Diagnostics for COVID-19: A case for field-deployable, rapid molecular tests for community surveillance.

Across the globe, the outbreak of the COVID-19 pandemic is causing distress with governments doing everything in their power to contain the spread of the novel coronavirus (SARS-CoV-2) to prevent morbidity and mortality. Actions are being implemented to keep health care systems from being overstretched and to curb the outbreak. Any policy responses aimed at slowing down the spread of the virus and mitigating its immediate effects on health care systems require a firm basis of information about the absolute number of currently infected people, growth rates, and locations/hotspots of infections. The only way to obtain this base of information is by conducting numerous tests in a targeted way. Currently, in Ghana, there is a centralized testing approach, that takes 4-5 days for samples to be shipped and tested at central reference laboratories with results communicated to the district, regional and national stakeholders. This delay in diagnosis increases the risk of ongoing transmission in communities and vulnerable institutions. We have validated, evaluated and deployed an innovative diagnostic tool on a mobile laboratory platform to accelerate the COVID-19 testing. A preliminary result of 74 samples from COVID-19 suspected cases has a positivity rate of 12% with a turn-around time of fewer than 3 hours from sample taking to reporting of results, significantly reducing the waiting time from days to hours, enabling expedient response by the health system for contact tracing to reduce transmission and additionally improving case management. FUNDING: Test kits were provided by AngloGold Ashanti Obuasi Mine (AngloGold Ashanti Health Foundation). The American Leprosy Mission donated the PCR machine, and the mobile laboratory van was funded by the Embassy of the Kingdom of the Netherlands (EKN). AAS, YAA was supported by (PANDORA-ID-NET RIA2016E-1609) and ROP supported by EDCTP Senior Fellowship (TMA2016SF), both funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2) programme which is supported under Horizon 2020, the European Union.

[Results obtained by a mobile handicap-prevention unit at the Institut de Léprologie de Dakar]. / Résultats obtenus par une équipe mobile de prévention des invalidités à l'Institut de Léprologie de Dakar.

Of 584 leprosy patients known at the Institut de Léprologie Appliquée de Dakar because they suffered a nerve lesion with or without chronic plantar ulcer (CPU), 242 (41%) could be followed-up during a mean period of time of 8.2 years (range: 5 and 10 years) by the means of the mobile disability prevention team (health education, medical care and shoe workshop). Every two months a visit of the patients, at their home town, was organized, with the purpose to assess whether they could actually put into practice the foot and hand as having been trained for. At the same time, further advice and encouragement were given to the patients. Adapted footwear was brought to the patient, at reduced fee, the foot prints and special moulds having been taken during the previous visit. The local health worker were responsible for light surgical cares. Among the 242 followed-up patients: of 107 without CPU at beginning, 90 (84%) remained so, of 135 with CPU at beginning, 57 (42%) were cured, of 135 with CPU at beginning, 74 (55%) remained stable (no worsening), the last 21, of whom 17 showed severe foot deformities but without CPU, worsened (all presented one or more CPU at the last control). Of the 242 patients, 221 (91%) remained stable or showed substantial improvement. Therefore, it must be emphasized that careful follow-up of patients is essential to insure the improvement or care of CPU as well as to prevent the onset, worsening or reappearance of CPU. Such follow-up must consist of cares, health education and special shoe wearing.

[An original experience through the creation of a new functional rehabilitation center for Vietnamese lepers]. / Une expérience originale à travers la création d'un nouveau centre de réhabilitation fonctionnelle pour les lépreux vietnamiens.

Since 1990, the creation of a Rehabilitation Center for Vietnamese leprosy patients under the aegis of "Oeuvres Hospitalières Françaises de l'Ordre de Malte" is the result of emphasized collaboration between governmental and non-governmental organizations, and between medical and paramedical specialists. This humanitarian action is not "a present home delivery". The end of this action is to set progressively a realist enterprise that depends on preliminary epidemiologic investigations on the spot to analyse means and necessities. Frequency of disabilities (49.6%) and predominance of grades 1 and 2 (83.5%) require aids. The realisation of technology transfer at all medical care levels is necessary. But at the same time, it is essential to build surroundings adapted infrastructure, to equip with effective material giving comfort and security for patients, and even to supply with pharmaceutic drugs in order to continue rehabilitation's activities. In short range, patient's selection and regular control give first objective results.

[Prevention of perforating plantar ulcers: trial directed by a mobile team]. / Prévention des maux perforants plantaires: essai mené par une équipe mobile.

AIMS: to prevent the appearance of plantar ulcerations and then mutilations, by going in the field in order to: make suitable footwear, educate the patients, train the paramedical staff. Means: 1 fitted lorry, 1 physiotherapist, 1 shoemaker, and 1 educator. RESULTS: In one year, 206 patients have been provided with shoes and followed up. Advice have been taken exactly in the leper villages in which the attendance rate is of 98%; this rate varies between 47 to 70% in the all-purpose dispensaries. Paramedical workers of all-purpose Health Centers did not take great interest in this action. After 6-12 months under observation: 84% of good results for the feet without deformity or slightly deformed; 51% for the deformed feet. The results are quite satisfactory for the feet without plantar ulcer at the beginning, and that whatever the food deformity stage. But for the feet wounded by plantar ulcer at the beginning, 33% of recovery have been reported after wearing these shoes.

[Current difficulties in leprosy control and proposals to foster the campaigns in French-speaking African countries]. / Difficultés actuelles de la lutte contre la lèpre et propositions de relance des campagnes dans les pays d'Afrique francophone.

In a great number of francophone African countries, Leprosy Control is failing. Early case finding and contact detection become deficient. Some countries, which have maintained multifunction mobile sanitary structures, issued from the French Service of Grandes Endémies Organization, record good results in Leprosy Control. The interest of early case finding is recalled, because 80% of new leprosy cases are discovered in systematic and periodic screening in non leprosy contact population. The Leprosy Control falling down reasons are reviewed and resolutions for improvement of existent health services are proposed. The priority should be given in strengthening of existent mobile services: either lightly multifunction teams under Grandes Endémies Service supervision nor itinerant medical workers based on dispensaries integrated in Health Primary Care structures. This strengthening must coexist with an increased contribution of general or private clinics and with a real information of sanitary and administrative authorities associated to good information of people. It is necessary that each African country choose a national leprosy medical officer for Leprosy Control. It should be better to follow example of some countries which have achieved some positive results in Leprosy Control by an operational strategy, adapted to African meaning, and sustained by the important aid of ILEP associations.

Where health is patriotism. Visit of New Zealand medical delegation to China: 20 August-9 September 1974.

PIP: At the invitation of the Chinese government a New Zealand delegation visited the People's Republic of China to observe medical administration and public health. The use of "barefoot doctors" and the integration of western and traditional medicine has led to a revision of the organization of medical care. Acupuncture has been implemented for anesthesia, diagnosis, treatment and drug addiction. Herbal medicine, treatment of fractures and burns and cupping and mixibustion are additional methods of treatment employed with success by the Chinese. The emphasis on preventive medicine has led to education of the people and "barefoot doctors" and to the elimination of various pests such as flies, mosquitoes, rats, bedbugs the semination of a wide range of endemic bacterial and viral diseases such as plague, cholera and leprosy and the elimination of diseases such as malaria, hookworm and venereal diseases. Population control is emphasized in schools (premarital sex is strongly disapproved of) and through the revolutionary philosophy that women can only gain equality when they are freed from endless childbearing. Birth rates have been reduced to 6.5 per 1000 in urban Shanghai. Medical training has been shortened to 3 1/2 years and is taught with the philosophy that it will be used to serve the people.^ieng