CCPSL recommends using WHO “Test, Test, Test” strategy to control COVID-19

CCPSL puts forward 12 proposals for strategic planning to address current COVID-19 epidemic situation

Says evidence from South Korea, Singapore show WHO strategy of aggressive testing helps flatten curve

One main objective of COVID-19 testing is to find and isolate asymptomatic carriers before they spread the infection unwittingly

Suggests Govt. revise testing criteria, expanding to cover more suspected cases and contacts, with clear prioritisation strategy by technical experts

 The College of Community Physicians of Sri Lanka (CCPSL) has put forward 12 proposals for strategic planning to address the current situation of the COVID-19 epidemic in the country, including employing the World Health Organization (WHO) strategy of “Test, Test, Test”, and said evidence from South Korea and Singapore suggests that flattening of the epidemic curve is achievable with an aggressive testing strategy.

“WHO advocates if countries detect, test, treat, isolate, trace, and mobilise their people in the response, those with a handful of COVID-19 cases can prevent those cases becoming clusters, and those clusters becoming community transmission. One of the main objectives of COVID-19 testing is to find and isolate asymptomatic carriers, before they spread the infection unwittingly,” CCPSL said in a news release yesterday.

In the Sri Lankan context, the CCPSL said the increased detection of cases and carriers reduces the need for more stringent government measures, like curfew and movement restrictions. “During the initial response, Sri Lanka adopted fairly strict criteria on who should be tested for COVID-19. As the epidemic evolves, this slow rollout of testing and limited testing capacity may blunt the response to the epidemic,” the CCPSL said.

The organisation observed that reasons for not carrying out more testing would be due to multiple logistics problems, with reverse-transcription polymerase chain reaction (RT-PCR) testing done only at seven centres currently. “These are the Medical Research Institute (MRI), Kandy Teaching Hospital, Anuradhapura Teaching Hospital, Karapitiya Teaching Hospital, Ragama Teaching Hospital, Infectious Disease Hospital, and Sri Jayewardenepura University, while there are many laboratories all over the country which have GeneXpert machines which could perform the testing, provided the FDA-approved kits are available for this purpose,” CCPSL said.

The College of Community Physicians gave several suggestions in this regard to expand testing across the country. These are:

Revise the testing criteria, expanding to cover more suspected cases and contacts with clear prioritisation strategy by a technical team

Employ volunteering medical laboratory technicians (MLTs) in other government laboratories and scientists with real-time PCR experience at laboratories with unutilised GeneXpert machines

Establish a larger central laboratory (at MRI) with some of the unutilised GeneXpert machines and employ volunteering MLT/Scientists

Adopt pooling of samples for PCR, which can exponentially increase the testing capacity

Explore the rationale and feasibility of rapid Ag or Ab based serological testing

CCPSL added that in keeping with the high testing rates expected, following the recently revised screening criteria, a prioritising mechanism should be worked out for the target groups being tested. “Further, other options should be considered to prevent hospitals getting overloaded with test positives. Self-isolation/separate centres should be considered for asymptomatic or mild cases,” CCPSL said.

The other proposals of CCPSL are streamlining the national and sub-national coordination of the epidemic response by effective coordination at both ground and national levels . “There will be multiple challenges when different specialties and various non-health sectors are involved in the process. We see several issues, both at national and sub-national levels, when implementing the prescribed protocols. It is apparent that some of the higher-level stakeholders are not fully involved in this process, and multiple instances of non-compliance with guidelines at ground level have occurred. An immediate revisit is needed to sustain the effective coordination from top to bottom, between the curative and public health sectors, as well as between relevant divisions within each sector,” the CCPSL said.

The other proposals deal with: scientific prediction of the epidemic; scenario-based approach; clear guidance on wearing masks; self-quarantine vs quarantine at centres; care for the COVID-19 patients; care for the non-COVID-19 patients, as it is equally important for the country to prevent both direct and indirect mortality from the outbreak; exit strategy of the modified “lockdown”; managing disease stigma; updating the general public; and learning from the success/failure of other countries.