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No blanket testing for COVID-19

The Nassau Guardian April 1, 2020

The government will not carry out mass testing for potential COVID-19 cases, Minister of Health Dr. Duane Sands told The Nassau Guardian yesterday, because of the “implications” it would have.

“We have not taken a position that we’re going to do blanket testing of any segment of the population, although it is something that may be considered,” Sands said.

“But that has implications and methodological challenges, as well as ethical challenges.”

He added, “In order to do mass testing, you have to have rapid tests.

“The rapid tests that we have are not molecular tests; they are antibody tests. So unless and until we get multiple molecular tests to do rapid molecular testing, then we would have to restrict antibody testing to a particular assessment of population epidemiology.

“So, without getting into the specifics, the gold standard around the world remains RT (real-time) PCR.”

Chief Medical Officer Dr. Pearl McMillan on Sunday said there were more than 1,700 real-time PCR test kits in The Bahamas.

Sands said yesterday, while appearing as a guest on Guardian Radio, that The Bahamas has made a request for rapid molecular tests.

But he indicated that they are a hot commodity worldwide.

Deputy Chief Medical Officer Dr. Delon Brennen added that another shipment of kits was expected in yesterday.

However, up to press time, Brennen was unsure of the exact number of kits based on how many new ones came in.

He said the concern is not whether there are sufficient tests as much as ensuring there are sufficient swabs to perform the tests.

“I think our issue isn’t just tests themselves,” Brennen said.

“I think when it comes to tests, we’re not worried about running out.

“It’s really testing supplies, like the appropriate swabs because it’s a very specialized swab that needs to be done; and so that’s more of our issue at present, that we are currently sourcing the appropriate swabs to be able to do the testing.

“So, we have testing kits for real-time PCR to be able to do so. We’re just trying to source additional swabs so that we don’t run out of the ability to actually do the sampling rather than the actual running the test through the machine.”

‘Increased volume of testing’

According to Brennen, 228 people have been tested thus far.

There are 15 confirmed cases of COVID-19 in the country – 12 on New Providence and three on Grand Bahama.

The cases include some individuals with no “relevant” history of travel.

The latest confirmed case is a 57-year-old woman with no history of travel and no known direct link to previous cases, health officials said yesterday.

She was hospitalized in stable condition.

Brennen said the Ministry of Health is testing based on whether someone who was in contact with a confirmed case is having symptoms or not.

“Essentially, because we know we have community transmission that’s currently occurring in country, what we are doing is sort of a three-pronged approach,” Brennen said.

“So, number one – if someone is a known contact of a case of COVID-19, then they are first told to self-quarantine if they have no symptoms.

“If they have symptoms, then they would be referred for testing.”

He added, “Usually, once they develop symptoms that are consistent with COVID-19 then they would be tested at that point.”

Brennen said the patient remains in self-isolation at home during this period, as well as while waiting for test results which he said can take up to 72 hours because of the “increased volume of testing that we’ve been doing”.

However, he told The Guardian that the Ministry of Health’s Surveillance Unit is usually already in touch with those who have been in contact with someone who tested positive for COVID-19 and would arrange a test with them without that person having to call the Bahamas COVID-19 hotline.

“[I]f they do decide to call the hotline, then they would be referred to the surveillance unit,” Brennen said.

“The surveillance unit would then get in contact with them, find out what’s different between their original no symptoms or mild symptoms and now, and if it seems like it’s consistent like what they’re saying they’re having is consistent with symptoms that are known to be due to COVID-19, then we will arrange going out and doing the testing.”

Brennen noted this testing is usually done by the unit going out to the patient as opposed to letting the patient go into an office to prevent possible spread of the highly contagious virus.

Testing of healthcare providers

According to Brennen, mass testing of healthcare providers is also not being carried out.

Instead, he said, they might be tested 14 days after being exposed to a positive COVID-19 case depending on individual assessments.

“For medical providers, it’s a little bit different,” Brennen told The Guardian.

“So if you are a sort of layman, not related to medical care and you go your whole 14 days after your contact and you don’t develop symptoms then there’s no testing that happens at that point. It’s only if you are symptomatic.

“However, if you are a healthcare provider, then at the end of your 14 days a general assessment is made using an objective tool from the World Health Organization (WHO); and then the decision is made as to whether you are a high risk or a low risk.

“If you are high-risk, meaning that either your exposure was high-risk or your movements going forward are going to involve like direct patient care especially with people who are at high-risk for developing disease, then you are likely to be tested.

“However, if you’re in a healthcare environment but your risk was minimal and you’re not likely to be delivering care to high-risk patients, then you may just be continued on monitoring, but you’re able to enter back into the system without necessarily having to be tested because your risk is minimal.”

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