Rising above the challenges


PETALING JAYA: With Covid-19 infections on the uptick again, the focus is back on the number of tests being carried out in the country.

Based on Health Ministry statistics, Malaysia conducted an average of 44,253 RT-PCR and RTK-Ag tests a day from March 4 to April 16.

The RTK-Ag tests, however, do not include those conducted by the Social Security Organisation (Socso).

These two tests – reverse transcription polymerase chain reaction (RT-PCR) and antigen rapid test kit (RTK-Ag) – are the two known popular Covid-19 tests available and used by health authorities worldwide to detect the virus.

In RT-PCR testing data released by the ministry, it was revealed that the maximum testing capacity for such tests is at 80,755 with an estimated 35,061 tests conducted on April 16.

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It also showed that testing was underutilized at university labs (0.3%) and private labs (24%), but was at overcapacity in public hospital labs (112%) and at the national public health laboratory (109%).

Tan Sri Dr Jemilah Mahmood, the Prime Minister’s Special Adviser on Public Health, said essentially testing had two approaches: one targeted at the outbreak and clusters, and the other was wider surveillance.

For the former, the country was testing enough based on the recommendations by the World Health Organisation (WHO), which said that the positivity rate needs to be less than 5% and testing must be between 10 and 30 times the number of cases reported.

“So, if we stick to the international criteria,

we are testing enough. Can we increase testing? Of course.

“Are we able to contact trace everyone? This is always a challenge and can be quickly overwhelmed when numbers rise, ” Dr Jemilah said when contacted yesterday.

Despite this, she pointed out that more tests should be done widely for increased surveillance to be conducted beyond regular close contacts testing.

“We need to step up on surveillance which means you just go out and test widely. This is good public health practice for pandemics. In some countries, citizens even do home testing.

“Testing should be expanded so that we find, test, trace, isolate and support, ” she said.

The country’s cumulative positive rate stands at 4.37% as at Saturday.

Health experts appeared lukewarm over the testing data revealed by the ministry.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud called for more detailed testing data to be released.

“For example, the private sector tests are being done on whom? Workplaces, clusters or voluntary screening?

“What is the positivity rate like for both RT-PCR and RTK-Ag tests? Were there double tests done like both RT-PCR and RTK-Ag for the same patient?

“Do the dates for samples correspond to the date of results?” he asked.

Independent health policies specialist Dr Khor Swee Kheng said that it was impossible to draw meaningful conclusions from what he felt was incomplete and inadequate data.

“The calls for more transparency are not new, and have been consistently and repeatedly voiced by academics, health experts, the media, think tanks and citizens for more than one year, ” he said.

Dr Khor wanted to know why there was “gross under-utilisation” of the overall testing capacity in Malaysia and why testing remains so dependent on the ministry despite the talk about public-private partnership and partnership with public university labs.

He said this in reference to the data on the testing capacity in the ministry’s related facilities, compared to the university labs as well as private sector labs.

“There is another datapoint that should be more readily available, the genomic surveillance of new variants. The ministry must provide this data publicly, instead of continuing to be paternalistic about the data, ” he said.

Universiti Malaya virologist Prof Dr Sazaly Abu Bakar believed that the low testing rates in the university labs was due to the lack of funding.

He noted that it was also difficult to tell if sufficient testing was being done in the country as not much was known on who and when the ministry decides to test.

“As such, it is likely that the daily cases being reported is merely a reflection of the testing limit. It is a possibility that if more tests are done, perhaps more cases will be detected, ” he said.

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