The NMIMR made a proactive decision and sourced for reagents and primers and began the optimization of real-time polymerase chain reaction (RT-PCR) methods for the detection of the SARS-CoV-2 (COVID-19) before its arrival to the shores of Ghana. In collaboration with the Ghana Health Service (GHS), NMIMR began screening for COVID-19 in suspected hospital and travellers’ samples in early February 2020 leading to the confirmation of the first 2 cases in Ghana in March 2020. From then, the NMIMR became the first and only testing laboratory for COVID-19 in the country through the lock-down period with samples being transported from across the country, by vehicles, aircraft and drones for testing. Later, the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR) began testing for COVID-19 as well but since nearly 50% of cases in the country were coming from the Greater-Accra region alone, the number of samples being tested at the NMIMR was still enormous. At the peak of the first and second waves of transmission in Ghana, the Institute was receiving more than 5,000 samples daily through the GoG contact tracing programme. The NMIMR operated a 24 hour, 7 days a week testing service with three teams each comprising over 100 personnel in a rotation of 12-hour shift system in order to meet the increased COVID-19 testing demand. As the outbreak subsided and more laboratories became capable of testing mostly through NMIMR training, the shift system was abolished and the teams were adjusted in accordance with the needed workload. As of May 2022, the NMIMR had tested a total of 513,628 samples with 59,780 (11.64%) being positive making it the single institution that has tested most of the COVID-19 samples in the country.

One main challenge encountered during the enhanced contact tracing at the peak of the COVID-19 pandemic in the laboratory was data management. Due to database gaps, there were initial challenges with timely reporting and feedback to stakeholders during the peak surveillance period. The gaps resulted from mismatches between samples and their accompanying case investigation forms, samples without case investigation forms and vice versa, huge data entry requirements, and delayed test results. However, a revamp in data management procedures, a transition from Microsoft Excel-based line list database to Research Electronic Data Capture (REDCap) later deployment of GHS Surveillance Outbreak Response Management Analysis System (SORMAS) helped to improve the turnaround time for reporting results to all interested parties and partners. Additionally, inconsistencies such as multiple entries and discrepant patient-sample information were resolved by introducing a barcoding electronic capture system