The power of testing for Covid-19
Andreea Stoian KaradeliSince the beginning of the Covid-19 crisis, testing has been labelled as one of the main elements in the prevention strategy that should be used worldwide, and the World Health Organization has been the first to emphasize its importance. However, countries have been pursuing different policies in regard to testing for Covid-19, largely due to supplies, shortages and priorities. For instance, countries like South Korea, Iceland, Germany, Netherlands or Switzerland quickly tested a relatively large part of its population, but other places have had a slower start. In the US, a country of roughly 329 million people, 3.861.596 specimens had been tested at the Centers for Disease Control and Prevention and other labs as of 19th of April with a rate of 11.666 tests per million people. In the first weeks of the global pandemic, perceptions of an initially slow testing pace have added to general concern. However, testing activity has picked up in a number of locations worldwide.
According to the World Health Organization and to various experts on the field, intensive testing is important to be undertaken in order to identify, isolate and treat the Covid-19 cases without leaving the chance for the virus to spread. This protects the rest of the population, on one side, and the national health system / infrastructure, on the other. However, the different testing strategies that we witness around the world depend on various elements such as the state of the epidemic in the country or community, the availability of testing resources - both the test kits themselves (or the swabs) and personal protective equipment (PPE) for health workers, who are required to wear these in order to take the sample from patients.
According to David Duong (MD, MPH - Instructor in Global Health and Social Medicine at Harvard Medical School and Harvard Medical School Director of Global Primary Care and Social Change, as well as a member of the World Economic Forum’s Global Future Council on Health and Healthcare) and Todd Pollack (MD - Assistant Professor of Medicine at Harvard Medical School and Country Director for the Partnership for Health Advancement in Vietnam, a Harvard Medical School Global Program), most governments and most tests deploy the strategy of real time reverse transcription polymerase chain reaction. This method resembles the tests done for other infections and it compares DNA samples from the suspected person with the DNA sample from the virus. The preferred way of testing is a swab. The samples are transferred, usually by a health worker to the lab, and the lab runs the tests. Usually multiple tests are run at the same time, which can cause a time delay. For example, when the testing is done at the drive-up testing site, people drive in, a nasopharyngeal swab of the patient is taken while they are in the car, then the sample goes into a vial. The vial then gets transported to the central lab in the hospital for testing.
This is the method that has been used intensively in the UAE. The first country in the Middle East to report a case of Covid-19 (January 29), The UAE has taken the crisis seriously and developed intensively its testing capacity in order to prevent the spread of the virus. So far, the UAE has one of the highest rates of testing per million people and this may explain its success in the fight against Covid-19. According to the latest data (April 19), the number of positive cases identified in the UAE is 6.781, with 1.286 recovered patients and 41 deaths. The total number of tests that have been done so far is 767.000, which provides a rate of 77.550 tests per one million people.
On April 9, Abu Dhabi Health Services Company Seha opened 13 new drive-through centers that were built in a span of 10 days. In the past few days, the Ministry of Health and Prevention has announced that it has conducted tens of thousands of tests, stepping up testing along with strict social distancing measures to flatten the curve in the UAE. According to the UAE regulations on Covid-19, if a person shows and symptoms of the virus, such as dry cough, fever and difficulty breathing, they are requested to consult a doctor immediately. In the case that no symptoms are exhibited, but the person still feels the urge to get the test done, UAE citizens have the test, but need to be aware of the priority given to the following people: the ones that are showing symptoms linked to COVID-19 (dry cough, fever or shortness of breath), the ones that have had close contact with a confirmed or suspected COVID-19 case, or a travel history within the last 14 days, and the ones that are in the particularly vulnerable groups, which include pregnant women, people above the age of 65, or those with comorbidities such as hypertension, diabetes, cardiovascular diseases, or those with a compromised immune system such as cancer, a history of taking immunosuppressants or severe acute respiratory illness. For the asymptomatic cases, if the tests are taken voluntarily, without a doctor’s prescription, the insurance does not cover the cost of 370 Dh (approximately 92 euro). Based on the result of the test, if it is negative, the person receives a notification through an SMS or call from the relevant authority; in the case of a positive result, the authorities will contact the patient and recommend self-isolation at home or in the hospital, depending on the severity of the symptoms.
Apart from intensive testing, the UAE strategy for fighting Covid-19 includes strict social distancing measures such as a home curfew from 8.00pm to 6.00am (people are only permitted out during the day to purchase necessary provisions or if they are deemed to work in essential professions), the use of medical innovation to limit community transmission, a daily disinfectant programme on the emirate’s streets, and having robots engaged in the disinfection tasks. The UAE has also implemented the telephone application called “TraceCovid”. Once downloaded on the phone, the application tracks the moves of the person and provides information regarding the contact with any infected person.
A similar telephone application has also been developed and used in Turkey, since last week, under the name “HayatEveSığar” (“Life is sufficient at home”). The application helps people check the symptoms online, apply for a Covid-19 test and be informed of any contact with an infected person in the surrounding environment. Turkey has also developed its testing strategy reaching an average of 40.000 tests per day, using the swab method. So far, the country with the highest number of positive cases in the Middle East (86.306 positive cases, 2.017 deaths and 11.976 recovered patients), Turkey has done 634.277 tests since March 11, having a rate of 7.521 tests per one million people. According to the Turkish Minister of Health, doctor Fahrettin Koca, testing is important not only for identification and isolation, but also from treatment, because Turkey adopted a different treatment scheme than other countries. The medications are provided from the first days of the illness, as soon as the case is confirmed, in order to prevent the symptoms to worsen.
The first epicenter of the pandemic, China hasn’t provided any numbers regarding the tests that have been done on the population since the spread of the virus. China is, in fact, the only country that has failed to provide the testing rates according to the Worldometer Covid-19 data. This fact does not come as a surprise because even the data that can be found regarding the positive cases and the number of deaths in China are questionable, leaving many to wonder what the reality on the ground looks like. Bearing in mind the number of cases and deaths registered in Europe and in the USA, many experts agree on the fact that the data provided by the Chinese government is far from being true.
Moving on with the testing comparison, the EU states have also proven the use of different strategies regarding the tests for Covid-19. While countries like Germany, Switzerland, Austria, Portugal, Spain, Italy, Norway, Denmark or Estonia have high rates of tests per one million population, other countries, such as France and the UK have extremely low levels of tests registered so far. As numbers speak now more than words, Germany has conducted 1.728.357 tests (20.629 tests/one million people), declaring 144.406 positive cases, 4.548 deaths and 88.000 recovered people. Switzerland, beyond the fake news about a herd immunity developed in the country, registered 221.263 tests (25.566 tests/one million people), declaring 27.740 positive cases, 1.393 deaths and 17.800 recoveries. Spain was also heavily hit by the virus, registering 930.230 tests (19.896 tests/one million people), 195.944 positive cases, 20.453 deaths and 77.357 recoveries. The European epicenter of Covid-19, Italy has registered so far 1.356.541 tests (22.436 tests/one million people), 178.972 positive cases, 23.660 deaths and 47.055 recoveries. As for the countries in Western Europe that were hardly hit, but undertook a very low rate of tests, the situation presents itself as follows: in France, 463.662 tests were registered (7.103 tests / one million people), among which 152.578 were positive cases, with 19.718 deaths and 36.578 recoveries; in the UK, 482.063 tests were registered (7.101 tests/one million people), among which 120.067 were positive, with 16.060 deaths and no data for the people that recovered.
Based on the data provided, it can be observed that in the countries that applied the intensive testing strategy, the rate of positive cases is around 10-20% out of the total number of tests. In the case of the countries with low testing rates, the number of positive cases is higher, representing more than 30% of the tests.
While the World Health Organization has made it clear that testing provides an advantage in the fight against Covid-19, it failed to provide all the necessaries elements – politically and material – for this to be equally implemented around the world. Covid-19 is not an easy enemy to defeat, but the more cards we have on our hands, the better become our chances to win this battle.
