Author: Alexander Omari K. Yeboah
For the past 9 months, the whole world has been engulfed by the threat of a novel coronavirus disease (COVID-19). The disease which started in a single city in China, Wuhan, spread rapidly to other parts of the world and it was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. The disease is virtually in every country of the world now and as at August 1, 2020, there were 17,405,103 confirmed cases of COVID-19 with 675,085 deaths (1). In Ghana, the case count reached 38,501 with 191 deaths as at August 1, 2020 (2). The rapid spread of the disease vis-à-vis its management has exposed the vulnerabilities of the health systems of several countries in the world including Ghana.
Vulnerability, as defined by the WHO, is the degree to which a population, individual or an organization is unable to anticipate, cope with, resist and recover from the impact of certain exposures or disaster (3). Within the health system also, certain health interventions, if poorly managed, could have unintended consequences and could equally maintain, and unintentionally create, vulnerabilities among certain groups. With respect to COVID 19 in Ghana, one good intervention whose implementation has inadvertently resulted in several challenges within the health system is the enhanced testing regime. Source: Times Magazine – https://time.com/5878732/covid-19-testing-delays/ One of the best ways found to limit the spread of COVID 19 is testing and isolating those who test positive from the general population. The implementation of the principle of ‘test, trace and contain’ is reported to have contributed to the rapid decline in the spread of COVID 19 in South Korea (4). Reporting their first positive case on January 20, 2020, South Korea had tested more than 270,000 people by the middle of March with as many as 20,000 tests performed on certain days and results were being obtained in less than 24 hours for planning purposes. By the time the WHO informed their member states to test, test and test (5), the disease was already on the decline in South Korea (4). Ghana began tracing contacts for testing immediately after the first two cases were recorded on March 12, 2020. The tracing of contacts for testing was enhanced when the country started experiencing community spread of the virus and as at August 1, 2020, Ghana had performed a total of 402,564 test making it the 4th country in Africa with the highest number test performed after South Africa, Morocco and Ethiopia (2,6). Despite the apparent success of this testing policy in Ghana, the intervention is not without challenges. Source:https://qz.com/africa/1832066/coronavirus-covid-19-testing-in-south-africa-leads-continent/The main challenge of the enhanced testing policy is the delay in releasing the results which can partly be attributed to the few centres involved in testing the numerous samples being taken daily. On a personal level, I had my first sample taken on April 10, 2020 (insert photo) within the regional hospital where I work but received the results after 2 weeks. At that time, only the Noguchi Memorial Institute for Medical Research (NMIMR) and the Kumasi Centre for Collaborative Research (KCCR) were performing the test in the country. By the end of May 2020, there were 9 testing centres (8 public, 1 private) in Ghana performing the test with 4 of these facilities located within the Greater Accra Region where I work and yet for my last test on May 27, 2020, I received the test results after 72 hours. Since then, the 72-hour window has now become the norm in my institution. Colleagues of mine who work remotely from the major cities in Ghana are still receiving results more than a week after samples are taken.
The delay in releasing results has several unintended consequences. First, it leads to delays in instituting the appropriate therapy. This was the case in our first positive client in May, 2020, who was 41 weeks pregnant. After the initial assessment which gave an indication of a healthy baby in an asymptomatic client, the team had to wait for 5 days to receive the results before the appropriate management for the pregnancy at that gestational age was instituted. Secondly, the delay in releasing results also lead to delays in tracing individuals who had come into contact with the client. This has the potential of resulting in large numbers of people being exposed. One of our doctors who had attended to our first positive client was found to have also tested positive one week after diagnosing the client. The news of our colleague testing positive brought a lot apprehension among the health care workers as many of us had interacted with our colleague for a whole week and several clients that our affected colleague had seen and cared for could not be traced. This, indeed was a sad reality!