Different covid test

President Jokowi instructed it to be carried out immediately rapid test for COVID-19 en masse. This mass test is expected to be able to test as many people as possible so that the government can find a fast response.

What is a rapid test and how is it different from the RT-PCR and genome sequencing recommended by the World Health Organization (WHO)?

Government plans do rapid test COVID-19 en masse

“Do it immediately rapid test. Rapid tests with greater coverage so that we can do early detection of indications of someone exposed to Covid-19. I asked for more tests and places for testing, ”said Jokowi when starting a limited meeting via video conference from the Merdeka Palace, Jakarta, Thursday (19/3).

Jokowi ordered his ranks to do so immediately rapid test en masse. According to KSP staff Brian Sriprahastuti, the government currently orders 500 thousand kits rapid test. It is hoped that within a few days the tool will arrive in Indonesia.

So far, those who can do the RT-PCR COVID-19 detection test at referral hospitals are those with ODP, PDP status, and on condition that they have symptoms.

"(For the rapid test) it can be done in an ordinary hospital and the conditions are very low," said Brian in Apakabar Indonesia Malam Kompas TV, Thursday (19/3).

Rapid test is said to have several advantages including being able to produce positive or negative results in just 15 minutes and can be done in almost all hospitals.

But it turns out that the rapid test has many loopholes, its accuracy is questionable and is not the main recommendation for diagnosing COVID-19 infection.

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The WHO recommended COVID-19 detection test is not rapid test

WHO determines recommendations for diagnosing COVID-19 infection, namely by testing RT-PCR.

RT-PCR stands for real-time Polymerase Chain Reaction. Namely a test carried out by taking a sample from a swab of the mucous membrane of the nose or throat. This location was chosen because it is where the virus divides.

Procedure: From the mucus membrane swab samples taken, there is a genetic virus called RNA. This is what is then used to determine the presence of the virus. RT-PCR test followed by genome sequencing (GS). GS is a more complex laboratory examination to determine the presence of viruses in the body.

These two methods are methods that have been used by the Research and Health Development Agency (Balitbangkes) in detecting cases of COVID-19 in Indonesia.

"The PCR results will be completed within 24 hours, the GS method, it will take 3 days to complete," said Achmad Yurianto, the government spokesman for COVID-19.

While the results rapid test can come out in about 15 minutes. However rapid test which is planned to be carried out en masse in the near future is not part of the recommendations by WHO.

Rapid Test and the accuracy of the results to consider

Rapid test is a virus-in-antibody-based test that is performed by taking a blood sample from a patient. The level of confidence this test is in fourth place.

Before explaining further, it is necessary to know that in detecting the presence of a virus or parasite (pathogen) in the body there is a ranking of a level of confidence called confidence level. This level of confidence determines how accurate the test is.

1. Culture is a microbiological test. This test is often referred to as the gold standard in diagnosing respiratory viral infections. But due to the novelty of the virus that causes COVID-19, this test is still not possible.
2. Molecular (DNA and RNA). These are the RT-PCR and genome sequencing which has been used.
3. Antigen
4. Antibody (Anti-pathogenic IgM / IgG / IgA). The rapid test method which is planned to be used in mass testing.

So for a diagnosis of COVID-19, molecular testing with RT-PCR is at the highest level of confidence.

Dr. Aryati, head of the Association of Pathology Specialists (PDS PatKLIn), released a press report entitled "Serology-Based Precautions for COVID-19 IgM / IgG Rapid Test".

In the report, this pathologist specialist said to consider several things related to accuracy rapid test.

First, detection of antibodies against SARS-CoV-2 by method rapid test has no clarity yet. Because antibodies in the blood are only formed some time after the entry of the virus into the body.

It is not yet known how long it takes to form these antibodies. This is because this type of virus is still new, so not many scientists have clearly determined the presence of SARS-CoV-2 antibodies.

One study states that new antibodies are formed and can begin to be detected as early as 6 days after the entry of the virus. However, most new cases were detected between the 8th and 12th day of the onset of symptoms.

Second, rapid test its accuracy is not yet known, making it difficult for expert interpretation. It is feared that this will produce results false negative (false negative result) or false positive (false positive result).

Aryati outlined several things that can complicate interpretation and lead to false positive results. Namely:

1. There is the possibility of cross-reactions with other types of coronavirus or types of viruses that have similarities with COVID-19
2. Previously infected with the coronavirus (other types besides COVID-19).

While several things that can cause false negative, namely:

1. No antibodies have been formed at the time of sampling or are still in the incubation period.
2. Immunocompromised patients (impaired antibody formation).

Still requires an RT-PCR test

Aryati said implementation rapid test still to be confirmed by PCR examination.

"If you find a positive result, it must be confirmed with a PCR test and if the result is negative, you have to do a repeat test 7 to 10 days later," said Aryati in the release.

SARS-CoV-2 antibody examination can be considered to indicate the presence of infection so that it can be used for epidemiological studies (patterns of disease spread) and further research.

Government Spokesperson for Handling Covid-19 Achmad Yurianto said this method needs to be carried out in tandem with a policy of independent isolation at home. Because in positive cases of Covid-19 with a rapid test or minimal symptoms, the indication is that self-isolation must be carried out at home with monitoring from the health center.

Although the rapid tests are not as accurate as the government's RT-PCR, they can measure the extent to which the COVID-19 infection has spread in Indonesia.

The head of the WHO, Tedros Adhanom Ghebreyesus, advised countries to carry out as many COVID-19 detection tests as possible.

"Test, test, test. All countries should be able to test all suspected cases, they cannot fight this pandemic blindfolded. "