By Prof Dr James Koh Kwee Choy
Dear readers an audio version of this article is available below.
Judging from the reported number of COVID-19 positive cases in Malaysia and around the world, the task to bring infections down to zero is near impossible.
In all honesty, we are all battle-weary since the pandemic started 18 months ago.
COVID-19 may never go away.
But we can live with it, turning this pandemic into something less threatening.
Perhaps this could be the way forward given the impressive vaccination rate in Malaysia, which is key in reducing the risk of infection as well as transmission.
Social responsibility such as practising good hygiene and being considerate to one another such as staying away from crowds when unwell is critical as well.
Another aspect is also to minimise the spread of the transmission if you’ve come in contact with someone positive.
To do this, self-testing and home isolation are two important strategies. Today, people can get themselves tested readily by using fast and easy tests. If positive, they can then confirm it with a more accurate testing method and isolate themselves to recover at home, stopping the spread there and then. Even if you test negative, it is best to remain in home isolation for at least 10 days. Recovery at home is possible because, with vaccination, the symptoms are mostly mild. This will at least give our healthcare system some breathing space so the more serious cases can get the medical attention they need.
In Malaysia, there are many different COVID-19 tests but in general, there are two types: PCR and RTK-Ag. PCR, short for ‘polymerase chain reaction’, uses nasopharyngeal samples. PCR is the gold standard in testing because it is highly accurate in detecting viral genetic material. In scientific terms, the sensitivity of a test refers to its accuracy in detecting an infection, while specificity refers to its accuracy to rule out an infection. The RTK-Ag test kit, short for Antigen Rapid Test Kit, which uses saliva or nasal samples, has specificity between 91 per cent to 95 per cent and specificity between 98 per cent 100 per cent. Unlike the PCR, the RTK-Ag kit detects spike proteins present on the coronavirus rather than viral genetic material. It is a less invasive and more affordable way to test for COVID-19. Please note that the sensitivity and specificity scores are different across brands.
When might you consider using a home test kit to detect COVID-19? You might want to do this if it is confirmed you are indeed a close contact with a positive case.
By close contact, it means that you have been in very close proximity to a person who tested positive for a significant period. You would need to establish when it was that you were in contact with the person. Two days prior and three days after a confirmatory test are when the virus is most contagious.
So, if your friend tested positive on Thursday, and you were near your friend two days before, which is Tuesday up to three days after, which is Sunday, you are likely to have had a significant risk of catching COVID-19. You may feel the need to test immediately after receiving news of being a closed contact; this is not a good idea as it is still in the early days and the viral load may not be high enough to be detectable. The best time to get tested is between three to five days after the last contact with the infected person.
However, if in doubt, and you were in really close contact, you can still perform the test for ease of mind but do take note of the recommended testing time. You may want to minimise your movement or contact with others while waiting for the best time to get tested.
Which test to use?
The PCR test is recommended for those who manifest symptoms or those who have come in close contact with a COVID-19 positive patient.
PCR tests are expensive, costing between RM200 to RM300 per test, and results may take between 24 to 48 hours to be available.
RTK home test kits may be a cheaper alternative for those who are concerned with their infection status but exhibit no symptoms of COVID-19, it takes under 20 minutes for the results to become available. However, if the RTK self-test shows a positive result, it is best to confirm it with a PCR test.
Isolate yourself once positive
What’s next if you have tested positive? If you are in category one (no symptoms) or two (mild symptoms), you can self-isolate at home, but you do need to consider these two factors.
Your home environment and the caregiver factor.
Do you have a well-ventilated room with an ensuite bathroom?
Otherwise, if you are sharing a bathroom, you will have to make sure you wipe down and sanitise after every use.
While it is best to be alone during your home isolation, it may not be possible, especially if you have people depending on you like young children or elderly parents.
It may be a challenge trying to stay away from them during isolation so it is best to arrange for their care while you are recovering.
Trying to go about your usual routine isn’t exactly possible given that your priority should be more rest.
You need a caregiver, someone who is able and healthy to attend to your needs throughout the isolation period.
More importantly, this caregiver should be someone who knows how to get you the help you need should your condition deteriorate.
Or maybe you are the caregiver – how will caring for someone with COVID-19 affect your health?
If you are older or have an existing medical condition but need to provide care to a family member, you may be at a higher risk of serious illness with COVID-19 should you become infected.
Fortunately, there are many informative home isolation guidelines you can read up online to help you get through the challenges.
The most important thing you will need to remember is to do close and careful monitoring and to strictly follow the SOPs (standard operating procedures).
It’s not just about staying at home.
It’s about observing your condition for any signs of deterioration, and most of all, if you are living with others, you will want to make sure that you do not spread the infection. The idea of home isolation is to wait out the infectivity of the virus.
The current practice is to quarantine for 14 days if you have symptoms; if you are asymptomatic, then it is ten days. During this period, you will be required to self-monitor and report your condition through your MySejahtera app so that healthcare authorities can perform follow-up action should your condition worsens.
A crucial thing to take note of is low oxygen saturation, which refers to very low oxygen levels in the blood. Some patients don’t display any symptoms in the initial stages of the infection and appear healthy, despite their oxygen level being less than 90 per cent.
This is a sign of “happy hypoxia”, a very serious condition for COVID-19 patients.
If undetected, it may result in a late presentation to the hospital and a worse outcome.
Get a pulse oximeter to measure the blood oxygen saturation.
A healthy level of blood oxygen saturation is above 95 per cent.
Anything lower than 94 per cent would be of concern.
For an accurate reading, try this tip.
Do one reading first. It may be a normal reading.
Then do this, sit down and stand up from a chair as many times as you can in one minute and check again with the pulse oximeter. If there is a drop from your first reading – of more than four per cent – you should probably seek help.
Aside from the MySejahtera app, there are also other daily assessments you can carry out yourself.
Get a thermometer to check your temperature twice a day to detect the onset of a fever. Be mindful of COVID-19 symptoms – is your cough getting worse or your breathing becoming more difficult? Are you experiencing a new loss of smell and taste, do you have diarrhoea?
If this happens, get medical attention immediately.
Home isolation is not easy, but it is necessary to curb the spread of the virus and one of the most likely scenarios should we test positive for COVID-19.
It can be done properly, with the right supervision and monitoring.
Follow SOPs. Test yourself. Home isolation can be inconvenient, and it can feel like a terrible, terrible 14 days. But you have to remember that it is for your good where you are giving yourself some self-care so you can heal.
About the Author: Prof Dr James Koh (pictured above) is the Associate Dean, Academic Affairs, Infectious Diseases Consultant at the International Medical University. This is an opinion column. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of this publication.