Coronavirus testing: how it works, what it costs and when you need a test

By Aisha Abdool Karim & Joan van Dyk for Bhekisisa

The National Institute for Communicable Diseases can run hundreds of tests at the same time but ultimately the number of tests South Africa will be able to carry out for the new coronavirus depends on the machines, people and testing supplies available.

Seven South Africans have tested positive for the new coronavirus, dubbed SARS-CoV-2 by scientists. There’s still no reason to panic. But if you are feeling sick, here’s all the information you need to take the next steps.

Who should get tested?
The virus SARS-CoV-2 causes coronavirus disease 2019, also known as COVID-19. People with COVID-19 have symptoms including cough, sore throat, shortness of breath or fever — but these can also be signs of the flu.

You should only get tested if you have symptoms and have also done one of the following, says the National Institute of Communicable Diseases (NICD):

  • Been in contact with someone who has COVID-19;
  • Have travelled to a country where you have a high risk of getting infected. The NICD currently lists the following countries as high risk: China, Hong Kong, Japan, South Korea, Singapore, Vietnam, Taiwan, Italy and Iran but this list is updated regularly. For the most recent information, go here;
  • Have worked in or been to a healthcare facility treating people with COVID-19;
  • Have a severe case of pneumonia with an unknown cause.

What does testing involve?
A healthcare worker collects samples from, for instance, your nose, throat and lungs before sending them off for testing. They collect the samples in a few ways, explain the latest NICD guidelines. Patients could be asked to do a deep cough and spit phlegm into a container for testing. In other cases, a healthcare worker might wipe your nose, mouth, or the back of your throat with what looks like a giant earbud. The sample is then put into a tube and sent to the lab.

Testing of samples takes 24 hours, people can expect results after 48 hours. This applies to tests conducted at both the NICD laboratory and the private Lancet Laboratories.

According to the NICD guidelines, if someone tests positive, this will be confirmed with another test. If that diagnostic comes back negative, then the test will be repeated to verify the result. This kind of repeat testing means it can take up to 48 hours to definitely detect a case of COVID-19.

If a person initially tests negative, then follow-up diagnostics are only done if the person begins to show symptoms or if the samples were of poor quality.

How does the test work?
After lab technicians have the sample, they’ll test it with a quantitative polymerase chain reaction machine, which looks a lot like a photocopier. It kind of acts like one too, De Oliveira says. The machine creates thousands of copies of the virus’ genes if it’s present in the patient sample. The results will show both whether the sample is infected with SARS-CoV-2 and how much of it is present, he says.

These machines are widely available in South Africa and the NICD says they can test hundreds of samples at a time.

If the result is positive for the virus, scientists move on to a second machine – a DNA sequencer, which unravels the whole genetic code of the virus’s DNA — this is the first step in helping scientists track the spread of the virus both locally and globally.

For instance, researchers can plug the virus’ genetic map into a free, web-based programme designed by international teams from Belgium, Brazil and South Africa’s KRISP unit at the University of KwaZulu-Natal. KRISP is a gene sequencing research organisation based at the university.

The software allows scientists to compare it with a database of similar samples from 10 types of coronavirus including the SARS-CoV-2.

Tulio De Oliveira is a bioinformatician from KRISP who led the development of the tool.

“It has three uses,” he explains “to quickly and accurately characterize new coronavirus genomes, to understand the source of the outbreak, and to identify mutations of the virus.”

The NICD is watching the changes in the virus carefully, says spokesperson Sinenhlanhla Jimoh.

Monitoring how a virus changes can help researchers develop treatments or vaccines for the newest coronavirus, De Oliveira says.

“So far, SARS-CoV-2 is spreading very fast [globally], but it hasn’t changed that much.”

He explains: “The small changes that have occurred have not made any difference on how the virus behaves, or how easily it spreads.

Where should you go for a test?
If you think you might have contracted the virus, you should call the NICD helpline on 0800 029 999. They will advise you where the closest public or private facility is for you to go for a test and how to access the facility.

What happens if I test positive for COVID-19?
Anyone who tests positive will be put in isolation at one of the hospitals designated to respond to the outbreak. You’ll remain there until tests show you no longer have the virus.

The NICD will then trace people who have been in close contact with the confirmed case. Anyone who could have come in contact with the patient in the week before they began to feel sick will be self-quarantined at home for 14 days. This group includes everyone from family to health workers who may have seen them. The NICD will closely monitor them for any of the symptoms of COVID-19.

How much does it cost, and what does medical aid cover?
Public sector testing is completely free. But as of 9 March, Lancet Laboratories announced that it would also be processing COVID-19 tests from private doctors for R1 400 — how much of this cost you will have to cover yourself depends on your medical aid scheme.

Discovery Health Medical Scheme will cover the costs of a test if you are found to be positive, if the result is negative, then you will pay for the diagnostic with medical savings.

The Government Employees Medical Scheme (GEMS), which covers more 70 000 South Africans, announced it would also pay for tests and treatments for the virus.

“We encourage medical schemes to provide comprehensive cover for all confirmed cases, in the interest of public health,” head of the Council for Medical Schemes Sipho Kabane said in a statement.

Kabane advised that people test at government laboratories.

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