Coronavirus testing shortfall in crisis-affected states risks undetected outbreaks, imperilling COVID-19 fight worldwide

New York, NY, May 20, 2020 —  Data compiled by the IRC(4) reveals significant shortfalls in COVID-19 testing in many conflict-affected countries, highlighting the dangerous prospect of undetected and therefore uncontrolled outbreaks as the Coronavirus continues to spread globally. 

According to IRC’s analysis of countries where we work, the lowest numbers of tests per million include: Yemen (31 tests per million), Chad (105 tests per million), Nigeria (165 tests per million), Mali (173 tests per million). The area of Northeast Syria is also of concern, with 59 tests per million. 

This suggests an under-detection of COVID infections in these states - thereby inhibiting the necessary contact tracing, isolation and treatment of cases to control an outbreak which stems from a lack of testing ability. By way of comparison, the United States - a nation struggling nonetheless, along with its wealthy counterparts, in the fight against this virus - has carried out a total of 38,394 tests per million people of the population; the UK 41,599; and Germany 42,581(5).

The crisis-affected states IRC operates in with the highest COVID test positivity(6) - where high rates suggest a far larger but undetected level of population infection - are Somalia (45%), Afghanistan (30.1%), Chad (29.30%), Mexico (28.6%), and Mali (25%). By way of comparison, the US currently stands at around 15% positivity; the UK at 11%, and Germany at 6%.

Of additional concern to IRC are crisis-affected countries for which data is either incomplete, inconsistent or absent entirely, such as Yemen, Tanzania, and Syria - which makes tracking the spread of the virus, particularly amongst the world’s most vulnerable, all the more challenging. Data from Venezuela, where 90% of hospitals already experienced critical shortages prior to COVID, is also of concern - there is high likelihood not only of untold numbers, but of a limited flow of information on infections writ large.

Fortunately, many of the countries where the IRC works - despite the stark differences with wealthier countries in terms of resources - have shown commendable foresight in instituting early mitigation measures(7). These include countries like Jordan, Thailand, Ethiopia and Uganda, all proactive in terms of testing and screening, contact tracing and social distancing measures. At the same time, these social distancing measures can only be managed with confidence, and adjusted in line with changes to the context, if testing capabilities are increased. Elsewhere, notable upticks in growth rates this week alone are of concern in countries like El Salvador, Nigeria, Yemen, Afghanistan, and Mexico - only validating fears of a growing but partly obscured pandemic.

David Miliband, President and CEO of the International Rescue Committee, said: 

These startling figures speak to the dangerous prospect of undetected and potentially  uncontrolled outbreaks in crisis and conflict-affected states. Rapid detection is essential for rapid response, and rapid response saves lives. COVID-19 has already brought the strongest health systems in the world to their knees - and we are now seeing virus hotspots growing in parts of Africa, Asia, the Middle East and Latin America. The IRC has already warned about the longstanding humanitarian vulnerability and shocking disparity of health system capacity in these states to handle the outbreak. Far from making progress in curbing the outbreak, the lack of testing is a major barrier to even seeing the tip of this global iceberg, let alone its full and devastating scale. 

This pandemic will not come to an end here until it is under control everywhere.  These countries urgently need the financial and programmatic support to significantly increase their surveillance, testing capacity and contact tracing to ensure we are capturing all information necessary to understand this pandemic - and to beat it. As part of a comprehensive and context-appropriate humanitarian response, testing and diagnostic services for COVID-19 must be available to all refugees and vulnerable groups in humanitarian settings. 

Without a truly global response, any effort, however extraordinary, to contain the virus nationally will be hampered by its spread and persistence internationally. As the Administration and US Congress consider the next round of supplemental funding for COVID-19, an additional $12 billion is needed for the international response. Urgent action is needed now to both secure additional resources and ensure that those resources reach frontline responses like the IRC’s. We are in a race against time.

The IRC has launched a US $30 million appeal to help us mitigate the spread of coronavirus among the world’s most vulnerable populations, with a focus on mitigating and responding to the spread in vulnerable communities, protecting our staff and ensuring continuation of life-saving programming.

Sources:

(1) Centers for Disease Control and Prevention, Testing Data in the US, updated as of 19 May 2020

(2) United Kingdom Government, May 19 Daily Update

(3) Robert Koch Institut, Epidemiologisches Bulletin, page 7

(4) Data updated daily as reported in Our World in Data and individual Ministries of Health across 32 countries. Updated as of 20 May 2020.

(5) The World Health Organization’s criterion with regards to adjusting public health measures to respond to COVID - including the thresholds needed to loosen restrictions in the face of a downward epidemiological curve- provides an alarming contrast to the state of the response in crisis-affected countries. In order to assess whether the epidemic is controlled, WHO set the benchmark of less than 5% of positive tests over the previous two weeks, assuming that testing is comprehensive to the tune of 1,000 tests per million inhabitants per week. The UK, US and Germany have respectively carried out approximately 10,000 tests per million over the past week alone (data as of May 20, 2020).

(6) Test positivity refers to the percent of confirmed cases out of the total number of tests performed: very high test positivity may indicate that only individuals with COVID symptoms are being tested, rather than a random and therefore extensive sampling of the population, which would catch mild and asymptomatic cases as well. 

(7) Across West African countries, thanks to early detection and mitigation measures, contagion doubling time has slowed from 4.1 days to 10.6 days after the introduction of mitigation measures. Likewise in central African states from 4.8 days to 15.2 days.