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Coronavirus: Test the testing and if it fails, fix it — fast

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Dr Michael Kahn is Extraordinary Professor in the Centre for Research on Evaluation, Science and Technology at Stellenbosch University, and a member of the DST-NRF Centre of Excellence in Scientometrics and Science Policy. Michael Gering is a strategy consultant and has consulted in a variety of industries both in South Africa and in Europe. He has a PhD in theoretical physics and an MBA from the Open Business School.

The big issues facing our country are not illegal cigarettes, when we can exercise, or whether we can get warm food at the supermarket. The big issues are how to drive the reproduction rate of the virus below one. One part of the solution is the good practice of hygiene, physical distancing and masking up. The other part is testing, tracing, isolation, and hotspot management.

Shortly after the Berlin wall fell, one of us was asked to meet with the top managers of a Trabant plant. The parking lot was full of trabbies with faults rendering them unfit for market. As far as the factory manager was concerned, they were made to spec. He had achieved the targets that he was set. But they did not fulfil the basic requirement of an automobile. They did not work.

Recently there was a report of a taxi driver in the Western Cape, driving passengers after testing positive for Covid-19. There was, of course, the immediate outrage. The driver was to be charged with attempted murder. 

Less conspicuous in the article were the dates. The man was tested on 30 April. But he was only informed of his status on 6 May. Was he under mandatory quarantine? We don’t know. The time lag between test and result is a crucial variable in attempts at managing the pandemic.

The Covid virus is believed to be most contagious in the first few days prior to showing symptoms. The days between the test and the result might well have been as problematic as the much later action, the action which has resulted in a charge of attempted murder.

Let’s compare this with the process in Wuhan, where timeous testing was the key to the lifting of lockdown. Anecdotally anyone entering or leaving a building was screened for temperature. If they tested positive, they were immediately taken to a dedicated facility and their lungs were CT scanned. In our country, CT scan turnaround times are at best several hours. But by targeting lungs only, Wuhan radiographers, working with radiologists, were able to reduce the process to minutes. A positive CT scan then led to swab testing with the patients waiting for roughly four hours, all the while in quarantine. Positive swab results led to immediate treatment and contact tracing. In Wuhan, contact tracing has reduced new cases to all but zero. This narrative is based on the early February on-site report of Dr Bruce Aylward for the WHO.

The contagiousness of the Covid virus and the now eight-day doubling rate in our country do not allow for test delays of days, let alone a week. Contacts need to be traced before they become symptomatic. In the US, a call has been made to discount tests where the results have taken more than 24 hours to be communicated. 

As Bill Gates put it, if the test comes back positive what should the patient do? Send their contacts a letter of apology? 

The big issues facing our country are not illegal cigarettes, when we can exercise, or whether we can get warm food at the supermarket. The big issues are how to drive the reproduction rate of the virus below one. One part of the solution is the good practice of hygiene, physical distancing and masking up. The other part is testing, tracing, isolation, and hotspot management. Here the strategy rests fundamentally on rapid results and decisive action.

Over the next few weeks, as the economy opens up, a lot of focus will be on managing potential hotspots. All enclosed spaces where workers spend long periods in close proximity to one another are Petri dishes for the spread of COV-2. The United States shows just how difficult it is to maintain safe production in meat plants. 

Potential hotspots include hospitals, care homes, prisons, funerals, food processing and packaging, and retail, our households, and educational facilities. Hospital workers are in the frontline, they must be protected. Care homes must restrict contact as much as possible, ensure spaces are well ventilated and monitor carefully. Prisons are highly problematic, given that they are routinely overcrowded, and often function in states of undeclared warfare. Each place where gatherings occur will need to be subject to a workflow study and scarce government resources will need to be allocated to this. Underlying all of this will be testing, and the testing will need to be fit for purpose.

Like East Germany in the 80s and 90s, South Africa has fallen behind in terms of basic management practices. We make absurd statements, such as: “We are good at policy, but bad at implementation.” There is no reason why it should take us a week to do what the Chinese do in four hours. 

To invoke a basic management principle, it is a case of basic “blocking and tackling”.

Basically, we need to map the process and identify bottlenecks, handovers and points of weakness. We need to optimise the repetitive tasks with standard operating practices. We need to quantify the line from start to finish and balance it. We need to identify points of weakness and put in place tools to monitor.

In South Africa, too often, process flows are done for the auditor and not used as a tool to eliminate waste, cut cost, and improve responsiveness. We need to set an initial target of a 24-hour response. Then we need to put in place a continuous improvement mechanism to take it down to “best practice”. Finally, we need to make strong decisions regarding laboratories unable to meet the criteria.

When the cars come out of the factory, they need to work. Not almost work. Test the testing, and if it fails, fix it, and fast. DM

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