New MOH circular no longer omits asymptomatic contacts from testing

 

COVID-19 | As case numbers dip and vaccinations begin, the Health Ministry has removed a directive to only test symptomatic close contacts.

Instead, it will now move to “prioritise” symptomatic and high-risk close contacts.

It has also removed a previous limit imposed on the number of close contacts it will test per infection cluster.

In a Feb 17 ministry circular sighted by Malaysiakini, Health director-general Dr Noor Hisham Abdullah said officials should continue to identify “all close contacts” and order them to undergo home quarantine.

“Covid-19 testing should be done on close contacts of Covid-19 positive cases.

“The taking of samples from close contacts can be prioritised for those who are symptomatic or those from high-risk groups,” he said.

This marks a departure from his Jan 13 circular, which stipulated that “only” symptomatic close contacts will be tested.

Now: Repeat tests

Last month’s circular also stated that only 20 samples will be taken in clusters with fewer than 50 close contacts. If a cluster exceeds 50 close contacts, either 30 people or 10 percent of people will be tested depending on which is a smaller number.

The latest circular made no mention of any caps when testing close contacts.

Another change observed is the ministry will now perform a second test on close contacts on their eighth day of home quarantine.

Last month's circular stated that patients will not need to be tested on the 10th day.

Now: RTK-Ag for hospital admission

The latest circular further stated that doctors will now be able to use antigen-based rapid test kits (RTK-Ag) for hospital admission under certain conditions.

The more accurate RT-PCR, which takes up to six hours of laboratory processing, ought to be used “if there is enough capacity on the ground”.

However, in areas with a high number of cases, the less sensitive but more efficient RTK-Ag can now be used without the need for repeated tests.

The RTK-Ag does not need laboratory processing and results can be generated in under one hour.

“For localities where the prevalence of Covid-19 cases is more than 10 percent, RTK-Ag can be used as an admission test without needing to repeat with an RT-PCR.

“However, using RTK-Ag as an admission test must be agreed upon by the state health department and informed to the national Crisis Preparedness and Response Centre (CPRC) for case reporting,” read the directive.

Now: Back to original strategy

Contacted by Malaysiakini, Noor Hisham confirmed that the ministry has reverted to its original strategy - which is to test all but prioritise high-risk close contacts.

“When you have increased cases, the focus is to capture the high infectivity which is the symptomatic (cases) but we isolate the asymptomatic (cases) too.

“This strategy was adopted in high-risk areas with soaring cases when the laboratory results were delayed because of the volume. We did this in Sabah and the Klang Valley.

“So (we are now) back to our approach from day one, which is to give priority to the high-risk groups and vulnerable population,” he explained.

Symptomatic close contacts are considered high-risk because they are more likely to be able to pass the virus to others.

Patients are typically most infectious between Day 3 and 10 after contracting the virus. Symptoms usually occur between Day 5 and 10.  - Mkini