Testing approach depends on epidemic management strategy. Our strategy has always been: find all diseased, and stop the epidemic.
In this strategy, you run around attempting to find every case so you can stop the disease from jumping on to the next person. This justifies testing every primary and even secondary contacts depending on how good your diagnostic test is at picking up disease.
However, when transmission evolves, you change the strategy accordingly and I know the Ministry Of Health - Malawi is already on top of this transition need.
So at the moment, we know that strategy 1 may have slowed, but did not succeed in stopping the epidemic (just like in almost all countries). We know that the disease has moved from sporadic/cluster LOCAL TRANSMISSION to COMMUNITY TRANSMISSION in which case the testing strategy has to change.
So with community transmission, testing is scaled back to a MEDICAL BENEFIT approach EXCEPT if testing capacity is large enough for the population AND there is good adherence to physical distancing. One way of understanding the approach, is via the question: of what benefit is identifying disease in all including asymptomatic or mildly symptomatic people who will get better without needing intervention?
So you only test those who need the test for their/other people's medical benefit. These include people with severe symptoms, frontline workers, and the institionalised.
This does not mean you stop public health measures in the rest of the population. These measures remain vital because at this stage you should consider yourself Infectious and view anyone you meet also as positive and infectious: so you have the duty to protect the other person and yourself. The public health measures are as follows:
1. First, for contacts of known positives, the key is to follow quarantine rules very strictly.
2. For individuals with demographic and medical risk factors for COVID-19 death, key is to shield.
3. And for all people it is to limit movements more than ever before.
4. If movement is absolutely critical and unavoidable, mask up! No one should exit their home without a mask. Masks are useless if they do not adequately cover your nose and mouth AT ALL TIMES.
5. Always wash hands with soap or hand sanitiser.
6. Ensure that you cough inside a mask
7. Individuals aged 60 and above, those with diabetes, hypertension, chronic lung disease, chronic heart disease, cancer, HIV and OTHER chronic illnesses must ensure that their illnesses are well controlled and ensure they are shielded from COVID-19.
The above SEVEN interventions will slow the spread down to the minimum which will reduce the pressure on health facilities (number presenting with severe illness), and REDUCE DEATHS.
SO PLEASE, UNDERSTAND IF YOU ARE TOLD THAT YOU DO NOT NEED TO BE TESTED BUT MUST PERFORM YOUR PUBLIC HEALTH RESPONSIBILITY OF QUARANTINING.
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