COVID-19 DIY: Self-Testing & Isolation

Professor Dr James Koh Kwee Choy of International Medical University (IMU) dishes out advice on how to correctly perform self-testing and home isolation to stay ahead of the virus

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RTK-Ag test kit, short for Antigen Rapid Test Kit, which uses saliva or nasal samples, has specificity between 91% to 95% and specificity between 98% to 100% (RTK kit brand featured for illustrations only)

Judging from the reported number of COVID-19 positive cases everywhere, the task to bring infections down to zero is a little hard although vaccines have helped bring down the numbers significantly, especially in Malaysia. 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 who is 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% to 95% and specificity between 98% to 100%. 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 in close proximity with 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,” says Prof Dr James Koh Kwee Choy, an Infectious Diseases Consultant and the Head of the Division of Medicine, School of Medicine at the International Medical University (IMU). 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 3 to 5 days after the last contact with the infected person. However, if in doubt, and you were really a 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 generally 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,” says Prof James.

Isolate Yourself if Positive

What’s next if you have tested positive? If you are in Category 1 (no symptoms) or 2 (mild symptoms), you can self-isolate at home, but you do need to consider these two factors, says Prof James: 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’s 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,” says Prof James.

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. “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,” shares Prof James. “The current practice is to quarantine for 14 days if you have symptoms; if you are asymptomatic, then it is 10 days,” says Prof James. 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 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%. This is a sign of “happy hypoxia”, a very serious condition for COVID-19 patients. If undetected, it may result in 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%. Anything lower than 94% would be of concern”, says Prof James. For an accurate reading, try this tip from Prof James: “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 4% – 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?” says Prof James. 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 own good where you are giving yourself some self-care so you can heal,” says Prof James.

Do it Right

*When self-testing with the COVID-19 saliva test kit, it is important you follow the right steps to get an accurate reading. Here’s what you should do:

* Rinse mouth at least 30 minutes before taking the test.

* Choose a well-ventilated and clean environment. Make sure you are alone to avoid spreading the virus if you are positive and so that you can focus on the task at hand.

* If you need assistance, make sure the other person is fully protected (mask, face shield, PPE, gloves).

* Have all the proper tools at hand:

o   Timer

o   Alcohol hand sanitiser

o   Disposal bag

o   Gloves

o   Apron

* Read the instructions properly before opening the test kit. Watch a how-to video beforehand.

* Collect the sample by spitting it into the test tube using the funnel. Then replace the funnel with a tube stopper.

* Mix the sample well by squeezing it 20 times and then shaking it 20 times.

* Allow the test tube to sit for five minutes while you prepare the test strip.

* Squeeze four drops of the sample onto the test kit and set your timer for 15 minutes.

* Read your results. 1 line equals a negative test result (no COVID-19) while 2 lines equal a positive test result. A faint line is an inconclusive test; you may want to repeat the test again the next day.

* Dispose your test kit properly. Put it into the attached plastic pouch, secure it and place it back into the test kit box. Then, dispose of the kit in a bin.

 

COVID-19 DIY: Self-Testing & IsolationProf Dr James Koh answers your most pressing questions about COVID-19 testing:

  1. I suspect my test is inaccurate. What should I do?  Test again but make sure there is a three-day gap. If you tested on Monday, then repeat the test on Thursday. If you want a more definitive result, you can always opt for the PCR test.
  2. What do I need to look out for when buying RTK kits? Make sure it is registered with MDA and approved by MOH. You can check the website to confirm: www.portal.mda.gov.my*Read related article on self-testing kits – https://theiskandarian.com/are-you-ready-to-self-test-for-covid-19-at-home/