The increasing COVID-19 deaths in the past few days is a sign that the outbreak may be larger than our current constrained PCR testing is able to track. As I and others warned six months ago, we needed to ramp up PCR testing to keep the virus at bay and prevent future outbreaks. The President and PM gave instructions to that effect, but in reality this did not happen. Why remains a mystery, but the current outbreak is the inevitable consequence.
Increasing PCR testing reduces COVID-19 transmission (Reff). In combination with contact tracing and isolation, it is the most effective intervention we have to control the virus. Better by far than lockdowns, masks, school closures and asking people to wash their hands… Other countries that were doing well back in May did continue to ramp up PCR testing, despite in some cases having no local cases. All these countries have managed to avoid a second wave.
Whatever happens, the most important gap in our current strategy and by far the most important one we need to fix remains PCR testing. It’s not ventilators, it’s not quarantine or contact tracing, and it’s not our border controls.
This is going to be hard and it will be impossible to fix in days or weeks. As of September, my understanding is that the health authorities had not placed orders for any of the large throughput machines we need (I hope I am wrong and I am happy to be corrected). The waiting lists on most of these machines now stretch to many months, so we are not likely to be able to fix this anytime soon.
Other than placing orders for those machines now, we need to focus on optimizing our existing capacity and especially throughput in MOH labs, as well as looking at use of methods such as pooled testing and saliva testing. When I met the Health Secretary, Dr Munasinghe, a few weeks ago, he understood the need to trial saliva testing, and I hope that he and the new DG follow-up on this.
MOH is already being forced to bring in rapid antigen tests out of desperation, but we should have no illusion. The available research and data indicate these are only a second best to the optimal control strategy of intensive PCR testing. If we want to avoid lockdowns, which the President has pointed out causes great hardship to the public, we need to replace it with something else. That something else remains widespread PCR testing on a routine basis.