…A ready to use solution inside our borders
FIFTY-YEAR old Peter (not his real name) has been working as a truck driver for over 30-years now.
He has spent more years in his truck, which has become home, away from his house.
For a driver that travels between South Africa and Zimbabwe, the COVID-19 outbreak has been his worst nightmare.
And his greatest fear is infect his family with COVID-19 as Zimbabwe is not testing truck drivers as they enter into the country.
“We are not being tested for COVID-19 when we get into Zimbabwe and my greatest fear is infecting my family,” says Peter.
He adds: “We are only checked for temperature at Beitbridge border post before we proceed into the country. It is different when we get into South Africa as we are tested on that side. Now my fear is the absence of testing as I return to Zimbabwe could put my family at risk. I get to spend at least a week or so with them while waiting for my next load.”
This is against the background that, to date, Zimbabwe has 734 Covid-19 cases and a total of nine deaths.
Peter is not alone in this dilemma.
His story is a reflection of thousands of Zimbabweans who work as truck drivers, a highly mobile group that can easily become carriers of the pandemic.
The Zimbabwean Government says a shortage of testing kits has been their greatest impediment in testing this group.
“The issue of shortages of testing kits is a global challenge and Zimbabwe has not been spared. It is indeed critical to test the truck drivers who are highly mobile and can change the face of the epidemic,” said Environmental Health Services director in the Ministry of Health and Child Care, Victor Nyamande.
In the same lines, United Kingdom based Zimbabwean medical doctor Farai Makoni says Zimbabwe should make use of technological advancements such as SAMBA-II machines to scale up its testing.
Makoni believes the over 100 SAMBA machines that are already available in districts hospitals can help Zimbabwe intensify its diagnostic rates, which currently remains very low.
Therefore, the country may be missing the true face of the epidemic.
“Zimbabwe can make use of the SAMBA-II machines to scale up case finding especially among truck drivers. The country is certainly sitting on a time bomb by not testing this highly mobile group”.
Makoni added that “it has been proved across the region that truck drivers are carriers of the virus and the fact that we recently had six of our truckers testing positive in Zambia speaks volumes. All this means is that by not testing them, Zimbabwe is missing the real face of the epidemic”.
This is paradoxical, considering the SAMBA machines are currently installed and a COVID-19 test adapted to them is available.
“The country can only ignore such technological advancement at its own peril” he said.
Zimbabwe is one of the first countries in the continent to roll out point-of-care HIV testing using SAMBA II, a technology developed at the University of Cambridge. Point-of-care means the test can be done outside a laboratory setting, including patient clinics with low resources and even facilities such as nursing homes. This technology is being used in Early Infant Diagnosis of HIV as well as viral load testing for therapy monitoring in adults.
The country has 104 SAMBA II machines in use at 25 health centers in all the country’s 10 provinces, according to data from the Ministry of Health and Child Care. In addition, there are 10 donated SAMBA machines still to be used. Interestingly, the same technology can also be used for COVID-19, with a turnaround time to results of only 75-90 minutes. Other tests take about 5 to 24 hours or even longer.
SAMBA II technology was developed by Diagnostics for the Real World, a spin-off company from University of Cambridge. While it was originally designed to test for HIV in hard to reach areas in Africa, work to adapt the technology to test for COVID-19 started early this year. In April, SAMBA II was approved for use in the UK and countries in Europe because its coronavirus test received CE mark.
The technology looks for tiny traces of viral genetic material present in the upper respiratory tract of infected people and amplifies it billions of times chemically, later detecting their presence.
Therefore, the test is extremely sensitive in the detection of active infections. A nasal and throat swab is collected from a patient and once uploaded to the machine, two regions of the COVID-19 genetic material are amplified in a fast and fully automated fashion.
SAMBA II is a cutting-edge technology so simple and robust it can be placed literally anywhere and operated by anyone with minimum training. It was designed for hard-to-reach areas.
The machine is resilient and can endure high temperatures and adverse environments with little to no maintenance. Zimbabwe has distributed the machines to clinics and hospitals in remote areas including Breitbridge.
The United Kingdom, one of the countries that have been hit hardest by COVID-19, has been using SAMBA II technology to test for the virus in its national health hospitals.
The test has got a green light after being extensively validated in the UK. In a study conducted independently in Cambridge with 149 patients, sensitivity, which is the ability to correctly identify positive cases, was reported to be 96.9%, and specificity, which is the ability to correctly identify negative cases, was reported to be 99.1%.
Over 30,000 tests have already been used in over 20 National Health Service (NHS) hospitals in the UK, reducing time to diagnosis from 24 or more to around 2 hours. Using SAMBA II was associated with faster time to triage from the emergency departments, release of isolation rooms, avoidance of hospital bay closures, and allowed discharge to care homes and faster access to hospital investigations and procedures. It was concluded that point of care testing in the form of SAMBA II was instrumental in mitigating the impact of COVID-19 on hospital systems by allowing rapid triage and patient movement to safe and appropriate isolation wards. The use of SAMBA II Corona testing will also reduce delays in patients accessing appropriate investigation and treatment, and could therefore improve clinical outcomes
As Zimbabwe grapples with expanding testing and case identification to get a true picture of the pandemic, answers to this challenge could well be found in the SAMBA II technology.
Each SAMBA II machine has the capacity to carry out around 10-12 tests a day. With 114 machines in use, Zimbabwe could conduct an additional 1,200 tests a day in a point-of-care scenario.
“The use of SAMBA II machines in Covid-19 testing could expedite testing in Zimbabwe, which is critical at the moment. The fast turn-around time for results for SAMBA II is a key factor, hence the need to use these for testing,” a Ministry of Health and Child Care official said recently.
The Zimbabwe Medical Association president, Dr Francis Chirowa concurs that the failure to test truck drivers posed a huge challenge for the country. “It is a known fact that truck drivers are a high-risk group hence we can only ignore testing them at our own peril. There is need to look at all avenues that can be used to intensify testing in Zimbabwe if we are to get a true picture of the epidemic,” he says.
Public Health specialist, Dr Prosper Chonzi also fears the lack of intensified testing could be problematic for the country.
Zimbabwe’s Health and Child Care Minister, Dr Obadiah Moyo admits that Zimbabwe is grappling with its COVID-19 response in the face of acute shortages of testing kits and personal protective clothing, noting that the country was working on exhausting all available avenues.
“It’s not easy because of the cost factor. But we are considering all available options that could help us test as many people as we can,” he adds.
With the country working towards decentralizing COVID-19 testing, health facilities with SAMBA II machines could be a welcomed solution.
The use of this technology could see truck drivers like Peter having regular tests as they come into Zimbabwe, hence reducing the risk of infecting their loved ones. Part of the answer to help contain the disease that changed the world appears to be already inside the country’s borders. However, as things stand, Zimbabwe is on a fast-moving track towards perdition and catastrophe. One that is stealthy and steady but whose impact may only be realised when it is absolutely too late to fix.