Abstract
Early in the course of the coronavirus infection disease 2019 (COVID-19) pandemic in South Africa, the Department of Health implemented a policy of community screening and testing (CST). This was based on a community-orientated primary care approach and was a key strategy in limiting the spread of the pandemic, but it struggled with long turnaround times (TATs) for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction test. The local experience at Symphony Way Community Day Centre (Delft, Cape Town), highlighted these challenges. The first positive tests had a median TAT of 4.5 days, peaking at 29 days in mid-May 2020. Issues that contributed to long TATs were unavailability of viral transport medium, sample delivery and storage difficulties, staffing problems, scarcity of testing supplies and other samples prioritised over CST samples. At Symphony Way, many patients who tested COVID-19 positive had abandoned their self-isolation because of the delay in results. Employers were unhappy with prolonged sick leave whilst waiting for results and patients were concerned about not getting paid or job loss. The CST policy relies on a rapid TAT to be successful. Once the TAT is delayed, the process of contacting patients, and tracing and quarantining contacts becomes ineffective. With hindsight, other countries’ difficulties in upscaling testing should have served as warning. Community screening and testing was scaled back from 18 May 2020, and testing policy was changed to only include high-risk patients from 29 May 2020. The delayed TATs meant that the CST policy had no beneficial impact at local level.
Highlights
In South Africa, the National Department of Health’s response to the growing coronavirus infection disease 2019 (COVID-19) was to introduce a policy of community screening and testing (CST)
Community screening and testing in Cape Town initially focused on screening in hotspot areas that were identified by the location of known cases and person under investigation (PUI) in areas with high socio-economic vulnerability.[2]
This approach built on a foundation of community orientated primary care (COPC) as it relied on the existing network of community health workers and professional nurses in the community employed by non-profit organisations and their linkages to local primary care facilities as well as various community stakeholders, such as the police
Summary
A new policy was introduced, which meant that only those older than 55 years or with comorbidity were investigated in public sector primary care.[9] This change in testing strategy was dictated by the circumstances surrounding prolonged TATs rather than the goals of CST. It has effectively moved the approach of the Cape Town Metro from preventing local transmission to case finding in high-risk people
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