some patients may wait up to ten days.
More than this, globally, PCR kits to test for SARS-CoV-2 are increasingly in short supply, which, in effect, has implications for testing in South Africa. It is possible that the country may run out of the test kits. Taking this into consideration, as well as public health principles and WHO’s guidelines – and after analysing the three key strategies for managing epidemics, i.e. surveillance, screening, and testing – they recommend that testing for Covid-19 should consider that: “The single biggest improvement that could enhance the South African response over the long-term would be to reduce the turn-around time for testing results while maintaining appropriate levels of testing.”
Based on this, the authors have made five recommendations:
Reduce mass screening and testing programmes
Mass screening is unlikely to yield benefit for containment of the virus, they explain. Instead, should resources allow, they advise adequate physical distancing, hygiene and personal protective equipment (PPE) to be in place at screening sites, and that screening and testing should specifically target areas where there is a known high prevalence of Covid-19. They also stress that planning should include timeous return of results. According to WHO, this ranges between 24 to 48 hours.
Consider current legal imperatives for testing negative and returning to work
Currently, those who have tested positive for Covid-19 and have recovered, are legally required to be re-tested before they can come out of isolation and return to work. However, the CMSA advises that these regulations be amended, based on the guidelines from the Department of Health, which specify that de-isolation should happen 14 days after the individual has tested positive, or 14 days after they had been displaying symptoms:
“Amend the Department of Employment and Labour Regulations no. 432577 published in notice 479 on 29 April 2020, that currently state:
- "24. If a worker has been diagnosed with Covid-19 and isolated in accordance with the Department of Health Guidelines, an employer may only allow a worker to return to work on the following conditions: 24.1 The worker has undergone a medical evaluation confirming that the worker has been tested negative for Covid-19."
"Regulations should remove the requirement for a negative test prior to return to work.”
Target Covid-19 testing in closed settings with confirmed cases
Focus on testing should be placed on high-risk transmission environments, such as schools, health facilities, care homes and prisons, as targeted testing within these kinds of facilities is more likely to produce a larger percentage of positive individuals per number of tests done. In these settings, the team recommend that individuals who present with Covid-19 symptoms be tested, and that all other symptomatic individuals be considered as probable Covid-19 cases, and therefore be isolated and quarantined.
Make allowances for exposed asymptomatic healthcare workers to be allowed to return to work
Healthcare workers in SA are stretched, and so, to avoid an unnecessary reduction in the healthcare workforce, CMSA calls for healthcare workers who have had high-risk exposure to confirmed Covid-19 cases, and have remained asymptomatic (displaying no symptoms) after seven days in quarantine, to be tested on day eight. Should the test be negative, they may be allowed to return to work, they suggest.
Stop baseline testing to determine negative status
According to the CMSA team, there is no benefit in the practice of baseline testing, which is testing employees or healthcare workers to either obtain a "baseline" of current levels of infection, or to determine fitness for work. To truly make this a beneficial exercise, repeated tests would need to be done, they explain.