The current sampling regime being adopted by Health Authorities in Liberia has an inherent loop hole that, if not addressed properly, may lead to more candidates opting to remain incognito for fear of being stigmatized. As a standard, the entire chain of custody (specimen collection, transportation, sample preparation, testing, data analysis and reporting) should be conducted in a manner that candidates presenting themselves for COVID-19 test fully understand and are assured that their privacy will be maintained at all times and that their identities will not be made public as having contracted the virus.
By Dr. Nathaniel Blama, [email protected], Contributing Writer
While it is understandable that health authorities need to take steps to investigate who else an infected person might have come in contact with, it is important to also keep in mind that this is a medical diagnosis and, as such, should be treated as confidential medical information. If an infected person diagnosis is released to the public, it is unlikely that other infected persons or suspects will be willing to present themselves for testing, resulting in greater risk to the public.
Current Sampling Regime
Candidates reporting from home or Preliminary Observation Centers (POCs)
In the current dispensation, if candidate ‘X’ is presenting symptoms of the COVID-19 or is deemed to have been exposed to persons presenting with symptoms, a contact is established using the hotline ‘4455’. Technicians are immediately dispatched to the candidate’ home to collect specimen. A form is presented to the candidate and personal information such as candidate’ name, age, date of birth, underlining conditions (if any), symptoms and contact number(s) are filled in. The candidate’ specimen and filled form are taken by the technicians for testing and filing. In the event that candidate ‘X’ test result comes back positive, there is a higher chance that the candidate name appears in the media even before he/she is made aware of the said result.
Candidate reporting at the Testing Center
If candidate ‘X’ is presenting symptoms of the COVID-19 or is deemed to have been exposed to persons presenting with symptoms and decides to voluntarily report for testing, he/ she arrives at the testing center and, as in the aforementioned scenario, a form is presented to the candidate and personal information such as candidate’ name, age, date of birth, underlining conditions (if any), symptoms and contact number(s) are filled in. The candidate’ specimen and filled form are taken by the technicians for testing and filing. As in the previous case, in the event that candidate ‘X’ test result comes back positive, there is a higher chance that the candidate name appears in the media even before he/she is made aware of the said result. This in no way suggests that all of the technicians are unprofessional but the mere fact that the Liberian society is very gullible and, as they say, “everybody knows everybody” makes it even more expedient to put a new sampling regime in place to ensure patient confidentiality.
Proposed Sampling Regime
Candidates reporting from home or POC
In the proposed regime, if candidate ‘X’ is presenting symptoms of the COVID-19 or is deemed to have been exposed to persons presenting with symptoms, a contact would be established using the hotline ‘4455’. Two teams would be dispatched separately. The first team would be comprise of the sampling technician(s) whose job it would be to collect specimen and issue a form with a unique identification code (UIC) corresponding to the code on the specimen container. When the second team arrives, the first team departs with the sample to the laboratory for sample preparation and analysis. The task of the second team would be to fill in the form left behind by the first team. The fill-in details should include all previous information except the candidate’ name (the UIC is enough for this purpose). The second team will submit the filled form to the Doctor who would instead contact a candidate (using the contact number on the filled form) in the event that a candidate’ UIC corresponds with a positive test result.
Candidate reporting at the Testing Center
If candidate ‘X’ is presenting symptoms of the COVID-19 or is deemed to have been exposed to persons presenting with symptoms and decides to voluntarily report for testing, he/ she arrives at the testing center and, as in the aforementioned scenario, the two teams will perform their tasks independently as outlined in the aforementioned scenario to enhance patient confidentiality and, by extension, build public trust and demystify the myth surrounding the testing and reporting process. It is important to note that this proposed regime is not a quick fix to the bridge of confidentiality debate, but it does offer an plan to make much more difficult to make public a candidate’ result without his/her consent.