Nigeria is aggressively looking for a way to build its testing capacity to meet the growing demand as its citizens resume going to school and work.
Experts believe Saliva Direct, a new testing regimen being adopted in many western countries can give a lift to the country’s testing capacity and reopening plans.
As of Tuesday morning, 403, 347 of Nigeria’s 200 million have already been tested for COVID-19, a potentially dangerous pneumonia-like disease. This resulted in the discovery of 54, 008 infections thus far.
In the past one week, cases have fallen below 300 daily suggesting that Africa’s most populous nation may be flattening the COVID-19 pandemic curve.
But despite a continued decline in the daily figure with a considerable improvement in testing from March when only 500 tests were conducted per day, Nigeria’s testing regimen is still lagging.
More still, there has been a troubling uptick in mystery cases, which health experts believe could upset plans of full opening of public activities across the country.
Majority of Nigerians who contracted COVID-19 so far, did not have relevant travel history or exposure to another individual with the virus, meaning that the origin of their infection is unknown, according to data from Nigeria Centre for Disease Control (NCDC).
Nigeria is still struggling to ramp up COVID-19 testing majorly due to lack of adequate equipment and reagents needed to carry out the Reverse Transcription Polymerase Chain Reaction (RT-PCR) which is currently the main source of testing in the country.
Tests to diagnose viral infections are key to controlling the pandemic, but Nigeria, among other African countries, do not make any locally and must import them.
On April 28, the Nigerian government announced its target of testing at least two million people within the next three months.
The 90 days’ target elapsed with Nigeria failing to cover at least 30 per cent of the two million.
“The main challenge Nigeria has had with testing has been its inability to test as many people as possible. Inability to secure test kits in a world where they are still in high demand means that cheaper, alternative, mass-produced options are being sought all over the world,” Ikemesit Effiong, a forensic expert, said.
Supplies of nasopharyngeal swabs were some of the first testing materials to run low sometime in mid-March across the globe, prompting a pivot to nasal swabs.
Nigeria’s health minister, Osagie Ehanire, at a bi-weekly Presidential Task Force on COVID-19 briefing said the country is monitoring new diagnostic technology, including the saliva-based test.
To boost testing capacity, Nigeria’s Federal Executive Council (FEC) had on August 12 approved N8.49 billion for the purchase of items needed to test for COVID-19.
While applauding the move, health experts believe more resources should be channelled towards adopting and domesticating Saliva Direct, a Saliva-based laboratory diagnostic test innovation which has emerged a safer, faster and simpler way to diagnose COVID-19 infections.
They believe this is capable of solving Nigeria’s testing challenges. – just spit a glob of saliva into a cup, close the lid and hand it over – as simple as that.
Developed by Yale School of Public Health in the United States and approved by the US Food and Drug Administration (FDA), Saliva Direct COVID-19 diagnostic test eliminates the need for swab or collection device as the samples can be collected in any sterile container. Additionally, the test does not require a separate nucleic acid extraction step.
Many countries in Europe, America and South Asia are beginning to show interest in Saliva Direct, a low-cost saliva test that will enable people to collect their own samples with minimal discomfort, without invasive nasal or throat swabs, according to Economic Times, a local Indian newspaper.
Experts Give Thumbs-up to Saliva Direct
Giving a thumbs-up to the alternative testing technology that is yet to be introduced in Nigeria, Olaide Shuaib, a Medical Laboratory Scientist, said Saliva Direct does not just have the potential of delivering results faster and more accurately but would also minimise the risk for healthcare workers collecting samples.
Although, Chairman of the Presidential Task Force on COVID-19, Boss Mustapha, said Nigeria’s testing infrastructure can undertake 15,000 tests per day, the country still conducts about 3,000 tests daily, across 64 molecular laboratories.
“We lack amenities needed to carry out the COVID-19 tests. “To carry out more tests, we need to explore other methods available such as Saliva Direct,” Mr Shuaib said.
“The advantage of the Saliva based Test is that it offers an improvement over the standard swabbing method because people can collect their own samples within minimal discomfort and no expertise require,” the scientist explained.
He said it reduces the risks of patients contracting the virus at the test point. Health workers will also be at a lesser risk of contracting the virus.
“It provides more active and accurate result, amplifying the target pathogen in less than 15 minutes, with tenfold greater sensitivity than conventional PCR.”
Mr Effiong, Head of Research at SBM Intelligence, described Saliva Direct as a low-cost, non-invasive saliva-based test kit (SBTs) which requires minimal processing and retains much of the accuracy of traditional nasopharyngeal (tests which require sample collection from nasal secretions from the back of the nose and throat) swabs.
“Countries that have had long-standing issues with consistent and widespread testing are clearly moving in that direction – the US approved its fifth COVID-19 SBT just last week. Nigeria should not be an exception.
“Saliva testing is simply cheaper and less expensive in terms of extraction, storage and analysis. With traditional COVID-19 testing, once the sample is collected, the virus’s RNA must be extracted before it can be detected by sensitive, PCR-based methods.
“What most saliva-based tests do is remove that need for RNA extraction; that step is replaced with something as simple as adding an enzyme and heating the sample up.
“Extraction has always been the most expensive and the most time-consuming step of the COVID-19 testing process. In addition, the total cost of the reagents needed for one SBT in some iterations is roughly $5 or about N2500, meaning it could be offered to the public at a fraction of current test kits. SBTs not only simplify the process, more tests can be done and results are delivered faster. some SBT designs can run as much as 90 samples in about three hours.
“They also compare favourably with existing testing options, researchers have estimated a 88 per cent to 94 per cent accuracy range for American SBTs.
“For Nigeria, being at the back of the queue in terms of product innovation and manufacture means that the priority of manufacturing nations will take precedent over our testing needs. Some SBT manufacturers, notably the Yale School of Public Health, are making their SBT protocols open source, enabling researchers globally, including here, to study and adapt the method for use in their own countries.
“Policy support to incentivize local manufacturers to produce these SBT kits will be an important component of driving improves testing outcomes. Nigeria needs all tools in its arsenal in orderly to properly tackle COVID-19. SBTs could be a game-changer in that fight.”
Just like every other technology adopted in the fight against COVID-19, experts also said authorities should thread with caution in applying Saliva Direct as well as lookout for its negative effects.
“The disadvantage of the saliva-based method is that the saliva contains enzymes called salivary amylase which chew up DNA and inhibitors that interfere with DNA amplification process,” Mr Shuaib said.