Medical workers wear 0ersonal protective equipment suits as they prepare for their shift in a dedicated Covid-19 ward in Kuala Lumpur, Malaysia. Picture: Rahman Roslan/Getty Images
Medical workers wear 0ersonal protective equipment suits as they prepare for their shift in a dedicated Covid-19 ward in Kuala Lumpur, Malaysia. Picture: Rahman Roslan/Getty Images

The world is embroiled in a high stakes game of ‘hide-and-go-seek’. As countries toil with the best method of defeating an invisible enemy, World Health Organisation (WHO) director-general Tedros Adhanom has a simple message: “test, test, test”.

At first glance, it may seem confusing as to why the early evidence suggests that comprehensive testing programmes have proven to be arguably the most effective tool in “flattening the curve”. It may be obvious as to why testing would better reveal the extent of the virus, but not necessarily how testing can combat the virus itself.

The answer lies in data. Testing creates data points. Only through these data points can governments really understand the extent and location of the spread of the virus, and thus formulate a plan to combat it.

Different testing philosophies

The main thing to look out for with testing is whether a country is following an approach of either passive or active testing. Passive testing (‘wait for the patient to come to you’) usually involves testing those with symptoms who have gone to doctors, hospitals or are known to have come into close contact with a positive case. Active testing (‘go find patients’) would refer to more widespread, random testing where governments are able to bring facilities to citizens or make them easily available (such as drive-through testing). Similar to polling data, the more random the sample the more representative it is likely to be, providing it covers a sufficiently diverse group.

Hence, testing beyond those who are visibly likely to have the virus is a fundamental tool in understanding its complexities, especially given the prevalence of asymptomatic cases. It is only through active testing that the virus can truly be tackled and it is no coincidence that the first countries outside of China to show signs of flattening the curve — South Korea and Singapore — adopted the most innovative and aggressive testing strategies in the early weeks, thus enabling them to isolate and pinpoint the virus and respond accordingly. Similarly in Europe, Germany’s focus on active testing has positioned them as the most successful in Western Europe in terms of their Covid-19 response, while other countries such as Spain, Italy and the United Kingdom have been reluctant to test those with no visible links to the virus. Similarly, the USA, especially in the earlier days, mainly only tested patients showing symptoms.

Where is South Africa at on testing?

Of course, widespread active testing is extremely expensive to rollout, explaining why South Africa has until recently only been able to test passively. A shortage of testing kits has meant that even private facilities have had to screen people for symptoms or contacts before allowing them to get tested and processing capacity has resulted in some significant backlogs. There have also been constraints in turnaround time, with tests taking up to four days to process, hamstringing attempts to stay ahead of the curve. The cost of testing from private laboratories has been too expensive for the majority of people in South Africa.

As such, the measures announced by the government to ramp up their active testing capabilities are every bit as important a measure as the national lockdown and the two represent inter-dependent parts of the overall strategy and should be understood as such.

Health Minister Zweli Mkhize said on April 6 that South Africa’s current daily testing capabilities stand at roughly 5, 000 a day — not an insignificant amount, but far from the several tens of thousands being tested on a daily basis by countries with bigger resources. Ideally, this number needs to increase at least five-fold in the coming weeks for the lockdown period to be effective.

We need to keep track of how this number evolves as additional mobile testing facilities are provided, as well as new equipment utilising the “GeneXpert” machines previously used for tuberculosis testing, which can radically reduce the turnaround time for test results.

What else is the data telling us?

Data on testing is extremely sporadic and thus suffers from several reliability deficiencies. It differs according to the type and accuracy of tests used, the extent to which all tests in countries are reliably reported to a central authority and whether the data represents actual tests conducted or the number of individuals tested (many people get tested more than once), as well as several other variables.

But at its best, testing data can help show the severity and location of outbreaks, the comprehensiveness of testing programmes and the accuracy of methods used to isolate the disease.

Taken from one specific source, the table below illustrates some of those points in selected countries, but with the caveat on the reliability of these numbers mentioned above.

From this we can see that South Africa is far behind the bulk of the Western bloc in testing numbers, but doing relatively well compared to countries with similar resource capabilities. In terms of tests per million in the population, we are ahead of other major African countries as well Brazil and India, for example. Comparing countries to their neighbouring states, we can also see clear evidence of the benefits of active testing. The number of total tests to positive cases may be a sign of where the virus is more prolific at this stage, but we would be wary of drawing firm conclusions from that until the testing numbers are much higher and the trajectories of the virus are more firmly established in countries that have more recently had their first cases.

The key point is that for everything that governments cannot control, active testing is one of the primary tools that governments can use to contain the virus. South Africa has benefited from the generosity of international donors in providing testing equipment and has some capabilities from past outbreaks of other diseases. Now is the time to push hard and roll out the testing programme as far and wide, and fast, as possible. Only then can South Africa hope to get on top of the pandemic.

  • The Paternoster Group is an independent consultancy that provides corporate and other clients with political risk and political economy analysis as well as strategic advisory services. For more analysis and subscription to our fortnightly bulletin contact or go to

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