Government admits mistakes in Covid-19 results

TONNY ABET & NOBERT ATUKUNDA

The Health ministry has admitted lapses in Covid-19 test results and have now developed strategies to address the rising cases of inconsistencies in results being released by laboratories it has accredited.
The ministry, however, asks those who have or will test positive for Covid-19 to take precautionary measures to curb the spread of the disease.

The ministry says some people claim to have received two different result slips, one indicating positive and the other negative, yet others claim to have taken two different samples on the same day, but returning different results.
The inconsistencies in Covid-19 test results can be traced back to June 11 when President Museveni, in his address, accused Makerere University laboratory for faking Covid-19 test results.

“Some of the 679 confirmed cases were classified as positive (for Covid-19) when they are not by a laboratory in Makerere because they were careless. Apparently, there were a few people working there and probably got tired,” he said.
The inconsistencies in Covid-19 test results mean some people have been served false positive Covid-19 results and wrongly started on treatment.

It also means those who are truly positive have been given false negative results and left to blend freely with the community and continue transmitting the virus.

A number of people have come out to refute the Covid-19 test results from the ministry, with the most notable being the family of the 80-year-old woman from Kampala, who passed away on July 25, and that of the family of Dr David Katuntu from Kamuli District.

Other concerns have also been about missing and delayed Covid-19 test results.
Dr Jane Ruth Aceng, the Health minister, while speaking in Kampala on Friday, said the ministry is receiving more complaints about the discrepancies in Covid-19 test results.

“Some people claim to have received two different result slips, one indicating positive and the other negative. Others claim to have taken two different samples on the same day and these give different results,” she said.

Dr Aceng said the differences in results “may arise from the sampling technique and the number of samples taken.”
The Uganda Virus Research Institute (UVRI) is in charge of quality assurance of Covid-19 testing and it assesses laboratories in the country before allowing them to conduct Covid-19 testing.

Prof Pontiano Kaleebu, the director of UVRI, said the way technicians take off a swab from the nose or throat for testing can give variation in results.

According to the World Health Organisation (WHO) standard, at a minimum, respiratory material should be collected from the nose or the deeper areas of the throat.

“We are also dealing with a virus that is multiplying so sometimes you see that if the test is done apart in terms of time, in the initial test, the virus may not be detectable but later it is detectable,” Prof Kaleebu said.

“It could also happen that towards the end in the acute stage, the initial test can be positive because the virus is still growing and in the second test, it is negative because the virus has disappeared,” he added.
The UVRI director also said they are still struggling with the results that are on the borderline.

“We are also learning, we have noted a few individuals who are hard to declare positive or negative. The individuals have a low virus in their body, their result is on the borderline positive and for others, the test shows borderline negative,” he said.

Facilities testing for Covid-19
There are 12 accredited Covid-19 testing facilities in the country, with nine owned by the government and non profit organisations.

These include UVRI, Central Public Health Laboratories, Makerere University College of Health Sciences Laboratory, Adjumani Mobile Laboratory, and Tororo Mobile Laboratory.

Others include Mutukula Point of Entry testing laboratory, Infectious Diseases Institute laboratory, Mildmay Laboratory, and Uganda Cancer Institute laboratory.

The remaining three labs are owned by private (for-profit) facilities and they are Lancet Laboratories, Medipal Hospital and MBN laboratory.

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Dr Aceng said: “All the laboratories that are accredited to carry out Covid-19 testing are continuously assessed and their staff trained and oriented by UVRI to ensure they are highly skilled and experienced.”
The UVRI has been nominated by WHO as one of the best laboratories in Africa , a centre for Covid-19 genomic sequencing for the whole of East and Central Africa, according to the Minister.

“The procurement of various test kits by the ministry is guided by WHO and other international entities that carry out external performance evaluations on the quality of the test kits. In addition, the ministry ensures quality control of the various test kits by using all its available mechanisms such as the National Drug Authority (NDA) and customs clearance,” Dr Aceng said.

“All new test kits that come into the country undergo mandatory internal performance evaluation at UVRI with gold standard test kits to provide approval for use,” she added.

Prof Kaleebu said: “We agreed with the team (in our laboratory) and the laboratories that are testing that we do not give out the result (that are at borderline) or we repeat the result after two days. The discrepancy can be a result of biological changes in the virus.”

Forging test results
The Ministry of Health has also warned the public against forgery of Covid-19 test result certificates.
Dr Aceng, in a statement issued on Friday, said: “We have noted serious forgery of test result certificates by sections of the public for reasons best known to them.”

Dr Susan Nabadda Ndidde, the commissioner of the National Health Laboratory and Diagnostic Services at the ministry, who strongly condemned the new practice of forging Covid-19 test results, said they have developed mechanisms to authenticate test results.

Although the ministry said it was still investigating what is driving the practice, participating in some activities like covering events involving the President required journalists to present their Covid-19 test results.

Dr Nabadda said they have come up with unique identifiers for results slips to differentiate them from the fake ones.
“The signature of the manager of the testing lab, name of the testing laboratory, stamp of the testing lab, QR code and the result must be traceable in the ministry database,” she said.

Dr Nabadda advised that upon receiving the Covid-19 result, one should scan the Quick Response (QR) code with their phone if they have the app for scanning.

This bar code will display your name, the date of testing and the name of the testing laboratory, according to the expert.

Private health facilities warned
Dr Aceng warned private health facilities against using rapid diagnostic test (RDT) kits to test for Covid-19.
“The Ministry of Health has noted with serious concern that some private health facilities are using (RDTs) to diagnose Covid-19. The ministry would like to categorically state that WHO guidelines recommend the use of a real-time Polymerase Chain Reaction (PCR) machine as the mandatory diagnostic test for confirmation of Covid-19. WHO does not recommend the use of antibody detecting RDTs for diagnosis of Covid-19,” she said.

RDTs rely on antibodies; a protective protein produced by the immune system in response to the presence of an infectious agent.

According to information on the WHO website, antibodies are produced over days to weeks after infection with the virus and so are not reliable because some patients don’t develop the antibodies and yet are infected and can transmit the virus.

“In some people with Covid-19 disease, molecular testing confirmed weak, late or absent antibody responses have been reported. Studies suggest that the majority of patients develop antibody response only in the second week after onset of symptoms,” reads the information on WHO website.

Community cases
Some of the Covid-19 positive cases are still within the community following the slow evacuation process by government.
Dr Aceng blamed the problem on poor access to homes, as well as congestion and heavy traffic jams, which often hamper evacuation.

“Due to congestion and heavy traffic in Kampala, Mukono and Wakiso, the Ministry of Health has not completed the evacuation of over 467 positive cases. This situation poses a threat to you and me, therefore, take precaution to stay safe,” Dr Aceng said on Friday.

Confirmed cases still in the community have been advised to stay home isolated from their families until the emergency evacuation teams reach out to them.

“The Ministry of Health and Kampala Capital City Authority, ministers of Works and Transport, and that of Internal Affairs and the private sector are working out a mechanism to enable us to smoothly complete the evacuation of the positives within the community,” Dr Aceng said.