Testing, Testing, Testing: An essential strategy for public health, vaccine deployment and economic reactivation during COVID-19

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Blood testing in Ecuador
Blood testing in an hospital in Quito, Ecuador. Photo: Paul Salazar / World Bank.

Beginning December 2020, Uruguay had 7,500 persons infected and 83 deaths, one of the lowest number of infections and deaths in Latin America for COVID-19. At the same time, the country had by far the highest number of tests, with 128 tests per case detected, the highest in the region.

To achieve this, Uruguay has implemented a multi-pronged strategy consisting of​ COVID-19 assessment centers offering tests to people regardless of symptoms;  aggressive contact tracing for each person with confirmed COVID-19; ​surveillance testing in outbreak situations​; sentinel surveillance systems and hospital-based testing in priority regions​; and enhanced testing approaches around the country’s borders.

This may seem a paradox, since Latin America and the Caribbean remain one of the regions most affected by the pandemic, with five countries in the top fifteen list. The effects have been hard and profound: GDP for the region is expected to contract by 7.9% in 2020 and millions of children have not been able to attend school during the pandemic , leading to a devastating impact on their learning and human capital potential.

All the hopes to return to a certain normality seem to rest now on the vaccines . Recently, the World Bank approved a US$12 billion financial commitment aimed at supporting the financing of and access to COVID-19 vaccines. This unprecedented initiative will help ensure a fair and transparent distribution of vaccines to the poorest and most vulnerable. Yet, challenges in the production and distribution of safe and effective vaccines are numerous and it is unlikely that they will reach most of the world population in 2021. In parallel to the distribution of vaccines, governments will have to strengthen further their public health containment efforts.

It is in this context that pro-active, population-based testing strategies, such as the one implemented in Uruguay, will be an essential instrument for countries to keep their economies and schools safely open next year and beyond. But what does this mean and how does it work?

In practice, it means that beyond symptomatic patients and their contacts, priority populations should be identified on a sample basis for regular testing. These populations include:

  • Vulnerable populations such as the elderly or those living in congregate settings
  • Geographic transmission hotspots
  • School children and staff
  • Key economic sectors in order to protect jobs and the economy
  • High-risk employment sectors such as health care workers and other jobs that put people into repeated contact with co-workers or the public

Identifying and testing

This is the key message of a guide developed by the World Bank containing critical knowledge to help governments get ahead of the curve of the pandemic by understanding which populations are being affected, where, when and how, and decide on proactive public health measures proportionate with the severity of infections for different communities.

The availability of accurate and affordable rapid antigen tests enables governments to scale up testing for highly contagious individuals and frees key resources for population-based testing strategies . These tests are an important complement to the current gold standard reverse transcription polymerase chain reaction, known as RT-PCR, for detecting SARS-CoV-2 (the virus causing COVID-19), which are more expensive and take longer since they need to be processed in a lab. Mobilization of antibody tests—which identify persons who have previously been infected with the virus—can help target population groups at elevated risk and take direct proactive public health measures to mitigate pandemic impact  moving forward.

Waiting for the vaccines

The World Bank guide to national testing strategies for COVID-19 in Latin America and the Caribbean provides practical advice based on best available international experience for countries to develop proactive strategies that will help them contain the pandemic as vaccines get distributed to the most vulnerable populations.

The guide covers essential elements for governments to consider as they develop and implement their proactive testing strategies:

  • Availability of data and resources including the range and quantity of tests available; and the availability of health human resources
  • Importance of good governance, use of best available data and stakeholders’ engagement to define priority populations to be tested
  • Key implementation considerations such as laboratories infrastructure and capacity; reliability of supply chains; transportation networks; and surveillance infrastructure and data communication
  • Importance of continuous evaluation and learning to refine strategies as they are implemented

Financing and implementing proactive, population-based testing strategies will be essential to contain the pandemic and reduce its negative impact on schools and the economy  as countries scale up the distribution of safe, effective vaccines. With the roll out of vaccines expected in 2021, there will be a considerable risk that public health behaviors related to COVID-19 prevention will erode. Recognizing that vaccines will not reduce transmission dramatically in the initial months of the roll out, it is critical to continue to invest in testing in order to promote adherence to good behaviors and manage outbreaks.

Ultimately, vaccines and testing strategies are two sides of the same coin: necessary investments to rebuild trust in societies, enable schools and the economy to operate safely and boost inclusive economic growth so that countries can reverse the increase in poverty inflicted by the pandemic

Authors

Jonathon Campbell

Fellow in the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University

Tim Evans

Director and Associate Dean of the School of Population and Global Health, McGill University

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