Fumigation Exercise is Terminal 3 ahead of Airport Reopening
Fumigation Exercise at Terminal 3 ahead of Airport Reopening

A letter from the Frontiers Healthcare Services sighted indicated an increase in the number of cases picked at the Kotoka International Airport (KIA) for COVID-19 using the antigen test among passengers.

As much as the information is deficient in my view because it is dealing with absolute numbers without account of the passenger inflow at the respective periods of comparison, it is still worth looking into across various scenarios and not swept under the carpet.

As per the protocols in Ghana for travelers, each passenger is expected to carry a negative PCR test for SARS COV-2 within 72 hours prior to embarking on the journey.

It is therefore worrying to have several of such people being positive when an antigen test is used.

This raises a lot of concerns that must be looked at and checked because it has several implications for our fight against the pandemic.

The concern are those passengers who might be missed and get across into the population to cause another waive of the pandemic.

Possible reasons for the KIA occurrence

First and foremost, one would want to know if passengers traveling to Ghana carry false PCR results? Is the system allowing people who do not do the test before traveling? Are the quality checks relaxed for travelers? These questions beg for answers.

Obtaining fake results before traveling to Ghana could be one of the reasons why some of these people are picked for positive antigen tests.

That is not to say that individuals who test positive to antigen tests carry fake PCR results.

It is just a matter of the proportion of positive antigen test results among those who had taken a PCR test and were negative.

Secondly, is it the case that the current platform for PCR test is missing the variants those passengers are carrying and rather the antigen test can pick?

The PCR test targets specific molecular components of the virus, it amplifies the nucleic acid materials of the virus when present and reports the amplified copies in real-time as positive after a certain number of cycles.

A possibility for people to test positive to SARS COV-2 antigen test while they are holding PCR negative test is for the PCR test to fail to pick up cases, but the antigen test does. 

Is it time for the development of new PCR tests that can be able to pick the current SARS COV-2 variants that exist and new variants coming up?

Again, the COVID-19 vaccines, particularly the ones from Pfizer/Moderna which are mRNA vaccines, and AstraZeneca which is a DNA vaccine, currently and largely in use, cause vaccinated individuals to produce certain proteins of the SARS CoV-2.

The individuals then elicit antibodies to these proteins. We are made to understand that the nucleic acid materials and the proteins from the vaccines should not make anyone test positive for any form of COVVID-19 test except the antibody test.

With the reported incidences at the KIA, is it time to investigate if the vaccines are now generating antigens (proteins) that the antigen test can pick contrary to what is known?

Could that cause individuals who have received COVID-19 vaccines to test positive with antigen tests as may be happening at the KIA? This must be investigated rather than discounted.

What do we need to do?

As a matter of urgency, the government must review the travel protocols and restrictions and possibly consider these regulations on a country-by-country basis.

For some of the countries and depending on their situation, we may have to allow only individuals with PCR tests as well as a covid-19 vaccination certificate.

To others, we may have to add a mandatory period of quarantine to observe before allowing them to mingle with the public.

It might be a difficult political decision, but the government might have to close its borders to citizens of some countries depending on the way the pandemic is being managed and responded to by the public.

The support to the health systems in Ghana must not relax as if we are out of the woods. This is the time to strengthen the good things we have done over the period in fighting the pandemic than to go to sleep.

Resourcing our medical laboratories and health facilities together with motivating the health workers should not be taken for granted.

In Ghana, counting about 40 COVID-19 testing laboratories is a good sign of our readiness to continue and win the fight but these are all useless without a constant supply of reagents.

Scientists must start investigating and not sit down. We need to investigate the development of test kits that can help in identifying the current strains of SARS Cov-2 and other new variants.

The possibilities of vaccinated individuals getting positive COVID-19 antigen test results should also be investigated to inform the discussions.

Quality checks at the airports where we admit travelers before they start their journey and when they arrive in Ghana must be stringent.

Anyone caught compromising on these checks must be brought to book because it is a public health emergency, and the necessary whip must be cracked to deserving culprits.

The public must continue obeying the COVID-19 protocols which are still in place.

They should not relent in wearing face/nose masks, maintaining social distances in gatherings, and must always endeavour to wash their hands with running water and soap.

What we have all failed to realise is the indirect benefit of these hygienic practices in reducing cases of diarrhoea in the previous year.

In addition to the vaccine, we stand a better chance to winning the fight against COVID-19.

All test platforms have their diagnostic performance indicators. One will always have to produce test results in the lenses of the validation performed on the test method.

This is a process that is not done once and for such reasons monitoring and regulations must be regular in facilities that conduct tests.

The system at the KIA must equally be checked regularly to ensure compliance with the quality assurance measures required of the ISO 15189 guidelines (GS ISO15189:2017) in order not to cause false panic in the country.

We must ensure the increased cases are not a matter of false positive results which by large could be a system failure.

This stretches to the competence of those performing the tests at the national airport.