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What will happen to travelers who do not have the resources to pay for a PCR test? What kind of certificates will be required of travelers? These are some of the doubts that remain in the air after the decision of a Bogota circuit judge that forces the Ministry of Health to require negative tests for coronavirus from international travelers entering Colombia.
On November 4, a Bogotá circuit judge decided to grant the guardianship imposed by the lawyer Alberto Elías González Mebarak before the Ministry of Health. The decision orders the National Government to demand (again) require the PCR test for COVID-19, with a negative result, so that international travelers can enter Colombia.
“It is evident that the negligence of the State expressed in the suppression of the requirement for international travelers to have a negative COVID-19 PCR test for entry into the country, exposes the health and life of the general population, which without place It will undoubtedly lead to the occurrence of irreparable damage, translated into the increase in the mortality of Colombians due to the Coronavirus, increasing the already scandalous figure of more than 32 thousand deaths that the pandemic has claimed, in a panorama of overcrowding of ICU beds at the national level ”, indicated the plaintiff.
“Although it is true that the PCR test is not a 100% efficient mitigation measure, nor are the other measures taken by the national government and territorial entities, it is configured as a measure and as a filter that leads to a fence epidemiological and prevent people who may have the virus from entering the country, being close to new outbreaks taking into account social interaction, the number of internal trips, among others, “said the firm, agreeing with the lawyer. He also urged that even with the negative test, the quarantine or preventive isolation must be complied with for a period of 14 days in the place of housing or accommodation planned in advance by each traveler. (In context: Judge orders the government to require PCR tests from travelers who want to enter Colombia)
As expected, the decision unleashed objections. On July 30, the World Health Organization issued measures for the resumption of international travel. Recommendations include prioritizing emergency, humanitarian and medical travel. Priority should also be given to the transport of essential medical, food and energy supplies, however, it does not say that PCR tests should be requested from any traveler to enter a country with greater or less risk than the country of origin. Those are the recommendations that the Colombian Ministry of Health adopted at the time, when deciding to open international flights.
Epidemics are faced through differential phases that are due to the dynamics of virus transmission, the number of infected people and the resources available to care for the sick. In the preparation phase, guidelines are generated to organize those resources (which happened before the outbreak was declared in Wuhan, China). The second phase is that of containment, which consists of cutting the chains of contagion. This phase was maintained until 11% of the cases were of community circulation, and when more than 10% of the confirmed cases are not imported, the mitigation phase begins (in which we are at this moment, and that the March 31 “officially”).
The reopening of international flights is part of the mitigation phase, and there are still some questions that still remain in the air and that are not resolved in the judicial decision: the first is when this measure will be maintained and what technical considerations it should have into account the Ministry of Health to stop requiring the PCR test and quarantine to international travelers.
The other question is exactly what type of PCR test should the Ministry of Health require of travelers. In the world, and according to the WHO, there are eight different methodologies for doing PCR tests. “Many in-house and commercial rRT-PCR assays have appeared; several of them have been independently validated. Some are capable of fully automated testing, integrating sample processing with RNA extraction and amplification capabilities and presentation of results. These systems give testing access to many locations where laboratory capacity is limited, and offer rapid response time when used for bedside testing, “says WHO.
Validation data for some of these trials are already available, and in certain settings, testing personnel must be properly trained, efficacy should be assessed in those particular settings, and a quality monitoring system must be established. But this opens a question, what evaluation system would be valid for the Colombian criteria?
According to the WHO, the confirmation of a Sars-Cov-2 infection is based on the detection of specific viral sequences using nucleic acid amplification tests (NAA), or on the polymerase chain reaction by reverse transcription in real time (rRT-PCR).
After a person has been infected with the virus, the average time it takes for symptoms to develop (incubation period) is 5 to 6 days, with an interval of 1 to 14 days after exposure. The virus can be detected in the upper respiratory tract 1 to 3 days before symptoms appear. The SARS-CoV-2 concentration in the upper respiratory tract reaches its highest value around the time of onset of symptoms, after which it gradually decreases. Some studies have found higher viral loads in the seriously ill than in the mildly ill, other studies have found the virus in the feces of some people (and the viral load increases during the second week of illness). In other patients, the virus can only be detected for a few days, while in others it can be detected for several weeks, even months.
On the other hand, and according to the WHO, respiratory secretions can be highly variable in their composition, and although swabbing is the most common detection methodology, the organization warns that the suitability of the samplings can vary, sometimes false ones can occur negative in PCR results.
The Pan American Health Organization said in October that “in the current situation of the pandemic it is not recommended to carry out or require tests for COVID-19 for people planning or making an international trip.” On the other hand, how to ensure that the certificates are legitimate, or what type of seal or certification is considered “legitimate” in Colombia.
Another objection is that, as El Espectador said, a PCR test can be expensive (between 400 and 600 dollars) and some are difficult to access in several countries, and they also have a considerable rate of false positives. What will happen to Colombian travelers who want to return to the country and who do not have the resources to pay for the test, or to travelers who travel in less than 15 days, a time shorter than the delivery of the result of a PCR test? On the other hand, why require international travelers to quarantine, if the PCR test required upon entry is already negative?
For now, it is unclear whether the government will challenge the decision. What is certain is that, for now, the decision is still in place and the obligation to certify the absence of the Sars-Cov-2 belongs to travelers who want to enter Colombia.
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