Lesson from Indonesia: Covid-19 testing strategy in obstetric emergency cases at low-resource health care setting

Background: COVID-19 identification in obstetric emergency cases with limited resources is problematic, particularly in asymptomatic cases. Aim: To examine the screening strategies of COVID-19 obstetric emergency cases in low-resource health care settings. Method: A retrospective cohort design was carried out on patients with COVID-19 positive screening results. It was assessed based on symptoms, contact history, lymphocytopenia, chest X-rays, and rapid antibody tests compared to RT-PCR results SARS-COV-2. Result: Out of the 190 cases that came to the delivery room, the staff suspected 69 COVID-19 cases (36.3%) through the first screening protocol. Positive SARS-COV-2 RT-PCR was found in 23 cases with a majority asymptomatic (52.2%). The percentages of sensitivity and specificity from the parameters as follow: 48% and 74% in COVID-19 symptoms (febris or respiratory symptoms); 9% and 100% in contact history; 22% and 83% in lymphocytopenia; 52% and 48% in chest x-ray; 78% and 30% in rapid antibody test. Rapid antibody tests have the highest sensitivity to increase the identification of 12 asymptomatic cases. Conclusion: Other screening beyond symptoms and contact history such as lymphocytopenia, chest x-ray, and rapid antibody test can improve the identification, especially for asymptomatic cases in areas with the limited testing ability and high Covid-19 transmission.