Namibia Institute of Pathology (NIP) acting CEO Dr David Uirab says there is absolutely no reason to test everyone for Covid-19 to be able to manage the pandemic. “Even if we wanted to, we do not have the infrastructure, finances or human resources to do that, no country in the world has.” Our reporter Kuzeeko Tjitemisa (KT) this week engaged Uirab on the coronavirus pandemic that is picking up speed across Africa with more than 500 000 confirmed cases. Namibia alone has 615 confirmed cases and 25 recoveries.
KT: There is a general assumption that Walvis Bay is the only town in Namibia where tests are being conducted for Covid-19. How widely spread are the tests?
DU: Given the fact that about 90% of positive cases in the last three weeks are from Walvis Bay, one can be excused for thinking that Covid-19 tests are only conducted on people from Walvis Bay. But this could not be further from the truth. We are receiving and have been testing samples collected from people all over Namibia. Fortunately, the rest of Namibia still only has sporadic cases thus far.
KT: How many tests are being done a day at this stage, compared to when we started testing? How does it influence the numbers of results we get?
DU: When we started testing, we were doing about 20-30 tests a day. Now we are testing about 450 tests at NIP alone. PathCare also does testing for Covid-19 now, so the daily tally is more than 500. The number of positive results has also increased, but it must be noted that the huge spike of positive results is mainly from the Erongo region up to now. The positive cases in the rest of the country are still relatively low, despite the fact that the number of tests done has gone up by more than tenfold.
KT: There are calls for the introduction of rapid test kits. However, there have been questions around their reliability. How are these kits compared to other forms of testing?
DU: There are a number of rapid test kits that have been validated by agencies so assigned by the World Health Organisation (WHO). However, the WHO still recommends that rapid tests NOT be used for early diagnosis or patient management. It should be used more for research purposes. This is because, even when these tests have acceptable sensitivity and specificity, they test antibodies in the person, and can only become positive after several (up to 10) days.
KT: Also, there are calls for mass testing. Explain to us what a good representative sample is of tests for authorities to get a good understanding of a situation on the ground?
DU: Numbers can be confusing. There is absolutely no reason to test everyone for Covid-19 to be able to manage the epidemic. Epidemiologists and statisticians can do the numbers to tell us what would be a representative sample to give us reasonably reliable data.
However, we should be fine if we do between 1-5% of the population. What is important is that the targeted nature of the testing strategy does not get lost in the numbers game.
That is while we should test a good number of people in the country to make proper projections and plan for managing the epidemic, we should ensure that those that are most likely to be infected (travellers from highly affected countries, contacts of known positive cases, etc.) are prioritised.
Although we started slowly, Namibia is well on the way to reach that target by the end of the state of emergency, as we are almost at 0.5% of the population tested as of now.
KT: Based on the last answer, does it mean we are within the world health standards with the number of tests we are doing and have done?
DU: At the moment, those who have tested positive in Namibia are mostly asymptomatic (they have no symptoms) or only have mild symptoms. These are mostly just monitored until they recover.
The only person, who was severely ill, is the gentleman who was admitted to ICU at the coast. He was on a ventilator and received other supportive treatment. This fits in with the international picture: the vast majority of people have only mild disease. The general health of a person, presence or not of pre-existing conditions like diabetes and age do contribute to the outcome of the infection.
KT: There has been an increase in the number of confirmed cases of Covid-19 in the country in the past week, in your own opinion, why the sudden increase?
DU: The sudden jump in positive cases in the Erongo region points to the fact that we now have community transmission there. This is what the health ministry has been preaching from day one: That we should adhere to the prevention measures that are being broadcast daily: minimise movement, avoid gatherings, implement social distancing, wear masks, wash or disinfect hands regularly.
These measures are meant to curtail community spread because once community spread starts, it is very difficult to control.
KT: Other countries such as neighbouring South Africa have recorded a high number of Covid-19 deaths, why is this not happening in Namibia?
DU: Please let us not wish such to happen here. The fact that we had so few cases for a long time, gave the country time to prepare for setting up infrastructure, train healthcare workers and to get the message across to our people.
Also, the early and drastic measures taken by President Hage Geingob have given us the window to get ready. But we must not think that this is it. We have yet to reach the peak and there is still a lot of work ahead. We have not seen the worse yet, believe me.
KT: Should we prepare for a long haul under Covid-19? Will Covid-19 be around for another year? In that case, also, what is your advice to the people out there?
DU: All the gurus out there predict that Covid-19 is not going away anytime soon. So, yes, we must be prepared for the long haul. It is likely that after peaking, it will gradually decrease over time.
The measures needed to manage it will become less draconian over time. The new normal should be a bit more tolerable in a year than it is today. But we need to continue to be adherent and do what each stage requires us to do.
The last thing I would like to say to my fellow countrymen and countrywomen is this: We have learnt through Covid-19 that it is important that we build self-reliance.
Let us believe in ourselves and our own institutions. Let us become self-sufficient in everything we can be in, especially food and other basic commodities. And let the goodwill and solidarity that we have seen, continue to unite us.