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Project of COVID-19 active case finding using antigen rapid diagnostic tests in the Democratic Republic of the Congo

The rollout in Africa of new World Health Organization (WHO)-approved SARS-CoV-2 rapid antigen test (Ag-RDTs) has significantly increased screening capacity in some African countries, like Zimbabwe and Rwanda, marking a real turning point in the fight against COVID-19 in the Africa region. Although the DRC is considered a pioneer in scaling up the use of Ag-RDTs through health facility and community-based COVID-19 active case finding, testing capacity remains very low, with a current average of 1.5 tests carried out per 10,000 population per week, against a standard of at least 10 tests per 10,000 per week. 

Given this low screening capacity, it is clear that there is under-reporting of COVID-19 cases. According to WHO AFRO estimates, only 1 in 7 cases would be detected in DRC. In an attempt to improve the case detection rate, the Ministry of Health, with the technical and financial support from the WHO DRC country office, has implemented since January 2021 an innovative pilot project for active case finding of COVID-19 using Ag-RDT screening in the community and in health facilities. This project is currently operational in 37 active health zones in 8 of the most affected provinces. 

This report presents the cumulative results obtained, lessons learned, challenges, and future prospects after 9 months of implementation (January to September 2021) of the activities of this pilot strategy of active COVID-19 case findings in the DRC community using Ag-RDTs. This report marks the official end of the GAVI (Phase I) and FIND (Phase II) funding. 

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COVID-19: why we can’t use antibody tests to show that vaccines are working

Why do we not use antibody tests to diagnose COVID-19 infections?

Checking for antibodies is not the most accurate indicator of the presence of a SARS-COV-2 infection.

What are antibody tests?

This article explains the role antibody tests are playing in fighting the pandemic. 

Antibodies neutralize foreign cells the body sees as a threat. Most COVID-19 vaccines trigger the body to produce antibodies against the spike protein in the SARS-COV-2 virus. 

The spike protein is a molecule found on the surface of the virus, and it helps the virus to enter the host cells and spread from there. 

Why can’t we use antibody testing to measure vaccine efficacy?

COVID-19 serology tests were designed early in the pandemic to detect only a few antibodies generated by natural infection, not vaccine-induced immunity.

They detect antibodies produced to fight the protein capsule around the virus and not the spike protein, while most COVID-19 vaccines introduce the body to small amounts of the genetic material in the spike protein to elicit an immune reaction.

Can antibody testing determine if a vaccine worked?

Not precisely. It takes around two weeks for the body to generate antibodies after COVID-19 vaccination, so even tests to detect the “right” antibody could be negative in the first few weeks after vaccination. 

Can antibody tests be wrong?

The United States Food and Drug Administration (FDA) has recommended that antibody testing not be used to evaluate either immunity levels or protection levels from SARS-COV-2.

Why still do antibody tests?

Data from antibody tests are helpful for surveillance studies. In these studies, large numbers of people in a community are tested. These studies estimate how many people were infected in the past and how fast the virus spreads.