What can Thailand do to achieve more extensive virus testing?

By hitapnews

In this current situation where the spread of COVID-19 does not seem to cease easily, the most worrying issue is undetected infections which are complicating the epidemic. Various countries realise how crucial the issue is, so they dedicatedly conducted as many tests as possible. South Korea can be an example of a country with deliberate and extensive testing for the virus that has been reported to test ten thousand patients per day. According to the World Health Organization (WHO), it is also advised to constantly “test, test, test.” 

Since the outbreak in Thailand began, around twenty to forty thousand suspected patients had been tested for COVID-19 infections. The latest evidence on 4 April revealed that the testing has been done up to 805 times, but its frequency is much lower than that of other countries. 

What are the reasons behind this low testing rate? How effective is the current testing capacity of Thailand? How can Thailand conduct more extensive testing for the virus?

Is low testing rate a result of low testing capacity?

At the beginning of the outbreak in Thailand, many people alertly sought a test to know if they were infected. Reagent used for testing was so limited some hospitals had to temporarily stop testing because they ran off of the solution. However, Thailand, now, has come so far from the shortage since the Department of Medical Sciences lately reported that there are 76 testing labs with a Real-time polymerase chain reaction (PCR) test method, and will be 31 more labs to be run in the next two weeks in order to enhance the testing capacity to be 20,000 daily tests (10,000 tests in Bangkok and 10,000 tests in other provinces). A certain amount of the reagent has been adequately reserved for up to 100,000 uses, and there is a plan to purchase more reagent for doing up to one million tests in the next four months.

Would everyone be tested if labs were up and run?

It is true that the more screenings are done, the better control of the COVID-19 spread will be, but a large number of tests means more burden for medical providers, namely doctors and nurses, working at the forefront in collecting specimens by nose and throat swabs from potential infected. It is undoubtedly risky for healthcare workers who are unavoidably in close contact with patients while there is a shortage of necessary personal protective equipment (PPE). 

The answer to the above question is to consider the whole health system, not just the sheer availability of labs. Effective and safe specimen collection should be taken into account not only for the safety of the tested but also for those who conduct the tests. Moreover, testing everyone who has wanted to be tested might delay the screening of patients at higher risk for COVID-19 infections. Testing everyone might not be the solution, but selective screening should be conducted in a proper manner to make it the most worthwhile, effectual way.

Are there any other screening methods?

Thailand might consider outdoor testing sites such as a drive-through screening in South Korea which can be quickly done and lower the risk of infections both for those tested and specimen collectors. This advantage from the drive-through screening enables a great amount of tests per day. Another screening option might be a self-collection of nose and throat swabs conducted by patients, but there is currently inadequate supporting evidence for this method. 

Apart from the Real-time PCR screening for COVID-19 infections, which is the standard methods, other testing methods have not been evidently proved how they can be put in practice. For example, the use of immune screening or IgG/IgM testing remains unclear how likely it will provide false positive results for healthy individuals and how long after the infection the virus can be detected. In addition, sensitivity and specificity of the screening among healthy people and asymptomatic patients who might be actually infected are still unprecedented because the information on sensitivity and specificity of the screening only come from the infected patients with obvious symptoms. 

In conclusion, Thailand should continue conducting the Real-time PCR as the main screening but may expedite the testing progress including the laboratory turnaround time for a test report.

If the testing for COVID-19 cases in Thailand is more extensive, there are more chances of separating the infected patients from healthy citizens and breaking the cycle of infections. However, people with higher risk for infections should be prioritised in getting screening in order to make the most of the health resources.

source: COVID-19 screening guidelines by situation and academic processing team, MoPH 8th April 2020