Policy responses for Kyrgyzstan - HSRM


Policy responses for Kyrgyzstan

1.5 Testing

The Ministry of Health algorithm for testing for COVID-19 envisages testing for the asymptomatic close contacts of confirmed cases, the symptomatic contacts of confirmed cases, and the suspected cases according to the WHO standard case definition. Primary care workers, medical workers in hospitals and isolation facilities and medical staff at point of entry can request testing. Tests are being performed at 8designated PCR laboratories and in addition the Ministry of Health has designated 3 mobile laboratories to perform COVID-19 testing.

The virology laboratory of the Department of State Sanitary-Epidemiological Surveillance is designated as the National Reference Laboratory for Covid-19, with the Virology Laboratory of the Osh City Centre for Disease Prevention and State Sanitary-Epidemiological Surveillance as sub-national Reference Laboratory for the southern part of the country. Additionally, the Ministry of Health has designated 10 labs (3 mobile PCR laboratories,8 stationary PCR labs) to perform COVID-19 testing. In case of increased sample throughput, additional laboratory specialists from other laboratories, trained to perform PCR, could be engaged for testing; this plan has been approved by the Ministry of Health.

Testing for COVID-19 started on 4 February 2020, with PCR tests procured by the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), using supplementary tests (Amplisens RiboPrep and AmpliSens Reverta-L, Central Institute of Epidemiology, Moscow, Russia, for RNA isolation and reverse transcription). Until the beginning of June 2020, around 135,000 tests had been performed, equivalent to an average of 2000-2500 samples per day in the country.  There is a National Algorithm for testing for COVID-19 developed by the National Headquarters for COVID-19 that requires testing of all persons coming from “epidemiologically disadvantaged” countries, which is broader than the WHO case definition. So far, all clinical samples tested were nasopharyngeal swabs. Upon reception, samples are aliquoted and a portion is stored for further testing and confirmation, if needed.

For confirmation tests, the National Reference lab for COVID used tests provided by WHO, specifically the TIB MOLBIOL LightMix® SarbecoV E-gene tests and the TIB MOLBIOL LightMix® Modular COVID-19 RdRP- tests (German). The extraction RNA is performed by Amplisens RiboPrep kit (Central Institute of Epidemiology, Moscow, Russia) and one-step RT PCR was done by AgPath-ID™ One-Step RT-PCR kit (Applied Biosystems by Thermo Fisher Scientific). According to protocols it takes 5-6 hours to receive the results, but with the increased number of tests results are delayed (up to 1-2.).

The Ministry of Health, with technical support from the WHO Country Office, developed an effective method of sample pooling for the detection of SARS-CoV-2 coronavirus RNA, using PCR and evaluates this approach with various test systems. SARS-CoV-2 coronavirus RNA was detected in samples containing samples of nasal swabs placed in a transport medium. 5 samples were combined into one pool to perform the analysis. The effectiveness of the “in single test tube” pooling method for performing mass studies on COVID-19 was evaluated using the Vector-PCRrv-2019-nCoV-RG-19 test systems, Russia; "ArtTest COVID-19", Belarus; "BioSpeedy", Turkey. A total of more than 10000 test samples were detected and confirmed by PCR. When studying the method of pooling samples, its specificity and optimal sensitivity for detecting SARS-CoV-2 RNA using the Vector-PCRrv-2019-nCoV-RG, ArtTest COVID-19, and BioSpeedy test systems were used. The results of applying the pooling method correlated with data obtained without pooling samples.

The COVID-19 alert is based on enhanced reporting from all health care levels and from the points of entry; syndromic surveillance is not carried out. Points of entry are considered as the most likely entry point of the disease into the country.

Patient data is transmitted through an electronic system, based on immediate notification, to the next-higher level. Three times per day the Ministry of Health receives data from oblast health authorities, who get them from district level authorities and points of entry medical staff. The Ministry of Health then reports 3 times per day to the Republican Task Force that is responsible for the national coordination and management of the COVID-19 crisis.

As of 7 July 2020, the following categories are subject to testing:
1. Contacts with confirmed cases of COVID-19;
2. Persons with COVID-19 symptoms, regardless of contact with confirmed cases;
3. Health workers;
4. Non-health workers involved in the fight against COVID-19;
5. Military service personnel.