COVID-19: Upper West witnesses improved testing regime

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Covid Testing
Testing

The Upper West Region recorded its first case of COVID-19 about weeks after Ghana recorded its first two cases of the global pandemic on March 12, 2020.

Dr Hafiz Bin Salih, the Regional Minister who announced at a press conference said the patient was a 42-year-old Ghanaian who returned to the country through Egypt after a visit to the United Kingdom and Spain.

“He returned to Ghana eight days ago through Egypt and travelled from Accra to Wa via public transport and has been confirmed to be COVID-19 positive”, he told the press after it was detected.

From then, until now, the case count of this global pandemic in the region stands at 741 cases of which 704 have been discharged leaving three active cases whilst 34 people, unfortunately, lost their lives to the most deadly disease in the world’s history.

Importance Of Testing

Testing of all people for COVID-19, including those who have no symptoms, those who show symptoms of infection such as trouble breathing, fever, sore throat, or loss of sense of smell and taste, and who may have exposed themselves to the virus will help prevent the spread of the disease according to the World Health Organisation (WHO).

A positive test early in the course of the illness enables individuals to isolate themselves – reducing the chances of infecting others and allowing them to seek treatment earlier, is also likely to reduce disease severity and the risk of long-term disability, or death, the WHO added.

“Testing for COVID-19 is so important that in April 2020, the National Institutes of Health (NIH) launched the Rapid Acceleration of Diagnostics (RADx) to develop rapid, easy-to-use, accurate testing and make it available nationwide”, said the WHO.

The country currently has 39 accredited laboratories to test for COVID-19; an effort that has improved the testing situation in the country.
Ghana’s Testing Regime

At the beginning of the pandemic, only three laboratories performed the COVID-19 tests in Ghana.

First, was the Noguchi Memorial Institute for Medical Research (NMIMR), later the Kumasi Centre for Collaborative Research and Tropical Medicine (KCCR), and the National Public Health Reference Laboratory.

Impact On Remote Regions

Madam Theresa Salifu, Deputy Chief Medical Laboratory Scientist, the Wa Municipal Hospital Laboratory Manager, noted that before the Tamale Public Health Reference laboratory was set up to do testing for COVID-19 in the Northern sector, samples were being transported from the region to the NMIMR in Accra and the KCCR in Kumasi for testing.

This according to her, caused delays in the release of results for clinicians to be able to make decisions on patients.

Suspected cases that were on 21-28 days period of isolation waited for extra long days to be able to get the results of their test because the few testing facilities themselves were overwhelmed, she said.

“We use to do seven-day test, 14-day test, 21-day test, and 28-day test until patients tested negative before we discharge. This was to ensure that patients had two negative tests before they could be discharged, she explained.

She said apart from the pressure it placed on health service delivery because of the cost involved in taking care of their feeding needs, it also gave patients some psychological effect as they left their families to stay in the hospitals for close to four weeks.

Transport

The Deputy Chief Medical Laboratory Scientist noted that there were times they had samples but no transport system was willing to take it at the height of COVID-19 because of fear borne out of misconceptions about the disease.

“So at that point, the Regional Health Directorate had to dedicate a vehicle, fuel it, get a driver to transport samples from Wa to Tamale twice in a week for testing.”

“Depending on the samples they had, they were also overwhelmed – so you could send samples and for two to three weeks you have not had your results yet”, Madam Theresa noted.

Gene Expert Machines

She said a national policy was pushed by the Ghana Association of Medical Laboratory Scientists to programme the about 150 Gene Expert Machines available across the country so they could use them to test for COVID-19.

Fortunately, the government bought into the idea, which then led to the importation of the test kids for the COVID-19 that were distributed to both regional and districts hospitals.

Madam Theresa noted that based on the fact that COVID-19 was an infectious disease, they needed safety cabinets to ensure that Medical Laboratory Scientists would not expose themselves to the risk of being infected.

“All laboratory personnel were also trained on how to handle samples to avoid the risk of being infected”, she added whilst also disclosing that glove boxes were also distributed to regional and district hospitals.

Wa Municipal Testing Centre

From the beginning of 2021, the Wa Municipal COVID-19 Testing Centre was set up and this according to Madam Theresa had improved the testing drive tremendously in the region.

“The situation has improved tremendously, now for emergency cases, once we do the test here, we’re able to pick suspected cases and test immediately and within an hour the results would be ready”, she said.

“So for in-patients where clinicians need to take an immediate decision, isolation as to treatment, they could get the results within an hour”, she added.

According to her, there were tussles between families and Hospital authorities over patients who passed on and needed to be given a supervised burial and the families were agitated and did not know their status.

She said now their worry was addressed because within an hour the results of their test were ready, adding that if the patient died out of COVID-19, then a supervised burial was arranged, if not, then the body was released to the family for their own burial.

Challenges

Madam Theresa noted that even though the situation had improved it was still not without challenges, noting that initially, the testing center in the region was just one and they were still overwhelmed with lots of samples coming in from all the Municipalities and Districts.

This, she said resulted in the Deputy Director of Public Health facilitating the release of the Gene Expert Machine from Wa West District Hospital to the Wa Municipal Testing Centre which further improved testing and release of results.

Four Medical Laboratory Scientists were also sent to the region to augment the staff strength, and this enabled them to initiate 24hr testing, which helped them clear the back lock of samples that were waiting.

Meanwhile, the region now has three testing centers located at the Wa Municipal Hospital, the Regional Hospital, and the Jirapa St. Joseph Hospital, which further improved the initial nightmare in testing.

Reducing the burden

She said a national policy was developed for them to test only those who come to the hospital with symptoms which according to her, put an end to contact tracing, thereby drastically reducing the number of samples and turning around the delay in results delivery to at least two hours.

She said people who walk into testing centers to demand voluntary testing because they think they might have come into contact with an infected person must also meet the case definition before testing would be done.

People who are traveling and needed evidence of a negative test also come in to request voluntary testing and they do it for them, adding that resources were not enough for them to be able to test everybody, hence, the decision to only test those who needed to meet deadlines.

“This is to ensure the little resources were conserved for those who really are sick of the disease and needed urgent care”, she said.

Conclusion

The country’s capacity to test from the beginning was not the best and an indication of the challenges in Ghana’s health system.

But to work to increase testing centers to almost 40 across the country is worth commendable as it reduced the delays associated with releasing the results especially from remote regions like the Upper West Region.

It also reduced if not eliminated the cost involved in taking care of patients in isolation as well as the tussle between hospital authorities and families of deceased persons.

Whilst patting government at the back, I also wish to remind her that there is still more to do to shape the health delivery system and make it more responsive to pandemics such as COVID-19.

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