Its an unfortunate (and ironic) fact that we can secure “peace” only by preparing for war. ~ JF Kennedy

In recent days, we have seen more countries going into lockdown in an attempt to break the chain of the spread of the virus. Our country Malaysia has implemented the Movement Control Order, that has seen most of the nation who are not in the essential services stay at home until the end of the month. The tough question that needs to be asked at this point, is it enough?

How many COVID-19 cases have gone undetected? Why does it matter?

And how many of those had mild symptoms of the disease—perhaps so mild they dismissed it as a cold or allergies?

These are hard questions, and the worrying part is: we have NO answers!

It is these people who will continue to potentially spread the disease without our knowledge, which can render our government’s containment as a failed effort when the number of infected cases and deaths escalate exponentially.

Now at the mitigation phase, we have tried to contain everybody into self-isolation, and then we have urged those with symptoms to come forward for testing. This completely places the onus on the public and their willingness to disclose information about their health status and contacts. There are serious shortcomings from all of the above.

Why NOW is the Crucial Window to Push for Massive Testing?

Answering how many are infected in the community is critically pivotal to managing the pandemic and forecasting its course.  But the answers will not come only from the RNA-based diagnostic tests that are now being administered. These look for the presence of viral genome in a nose or throat swab, a sign of an active infection. But we also need the data from testing a person’s blood for antibodies to the new virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Such tests can detect active infections, too, but more importantly, they can tell whether a person has been infected in the past because the body retains antibodies against pathogens it has already overcome.

Testing is also important to reveal the real numbers behind the pandemic. Testing can also be used to ascertain if indeed our containment efforts have indeed “flatten the infected curve”; in which after 2 weeks of containment, our new incidences of infected cases have reduced in numbers.

Why do we need to Push for Massive Testing of our Health Care Workers?

Testing on-site is also important for all health care workers dealing with “potential” Covid-19 infected patients and we have to assume that we will not be able to obtain an accurate history of contact from many patients, either wilfully or ignorantly concealed.

And also testing can help to mitigate the risk of “silent transmission” once healthcare workers are unknowingly infected who continue to carry out their duties in the healthcare and hospital setting. Testing can safeguard our healthcare workers and this is imperative as we also have families at home that we need to think about.

Taking the painful lessons learnt from the countries who have been successful, China – with the highest number of cases in the world, has lower mortality than Italy. Their model of rapid detection using their test kits could be replicated to safeguard our health care workers and the general public. Same has been observed by South Korea (watch the video interview by BBC https://youtu.be/0IQkhaBifGQ).

We need massive testing urgently and we cannot do it without the help of our government and people.

Massive testing also can reinforce the movement control effort as the statistics show that it would encourage people to be more willing to contain themselves at home and then perhaps we can then began to see the effectiveness of containment imposed.

Malaysia needs to understand that will not we able to survive the economic impact if the containment needs to last more than a month. Therefore, investing in the massive testing will shorten the containment period and we can then look at ways to rebuild our nation.

Let us also learn from the delay in the lockdown imposed, that we should not have to debate about the shortcomings which may be a large amount of investment needed to purchase the kits for testings, as we are starting to witness deaths which will also rise exponentially.

“You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.” ~World Health Organization Director-General, 16 March 2020

Let us stand, united, in the solidarity to save our nation and nations the world over.

By:
Dr Anita Codati

Fellow YoungMinds Malaysia

MBBS (IMU), MsPsychMed (UM)

Psychiatrist, Child & Adolescent Psychiatry Fellow

Women & Children’s Hospital Tunku Azizah

With advice from:

Dr Ng Kee Sing, Physician, Advanced Acute Internal Medicine, Hospital Kuala Lumpur

An alumnus of M1/99 International Medical University (IMU)

Kuala Lumpur

22 March 2020

References

  1. Coronavirus: The Hammer and the Dance https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56
  2. Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf
  3. ‘It’s Just Everywhere Already’: How Delays in Testing Set Back the U.S. Coronavirus Response https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html
  4. How much is coronavirus spreading under the radar? https://www.nature.com/articles/d41586-020-00760-8
  5. COVID-19 epidemic in Switzerland: on the importance of testing, contact tracing and isolation https://smw.ch/article/doi/smw.2020.20225
  6. How many tests for COVID-19 are being performed around the world? https://ourworldindata.org/covid-testing
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