Getting to the end of 2019, a novel coronavirus, SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2) which belongs to the Coronaviridae family of viruses emerged in China, specifically in the famous city of Wuhan, in the province of Hubei. The virus is now known to cause Coronavirus Disease 2019 (COVID-19). This virus has spread across the entire world so fast and has been declared a pandemic by the World Health Organization (WHO). The virus is highly infectious, progressive, and destructive and is causing large numbers of deaths of infected persons across the world.
The virus which grows exponentially, largely affects the respiratory system and its infection leads to pneumonia with an incubation period of 2-14 days. There have been recent developments of the disease mechanism leading to infection of the blood (viremia), activation of the clotting system (disseminated intravascular coagulation- DIC), and multiple organ failure.
In Ghana, the infection which started in two epic centers; Accra and Kumasi, has now spread to 10 other additional regions with 3,091 confirmed cases, 303 recoveries, and 18 deaths at the time of writing.
Several measures have been put in place by the President of the country to ensure that the disease is combated. The measures included mandatory and self-quarantine, restriction movement, closure of borders, disease surveillance through contact tracing, enhance testing, and treatment of confirmed cases.
Medical laboratory services are an essential component in the diagnosis and treatment of patients infected with COVID-19, human immunodeficiency virus (HIV), mycobacterium tuberculosis (TB), sexually transmitted diseases (STDs), malaria and other infectious diseases. The laboratory, therefore, plays a pivotal role in medical practice as test results have a major influence on clinical diagnosis and patient management.
The role of medical laboratory scientist (MLS) in the fight against COVID-19 is in the area of testing in the following three laboratory processes: preanalytical (contact tracing, samples collection, packaging, and transportation); analytical (samples reception, processing, and testing); and post-analytical (interpretation of results and delivery, disposal and/or archiving of the specimen).
The success of the fight against COVID-19 is adequate laboratory testing across the country as advised by the WHO so that results are obtained in real-time for patient treatment and management as well as frontline health workers. Unfortunately, there are few tests recommended by WHO for the diagnosis of COVID-19. Reverse transcription-polymerase chain reaction (RT-PCR) tests are the gold standard (a superior technique that determines the presence or absence of the virus) where viral particles are amplified in numbers so that they can be measured.
In Ghana, few research laboratories had the PCR machine: for instance, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana; and Kumasi Center for Collaborative Research into Tropical Medicine (KCCR) that has Biosafety level 3 (a separate laboratory with safeguard measures put in place to protect the laboratory personnel as well as the environment and community from an infectious virus, like SARS COV-2). Subsequently, testing was expanded to cover other testing sites such as National Public Health and Reference Laboratory in Korle-Bu Teaching Hospital; Public Health Laboratory at Tamale; and other public and quasi institutions as a result of backlog of samples generated from the increased disease surveillance. The country’s Food and Drug Authority (FDA) is in the process of approving a rapid diagnostic test (RDT) kit for serological (antibody, IgM/IgG) testing of COVID-19. This test will enable quick screening of individuals who have been exposed to SARS COV-2 in the community to make a decision, thereby reducing the turn around time (TAT) of testing.
The Medical Laboratory Scientist is a member of the regional, district, and hospital COVID-19 response team, thus, a key person in the frontline responsible for contact tracing and sample collection for all suspected patients.
Respiratory specimens such as nasal (nose) and oropharyngeal (throat) swabs are taken alongside blood specimens for testing. Recently, sputum specimen has become an alternative specimen for COVID-19 testing. These specimen after the collection are packaged using the triple packaging system to ensure that the integrity of the sample is maintained. The samples are then transported at the appropriate cold chain to the testing sites to initiate testing.
The second essential contribution is that the laboratory continues to perform other lab investigations to monitor the progress of COVID-19 patients to determine the disease prognosis of an individual. Haematological, coagulation, and biochemical tests are routinely performed while patients are isolated to receive treatment. There have been indications from research to show that these parameters are affected in COVID-19 patients. Post-mortem samples have also been taken for testing to detect the cause of death. Here too if there is interest to look at the tissues of the body for changes caused by SARS COV-2 to the cellular architecture, the MLS prepares the tissues for examination in cellular pathology.
In spite of the several roles played by the medical laboratory in the fight against COVID-19, the country has no National Health Laboratory Policy (NHLP) that will provide strategic directions and guidelines to strengthen the laboratories in periods such as this. During the Ebola outbreak in 2014, the Global Health Security Agenda was introduced to strengthen medical and veterinary laboratories so that specimens could be referred to facilities more equipped to perform infectious diseases during epidemics and pandemics for testing at the regional hospitals. Unfortunately, things were not meant to be and we are caught with this new pandemic.
In a nutshell, the medical laboratory scientist plays a critical role in the fight against COVID-19 in terms of diagnostics and disease surveillance. The call for the launching and implementation of the NHLP is not a mere vociferous cacophony but to strengthen the laboratory’s capacity and medical laboratory scientist dexterity to prepare for future outbreaks. The call by the President to build infectious disease centers (Ghana Centers for Disease Control and Prevention- GCDC) is a call in the right direction to effectively tackle infectious disease head-on in Ghana.
Ghanaians are advised to follow the guidelines given by the President and the health care professionals on the wearing of mask, social distancing, hand washing, and sanitizers to avoid infection. Individuals with abnormal hemoglobin (such as sickle cell anemia and thalassemia) should be cautious in the use of inappropriate nose masks that are not recommended by WHO, and/or by FDA because that could be a major course of hypoxia as a result of poor oxygenation. Let’s all stay safe. The country needs us alive.
