Izah Azahari
As the country is already in the Endemic Phase, the Ministry of Health (MoH) introduced four new health protocols for COVID-19 detection as explained by Public Health Consultant and Head of Disease Control Division at the MoH, Dr Justin Wong during a press conference on the ‘Revision to Testing, Diagnosis and Quarantine procedures for COVID-19 cases and contacts’ yesterday.
Dr Justin said individuals will no longer be able to go for PCR testing on their own accord following the first protocol where a doctor will have to refer an individual to take the test.
This is used for exceptional circumstances such as when there is a conflict in antigen rapid test (ART) results. An individual will have to consult a doctor who will refer them for a PCR. If the individual tests positive on PCR, they will then have to await instructions from the MoH.
The second protocol is directed by individuals themselves. When an individual displays flu-like symptoms, the individual isolates and conducts two ARTs consecutively. If they test positive on both tests, this means that they are confirmed positive. The MoH has developed a portal for individuals to self-report their results which the MoH will then verify. Individuals will be contacted if they are positive via an SMS asking to refer to their BruHealth application.
“The purple code will be the first indication that you have been verified positive for COVID-19 from the MoH,” said Dr Justin.
The third protocol is similar to the second, but applies to individuals who do not have any symptoms but tested positive on ART. Individuals should isolate and repeat the ART. If both ART results are positive, then they must provide a self-report of their results.
The fourth protocol is for individuals who are close contacts of a confirmed case. They are required to isolate and conduct ART on Day 1 and Day 5 from the notification. If the individual tests positive by ART on either Day 1 or 5, they are a confirmed case. If individuals are contacts, only one ART test is needed. They then need to self-report and await instructions.
On attaining ART kits, Dr Justin said most people already have their own, and if they have yet to get ART kits, these can be purchased at pharmacies, supermarkets or online resellers. However, if none are available, Dr Justin said there is another option available via dialling Darussalam Line 123 (TD123) to get the ART kits, which will then hopefully be delivered within 24 hours, but may also take some time as the ministry is sorting out logistics.
“Do remember that there is a limited supply of ART kits and we encourage people who have their own to use them so it is available for those who do not have any options and cannot purchase ART kits as we do not want to take them away from the most vulnerable and marginalised,” he said, adding that the ministry also wants to ensure the safety-net is there for those in need.
On what to do if an individual is positive for COVID-19, Dr Justin said to first carry out diagnosis and reporting through staying at home and isolating from other members of the household. If tested positive by PCR, the MoH will automatically receive the results. If an individual tests positive by self-administered ART, they will need to report the result on www.moh.gov.bn/ARTReport. Once the MoH verifies the results, they will be contacted by SMS and individuals need to read and comply with the instructions.
The second step is to inform contacts such as household members and individuals (workplaces, schools, social group) who the individual has been in close contact with up to two days before the swab date, and ask them to follow the protocol for close contacts.
The third step is through symptom assessment conducted by a clinical team. Individuals who do not have symptoms, or have only mild symptoms will be allowed to recover at home. Those with moderate to severe symptoms, or are considered higher risk will be admitted to a specialised facility to recover.
In the fourth step, which is recovery, individuals on home recovery will be issued a care package containing ART kits. They should monitor and report symptoms daily and using the ART kits when instructed to do so by calling the team from Talian Darussalam (TD) 123. If symptoms worsen during recovery, they should contact TD123 or call 991 (for severe symptoms).
The final step is ‘Test-To-Discharge’, where discharge from home recovery will depend on the results of the ART. If on Day 5 the individual tests negative, they will be asked to repeat a test on Day 6 and discharged once negative. If the individual remains positive on Day 5, they will need to repeat the test on Day 7. If the individual remains positive on Day 7, they will need to complete 10 days of isolation. They should only conduct Test-To-Discharge under guidance from TD123.
If an individual tests positive, but are well or assessed to have mild symptoms, they will undergo mandatory home isolation. On Day 1, they will receive the verified positive with a purple code on their BruHealth, while from Day 2 to Day 4, they will have to self-isolate at home and update their symptoms daily after receiving a prompt call by TD123. On Day 5, the individual will have to take an ART self-test and if the ART is negative, they will have to do another ART on Day 6, and if the ART is still positive, they will have to carry out another on Day 7. On Day 6 and Day 7, individuals will have to repeat ART self-test depending on the ART results taken on Day 5 where they will be discharged if the result is negative. If the ART result is positive, continue isolating until Day 10. Individuals can automatically exit isolation after completing Day 10.
Meanwhile, if an individual has been identified as a close contact of a confirmed COVID-19 case, the first step is to complete the Self-Assessment Tool on their BruHealth and quarantine at home for five days from notification. The second step is to conduct an ART on Day 1. If the result is negative, continue isolation at home for five days and conduct the second ART on Day 5. If the result is positive, they do not need a confirmatory PCR. Isolate at home and report results on www.moh.gov.bn/ARTreport. The third step is to submit their ART result to the ART reporting portal and they will be discharged once their BruHealth reverts to their previous colour.
During the press conference, Dr Justin also stressed the importance of reporting ART results as the MoH will not know unless it is reported.
“The government will try its best to provide to anyone who wants ART kits, but we want to prioritise those who have no way of attaining them on their own,” said Dr Justin, adding that the ministry hopes the public will learn about the new protocols so they will know what to do.
“The only way out of this pandemic is self-treatment and self-management, and really trying to learn to live with COVID,” said Dr Justin, adding that the most crucial part of living with COVID-19 is that each individual person takes responsibility for knowing what to do and how to test themselves.
