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Government to keep oropharyngeal sampling despite incident

The government has decided not to cancel sampling via oropharyngeal swabs in its nucleic acid testing (NAT) scheme, after considering residents’ preferences in having their samples collected for a COVID-19 test by this method.

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UPDATED: 22 Dec 2023, 5:44 am

Addressing Wednesday’s press conference about Macao’s novel coronavirus situation, Alvis Lo Iek Long, a clinical director of the public Conde de São Januário Hospital Centre, announced that the government has decided not to cancel sampling via oropharyngeal swabs in its nucleic acid testing (NAT) scheme, after considering residents’ preferences in having their samples collected for a COVID-19 test by this method.

However, Lo said that if Macao’s COVID-19 situation changed in the future like the one in Hong Kong – which is being hard hit by a citywide outbreak – residents would have their samples collected under the Macao government’s NAT scheme only via nasopharyngeal swabs, which ensure more accurate results than oropharyngeal swabs.

Lo’s remarks came after the local government said in a statement on Tuesday night that the Health Bureau (SSM) would require all COVID-19 testing institutions in the city to collect samples from those undergoing their nucleic acid tests only via nasopharyngeal swabs – i.e. to no longer take oropharyngeal swabs, after a seven-year-old boy accidentally bit off the swab and swallowed its tip on Tuesday morning when he was having his sample collected for a COVID-19 test via an oropharyngeal swab at the NAT programme’s main testing station in the Taipa Ferry Terminal in Pac On.

The Health Bureau has commissioned a third-party testing institution – Kuok Kim (Macau) Hygiene Examination Company Limited – to carry out COVID-19 testing at the Pac On testing station under its NAT scheme, which was launched on 7 May.

A new testing station for the government’s NAT scheme, which is located at the Macau Forum complex in Zape, came into operation on Tuesday with the aim of diverting the flow of people from the Pac On testing station. The new Macau Forum testing station is temporarily being operated by the Health Bureau before it commissions another third-party testing institution in the near future to carry out COVID-19 testing there.

Residents who plan to visit Guangdong have to make an appointment online to be tested for COVID-19 under the Macao government’s NAT scheme so that they can present a NAT certificate confirming that they have tested negative for COVID-19 when crossing the Macao-Zhuhai border. In addition to the COVID-19 testing at the Macau Forum testing station, the Health Bureau has been carrying out nucleic acid tests for certain groups of people such as confirmed and suspected COVID-19 patients, those who have been in close contact with confirmed COVID-19 patients, those with a fever or any respiratory symptoms, newly hospitalised patients, and those undergoing quarantine.

Tuesday’s statement pointed out that the Health Bureau has been collecting samples from those undergoing their nucleic acid tests via nasopharyngeal swabs, adding that sampling via nasopharyngeal swabs has advantages over sampling via oropharyngeal swabs. The statement said that a nasopharyngeal swab can remain in the pharynx for a longer period of time to obtain more sufficient samples than an oropharyngeal swab, adding that therefore a person who has been infected with the novel coronavirus disease is more likely to test positive for COVID-19 if he or she has had his or her sample collected via a nasopharyngeal swab rather than via an oropharyngeal swab – i.e. enabling a higher rate of positive results.

During Wednesday’s press conference, Lo said that after considering residents’ various preferences in the two sampling methods – oropharyngeal swabs and nasopharyngeal swabs, the government has decided to “keep the current sampling arrangement unchanged” – i.e. sampling via oropharyngeal swabs and sampling via nasopharyngeal swabs will remain in place.

Lo was quick to underline that sampling via nasopharyngeal swabs is “definitely” better than sampling via oropharyngeal swabs in terms of the accuracy in test results and safety in the sampling process. Lo said that while some residents may feel less uncomfortable in sampling via oropharyngeal swabs, there is a concern that an oropharyngeal swab cannot remain in the pharynx for a long enough period of time, which in turn adversely affects the accuracy rates in test results.

Lo noted that as the Health Bureau has determined that Macao-Zhuhai cross-border commuters merely involve an “extremely” low risk of COVID-19 infection so that the oropharyngeal sampling’s lower rate of positive results was still “within an acceptable range”. However, Lo said that Macao would need to only adopt sampling via nasopharyngeal swabs if Macao’s COVID-19 situation changed in the future like the current situation in a neighbouring region (Hong Kong), in which case the Macao health authorities would need to be sure whether a particular person who has undergone a COVID-19 test has in reality been infected with the novel coronavirus disease.

Concerning a report by local Chinese-language newspaper Macao Daily News that the boy’s father has complained about Tuesday’s incident at the Pac On testing station, Lo said that the Health Bureau has preliminarily determined that the case was not a medical incident. Lo pointed out that the bureau has ordered the testing institution – Kuok Kim (Macau) Hygiene Examination Company Limited – to submit a report about the case.

Lo underlined that a medical incident comprises three conditions, namely 1) the medical staff members have committed mistakes in the carrying out their medical task, 2) the task has caused damage to the patient, and 3) the damage is caused by the mistakes. Lo said that after studying the case, the Health Bureau has preliminarily determined that the case belongs to a normal complication which is expected to happen with children who are having their sample collected for a COVID-19 test via oropharyngeal swabs so that it did not constitute a medical incident.

Lo also said that it would be unfair to the medical staff members who collect samples from those undergoing their nucleic acid tests at the Pac On testing station if people rushed into considering the case as a medical incident. Lo pointed out that about 200,000 nucleic acid tests have been carried out in Macao – with just one incident so far.

The boy’s father called Macao Daily News on Tuesday complaining about the incident, saying that as it was a medical incident so that he had reported the case to the police and decided to file a “criminal complaint” against the testing institution.

(The Macau Post Daily/Macau News)
PHOTO © Government Information Bureau (GCS)

UPDATED: 22 Dec 2023, 5:44 am

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