Diagnosis of Covid-19 relies on a laboratory test that is simple, but laborious.
The time taken from the sample being taken to communication of the result – the “turnaround time” – is influenced by a number of factors. These include the speed at which the sample reaches the lab, the lab’s capacity to run the test – access to reagents and test kits, number of analysis machines, availability of staff, errors leading to a need for re-testing – and the communication process.
Identification of infectious cases – even if only a quarter of those who are infected are identified – coupled with adequate tracing of their contacts and ensuring isolation and quarantine of test-negative contacts, could assist in slowing the rate of community transmission of the virus. It is estimated that any single case will, on average, have 20 close contacts who should be traced. These include any close contacts occurring from at least 2-3 days prior to symptom onset in the identified case, and up until the case has been isolated. Assuming that isolation occurs on the third day after symptoms appear, for each case there would be approximately 120 close contacts to be followed up.
This points to the need to shift the focus of PCR testing to patients being admitted to the hospitals. This would inform the management of the patient and limit the likelihood of spread within hospitals. * Stop the testing and contact tracing components of the community surveillance programme, in favour of self-reporting of symptoms via an app-based programme on mobile phones. We believe there is sufficient mobile coverage and access to do this. This would allow monitoring of disease activity, and self-isolation of symptomatic people for 14 days on the probability of COVID-19 infection.
* Allow rapid diagnosis of hospitalised people under investigation, which allows optimal case management of severe COVID-19, optimal infection prevention and control, and patient flow to enable hospitals to cope with the escalating numbers as we climb the exponential curve to the peak.
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