Detection of new coronavirus cases in country heightens concerns highlighting certain crucial initiatives by the Sindh government are timely and highly commendable. Implementation of such steps in their true spirit is a shared responsibility of community, industry and institutions. The goal of all such steps is to contain spread of Coronavirus (Covid-19) which has not only started knocking our doors but is already penetrated in our community at few places.
There has been some confusion about screening, screening test and diagnostic test.
Screening done at arrival points including airports, sea ports and road entry routes is only Thermal screen to check if the incumbent is suffering from fever. This screening is misunderstood by many as a test of Coronavirus infection check. This misunderstanding has the disadvantage of creating a ‘fear’ among those who are having high temperature because there may be thousands of other causes of fever on the one hand and on the other creating a sense of Complacency in those who do not have fever at that moment. Moreover, ‘forced quarantine’ done at certain entry points without proper counselling resulted in a widespread message to all travellers to take anti-pyretic (fever lowering) tablets before reaching the point of entry to mask fever. If proper counselling is done and reason of quarantine explained no prudent person will try to defy the system. During such a rapidly evolving Pandemic quarantine services cannot be provided to all the travellers or exposure suspects. Volunteer self-quarantine and self-isolation with tracking, support, counselling and follow up by community, NGOs, Medical Associations, faith groups and government is a need of the time. We hope for the best but prepare for the worst.
Heavy rush of patients and attendants is observed at public Hospitals and clinics. This is a serious threat of spread of Coronavirus in patients and health care providers. Patients visiting hospitals are already having some health problems and by exposure are more likely to suffer from severe Covid-19. One important step which is required at this stage is to take concrete steps to decrease the crowding of such facilities. This can be done by three approaches (I) Use of clinical services on telephone for minor ailments (II) Use of Tele-medicine using proper medical records and case files, management of chronic cases, treatment and follow up of patients, connecting patient with labs, referral to other services etc. (III) Increasing the time span of clinical outpatient services by providing services in two or three 8 hourly shifts.
Several Laboratory tests for diagnosis of Covid-19 are available. The gold standard test is based on PCR Technology which is available only at few locations in the whole country and cannot meet the increasing demand of community. Additionally these tests are costly, supply of reagents and kits is limited and may be used only for diagnosis of ACTIVE infection. The tests come negative if person has developed immunity or has warded off infection. Sample used for PCR is throat, pharyngeal swab or sputum and plural fluid etc., Procedure for collection of sample for PCR has a risk of direct exposure to virus and require strict observation of Infection control practices at the facility and by the technician. This test should be reserved for diagnosis of highly suspected clinical cases.
Rapid serological tests are used for laboratory screening. These tests are based on checking of antibody against Coronavirus. IgG and IgM based tests are available in market. These tests have a sensitivity and specificity in the range of 85-90% and correlation with PCR of 90-95% according to the published papers in peer reviewed scientific journals. These tests become positive few days later than PCR but remain positive for longer period of time, even after PCR become negative. IgG test remain positive for months to years after recovery. Sample collection for these tests is less exposure prone and relatively safe for technician and the facility. These tests are also economically priced and can be performed in field conditions and at points of entry. Moreover, there is a demand from several institutions abroad and even within country to bring laboratory report of Coronavirus screening test. Another important utility of these tests is epidemiological surveys to find out previous exposure to the virus in a given community. Some of these tests have already been approved by CDC China and are CE marked and manufactured by well reputed ISO Certified companies. FDA US is also evaluating some of these tests and approval is awaited.
As with any laboratory test due caution is required in test performance and interpretation of results. PCR test is a highly sensitive test, which requires sophisticated facility to prevent contamination of workers and samples. It cannot be performed in field conditions or even ordinary clinical labs.
Healthcare professionals and medical societies should come forward and help government, NGOs and community to ensure dissemination of correct information to alleviate fears and prevent rumours.
