Liberia’s Coronavirus Positive Rate Indicates Adequate Testing is Being Done

By Gbatemah Senah

MONROVIA, Montserrado – As of May 30, Liberia has recorded a total of 288 Coronavirus cases in the country, since the first index case was reported on March 16 this year. Although this is one of the lowest numbers in the West African region, the number is nevertheless a result of widespread testing.

According to the Director-General of the National Public Health Institute of Liberia or NPHIL, Dr. Mosoka Fallah, 3,384 tests have been conducted during this period, indicating a test positive rate of 8.51 percent. In other words, for every 100 people that have been tested for COVID-19 in Liberia, there have been about 8 people who were found to be ill with the disease.

“150 tests are being done daily. A total of 3,384 tests have been done to date,” Dr. Fallah told The Bush Chicken in an email. He said the number excludes duplicate or follow-up tests conducted on positive cases, which are done for confirmation purposes.

An article published by the Canadian Global Television Network to explain the meaning of doing adequate testing indicates that the higher the number of contacts tested for each death, the better the surveillance and the chance of finding people who are asymptomatic of the infection.

The NPHIL Director-General did not provide the number of contacts being tested for each death or positive case, but WHO Director for Health Emergency Programs, Dr. Mike Ryan disclosed during a press conference in March that a good benchmark for COVID-19 testing is to have at least 10 negative cases for every one positive case confirmed. That means if a state or country carries out testing and comes back with positive cases of around 9% or under, then it’s likely that it is testing well.

“If 80-90% of the people test positive, you are probably missing a lot of cases,” Dr. Ryan explained.

According to him, countries that have extensive testing have fewer than 12% of their tests being positive. The lower the number, the better the chance is that countries are finding the majority of their cases – assuming that widespread testing is being carried out.

“We would certainly like to see countries testing at the level of 10 negative tests to one positive, as a general benchmark of a system that’s doing enough testing to pick up all cases,” he added.

Liberia’s current daily projection for testing, according to the head of the public health institute, was made based on its current testing capacity.

“We projected a range of 100 to 300 samples per day. Over the past few days, we have been testing on the average 150 samples per day. We are therefore within and even above our minimum estimate for testing,” Dr. Fallah said.

According to him, there are currently 10,000 testing kits available in country – which are expected to last for a period of one month, at the rate of 300 usage a day. An additional 43,000 more test kits are expected to arrive in late June, through an arrangement between the government and the World Bank. He added that USAID and UNICEF have both also promised additional consignments.

He said testing in Liberia is unrestricted in order to encourage many individuals to voluntarily offer to get tested, especially when they feel they may have been exposed to the virus.

“We are testing persons at our POCs, low and high risk contacts of positive cases, travelers coming to Liberia, persons in the treatment center and of course volunteers,” he said.

He added that walk-in or drive-through sample collection centers have been created in strategic communities to encourage and support voluntary testing. He lauded community and institutional support for voluntary testing, noting that individuals and staff of institutions were showing up for voluntary testing.

Explaining the process of testing, Dr. Saah said a laboratory technician is assigned to collect the sample for each testing candidate as the candidate’s personal information is entered into an automated system which generates the candidate’s animated ID and sends that to the sample collector or laboratory technician.

The candidate will then proceed to the laboratory technician who marks the person’s sample collection tube with his or her automated generated ID number, before collecting a swab from the person’s nose. The collected sample is then packaged and given to the sample transporter (RIDERS), who deliver the sample to the National Reference Laboratory in Charlesville, Margibi County.

At the laboratory in Charlesville, a sample receptionist receives the sample and logs it in to the sample data base, which is then accessed by the lab technicians for processing. The sample is processed RNA extracted and taken for reading. The result is sent to the data center when completed. At the data center, the team forwards the result, according to the lab protocol for release.

However, the head of NPHIL identified a number of challenges threatening smooth testing, such as the lack of a backup machine for Polymerase Chain Reaction or PCR – a technique that allows lab technicians to amplify or copy samples, so that they can be studied in more detail.

According to him, a backup PCR machine would ensure continuous testing, in the case of a breakdown of the current machine, which is in a wear and tear condition. He also recommended for additional lab supplies and consumables to support continuous testing, and county-level infrastructures to expand testing across the country.

He dispelled the perception among members of the public that authorities were using the rapid test methodology to arrive at positive cases. He clarified that NPHIL is using the Gold Standard testing method, PCR, the same as other countries are using currently, around the world.

“When the lab reports a positive result, it is a true positive,” he says, confidently. “When results are positive, psychosocial personnel are the ones who give the result, to provide support to the case.”

He wants members of the public to know that testing is not a crime, and he encourages individuals to come out to be tested if they are experiencing symptoms of the illness (such as coughing, or fever), or if they believe they may have come in contact with the virus – as being tested will help protect their friends and family. Additionally, he warned against stigmatizing people who are being tested.