South Africa: Who Qualifies for Covid-19 Testing

Not everyone can get tested for the coronavirus. There are structures in place guiding health practitioners when it comes to screening patients for testing.

Testing is a crucial way to limit the reach of the coronavirus through quarantine and tracing. But do you know what to do if you suspect you may have contracted Covid-19? And how do you qualify for testing?

The Department of Health and National Institute for Communicable Diseases (NICD) have compiled strict guidelines to assist testing facilities when deciding on who qualifies for a Covid-19 test.

Those who qualify are people who have travelled internationally in the past 14 days; been in contact with someone who has tested positive; are displaying the symptoms of a dry cough, fever or sore throat; and have worked or been in a health facility where patients with the virus are treated.

How to get tested

You do not need a doctor's referral letter to get tested through the National Health Laboratory Service (NHLS), said Cheryl Cohen, co-head of the NICD's Centre for Respiratory Diseases and Meningitis.

"If a member of the public suspects that they may have coronavirus, they should call their healthcare provider or the Covid-19 hotline before they arrive for a consultation with their health professional or healthcare facility, for an assessment to determine if testing is warranted," she said.

Although a referral letter is not needed, every test requires a written requisition from a health professional. This is so the results can be communicated through that health professional and not directly to the patient.

Public vs private testing

Cohen explained that there are slight differences between testing public and private healthcare patients. A private laboratory is used to test private healthcare patients who exhibit symptoms and qualify for testing.

"The individual can consult their private general practitioner [GP] and get the required forms completed or the necessary sample collected by the GP for testing, or go to a dedicated laboratory depot directly with the completed forms where they will be tested," she said.

Those using public healthcare can go to one of the dedicated public hospitals, where they will fill in forms and submit a sample for testing at the NHLS.

Earlier in March, Minister of Health Zweli Mkhize announced the hospitals that will take suspected Covid-19 cases. These are Tygerberg Hospital in the Western Cape, Kimberley Hospital in the Northern Cape, Polokwane Provincial Hospital in Limpopo, Port Elizabeth's Livingstone Hospital in the Eastern Cape, Grey's Hospital in Pietermaritzburg in KwaZulu-Natal, Nelspruit's Rob Ferreira Hospital in Mpumalanga, Pelonomi Hospital in Bloemfontein in the Free State, Klerksdorp Hospital in North West, and Tembisa Hospital, Johannesburg's Charlotte Maxeke Hospital and Pretoria's Steve Biko Hospital in Gauteng.

Cohen said that although testing done through a public hospital and the NHLS is free, there are public hospital fees that will be charged. Tests done in the private healthcare sector are not free.

Medical aid schemes such as Discovery Health have confirmed that they will pay the costs for members who have been confirmed to have Covid-19, through a benefit called the World Health Organization Global Outbreak Benefit.

"It will provide covering any global health emergency like Covid-19, for confirmed cases, in order to pay for diagnostic testing, and for all treatment both in and out of hospital," Discovery Health chief executive Ryan Noach told radio station 702.

On 16 March, World Health Organization director general Tedros Adhanom Ghebreyesus emphasised the importance of testing. "Once again, our key message is test, test, test. This is a serious disease. Although the evidence we have suggests that those over 60 are at high risk, young people, including children, have died," he said.

A different experience

John Lombardo, 51, had a persistent cough that saw him get tested for Covid-19. Lombardo is an art teacher in the Joe Slovo township in Port Elizabeth. He travels back and forth between South Africa and New York in the United States.

"I had a severe flu while I was in New York from the 24th to the 27th of February. I was coughing. I was even calling the airline saying, 'What if I can't travel?'"

He was able to fly back to South Africa once he'd recovered, but his cough persisted. "I was still feeling sick. It was just a cough, I didn't have a fever," he said.

Lombardo decided to go to Life St George's Hospital in Port Elizabeth and get tested for Covid-19. But when he told the medical practitioners about wanting to get tested as he had flu-like symptoms and had travelled internationally, he was told it was optional to take the test.

"Why are they giving me the option? They told me that the test will cost me several thousand rands. I said to them, 'Do you think I should take it?' I don't have several thousand rands. I don't even know what they meant by several thousand rands. I am thinking R5 000 or more," he said. "They said, 'You are fine. It's up to you.'"

Lombardo did not take the test, but decided to self-isolate in the hope of getting his cough under control. It didn't work. He then went to a GP who immediately gave him a mask and transferred him to Netcare Greenacres Hospital.

There, he was seen by another doctor who took down his information and sent him to be tested. "They had all this protective clothing on and they took blood. They were about to give me the test and I asked how much it costs. They said something around R1 200."

Lombardo asked what would happen to those who can't afford the test. "They totally misunderstood me and thought I was saying I couldn't pay the fee. If they understood that I could pay, they could've done the test at the hospital and would have got the results in a day."

He paid a hospital fee of R1 200 and his blood was sent to a testing laboratory in Johannesburg. "They said you should stay home for three days until we get the results."

His results came back negative. He said that although he got his Covid-19 results, nobody addressed his symptoms.

What the test entails

Although there are multiple laboratories across the country with the capacity to test for Covid-19, the testing process remains the same. "The lab performs what is called a polymerase chain reaction [PCR] test on the sample, which is used to detect if the virus is present by identifying the genetic material of the virus," said Cohen.

The PCR test is a technique used to enlarge small DNA samples so they can be examined properly.

Pathologist Michael Harrison told The Guardian newspaper that swabs have to be taken from specific areas. "The nose and the back of the throat are the two sites where the virus is replicating. So the swabs are picking up those cells where the virus might be," he said.

"The result of the formal report will show SARS-CoV-2: Positive if the genetic material has been identified," said Cohen. SARS-CoV-2, or severe acute respiratory syndrome coronavirus, is the virus that causes Covid-19.

Cohen added that to avoid inconclusive tests, medical practitioners have to ensure that they take an adequate sample as this guarantees that the genetic material of the virus can be identified with confidence.

Certain private laboratories are offering Covid-19 tests at drive-through depots. "This entails being tested or getting your sample collected in the confines of your vehicle while in the parking lot. This avoids the potential contact while in the waiting room waiting to get your sample collected," said Cohen.

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