Testing asymptomatic people is imperative to fight Covid-19

The government faces serious challenges in the fight against Covid-19. Should the lockdown be lifted or extended for a longer period? If not lifted, should it only be a partial lockdown? Can the economy survive a further extension of the lockdown?

Important information is emerging, highlighting that the negative effect of Covid-19 on the economy is intensifying. Job losses continue to mount. Public discourse is growing in response to an apparent lack of government co-ordination around relief packages. Increasingly, frequent warnings that people who face starvation are unlikely to heed recommendations to prevent the spread of the coronavirus are gaining traction.

The Covid-19 outbreak in SA is in a relatively early stage. The first confirmed case was identified less than two months ago, on March 5. Some commentators predict that SA will experience a peak of infections towards the end of 2020. As of April 20, there were just over 3,000 confirmed cases of Covid-19. However, this is based on testing symptomatic people. Increasing evidence from across the globe suggests that confining testing to symptomatic people may result in a large pool of undetected infected but asymptomatic persons.

It is estimated that 50%–85 % of infected people remain asymptomatic. The implication is that the actual number of cases in SA is currently closer to 150,000 (3,000 x 50). Furthermore, experts believe asymptomatic people can transmit the virus. This emerging picture supports the argument that SA needs to massively scale up the testing programme to identify asymptomatic spreaders and manage them accordingly.

Employers’ responsibility

Employers have an opportunity to make a significant contribution to testing for the coronavirus. In consideration of the emerging picture described above, it may be prudent to consider every person as a potential asymptomatic carrier/spreader. Thus, the importance of infection prevention control (IPC) measures cannot be over-emphasised.

A strengthened partnership between the government and employers, in which each stakeholder commits to fulfilling its responsibilities, may provide an acceptable argument in support of lifting the lockdown, within reason, and mitigating the negative impact of Covid-19 through re-igniting the economy.

Employers have a legal responsibility in terms of the Occupational Health and Safety Act (OHSA) to ensure that the workplace is safe and without hazards to the health of employees or, indeed, any other persons visiting a workplace.

It could be argued that not identifying asymptomatic cases and thereby exposing those not infected is tantamount to employers breaching the law. The hazardous biological agents (HBA) regulations of the OHSA obligates employers to conduct risk assessments in terms of biological hazards, such as the coronavirus. Where exposure to such agents is likely, the HBA regulations provide for medical surveillance of the at-risk people.

By implication, this can be interpreted that — in addition to the daily screening of the workforce, identifying symptomatic persons, and prompt testing of symptomatic persons — routine testing of asymptomatic persons under the guidance of occupational health professionals, forms part of the legal requirements for employers. This approach offers a reduction of the testing burden, which is currently confronting the government.

The timeous, proactive identification and management of infected, asymptomatic people has the potential to mitigate the transmission of Covid-19, prevent health services from being overwhelmed, and help reduce coronavirus-related fatalities.

• Dr George is national occupational medicine executive with the Momentum wellness unit.