The Perils of Not Knowing Our Epidemic: Could Reducing Testing Be Counterproductive?

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Think: given the extent to which the COVID-19 pandemic has impacted our lives over the past two years, who will be at risk of being caught in Ostrich Syndrome? But this is what is happening: the drop in COVID-19 testing in several countries is very alarming, as well as a fragmented genome sequencing capacity that limits and seriously compromises the ability of health agencies to respond with measures of effective and timely disease control.

March 11, 2020 and January 30, 2020

Before talking about COVID-19, let’s recognize the importance of March 11, 2022: two years ago, on March 11, 2020, the United Nations health agency (World Health Organization – WHO), declared COVID- 19 a pandemic. Almost six weeks before this important declaration, on January 30, 2020, the WHO had declared COVID-19 a public health emergency of international concern. At the time, as of January 20, 2020, 282 confirmed cases (only 4 of them were outside of China) had been reported and no deaths had occurred globally outside of China. However, by the end of January 2020, 9,826 cases had been confirmed worldwide, and only 106 of them were outside of China, which had also recorded 213 deaths. Today, in the space of more than two years of torture, more than six million people have died worldwide from COVID-19 and more than 450 million have suffered from the disease – and we all know that are under-reported numbers.

Ignorance is not bliss: knowing about our pandemic is vital

Although reported cases and deaths are declining around the world and several countries have lifted restrictions, the pandemic is far from over – it won’t be over anywhere until it’s over everywhere. Many countries in Asia and the Pacific are facing increases in cases and deaths.

“The virus continues to evolve and we continue to face major obstacles in getting vaccines, tests and treatments to where they are needed. WHO is concerned that several countries are drastically reducing testing. This inhibits our ability to see where the virus is, how it is spreading and how it is progressing. Testing remains an essential tool in our fight against the pandemic, as part of an overall strategy,” said Dr Tedros Adhanom Ghebreyesus , Director General of the WHO.

If we are not testing for the corona virus and if we are not using other disease surveillance systems, such as genome sequencing, how will public health programs respond quickly and effectively to curb any increase or potential spread? When new variants of the corona virus had emerged in the past, it was only the strength of disease surveillance systems (or lack thereof) that defined how good or bad the response to the pandemic was. This is why making COVID-19 testing available to everyone is so vital. And the self-test can no longer be skipped.

WHO releases new guidelines on self-testing

The WHO has issued new guidance on self-testing for COVID-19, recommending that self-testing be offered in addition to professionally administered testing services. This recommendation is based on evidence that shows people can self-test reliably and accurately, and that self-testing can reduce inequities in access to testing.

“How countries use self-testing will need to be adapted based on national priorities, local epidemiology and resource availability, with input from the community. We hope our new guidelines will also help increase access to testing, which is too expensive for many low-income countries, where these tools could play an important role in scaling up testing. WHO and its COVID-19 Tools Access Accelerator partners 19 (ACT) are urgently seeking additional funding to ensure that all countries that need self-tests can receive them as soon as possible,” added Dr Tedros.

In preparation for these self-testing guidelines, WHO contacted manufacturers to encourage them to apply for pre-qualification of self-tests by WHO. To date, the WHO has granted the emergency use list to five rapid antigen tests for professional use.

It is important to mention that towards the end of January 2022, more than a hundred organizations and global experts had published an open letter asking the WHO to authorize and recommend the use of COVID-19 rapid antigen tests. 19 for self-testing in low- and middle-income countries. People should be able to know their COVID-19 status in a simple, cheap and non-discriminatory way. Such information will help them take quick action to break the chain of infection transmission, and a quick link to the healthcare pathway will be another important outcome, the open letter argued.

About 11 billion doses of COVID-19 vaccine have been administered globally in a world of more than 7 billion people. But more than 3 billion people have yet to receive even their first dose. Vaccine inequality has cost unnecessary human suffering and premature death. Now, inequality in access to self-testing is a looming danger that we cannot and must not address if we are to fulfill the great promise of health for all where “no one is left behind”.

85% of the world’s population lives in low- and middle-income countries. Yet only 40% of COVID-19 tests have been carried out in these places. The average daily per capita testing rate reported in high-income countries is almost 10 times higher than in middle-income countries and almost 100 times higher than in low-income countries.

In Africa alone, 85% of COVID-19 infections go undetected according to the WHO. This unequal access to diagnostic tools that trigger vital individual and public health measures is part of the same “medical apartheid” that has plagued the rollout of COVID-19 vaccines.

Self-testing is a necessary tool to enable rapid linkage to care and initiation of outpatient treatment to prevent hospitalization and death, especially in people at high risk of disease progression.

Self-testing has the ability to dramatically increase the number of people who know they have contracted COVID-19 and are likely to be contagious to others. Access to self-testing promises significant benefits, especially in resource-constrained and geographically remote settings that lack sufficient RT-PCR testing capacity. Even in areas with expertise in RT-PCR testing, self-testing can increase uptake among marginalized populations who are less able and/or likely to engage with the health system due to stigma, discrimination or financial inaccessibility.

More than a hundred signatory organizations of this open letter, including: Amnesty International, AVAC, CNS (Citizen News Service), Drugs for Neglected Diseases initiative, Global Network of People Living with HIV, Global Network of Sex Work Projects, Health Global Access Project (Health GAP), Health Justice Initiative South Africa, International Community of Women Living with HIV/AIDS (ICW) Latina, International Treatment Preparedness Coalition, Oxfam, Partners in Health (PIH), Third World Network, Treatment Action Group, Treatment Advocacy and Literacy Campaign Zambia, among others.

Shobha Shukla, Bobby Ramakant – CNS (Citizen News Service)

– Shared under Creative Commons (CC)

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