Hassib Sayhoun, Alum, Honorary Graduate and owner of Medlabs, shares with you his COVID-19 pandemic experience in Jordan over the last few months.
Jordan has a population of ten million with a high rate of literacy. It has very limited natural resources, no oil and no gas. However, Jordan’s health services, public and private, are one of the most advanced if not the most advanced regionally. As per the World Bank Jordan ranks number five worldwide for Medical Tourism. Over the last ten years Jordan’s Health Services were stretched to the limit by the inflow of more than one and a half million refugees from war stricken Iraq and Syria.
As of January 2020 Jordan was closely following up on the developing COVID-19 pandemic. At the end of January the WHO declared it as a major medical threat that it could spread worldwide. Then in early March the WHO declared the COVID-19 pandemic. Immediately after this declaration by the WHO Jordan ordered a partial lockdown which was soon followed on the 18th of March with a total lockdown.
The most critical action was the isolation of all inbound travelers as of the 1st of March for two weeks in government rented 4 and 5 star hotels in Amman and the Dead Sea. Once allowed to return to their homes after the two week isolation these travelers were asked to isolate themselves for a further two weeks at home. I say a critical factor as all the positive cases in Jordan were imported and several of these inbound travelers were tested positive for COVID-19. It is the early decision of lockdown and the isolation of the inbound travelers together with the high percentage of young Jordanians that has contributed to the low incident rate of infection (30th April 471 positive cases and 8 deaths from COVID-19).
I truly commend the actions of the Jordanian Government, its infectious diseases committee and the MoH for their quick and decisive decisions that have saved the lives of many Jordanians. As a result, as of the 1st of May the government started to open up the country slowly to allow the economy to recover. However, strict safety and distancing procedures are in place and in my opinion will remain until a vaccine is available and the population is vaccinated.
During the first half of March the Ministry of Health started to realize the importance of testing for the COVID-19 by RT-PCR (the only WHO approved method for the diagnosis of COVID-19). Thankfully, the MoH had the facilities and expertise to perform the tests. However, they were limited by the number of tests they could perform per day. At that time they had forbidden any Laboratories in the private sector to perform the COVID-19 test to avoid uncontrolled testing. By mid-March they inspected the facilities for performing the test at MedLabs and gave immediate approval to our reference Laboratory in Amman to perform the COVID-19 test. Our reference Laboratory is CAP and ISO15189 accredited for a wide range of Laboratory tests including Molecular Biology where the RT-PCR testing takes place. By doing so, the MoH immediately doubled the capacity of testing. Furthermore, by mid-April both the MoH and MedLabs had increased their capacities for testing to reach 1500 tests per day from the original 250 tests per day at the MoH. We were asked to support the MoH who would send us collected nasopharyngeal swabs on daily basis as well as collecting our own samples from the public, the charge of the latter was set by the MoH.
Our first challenge was the availability of kits, reagents and PPEs. The local availability was very limited so we had to cooperate with the suppliers, MoH and Governmental departments to order all our needs and facilitate boarder customs procedures. The second challenge was to design the process of sample collection from private patients with all the safety measures for patients and staff. For that purpose we refused to receive the patients at any of our 45 Laboratories in Jordan. Instead we created a Call-Center dedicated to COVID-19 testing appointments with 11 staff and a team of 11 trained Medical Technologists (MT) and cars to collect the samples. A special SOP was prepared by our Quality and Safety Department which in summary stipulated the following methodology:
- Private individuals would call the dedicated call-center to arrange for an appointment to collect the samples at their homes. IDs and location are sent via WhatsApp, medical information and telephone numbers taken. All information are entered to the LIS and bar codes issues and placed on a copy of the ID and the nasopharyngeal swab (swab and transport media containing viral neutralizing agent). Any individuals suffering from severe symptoms were referred to the MoH for testing as per MoH request.
- The Medical Technologists with the bar coded swab, copy of ID and PPE kit (disposable robe, shoe covers, gloves, masks, goggles and hair cover) would go to the individual’s home at the appointment time. The MT would wear the PPEs before entering the individual’s premises, identify the individual to be tested, takes the nasopharyngeal sample applying strict conditions and removes the PPEs upon exiting the premises and places them in a yellow bag for proper disposal upon returning to the Laboratory. The swab is placed in a cool box and the MT proceeds to the next appointment.
- By the end of the 10th visit the MT returns to the Laboratory to deliver the collected swabs.
- The swabs are immediately delivered to the Molecular Laboratory to issue results within 24 hours.
- At the Molecular Laboratory the samples go through three isolated rooms for the three stages of testing – room-1 extraction of the RNA; room-2 pre-PCR preparation; room-3 analytical RT-PCR testing. All staff are wearing full disposable PPEs and are only allowed a one way movement between the three rooms.
- Upon the request of the MoH, any positive results from samples provided by them or collected by us must be reported within 60 minutes from result time to the MoH and a list of the total samples tested are sent to the MoH at the end of every day.
- After reporting the results to the MoH, tested individuals are informed of their results.
- All positive samples’ transport media and extracted material are frozen for future reference.
Presently the MoH has approved five other Laboratories to perform the COVID-19 test. This has increased the capacity to 2,500 tests per day. The target is to test 10,000 per day. I personally am on a committee appointed by the Minister of Health to find ways to expand the testing capacity and to provide the means of testing every inbound traveler at the airports or land borders. At MedLabs we have performed close to 10,000 tests since mid-March.
It is true that Jordan, as are many other countries in the world, is easing the lockdown to get the economy back on track to save and create jobs. However, we must not believe that the COVID-19 Pandemic is coming to an end. If we do not play it wisely we will soon be in the thick of it again and our economies will suffer further. We need to balance between the economic recovery from one side and social distancing, avoiding large gatherings, warring of masks, continuously washing of hands and disinfecting surfaces continuously especially in public spaces. A challenging time for all of us will be the FLU season next fall and winter. This is a virus that takes no time off and we have to live with that fact until a vaccine is produced and is made available worldwide.
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