Alarm over backlog of coronavirus tests spiralling out of control

Vials with blood samples are pictured at a clinic providing testing for the coronavirus disease (COVID-19) and antibodies, after authorities launched free mass screening for residents in the Russian capital, in Moscow, Russia May 15, 2020. REUTERS/Maxim Shemetov

Vials with blood samples are pictured at a clinic providing testing for the coronavirus disease (COVID-19) and antibodies, after authorities launched free mass screening for residents in the Russian capital, in Moscow, Russia May 15, 2020. REUTERS/Maxim Shemetov

Published May 29, 2020

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Cape Town – Alarm has been expressed over the extent to which the growing backlog in the number of coronavirus tests could influence the country's ability to manage the Covid-19 pandemic.

With the pandemic in South Africa now in its exponential phase, cases are rapidly increasing in many areas. Health Minister Zweli Mkhize has pinpointed the global shortage of test kits for the "constraints beyond our control".

A total of 655 723 tests have been conducted nationally, with 20 727 having been done in the past 24 hours, the Health Department said in a statement. 

The department said there were 96 480 specimens which had not yet been processed, but confusion surrounds the exact figure.

Earlier in the day, when Parliament's health committees had a joint meeting, the acting director-general of the Department of Health, Anban Pillay, indicated that the backlog is 80 000, having confirmed it with National Health Laboratory Services chief executive Dr Karmani Chetty.

During a virtual press briefing on Thursday, Western Cape Premier Alan Winde claimed the national backlog was about 100 000 tests. 

Data provided by the National Department of Health

"With testing under such severe pressure at the moment, I think (we are) 100 000 tests behind in the backlog at the moment in South Africa," Winde said. 

Due to the shortage in test kits, the Western Cape has changed its strategy – from actively testing as many potential contacts of a confirmed case as possible to reserving tests for patients in hospitals. 

"As of last week, we had to change that approach… We have got to reserve tests for in our hospitals, for our healthcare professionals, but also to make a decision in a hospital as to whether a person must go to the Covid-19 ward or perhaps get treatment for regular flu," Winde said. 

Western Cape MPL and chairperson of the provincial legislature's ad hoc committee on Covid-19, Mireille Wenger, said the backlog in the province was 18 000. "If we can't measure, we can't manage," she said.

While South Africa has the highest number of confirmed cases on the continent, Egypt had the highest number of deaths. According to Mkhize, this was influenced by the number of tests Egypt had done.

The Free State has the highest case fatality rate of 3.6, followed by the Western Cape and Eastern Cape (both 2.3) and KwaZulu-Natal (2.2).

The highest number of tests have been conducted in Gauteng (209 657, with 3 329 cases), followed by the Western Cape (143 741, with 17 745 cases), KwaZulu-Natal (106 945, with 2 349 cases) and Eastern Cape (62 586, with 3 306 cases).

Data provided by the National Department of Health

"We continue to see the number of tests increasing rapidly and they consist of those who present to hospitals/ laboratories (passive cases) and those who are identified for testing through the screening process," the Health Department said. 

"For various reasons, a lot of work has to be done to synchronise these figures at the laboratory. The figures that are reported are tests that have been conducted.

"Several tests are concluded. However, a backlog arises where a number of them are not allocated per province. Of the specimens that have been collected based on the clinical prioritisation, some specimens do not immediately get processed resulting in a backlog in tests.

"This means tests are not concluded on the same day when the specimen is received. The number of days it takes to clear those specimen remains variable."

More than 40 000 people are expected to die from the coronavirus in South Africa by November, with a million people expected to have been infected. 

The diagnosis of Covid-19 relies on a laboratory test that is simple, but laborious. 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, the number of analysis machines, the availability of staff, errors leading to a need for retesting – and the communication process.

Marc Mendelson, professor of Infectious Diseases at University of Cape Town, and Shabir Madhi, professor of Vaccinology and director of the MRC Respiratory and Meningeal Pathogens Research Unit at University of the Witwatersrand, have advocated for significant changes to be made to the testing procedure.

These include stopping the testing and contact tracing components of the community surveillance programme, in favour of self-reporting of symptoms via an app-based program on cellphones, and introducing high-risk group surveillance and testing, including patients and staff at long-term care facilities.  

* For the latest on the Covid-19 outbreak, visit IOL's  special #Coronavirus page

** If you think you have been exposed to the Covid-19 virus, please call the 24-hour hotline on 0800 029 999 or visit  sacoronavirus.co.za  

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