“To each, there comes in their lifetime a special moment when they are figuratively tapped on the shoulder and offered the chance to do a very special thing, unique to them and fitted to their talents. What a tragedy if that moment finds them unprepared or unqualified for that which could have been their finest hour.” -Winston Churchill
Though we are still in the middle of a pandemic with no universal treatment or vaccine in sight, global conversations about opening up operations are happening in earnest. There is a universal acceptance that the world cannot be in lockdown indefinitely. The collateral damage to almost everything is a consequence even this virus could not have “envisaged”.
Every single strand of human endeavour is now under strain and livelihoods are at stake. At this rate, if care is not taken, the excess mortality and morbidity that this pandemic will damp on us is a toll that will take years to grapple with. Therefore, though caution must not be thrown to the wind, these conversations are in line.
With the ongoing conversations, most from world leaders through academics to civil society and the general public are eager to avoid one issue, the risk of a second wave. They are, because any such event will compound the grave situation the world finds itself in.
Thus, in parallel, there are conversations around how to minimise contagion until hopefully a vaccine is found. The key to these conversations is the knowledge that for most countries, COVID-19 was imported either through air or sea travel and in some few instances through land borders.
At the height of the pandemic, many countries have had to close their borders as part of restrictive measures whilst dealing with internal contagion spread. This situation can also not continue indefinitely as international travel underpins a huge component of the world economy. Several countries have floated the idea of a fourteen-day quarantine period for travellers, should borders be reopened.
This, though plausible, may come with huge challenges especially in the area of business travel. This is because many cannot afford to add two weeks to their schedule simply because they are due to attend a four-day meeting abroad. Also, for international tourism, the implications for such a decision will be catastrophic and could lead to the folding up of many in the hotel, beach resort and airline industry accompanied by significant job losses.
We believe a lot of these bottlenecks can be avoided if the world, especially Africa, begins to look using Rapid Diagnostic Tests (RDT). These are medical devices that rely mainly on antibodies to determine whether a person is or has been infected by a particular pathogen. They function through the qualitative or semi-quantitative evaluation of these antibodies and provide an outcome in a relatively short time. They are currently widely used in pregnancy test kits, diabetic patient monitoring and malaria diagnosis.
Though very versatile, some have had concerns about their reliability and application in the fight against this novel coronavirus. These concerns primarily relate to the sensitivity of these tests. The sensitivity of an RDT is the ability of the test to correctly identify most people who are positive for the particular disease or have previously contracted the disease( true positives).
An RDT needs to higher than an accepted level of sensitivity because if it is below such a level, one can misdiagnose someone as negative when they are actually positive. For a disease such as COVID-19, this is important so that people are not flagged as not being infected when they are. If many such cases occurred, this could lead to asymptomatic carriers walking around, and unknowingly infecting people; further complicating the situation by giving the virus an undue advantage.
Then there is the issue of specificity of these tests, that refers to the ability of any RDT to accurately determine people who have not been infected with the disease (true negatives). An RDT needs to higher than an accepted level of specificity because if it is below such a level, one can misdiagnose someone as positive when they are actually negative.
This is important, especially for COVID-19, because any such false positives could result in a person inadvertently losing their liberty due to the requirement for self or mandatory isolation and could come at the expense of significant mental and emotional stress. Simply put, in such a high stakes war we could all do without false positives and negatives.
That said, we see their use as the best opportunity for the world to open up for several reasons. The first is in the area of increasing the number of tests in many less-resourced countries, where the cost of the conventional tests that rely on Polymerase chain reaction (PCR) may be putting a drain on their economies and mitigating against their ability to slow down and contain community spread.
This is because if sensitivity and specificity were not an issue, large-scale RDT testing in hotspots could be undertaken resulting in quick outcomes. This will allow those who test positive to be put in mandatory isolation before the highly sensitive PCR tests are performed. By so doing, contagion could be slowed and any person who tested negative after the PCR test could be let back into the community.
There could also be a requirement for all air travellers to undertake a COVID-19 RDT, say 24 hours, before travel and at the port of entry at their destination. This will serve as a double lock check where if the passenger tested positive before travel they could be prevented from undertaking the journey or if they tested positive at their destination could be put into mandatory quarantine and treated. With this, nations could do away with the mass quarantine of travellers and perhaps move up the reopening of the world economy.
Finally, these tests could aid in national surveys aimed at determining the proportion of the population that has already been exposed to COVID-19 as a means of predicting how these states are progressing towards herd immunity. This can also assist the prioritisation of those in the general population who need to be immunised, should a vaccine be found. Such data could also be useful in determining the extent to which restrictions could be relaxed or ramped up as the war against this pathogen progresses.
Already, Public Health England has licensed an antibody test manufactured by Roche that they have assessed as being “highly specific” and with an accuracy of 100%. This has been hailed as a game-changer in the UK COVID-19 fight and is due to be rolled out across the country. In Ghana, a collaboration between the Kwame Nkrumah University of Science and Technology (KNUST) and Incas Diagnostics has also produced a COVID-19 IgM/IgG test that is currently undergoing assessment by Ghana’s Food and Drugs Authority. We hope that these assessments give it the green light.
It is our view that at this point the world has tapped on the shoulders of the likes of Laud Anthony Basing to show the way and help us all get out of this gridlock. Though the world has demonstrated how tragically unprepared we have been in dealing with this virus, we hope that those working and researching in the RDT space will just as Churchill did, feel the collective tapping of the global citizen on their shoulders and stand to be counted.