govt rationing covid-19 tests

At a time the country continues to register positive cases and deaths due to the coronavirus, government has started rationing testing for the pandemic, limiting it to only those that are showing symptoms.

This, health experts say, partly explains why the country is registering low numbers of cases, further spelling doom for the country as it ponders on reopening of schools in September.

Data shows that Malawi has only conducted 40 640 Covid-19 tests in 45 testing sites.

The country received 20 800 test kits from Chinese Mogul Jack Ma in May, before procuring 38 000 more kits in July, which Secretary for Health Charles Mwansambo said would last for five weeks. This means the country is still supposed to have about 18 000 test kits.

The decision to ration Covid-19 tests, according to co-chairperson of the Presidential Taskforce on Covid-19 Dr John Phuka, is due to inadequate test kits, and Capital Hill is not even clear on when others kits will arrive.

In a daily update on the pandemic on Wednesday, Phuka said government had rationalised use of test kits as they are in short supply.

He said: “We are currently testing only those that are showing symptoms. For asymptomatic patients there is no need for re-testing to discharge someone for as long as one remains asymptomatic for 10 days from the day of diagnosis.

“Some people are demanding to be tested for discharge even if they were asymptomatic at personal level or on demand from workplaces—this is wasting our limited resources.”

He urged people to be guided by protocol and that they should not be moving from one testing centre to another when they are not satisfied with the test results.

Even in an update on Wednesday, the Ministry of Health was not clear on when exactly more kits would arrive in the country, stating: “30 000 Abbott kits procured, with support from Global Fund will be arriving in the country by August/September.”

Situation critical

In an interview, Society for Medical Doctors president Victor Mithi said the situation is a cause for concern, for not only health care workers, but also the nation at large.

He said it calls for serious preparations among all sectors involved.

“We should be worried, but that worry has to be balanced with reality. At the moment we can’t continue with the status quo of shutting down everything. We need to open up some of them. However everyone should have that high sense of understanding on what is going on,” he said.

Malawi Health Equity Network (Mhen) executive director George Jobe said the revelations from government mean that authorities have been under-reporting Covid-19 cases, as not many people are being tested.

He said: “Much as we appreciate that we have run short of test kits, we should not set this as a practice. We should not be comfortable.”

“As a nation, we must budget for test kits because we have been receiving support from different stakeholders and we are at the mercy of those donors. For us to be prepared, we must plan and have a budget for the kits.”

On his part, health rights activist Maziko Matemba said acknowledging shortage of test kits which is the basic important tool to help in identifying Covid-19 cases punches holes on the decision to reopen schools.

“Covid-19 has caused serious disruption of critical social services like education and reopening schools needs serious consideration by government due to limited availability of test kits.

“If the country is acknowledging lack of test kits which is an important tool to help in identifying Covid-19 cases and then on the other side critical institutions with high volume of people like schools are opening, are we not encouraging the spread?” he wondered.

Physicians Assistants Association of Malawi (Paum) president Solomon Chomba urged people to understand that Covid-19 tests play a confirmatory role while signs and symptoms play a suspect role in the pandemic’s diagnosis.

“Recent study findings report that Covid-19 transmission rate is higher in symptomatic patients and very rare in asymptomatic patients. This then justifies the call to rationalise test kits to only those with symptoms.

“However, the problem may arise from some patients who are unable to physically depict and distinguish Covid-19 symptoms from other diseases with similar clinical presentation.

He said this has its own consequences of either furthering local transmission by the patient with such symptoms as well bringing stigma and discrimination to the same patient by colleagues and the community.

What now?

Mithi has urged government to prepare for the worst ahead of school reopening, but must ensure that the kits are available as soon as possible.

“Once we open schools we expect that the cases will start going higher and at the same time, hospitals also need to be prepared because of the impending rising cases.

“This calls for critical thinking. We have to do this strategically with focus on the end goal which is to put the community safe and continue with life as usual.”

For Jobe, closure of airports is exacerbating the problem, as it is more expensive to charter a plane to fly in the kits, arguing that during normal periods when the airports are open, the apparatus would be charged as weight.

“In various committees, we have heard that those who support us are waiting for other supplies like for Malaria and Tuberculosis (TB) so that they come together in a chartered plane, because it is expensive just to have test kits for Covid-19.”

Epidemiologist Titus Divala said with community transmission, testing is scaled back to a medical benefit approach except if testing capacity is large enough for the population and there is good adherence to physical distancing.

“One way of understanding the approach, is via the question: of what benefit is identifying the disease in all including asymptomatic or mildly symptomatic people who will get better without needing intervention?

“So you only test those who need the test for their/other people’s medical benefit. These include people with severe symptoms, frontline workers, and the institutionalised. This does not mean you stop public health measures in the rest of the population.”

Meanwhile, spokesperson in the Ministry of Health, Joshua Malango has said the situation should not be cause for concern as the country still has many test kits.

He said: “We still have kits that can sustain us for sometime, but we cannot test everybody because they won’t be enough.

“Last week, we had about 28 000 kits, and I don’t think that we have a deficit which should be a worry.

Malango assured that government has plans to purchase more test kits, however, internationally, the demand is so high while supply is low.

“But government is procuring the kits along with other organisations,” he said. As of Wednesday, Malawi had recorded 5 240 cases including 164 deaths.