The use of antibody-based tests (rapid test), the accuracy of which is low, has become a source of new problems and it needs to be reviewed and stopped.
By
AHMAD ARIF/DEONISIA ARLINTA
·4 minutes read
JAKARTA, KOMPAS -- The capacity for Covid-19 test using polymerase chain reaction (PCR) in Indonesia has increased, but it has not yet met the minimum standard and is still unevenly implemented. The use of antibody-based tests (rapid test), the accuracy of which is low, has become a source of new problems and it needs to be reviewed and stopped.
The government’s Covid-19 task force reported on Thursday (2/7/2020) a record high daily addition of Covid-19 cases, that is 1,624 cases, totaling 59,394 confirmed cases of Covid-19 in the country so far. The death toll increased by 53. Thus, 2,987 Covid-19 patients have died.
Given this figure, Indonesia is the country with the highest number of Covid-19 cases and fatalities in Southeast Asia. As the addition of cases in neighboring countries, such as Malaysia and Singapore, continues to decline, the transmission of Covid-19 in Indonesia sharply increased.
The additional 1,624 cases were discovered on Thursday through PCR tests on 10,814 people. Thus, the average positive rate (positivity rate), which is the ratio of the number of positive cases and the people being tested, reaches 15 percent. To date, a total of 503,132 people have undergone the test, making the average positive rate at 11.8 percent. This figure is far higher than the positivity rate set by the World Health Organization (WHO) at 5 percent.
Dewi Nur Aisyah from the government’s Covid-19 Task Force experts team, yesterday, in Jakarta, said that the average positive rate in Indonesia in June 2020 had dropped, compared to last May, which was at 13 percent.
The WHO report on the progress in Indonesia, which was published on Wednesday (1/7), said that the risk of transmission in Indonesia was high because the movement of people between regions, regencies and provinces had increased following the easing of large-scale social restrictions. The WHO highlighted that there was around a one-week delay between the testing and results.
According to WHO standards, the percentage of positive samples, which indicates there is comprehensive supervision and case examination, can only be measured if the number of tests is at least 1 per 1,000 people per week. "The only province in Java that has achieved this minimum case detection benchmark is Jakarta," said this report.
Rapid test problems
Henry Surendra, a serology researcher and epidemiologist from Laporcovid19.org, said that one of the obstacles in the effort to speed up the Covid-19 testing with PCR in Indonesia was the use of antibody-based rapid tests for diagnosis, even though its accuracy was low. Laporcovid-19 received information from a number of doctors who were pressured by regional heads to reduce PCR tests and, instead, only use rapid antibody tests so that the number of confirmed cases do not increase.
In fact, rapid tests are more appropriate for studies to determine the level of community immunity and the distribution of people who have been infected. So the government needs to evaluate the use of rapid tests that are prone to be misunderstood and misused.
Many of the rapid tests circulating are not validated.
"The government should focus on increasing the PCR tests and not using rapid antibody tests for diagnosis. Moreover, many of the rapid tests circulating are not validated," he said.
In addition, the government must open the daily number of PCR tests in each region as a tool to measure their performance. If the PCR test data is not opened, there is possibility that an area is declared a green zone or having minimum number of confirmed cases due to lack of tests and not indicating the real situation.
Tri Maharani, a physician at Daha Husada General Hospital in Kediri, East Java, said that the use of rapid tests had slowed the treatment of patients. Tri had Covid-19 according to PCR test results, even though the result of her rapid test was nonreactive.
According to an epidemiologist from the School of Medicine, Public Health and Nursing at Gadjah Mada University, Bayu Satria, no country has successfully controlled Covid-19 using antibody-based rapid tests for diagnosis. Under the WHO guidelines, the standard used is molecular testing with PCR. "In South Korea and Taiwan, this so-called rapid test uses PCR, not serology [antibodies]. In other countries, PCR tests can be completed in a day," he said.
The Indonesian government is advised not to make antibody-based rapid tests a requirement for anyone who wanted to travel by airplane. In Taiwan, among the requirement to fly is to have a PCR test no later than three days before flying.
The suggestion to stop the use of antibody-based rapid test is in line with research published in The British Medical Journal on 1 July 2020. A study by Mayara Lisboa Bastos of the Research Institute at the McGill University Health Center, Canada, revealed the main weaknesses of the Covid-19 antibody testing.