South Africa should prioritise more focused testing due to the limited resources available to it, says the Colleges of Medicine of South Africa (CMSA).
In a guidance note published on Friday (15 May), the CMSA said that the single biggest improvement that could enhance the country’s response to the coronavirus over the long-term, would be to reduce the turn-around time for testing results, while maintaining appropriate levels of testing.
“Testing kits for SARS-CoV-2 are limited and use therefore need to be rationed to optimise the use of each test, such that the greatest number of infected individuals can be identified to enhance contact tracing, and epidemic containment,” it said.
“We recommend that managing the Covid-19 epidemic is viewed using a long-term approach. To this end, immediate consideration should be given to enhancing laboratory capacity, resources and management to improve the turn-around time for laboratory results.”
To address some of these issues, the CMSA made the following recommendations:
Reduce mass screening and testing
The predictive value of a test is low when background prevalence is low, so mass screening is unlikely to yield benefit for containment, the CMSA said.
It noted that bringing people together poses a transmission risk to community members and community healthcare workers – so the potential benefits of these events may not outweigh the potential harms.
Any screening should have a clear aim which is defined in a publicly accessible protocol. Should resources permit, screening should:
- Not put community members and screeners at risk;
- Adequate physical distancing, hygiene and personal protective equipment to be implemented and available at the screening site;
- Should target areas where there is known high prevalence of Covid-19;
- Planning should include timeous return of results (WHO specifies within 24 to 48 hours) and contact tracing;
- Screening should use standardised tools to allow clearer interpretation of data.
Stop the legal imperative for all testing of employees with confirmed Covid-19 to test negative prior to returning to work
The CMSA said that test accuracy is variably reported and both false positive and false negative tests are noted.
It is also not clear how well the presence of virus correlates with infectiousness, it said.
Return to work should be based on the recommended guidelines from the Department of Health which specify 14 days since tested positive or 14 days after symptoms.
Target testing to closed settings with confirmed cases
The CMSA said that institutions such as care homes, health facilities, boarding schools, prisons, health facilities should be seen as ‘high-risk transmission environments’.
“Because of the likely higher background prevalence in these environments when more than one individual is diagnosed with Covid-19, targeted testing within a facility is likely to yield a greater percentage of positive individuals per number of tests done,” it said.
“This permits efficient identification of individuals who are confirmed with Covid-19 and their close contacts and should guide further screening and testing. Grouping of individuals can be done according to illness or exposure with isolation of those who are ill, and quarantine for those who are exposed contacts.”
Retain current Department of Health guidelines for testing for exposed, asymptomatic healthcare workers
Given limited human resources in the healthcare sector, and to avoid an unnecessary reduction in the healthcare workforce, healthcare workers who have had high-risk exposure to confirmed Covid-19 case, and remain asymptomatic after seven days in quarantine, may be tested on Day 8, and if negative, may return to work.
Alternatively, the healthcare worker should remain in quarantine for 14 days post-exposure.
Cease baseline testing to confirm negative status
The CMSA said that there is currently no benefit to testing employees or healthcare workers to obtain a baseline of current infectivity and/or to determine fitness for work.
While the benefit may be to individuals who test positive and to their contacts, the risk of transmission is dynamic and repeated tests would be required to make this a useful ongoing exercise. The utility of test to benefit ratio is very low, it said.
You can read the full guidance note below: