As Nigeria battles a twin evil of shortfall in revenue as well as a spike in COVID-19 infection, researchers and health experts are recommending Ghana’s pool testing—a kind of testing mix made from several individual samples pulled together into a tube to form one whole sample—as a veritable option in the fight against the coronavirus pandemic
Africa’s biggest economy is one of the hardest hit in the continent from both the health and the economic impact of the novel coronavirus, as daily reported cases of the virus continue to rise, overwhelming the country’s frail health infrastructure.
Some 37,801 persons have been infected with the virus as of 12th July 2020, including 15677 of which have recovered and 805 who have died, according to data from the Nigerian Centre for Disease Control (NCDC).
That’s a surge of 420 percent from the 7261 cases reported two months before, showing how fast the virus is spreading.
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Nigeria’s increasing spread was majorly due to its inability to quickly ramp up testing at the time it commenced five-weeks of economic lockdown to keep the virus at bay, analysts have said.
Although testing capacity has improved after the country added seven private laboratories to assist in ramping up testing however, it is still low for a country of its size.
With a population of over 200 million people, the country has managed to get 247,825 people tested on the virus, one of the lowest among its peers.
But to bridge the country’s testing gap would require the country dipping its hands into its resources which have been strained after a big drop in crude oil prices has wiped off more than 60 percent of its revenue.
There is also no respite in sight for the Nigerian economy in both the short and medium terms after projections from the International Monetary Fund (IMF) and the World Bank, which shows the economy will contract 5.4 percent and 3.2 percent respectively in 2020.
The above fiscal doldrum has made health experts and researchers task the government to rethink its strategy by adopting the pool testing which requires fewer resources while still delivering quality outcomes.
Why the pool testing method appears more important now than ever
The argument of comparing Nigeria’s low testing capacity to that of its peers, particularly Ghana has been an issue that has sprung up in the past, and Africa’s biggest has always defended its testing strategy saying it might be slow and costly, but it’s best.
Ideally, Nigeria’s method of running individual testing is not a bad approach, however; the approach is not feasible for a country like Nigeria with a population of over 200 million people, said Peter Imoesi, molecular neuroscientist and a research fellow at the University of Aberdeen, Scotland, United Kingdom.
In a series of tweets, Imoesi explained that the individual testing approach adopted by Nigeria requires the use of more consumables which might be a bit capital intensive. This is not just limited to supplies, but also the required human capacity in terms of competence and skilled experts.
For him, in the case of a small outbreak e.g. endemic disease, RT-qPCR individual testing is feasible. However, in a pandemic such as the one at hand – COVID-19 disease it may not be sustainable.
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If we continue with this individual testing approach, we may have more people infected with the COVID-19 disease, and since we are under-testing, the virus will spread further, he said
“The resultant effect of under-testing will potentiate the continuous transmission of the disease among the entire population owing to the slow pace at which we identify, and isolate COVID-19 positive cases,” he said
Although doing a coronavirus test is free as the fees are borne by the government, however, it cost as much as N50,400 for a person to get tested in any of the seven private laboratories recently approved by the Lagos state government, Professor Akin Abayomi, Commissioner for Health, Lagos said in while briefing newsmen of the response of the state in the fight against the virus.
Using that as a proxy to gauge the likely amount spent on testing for the virus, it shows Nigeria may have spent as much as N12.5 billion.
That’s about half the amount in which Nigeria earmarked as funds for basic health care in the 2020 budget.
Many countries are now beginning to see the pool testing as viable options particularly in Africa where the infection rates are still very low.
East African nation, Rwanda has opted to use the pool testing method as opposed to testing everyone individually.
Leon Mutesa, Professor of Human Genetics, University of Rwanda, in his paper titled “Rwanda’s COVID-19 pool testing: a savvy option where there’s the low viral prevalence,” lauded the move by the Rwandan government adopting the method.
The U.S is also considering pool testing in certain parts of the country where numbers are lower
In a paper done by James Dzansi, country economist and researcher at the International Growth Centre Ghana, he urged Nigeria and Ethiopia, in particular, to adopt the pool testing method as opposed to individual testing.
According to him, sub-Saharan Africa needs to be strategic in handling the pandemic as it has an inadequate health sector, incapable of managing COVID-19 cases at a similar footing to the rest of the world. Whether it is in terms of the number of doctors, ventilators, personal protective equipment, or simple test kits, the region comes up short.
Similarly, the region had very little fiscal headroom even before the pandemic, which has now worsened hence, the pool testing will help in reducing testing cost while still achieving efficiency.
The inadequacy of tests is so acute in Nigeria that doctors have to “wait for three to five days for the tests results” of patients exhibiting COVID-19 symptoms.
In a recent interview, Chikwe Ihekweazu, the Director-General of the Nigerian Centre for Disease Control, attributed the backlog of tests to a scarcity of test kits globally. He went further to assure that Nigeria “… will be able to scale radically our testing capabilities” when the global test kit supply situation improves.
Neither Nigeria nor the rest of the region can afford to wait until the global shortage of testing kits eases to ramp up testing. What is required urgently is a rethink of how to increase testing with the limited available test kits. In this regard, the Ghanaian pool testing experiment provides a useful starting point.
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How the pool testing works
The pool sample testing was first proposed for syphilis screening and the same testing approach has been employed in screening blood donors for antibodies to HIV, hepatitis B and C virus respectively, according to Imoesi.
The testing approach works in a way of bringing individual samples to be tested as one. If the pooled samples test negative, it is assumed that each of the individual samples is not carriers of the virus but if it tests positive, an individual sample test is being done to ascertain actual carrier(s) or the virus
For instance, consider a test facility with a capacity of 200 tests per day. Assume the COVID-19 prevalence rate is 1.5 percent, as is currently the case in Ghana. Ordinarily, 200 test kits are needed. However, when 10 specimens each are combined into 20 separate pools, at most, 50 test kits are needed. In total, 20 kits are used to test each of the 20 pools, plus 30 kits to test the individual specimens in the three pools which test positive.
That is a savings of 75 percent compared to the amount that could have been spent if the individual test was done.
To increase the level of sensitivity of the test, experts recommend increasing the required volume from each sample.
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