Ex Eastern Cape health boss raises alarm over Covid-19 testing

A proposal has been put forward to Eastern Cape premier Oscar Mabuyane to change the approach to Covid-19 testing because glaring flaws exist in the current system and tests are not picking up everyone who has the virus.

One of the biggest problems is the type of swab being used. According to Dr Siva Pillay, some swabs sent for testing should have been regarded as “unsuitable”.

The provincial government on Sunday, however, poured cold water on these claims, saying their testing methods and instruments were “credible” and similar to those used in other provinces.

Pillay is a former provincial health head of department who has returned to assist Bhisho in its fight against Covid-19.

“The swabs we are using should have been a different type of swab but there is a worldwide shortage.

“We are using a drier swab which dries up faster, so the pickup rate becomes less,” Pillay said.

“The tests are weakly sensitive. If we do a lot of tests, they are not picking up everybody who is positive [for the virus].

“A false negative can give you a false sense of security.”

SA has a backlog of thousands of results, with laboratories under immense pressure to return them as quickly as possible.

This was where the approach needed to change, Pillay said, explaining that “the infection period is only just before people get symptoms to just after the symptoms finish”.

So if one person is found to be positive and everybody around them is tested, it is a waste of test kits.

“This is testing out of paranoia. It is not based on science.”

“There is something else that is happening. Many of these tests are sent to Johannesburg but because we have no flights, they have to go by road.

“It takes up to eight or nine hours, and it’s a dry swab.

“Most of the results that have come back now should have been reported ‘specimen unsuitable for testing’.”

He said the significant turnaround time for results — sometimes up to a week — did not help.

“If I get a result in five days, that person will not have been isolating themselves while they wait for their results. So you’ve got five days where somebody is spreading the illness.”

Pillay believes tests should be reserved for those who have come into contact with patients who died or were very sick, as well as front-line workers.

“You don’t want to deplete your front-line workers because if they are negative you can return them to work faster. The strategy has been screen-triage-test-isolate-quarantine.

“Now we are saying we don’t need to depend on testing. It is screen-triage-isolation and quarantine, not necessarily testing because they must be reserved for those who need them.”

Smaller numbers of tests would mean results would be returned in a shorter space of time.

Pillay’s views appear supported by researchers Marc Mendelson of Groote Schuur Hospital’s department of medicine, and by Shabir Madhi of the University of the Witwatersrand.

Writing in the SA Medical Journal earlier in May, they said SA’s focus “needs to be on mitigation of severe illness and death rather than aspiring to containment”.

According to Pillay, mass screening could still take place but should take the form of mass “targeted” screening in hotspot areas.

“With the coronavirus, we are having a high, high panic rate, yet no-one is reporting on the fact that 70-80% of people recover.

“What is happening is that one person gets the coronavirus and you close the whole hospital. Now that is really paranoia.

“One of the things we say is that we are going to flatten the curve, we don’t say we’re going to stop the curve. You have to accept that this thing is going to spread.

“The new norm is living with Covid-19,” Pillay said. 

Some of his suggestions for a new way of living include every shopping centre screening people and putting a decontamination chamber in place.

“Tellers should be told that after every client they should clean their table and surfaces with a disposable cloth. We need to start ingraining that into people so it becomes second nature to them.”

Mabuyane’s spokesperson, Mvusiwekhaya Sicwetsha, on Sunday said the main reason for his boss to draft a team of doctors and other experts into the programme to fight Covid-19 in the province was for them to make a contribution to the work being done.  

“Ideas and proposals from the advisory team are then submitted for collective engagement and processing so that they sharpen our response strategy to the pandemic.

“The government is implementing a testing system similar to what other provinces are implementing, and we are following the guidance of the national health department.  

“The province will continue with the testing system being used to test people for Covid-19. In everything we do, we are committed to saving the lives of our people by mitigating the spread of the virus.” 

Sicwetsha refused to comment on Pillay’s proposal to Mabuyane until it was “engaged and processed by provincial government leadership”.

However he added: “We would like to assure the people of our province that the testing method and  instruments we are using are credible.”