This question gained importance this week when someone said they had a cough and asked whether they should be screened. If you are living in a red zone and have health complains that fulfill the clinical criteria, please consult your nearest healthcare facility, and asked to be screened.
A good guideline to base our decision on whether to screen is the Case Definition of COVID-19.1 In summary, a suspected case needs to meet the clinical AND epidemiological criteria (refer to the diagram below).
With the increasing transmission in the recent weeks, many more districts have been declared as Red Zones.2 Being in a red zone fulfills the epidemiological criteria of this case definition. As such, anyone living in red zones fulfilling the clinical criteria should be screened for COVID-19.
What happens if you have Fever?
We are screened for fever at almost every external establishment based on current SOPs. Based on current SOPs, having a fever means you are typically denied entry to these premises. Have you wondered what happens if you do have fever? Should you be screened for COVID-19? The simple answer is it depends. Your likelihood of being tested for COVID-19 depends on meeting the suspected case definition.
1) You do not need to be screened for COVID-19 if your only health complaint was fever. You are more likely to have another illness and should consult a healthcare professional and seek further advice.
2) You should seek COVID-19 screening services if you had fever and one or more additional complaints as listed in Table 1 AND fulfill the epidemiological criteria.
As can be seen, a major determinant to screening for the community appears to be the classification of localities as Red Zones. This is actually a proxy for the likelihood of community transmission in that area.
What is Community transmission of COVID-19? Have we not had COVID-19 in the community all this time?
Community transmission is supported when there are newly diagnosed cases of COVID-19 that cannot be linked to a previous cluster. Based on the reporting methods of new cases, these are the cases that were identified either by symptomatic screening (saringan bergejala), through surveillance systems, or though pre-operative screening. Cases identified from contact screening is not an indicator of community transmission as these new cases would have been linked to a previously known cluster that is being actively managed.
Community transmission has great implications as these types of transmission are not being managed and represents the tip of an iceberg of undiagnosed cases in the population. Community transmission of COVID-19 has the ability to exponentially increase the generation of new cases in a population.
1Annex 1 of the Guidelines COVID-19 Management In Malaysia No. 5/2020 ; Last updated on 5 October 2020
2The list of red zone areas is based on the 14 days moving data by mukim/zon/presint updated daily in the CPRC telegram : https://t.me/cprckkm
3Close contact defined as:
• Health care associated exposure without appropriate PPE (including
• providing direct care for COVID-19 patients, working with health care
• workers infected with COVID-19, visiting patients or staying in the
• same close environment of a COVID-19 patient).
• Working together in close proximity or sharing the same classroom
• environment with a with COVID-19 patient
• Traveling together with COVID-19 patient in any kind of conveyance
• Living in the same household as a COVID-19 patient
Prepared by Prof Dr Sanjay Rampal, 16 October 2020.