Worldwide Shortage Of COVID-19 Test Agents Plagues Health Systems – Even As Infections Surpass 200,000
Public health laboratory in Pennsylvania, USA extracts COVID-19 samples for testing

A worldwide shortage of chemical reagents needed for COVID-19 testing has emerged, World Health Organization officials admitted on Wednesday – even as the number of confirmed cases of the novel coronavirus worldwide surpassed the 200,000 mark.

Reports of shortages come days after WHO’s Director General Dr Tedros Adhanom Ghebreyesus issued an urgent appeal to countries worldwide to accelerate diagnostic testing in order to get the pandemic under control.

“There have been shortages of ancillary materials used in PCR (Polymerase Chain Reaction) reactions, which is the most common way to diagnose coronavirus,” said Mark Perkins, WHO lead for laboratory networks for infectious disease management, speaking at Wednesday’s press briefing.

Some important chemistries [reagents] you cannot find anywhere other than diagnostic manufacturers. And a lot of the diagnostic manufacturing has been done in China; with the outbreak in China, it decimated the workforce – and that has made them difficult to procure.”  

To make up for the gap, some 200 PCR tests have also been created and are being manufactured locally by different national, regional and local laboratories or private firms, he noted. “The vast number of diagnostic companies are scaling up their own capacity to produce reagents, so I think we are getting over that hump.”

However, having a “plethora” of choices is also creating new issues, he admitted.  “Sorting out which ones work and meet which needs is the next step.”

Additionally, tests on their own are not a panacea, stressed Maria Van Kerkhove, WHO’s Health Emergencies technical lead. What is required is a multi-pronged approach: increasing the number of tests; the number of labs that can run the tests; and the number of qualified technicians.

Testing alone is not enough either, stressed Mike Ryan, WHO Emergencies Head. To slow or interrupt transmission, not only do people found to be positive for the virus need to be isolated, but their close contacts as well: “The difficult part is contact tracing – countries need to mobilize a large public health mechanism needed behind to identify and isolate contacts of cases.”

Aggressive Testing Helps Reduce Germany’s Death Rates 

Even so, Germany’s aggressive early testing strategy may help explain why the country has so far managed to to keep disease death rates low, added Ryan. “They have had a very aggressive testing programme, and so far confirmed over 6000 cases with just 13 deaths.” The testing dragnet captures milder cases and also allows people to get treatment faster, reducing the overload on health systems. 

In contrast, Italy has experienced an 11% death rate from the virus.  However no one factor alone can explain the variations, the WHO officials stressed. Italy’s high death rate is likely also due to the older average age of its population; the fact that the epidemic cycle is more advanced; as well as the fact that health systems were caught by surprised and overwhelmed at the outset of the epidemic, also reducing the ability to treat serious cases.

“We see a pattern of long hospital admission,” Ryan observed.  “Italy, having experiencing the first wave, and a number of people reach a point when they can no longer be saved in the clinical system. We have to look at where each country is in the epidemic cycle.”

“We also have to look at demographics Italy has a much older profile. Italy has been a panacea for healthy people living to old age, but unfortunately in this case, the fatality rate may appear higher because of age distribution. 

“And there may be technical reasons as well in ability to provide care,” he added, noting that the country has seen over 1200 COVD-19 patients in intensive care simultaneously. “Anyone who has worked in the front lines of emergency, knows that when numbers begin to overwhelm, standards of care cannot be maintained.” 

At the same time, Van Kerkhove emphasized that it remains difficult to define and compare mortality rates, since in some countries many milder cases may be flying under the radar.

Also, the notion that the disease mainly affects older people, can be misleading, she added.

“Almost 20% of their [Republic of Korea] deaths have occurred in people under the age of 60,” Van Kerkhove said. “The idea that this kills only elderly is dangerous. This isn’t just a disease of the elderly – young people may have higher rates of mild disease. Otherwise healthy adults can develop a serious form of the disease.

“We haven’t seen how it will behave in vulnerable populations, HIV-positive and malnourished children, and that’s what we need to prepare for.”

Active cases of COVID-19 (middle) around the world as of 6:53 PM CET 18 March, Numbers change rapidly.

Europe Hits 80,000 Cases – Equal To China’s Cumulative Total  

Europe, now has over 80,000 confirmed cases and close to 3,500 deaths, Johns Hopkins University – making it the full-fledged epidemic epicentre.  In comparison, China has had over 81,000 confirmed cases but only 8,183 still remain active

Italy continued to be the hardest country hit, with a cumulative total of 31,506 confirmed infections and 2503 deaths, followed by Spain with 13,910 cases and 623 deaths; France with 7661 cases and 148 deaths; and Germany with 10,082 cases and only 27 deaths. Switzerland has reported 2772 cases while the UK has reported 1966 cases and 72 deaths. 

In a bid to contain transmission, the European Union (EU) has banned travellers from outside the bloc for 30 days – these measures also apply to Iceland, Liechtenstein, Norway and Switzerland, however travelers from the UK are unaffected. The travel ban will affect all non-EU nationals from visiting the bloc, except long-term residents, family members of EU nationals and diplomats, cross-border and healthcare workers, and people transporting goods. 

In Spain authorities were maintaining a partial lockdown on 47 million people, while in France people must carry a document detailing the reasons for leaving home, and face a €135 fine for non-essential travel. In the UK, in contrast, only voluntary measures are being used; the public has been told to avoid social contact, work from home and avoid all non-essential foreign travel. Germany has banned religious services and asked the public to cancel all domestic and international travel.

The Swiss government on Monday declared an “extraordinary situation” over the coronavirus, instituting a ban on all private and public events and closing restaurants and bars in a bid to harmonise policies nationwide; the new measures are in place until April 19. Some cantons have instituted even more stringent measures. Geneva, for instance, banned all gatherings of more than five people

In a World War II era move, US President Donald Trump on Wednesday announced he was invoking the “Defense Protection Act” in an effort to redirect American industries to produce more medical supplies amidst a growing shortage of protective equipment in healthcare facilities. Some 7769 cases have been reported in the US, with 118 deaths.

In WHO’s Eastern Mediterranean Region, Iran and other neighboring states continued to post the highest number of cases, with over 16,000 cases in Iran, 442 in Qatar and 100-200 cases each scattered across Bahrain, Egypt, Iraq, Kuwait, Lebanon, Saudi Arabia and the United Arab Emirates.

Health worker at Bole Chefe in Ethiopia wears protective gear to treat suspect cases of COVID-19

Latin America, South-East Asia and Africa Bracing For Next Wave  

Meanwhile, Latin America appeared to be poised to absorb the next wave of infections, with some 973 confirmed cases with 6 deaths; Brazil and Chile account for the most cases with 291 and 201 reported infections, respectively. In Venezuela, President Nicolás Maduro announced a nationwide quarantine amid deep concern about the havoc the coronavirus could cause in a nation where the health system’s collapsed and there’s a massive shortage of doctors, equipment and medicine. 

Colombia and Argentina have closed their borders to arriving foreigners; Chile followed suit Wednesday. Ecuador and Paraguay have established night time curfews.  And in Brazil, firemen using megaphones were patrolling beaches in Rio de Janeiro, asking people to go home. Rio’s famed Sugarloaf Mountain has been closed to the public.

WHO’s Africa Region, reporting 477 cases and South-East Asia with about 480 cases, were also trying to beef up their preparedness.

WHO’s Southeast Asia Regional Director Poonam Khetrapal Singh issued an urgent call Tuesday to all Member States in the region to “scale-up aggressive measures” for COVID-19 preparedness, as new cases trickled in and more clusters were confirmed. 

Looking at the numbers, some countries are clearly heading towards community transmission of COVID-19, said Singh in a press release“The situation is evolving rapidly. We need to immediately scale up all efforts to prevent the virus from infecting more people,” added Singh, calling on countries to ramp up testing and contact tracing, social distancing, as well as preparing networks of health facilities to triage a potential surge in patients.

In India, the total number of confirmed cases has risen to 151 with 3 deaths. The government on Tuesday banned the entry of passengers from Afghanistan, The Philippines and Malaysia.  Travelers arriving from the European Union, Turkey and the United Kingdom, including both foreign citizens and Indian nationals, are also barred from entering the country until March 31. 

As for Africa, WHO has equipped laboratories in countries across the continent with tens of thousands of tests, trained technicians, and distributed personal protective equipment to support COVID-19 surveillance, early detection and treatment. Some political leaders have also made personal appeals to their citizens to adopt preventive measures, such as social distancing and handwashing practices, including online challenges to promote good practices by Paul Kagame, President of Rwanda, and Abiy Ahmed Ali, Prime Minister of Ethiopia.  And many countries have also put into place unprecedented travel restrictions on visitors from Europea and the United States. 

Still, in the WHO briefing on Wednesday, officials said that the measures taken have been insufficient. In particular, they urged countries with reports of cases to consider bans on mass gatherings where the virus could be easily transmitted.

“Certainly at this time, all countries with disease inside their borders should limit contact between individuals, particularly during large gatherings, particularly large, religious type gatherings that bring people from very far away into close contact.”

Dr Tedros, formerly Health Minister of Ethiopia, made a personal plea, saying: “Africa should wake up. My continent should wake up,” 

-Gauri Saxena contributed to this article 

Image Credits: Governor Tom Wolf, Johns Hopkins CSSE, WHO/ Otto B..

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