When a sample sent to the referral laboratory in the capital Algiers gave a positive result, the Ministry of Health announced Algeria’s first COVID-19 case on 26 February, becoming the second African country to confirm the virus. Since then, dozens of people have caught the infection. Unlike years past, it now takes just two hours to analyse such specimen. In addition to speed, the laboratory is also striving to ensure testing integrity – an important cog in the efforts to halt the spread of COVID-19.

Sample collection, transportation and analysis are critical steps in detecting the virus. To be effective, the collection of laboratory samples must be done in accordance with strict rules.  The diagnostic test consists of a swab -- a long stick with a piece of cotton or gauze at the end -- taken from the throat and nose of the suspect case. "When suspect cases are sent to referral hospitals and placed in isolation, the samples are sent to our laboratory to confirm if they have COVID-19. Once the sample arrives at the lab, it is logged and placed in a microbiological security station for analysis,” says Dr Fawzi Derrar, the acting director of the Institut Pasteur d’Alger (IPA).

The collection is just the start of the process. Subsequent steps are crucial, too. “There are cases where samples are declared inadmissible. For example, it’s only valid if it’s accompanied by the right documentation,” Dr Jonas Nsenda Nkongolo, a World Health Organization (WHO) expert on infectious diseases, said during a Rapid Response Team training course in Algiers in early March. 

"Correct documentation should ensure that the identity of the person is clearly and legibly stated. When this is not done properly, the test result will not be assigned to the right person and as a result any measures that follow, such as isolation or care, will be distorted,” he added.

Handle with care

The IPA is working to overcome other challenges including the proper handling and transportation of samples to the laboratory in Algiers. "According to common standards, for precise results, the samples must be handled with the utmost care. Unfortunately, we have come across cases where the officers who transport the material mishandle it," Dr Derrar explains, adding that training is essential to tackle such obstacles.

“It is also important to respect the timeframe for transporting the sample, and in particular, to ensure that it is stored and transported at a temperature of 4°C, so in a refrigerated cooler, say. If it is placed outside this ideal temperature, it no longer conforms to the standard. It must also be transported correctly and not placed in a horizontal position or upside down. For this reason, it is important to place the samples in a rack that indicates the direction of storage with an arrow to keep them upright throughout the journey,” he says.

“Long before this outbreak, WHO had already supported us through staff training. The support of WHO has helped us to perform better and we can now meet the high demand resulting from the coronavirus epidemic,” says Dr Derrar.

“In recent years, we have put in place uniform procedures for the receipt of samples and laboratory analysis. WHO has provided us with sufficient laboratory equipment, diagnostic tests, means of transport and detection kits. This has made a notable difference. A few years ago, especially for the MERS coronavirus in 2014, it took us a full day to confirm a case. With COVID-19, we get the results in two hours.” Dr Derrar explained that now only 0.1% of the samples are invalid. Since the start of the outbreak the laboratory has received some 3000 samples of which 302 turned out positive for COVID-19 as of 25 March 2020.

Decentralizing

As the coronavirus epidemic was spreading in other regions, WHO was already stepping up its support to African countries, in particular by providing laboratories such as the one at the IPA with a large quantity of test kits to strengthen their diagnostic capacity. To accelerate its capacity to diagnose COVID-19 and overcome the obstacles posed by the long distances involved in transporting samples, four laboratories have been identified in other Algerian provinces to serve as referral laboratories under the supervision of the IPA lab.

Given its expertise and the current context, the IPA has become a key player in the response to coronavirus, routinely consulted and involved in decision-making. "When we confirmed the coronavirus and with the trend we observed, our technical advice was to instantly limit the movement of people and put an end to mass gatherings in order to stop the spread of the disease,” says Derrar.