Delay in test results causing avoidable deaths, say medics

A backlog and delays in testing for Covid-19 is rendering the ‘test, trace and isolate’ guiding principle an exercise in futility.

This revelation comes amid confirmation that some people had died while waiting for tests.

With a backlog, it is unclear what the Ministry of Health refers to when they announce “in the last 24 hours” results because medics say Covid-19 results of their patients take up to 14 days.

In a recent incident in Nairobi, a patient whose sample was obtained after displaying key symptoms died at home while still waiting for the results, which came back positive seven days too late.

He died at home on Day 5 of calling the Nairobi Metropolitan Services.

Only on the seventh day did his results, and that of many others waiting to know their Covid-19 status arrive, some missing vital data such as telephone contacts to enable contact tracing.

“I am in Kiambu and we take our samples to KEMRI and the turnaround time is usually one to two weeks,” said a doctor who did not want to be named because they are not authorised to speak to the media.

This delay in results, they say, is causing conflict with relatives more so of deceased patients who are incurring mortuary bills as they wait.

This is in addition to late isolation of the confirmed positive cases though the medics advise them to isolate even as they await results.

The same story is repeated across different counties where some health workers exposed to the virus waited for nine days before knowing their Covid-19 status.

This delay in getting results to inform clinical care and treatment of patients costs lives, either directly from unattended to Covid-19 complications or non-Covid-19 conditions. In Murang’a, a young man collapsed and died after his samples had been taken for testing. After a week, the results came back negative but it was too late to do anything.

“Most counties do not have their own labs for testing and they have to rely on the national labs,” Dr Elizabeth Gitau, CEO Kenya Medical Association, said. 

The GeneXpert machines used in testing for TB are yet to be used due to lack of essential components to make them test for Covid-19. This has been explained to be as a result of the manufacturer’s inability to meet global demand occasioned by the pandemic.

While medics need to know results of such tests to come up with best care for patient, a delay in such urgent results only make it impossible to do this, risking lives of not only the patient but that of healthcare workers attending to them.

Kenya had embarked on targeted testing as opposed to mass testing to prioritise and test high risk groups such as healthcare workers and truck drivers.

But with the current situation where results delay for up to two weeks and proper contact tracing is not done, the medics are wondering whether it is time to change the targeted testing to prioritise patients presenting in hospitals first so as to avoid people dying of other things not related to Covid-19 while awaiting results.

“We recommend rapid review of results where best practice is 24–48 hours as opposed to now where it is five to 10 days,” Gitau said.

In addition, KMA recommends the results be fast tracked by increasing capacity of county laboratories to do the tests.

In its daily Covid-19 Situation Reports, the MoH acknowledges the long turn around for relaying laboratory results as a key challenge that delays public health action. The ministry plans to “strengthen Covid-19 diagnostic quality assurance.”

In further plans to streamline testing, the government plans to match the samples collected and the lab capacity at any given time, by drawing up a sampling schedule that allows collection of samples to be spread over a number of days thus avoiding backlog.

“This is with a view to improve data quality because all samples will be “fresh” by the time of analysis.”

The medics also recommend that the rapid response teams should keep track of samples and obtain the results directly from the labs as opposed to waiting for these same results to be submitted to the national data centre prior to being released to their clients through them.