As COVID-19 spikes, Nigeria turns to rapid testing

Nigeria has dropped pre-COVID test screening mostly used in hospital’s triage system, for Rapid Diagnostic Testing (RDT) following its failure to detect COVID-19 suspects, as infection rate surged almost 70 percent among healthcare workers.

The pre-screening entails taking history of suspected patients in relation to symptoms such as coughing, fever, sore throat, loss sense of taste, smell and chest pain.

Triage teams also check temperature using a non-touch method and observe oxygen saturation. They combine this information to arrive at a verdict that a patient is a suspect to be admitted in its holding bay or clearly negative and qualified for onward care. But hospitals have had a tough time drawing the truth out of patients desperate for care.

The shortcomings of the rapid testing method, such as a wider margin of error which can allow few positive cases to pass off as negative, initially discouraged the National Centre for Disease Control (NCDC) from approving it.

However, infections have been escalating out of control with healthcare workers fast becoming patients.

Waiting several hours for patients’ swab samples to return from Polymerase chain reaction (PCR) laboratories where the virus is accurately detected is turning into an expensive venture in the face of a deadlier second wave that is more transmissible.

Presentation of medical cases from serious illnesses to elective surgeries at hospitals has not slowed. Yet, the triage team of most hospitals can’t clearly and quickly determine which patient is positive or not.

The triage system offers the first-contact assessment of a patient that includes key checks of vital signs and identification of the main complaint.

Sighting the danger brewing, the Africa Region of the World Health Organisation (WHO) last week authorised emergency use of the rapid testing for healthcare workers to at least stop working in the dark.

Chike Ihekweazu, director-general of the NCDC told BusinessDay that the disturbing rate of infection within the healthcare environment has forced Nigeria to seek the gains of rapid testing, although it is not expected to replace the molecular PCR method, which remains the gold standard. Both methods will be used in complementary roles to scale-up COVID-19 testing across the country.

“We have decided to deploy these in hospitals, to ensure that healthcare workers can be tested quickly and also for patients who require surgery,” the infectious disease expert said in response to BusinessDay.

“The Rapid Diagnostic Test kits have the advantage of shorter turnaround time, compared to the molecular PCR method which we have been using in Nigeria.”

The centre has deployed the test kits produced by SD-Biosensor and Abott to five hospitals in the Federal Capital Territory (FCT), with plans to spread across the country from mid-February, the director-general said.

Before the approval, Adetokunbo Fabamwo, chief medical director, Lagos State University Teaching Hospital (LASUTH), mulled over the option as his healthcare workforce was depleting from exposure to the virus.

With about 60 percent of staff of the Anesthesia Department COVID-19 positive, for instance, elective surgeries are up for suspension until they recover.

“That is not an infallible method of screening. A lot of patients deceived us and took paracetamol before coming to the hospital so that their temperatures will be normal. So we found that despite that screening at triage, positive patients were slipping through,” Fabamwo, a professor of Obstetrics and Gynaecology said, responding to BusinessDay.

The same event played out at the Lagos University Teaching Hospitals last year where screening doctors raised alarm over the risk of the hospital wards becoming a super spreader as coronavirus patients were mixing up with negative ones.

“If we use that method of screening with symptoms, temperature and oxygen saturation and we now add rapid testing to it, we will pick up more suspects. Hospitals should adopt it. It will help us to identify more suspects and reduce the risk to our workers,” the director added.

While he admits that few patients will still escape because of false negative: a patient who is positive but which the rapid test doesn’t pick it, it will shine more light on screening.

Chris Bode, chief medical director, LUTH said the hospital will adopt rapid testing especially in qualifying patients for surgeries but still subject them to PCR test during the process of care.