Rapid COVID-19 tests: What negative or positive results mean

An at-home COVID-19 antibody rapid test cassette. Bloomberg
Image Credit: Bloomberg

DUBAI: Authorities around the world are easing quarantine measures, though sometimes local lockdowns are re-imposed due to localised outbreaks.

With social distancing still in place, and daily news of infections and deaths, testing has become part of public discourse. Yet, there’s some confusion about the tests, how or when they’re used.

The most reliable and authorised by most governments around the world so far is PCR (polymerase chain reaction) test, which is mostly done in a lab by a trained staff. In the UAE, this test is widely available.

In other countries, it’s a different story: There’s an issue of cost, shortages of lab capacity and reagents.

Here, we describe the cheaper rapid tests and their relevance to us as we all learn to live — and deal — with SARS-CoV-2 going forward:

Q: What are the types of “rapid” tests for COVID-19?

In general, there are two types of rapid testing for COVID-19:

1. Antigen test

Detects of viral proteins (antigens) from the COVID-19 virus in respiratory samples (e.g. sputum, throat swab); and

2. Antibody test

Detects of human antibodies in blood or serum (clear part of blood, free from red cells) generated in response to COVID-19 infection.

Rapid test kit

A health worker with boxes of test casettes. Numerous diagnostic test manufacturers have developed and begun selling “rapid” and easy-to-use devices to facilitate testing outside the lab.

Numerous diagnostic test manufacturers have developed and begun selling “rapid” and easy-to-use devices to facilitate testing outside the lab.

They’re called “rapid” because the test is usually done within minutes and at the point-of-care, at home, bedside or workplace. 

ANTIGENS VS ANTIBODIES

Antibodies, also called immunoglobulins, are Y-shaped molecules — proteins naturally produced by the body that help fight against foreign substances called antigens.

Antigens are any substance that stimulates the immune system to produce antibodies. Antigens can be bacteria, viruses, or fungi that cause infection and disease.

How does the antigen test work?

A typical antigen test detects the presence of viral proteins expressed by the COVID-19 virus in a sample from the respiratory tract of a person (usually through via a nasal or throat swab to get a fluid sample).

Antigen tests can produce results in minutes and less expensive than molecular tests. Some experts consider antigen tests more practical to use for large numbers of people.

If the target antigen is present in sufficient concentrations in the sample, it will bind to specific antibodies fixed to a paper strip enclosed in a plastic casing and generate a visually detectable signal, typically within a few minutes.

The antigen(s) detected are expressed only when the virus is actively replicating. The WHO said such tests are best used to identify acute or early infection.

False positive and false negative?

A positive antigen test result is usually considered highly accurate.

However, there’s an increased chance of “false negative” results: You have have been already infected with the virus but have negative antigen test results.

Thefore, antigen tests are not as “sensitive” as molecular tests (i.e. PCR test) are.

PREDICTIVE VALUES

Every test returns some false positive and false negative results.

Test are described by their Positive and Negative Predictive values (PPV and NPV).

These measures are calculated using a test’s sensitivity, its specificity, and using an assumption about the percentage of individuals in the population who have antibodies to SARS-CoV-2 (which is called “prevalence” in these calculations).

How likely it is that a person who receives a positive result from a test truly does have antibodies to SARS-CoV-2? Or how likely it is that a person who receives a negative result from a test truly does not have antibodies to SARS-CoV-2? The answers depend on these measures.

Finger prick or blood from vein or swab?

The commercial tests often use a finger-prick of blood and reveal a “yes/no” answer, like a pregnancy test. The antigen test uses a nasopharyngeal swab, which gets liquid samples from the throat or nose.

Antibody test vs PCR test: What’s the difference?

A virus like the SARS-CoV2, enters human cells and hijacks their machinery to make more copies of itself. This fires up our immune system to make antibodies to track down and kill these clones.

An antibody test checks whether you had COVID-19 in the past and now have antibodies against the virus.

On the other hand, the PCR molecular test to diagnose COVID-19. It can tell if someone is currently infected with a high degree of accuracy.

Experts say that while millions of people worldwide have been diagnosed with COVID-19, they hypothesize many more may have had it but were not tested — or didn’t even notice the infection.

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In this image taken through a tinted car window, a technician takes a nasal swab for a new coronavirus detection test at a drive-thru testing facility in Abu Dhabi, United Arab Emirates, Thursday, April 2. Drive-thru test centres: Multiple drive-thru test centres are opening across the country. Residents can apply for tests provided they fit the criteria required by authorities.
Image Credit: AP

What are antibodies?

Antibodies (called Immunoglobulin M, or IgM) help identify recent infections.

Some antibodies are made early in an infection and go away, usually within a few weeks, while others can linger for months — or even years.

Immunoglobulin G, or IgG, stays around longer. So far, all of the announced tests look for IgG.

A third antibody, Immunoglobulin A, or IgA, plays a role in the immune function of mucous membranes.

rapid antibody test

For illustrative purposes only. Test are described by their Positive and Negative Predictive values (PPV and NPV). These measures are calculated using a test’s sensitivity, its specificity, and using an assumption about the percentage of individuals in the population who have antibodies to SARS-CoV-2 (“prevalence” in these calculations).
Image Credit: https://bit.ly/2Zm9kmB

Antibody test vs serology test: What’s the difference?

They’re the same. An antibody test is also known as serology (blood) test. It checks for the presence of antibodies in your blood when your body responds to a specific infection, like COVID-19.

Simply put, it detects your body’s immune response to the infection caused by a pathogen (disease-causing agent). It does not detect the specific pathogen (or specific virus) itself.

rapid antibody test kit

COVID-19 antibody test casettes. An antibody test is also known as serology (blood) test. It checks for the presence of antibodies in your blood when your body responds to a specific infection, like COVID-19.

What’s a C-reactive protein (CRP) test?

Patients that come to clinics/hospitals with fever and other suspected symptoms may be first checked with C-reactive protein (CRP) test and whole blood cell count. These routine tests help to identify a common cold from this more severe new virus infection.

CRP is a key marker needed to diagnose and follow up the treatment of COVID-19. Chest imaging and nucleic acid test are also used to confirm the infection.

During the treatment of an infected patient, CRP is also monitored together with other biochemical markers throughout the whole treatment and recovery process.

What is a multi-protein test?

The ugly-looking COVID-19 “spikes”, which help them enter human cells, are made up of proteins, or “exo-proteins”. A protein test detects the presence of such proteins in people’s blood.

In fact, scientists have found 27 key proteins in blood samples of COVID-19 patients.

The proteins are present in different levels in COVID-19 patients, depending on the severity of their symptoms, said scientists at Britain’s Francis Crick Institute and Germany’s Charite Universitaetsmedizin Berlin.

This, they said, could act as predictive markers for how ill a patient could become with the disease, according to a study published by British and German scientists in the journal Cell Systems early this month (June 2020).

Three of the key proteins they found were linked with interleukin IL-6, a protein known to cause inflammation. It is also a key marker for severe COVID-19 symptoms.

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A health worker draws blood from a patient. If the target antigen is present in sufficient concentrations in the sample, it will bind to specific antibodies fixed to a paper strip enclosed in a plastic casing and generate a visually detectable signal, typically within 30 minutes.

What could this discovery mean for COVID-19 testing?

This discovery could lead to the development of a test that would help medical professionals predict how ill a patient might get when infected with the new SARS-CoV-2 coronavirus.

This could also provide new targets for the development of potential treatments for the disease.

It appears that those infected with SARS-CoV-2, respond differently — with some developing no symptoms at all, while others need to be hospitalised and others suffer fatal infection.

“A test to help doctors predict whether a COVID-19 patient is likely to become critical or not would be invaluable,” said Christoph Messner, an expert in molecular biology at the Crick Institute who co-led the research.

This type of mutiple-protein test for COVID-19 may become available in the near future.

How long does it take for antibody test to yield results; how much does it cost?

Typically under 20 minutes. Cellex’s test, one of those approved by the US FDA, takes about 15-20 minutes.

Abbott’s test can be analysed on their machines. Each machine can run 100-200 tests a day at a cost of about $6 each, according to a company spokesperson.

When is an antibody test to be used — and not used?

In the early days of an infection when the body’s immune response is still building, antibodies may not be detected. This limits the test’s effectiveness for diagnosing COVID-19.

This is one reason why serology tests cannot be used as the sole basis to diagnose COVID-19. 

On the other hand, testing for antibodies reveals whether a person has been infected — even if they never felt sick.

And this is where an antibody test can be useful: In the short term, it can help you answer the question: “Was I infected?”

What are the authorised antibody test kits? How much?

The US Food and Drug Administration (FDA) has authorised and verified certain antibody tests. However, many cheap $3 antibody “test kits” with questionable accuracy are now on the market.

Here’s the list of FDA-licensed antibody test kits, under the agency’s emergency use authorisation scheme.

The World Health Organistion (WHO) has also outlined studies being conducted to answer questions on the optimal or appropriate use of an antibody test, as well as others.

Studies will also answer questions about the duration of immunity. The jury is still out on this immunity duration question.

SENSIVITY VS SPECIFICITY

One performance indicator of a test’s effectiveness describes its “sensitivity”, or the ability to identify those with antibodies to SARS-CoV-2 (true positive rate).

The other is “specificity,” or the ability to identify those without antibodies to SARS-CoV-2 (true negative rate).

A key benefit of accurate antibody testing is that people who’ve recovered from COVID-19 may be eligible to donate plasma. This could be used to treat others with severe disease and boost the ability to fight the virus. Doctors call this convalescent plasma.

Why do antibody tests hold the key to vaccine development?

There are several ways antibody tests can help us all today:

1. Test volunteers in Phase III trials:

One of best use cases for an antibody test for COVID-19 is for testing those who had been given vaccine candidates.

An antibody test will help determine the success of a vaccine in Phase III trials, done on a big number of volunteers, say experts.

It will help identify individuals who may have developed an immune response to SARS-CoV-2.

Antibody test steps

Antibody test results can aid in determining who may donate a part of their blood (plasma), seem as a possible treatment for those who are seriously ill from COVID-19.
Image Credit: File

2. Identify blood plasma donors:

Antibody test results can aid in determining who may donate a part of their blood (plasma), seem as a possible treatment for those who are seriously ill from COVID-19.

3. Know the extent of infection:

Because the test kits are generally affordable, Dr Marc Lipsitch, an infectious disease epidemiologist at Harvard, proposed the use of antibody tests to determine how many people have the disease and how many have immunity against it.

This is one tool that could then help policymakers decide when it’s safe to loosen social distancing rules and when they will need to tighten up again to cope with a new wave of infections.

HERD IMMUNITY

“Herd immunity” occurs when a large portion of a community (the herd) becomes immune to a disease. This condition makes the spread of disease from person to person unlikely.

As a result, the whole community becomes protected — not just those who are immune.

Source: Mayo Clinic [https://mayocl.in/3gfzpKG]

SPANISH EXPERIENCE

Early in May 2020, Spain published the results of a country-wide “seroprevalence” survey. It tested 60,000 residents for antibodies. The survey estimated that about 5 percent of the country’s population had been exposed to the virus, varying from 1.1 percent to 14.2 percent between regions of the country.

The survey results has several implications:

One, it means almost all of the population is still at risk.

Two, the results point to 2.3 million of Spain’s 45 million population being affected by the virus, even if they have no symptoms in many cases, considerably more than the official count of under 250,000 cases (as of June 27, 2020).

Three, data suggest there’s still no herd immunity in Spain.

Until recently, scientists have assailed seroprevalence surveys for anti–SARS-CoV-2 antibodies: the accuracy of tests posed problems, and kicked up “misleading results.” The Spanish, however, survey was lauded for the successful test and design.

Chris Sempos, an epidemiologist with the US National Institutes of Health based on the accuracy of the tests, it’s possible that the true prevalence of SARS-CoV-2 exposure in Spain is around 6 percent instead of 5 percent.

Sempos recently published a preprint version of a study showing how data from serology tests can be analyzed to produce the most accurate estimates. 

“Everyone’s trying to do a good job, and they don’t have much time right now,” Sempos told The Scientist.

Takeaways:

  • An antibody test, as long as it works, can tell you whether or not you had been infected.
  • Knowing how many people were actually exposed and developed antibodies will help epidemiologists understand the dangers, and whether or not “herd immunity” has kicked in.
  • Morever, it could also help health officials establish whether herd immunity in a certain community has already kicked in.
  • Parallel studies are being done to help researchers understand exactly what having antibodies really means.
  • There’s still no answer to the question: “Does having these antibodies actually make someone immune and for how long?”
  • Tests looking for immune responses to the virus will be essential as the world moves forward.
  • Only by knowing the extent of infections could allow data scientists to be able to answer the question “how deadly is COVID-19 really?”

Nine months after Bur Dubai gas explosion, victim is desperate for help

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Kaniz Shaikh with her husband Muhib before the gas explosion
Image Credit: Supplied

Dubai: Kaniz Shaikh, 36, has not seen herself the mirror in the last nine months. Once a social media influencer who would often post pictures of herself on Instagram, she suffered horrific burn injuries in a piped gas explosion in her apartment in Bur Dubai on September 29 last year. Shaikh subsequently underwent treatment and moved to another apartment in Deira, but she hasn’t stepped out ever since as she is in constant pain and worries she will frighten the neighbours away.

The gas explosion, which occurred when a faulty gas pipeline was being repaired claimed the life of one building tenant, injured three and rendered many homeless. Shaikh was admitted to the Rashid Hospital Intensive Care Unit with 75 per cent burns and hung between life and death for over three months with severe infection, including pneumonia. She underwent several surgeries to treat her wounds and was discharged on December 26.

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Once a social media influencer, Kaniz would often posts pictures of herself on Instagram
Image Credit: Supplied

Her traumatised husband Muhib Shaikh, 39, said it is bad enough to see his wife suffer so much. Worse, she had not received any compensation so far.

Working for a real estate firm. Muhib is desperately appealing for help as he claims he can barely afford their living, let alone  his wife’s treatment, after his salary has been drastically cut.

“It is so difficult for me to see my once beautiful and bubbly wife in so much pain. She can barely hold her head or walk, she needs assistance for everything. I cook, clean, feed, bathe and help her with her clothes every day. She is in so much pain and feels as though a thousand pins and needles are piercing through her. She cannot close her eyes properly because of a scar tissue. Her eyes keep getting dry. She has pigmentation, discolouration and hypertrophic scars all over her body. Contractures prevent her fingers from opening,” said Muhib.

In January, when Muhib resumed work, he had initially hired a part-time help to look after his wife while he was away. “But after COVID-19 struck, my salary was cut drastically and I had to do away with the help. Now I make a sandwich for my wife and leave it for her before I leave for work. She struggles to have that by herself. In the evening when I come home from work, I clean up and try to cheer her. My money has run out; I cannot afford medicines. I just pray to the Almighty to protect her while I am away. It is so difficult for me to see her this way and I wish I could get her all the medical help she needs,” added Muhib.

Praying for a miracle

He said Kaniz needs at least six or seven plastic surgeries and skin transplants to free her of the contractures that are restricting her movement. “Each surgery costs an estimated Dh35,000. Plus she needs regular physio therapy. There is an open wound on her ankle which refuses to heal as she needs yet another skin transplant,” said Muhib, wishing for a miracle that could provide some relief for his wife.

He said her basic insurance plan does not cover her doctors’ consultations,physiotherapy or medicines now. “She is depressed and asks me if she will ever be well again. She needs psychological counselling too, but even that is not covered under insurance.”

Dreams shattered

Four years ago when the Shaikhs got married, they had no idea that their world would turn topsy turvy. They fell in love with each other in Mumbai, India, and were married in 2016. They moved to Dubai with big dreams and were leading a happy life until the fateful day on September 29.

Kaniz who was going to the gym for a work out, stopped to let the gas mechanics come in and check her piped gas supply as it had not been working for two days. She was several feet away from the mechanics, but she still received the brunt of the burn injuries while the mechanic near the gas stove received 40 per cent burns. “I wish I had not let the mechanic enter the house that day and continued to the gym,” Kaniz whispered.

Video: Massive fire ravages 3,000 cars in Kuwait

Abu Dhabi: A huge fire broke out on Monday evening in Abdullah Port, Al Ahmadi Governorate in Kuwait, which resulted in the destruction of more than 3,000 new cars, miscellaneous goods, dyes and wood, according to KUNA news agency.

Kuwaiti ports said civil defense teams were working to put out the fire.

Lieutenant General Khaled Al Mekrad, director general of Kuwait’s Fire Department, told Kuwait TV that nine fire stations were dealing with the huge fire that broke out in a warehouse in Mina Abdullah area, estimated at 125,000 square meters.

General Al Mekrad confirmed that no human casualties were recorded.

He said the outbreak of fire in an open area and wind activity made it difficult for firefighters, who were trying to contain the fire.

General Al Mekrad expressed the hope that the wind speed will not increase until the fire is controlled in the coming hours.

COVID-19: Cirque du Soleil files for bankruptcy

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Artists of the Canadian entertainment company “Cirque du Soleil” in a file photo
Image Credit: AFP

Cirque du Soleil Entertainment Group filed for bankruptcy protection after the coronavirus pandemic forced it to close shows around the world, bringing one of the best-known brands in live performance to its knees.

The Montreal-based company, controlled by private equity giant TPG Capital, requested court protection through the Companies’ Creditors Arrangement Act in Canada. Application under the CCAA will be heard by the Quebec Superior Court Tuesday and the company will also seek its immediate provisional recognition in the US under Chapter 15.

Entertainment companies that depend on large crowds were among the first business casualties of the virus. Cirque du Soleil laid off 4,679 employees — about 95 per cent of its workforce — on March 19 after shutting down 44 productions to comply with government orders around the world.

The company, which grew from a troupe of Quebec street performers into a global live entertainment giant, entered into a so-called stalking horse purchase agreement with its top shareholders — TPG, Shanghai-based Fosun International Ltd. and Caisse de Depot et Placement du Quebec. The Quebec government’s investment and lending arm, Investissement Quebec (IQ), is involved as a lender, the company said.

Under the terms of the proposal, the sponsors will inject $300 million of liquidity into the restructured business to support a successful restart and assume some of Cirque’s liabilities, the company said.

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Cirque du Soleil performance in Dubai
Image Credit: GN Archives

IQ would act as a debt provider, lending $200 million as part of the $300 million, while the shareholders acquire substantially all of the company’s assets for a combination of cash, debt, and equity. Cirque du Soleil’s existing secured creditors would receive $50 million of unsecured, takeback debt in addition to a 45 per cent equity stake in the restructured company.

The crisis hit the 36-year-old company just as it emerged from a string of acquisitions, which helped it diversify from its original acrobatic shows but also put it deeper into debt.

It bought Blue Man Productions in 2017, followed by children’s entertainment company VStar Entertainment Group in 2018. Last year, it added Works Entertainment and its troupe of magicians called the Illusionists to its portfolio, before striking a separate deal to make feature-length films with the company that co-produced the hit “The Lego Movie.”

Cirque du Soleil, which ran shows in Las Vegas including Mystere and Michael Jackson ONE, hired advisers to explore debt restructuring options in March, people with knowledge of the situation said at the time.

Clarified: Have you received a message stating that a coronavirus tracker has been ‘inserted’ into your phone?

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Picture for illustrative purposes only
Image Credit: Pexels

Have you received a broadcast message on social media warning you about a coronavirus tracker that has been “inserted” into your phone over the last few days? Well, that’s not exactly what has happened and here is what you need to know.

Called the ‘COVID-19 exposure notifications’, Google has introduced coronavirus contact tracing technology to help identify whether a user has been exposed to someone with the disease.

For those who are worried about their privacy, Google and Apple have stated that the feature is only turned on when a user chooses to. The technology works in conjunction with participating apps health authorities of a particular country.

However, you can already find it on your Android or Apple phone, turned off by default.

For Apple users, it can be found under ‘settings’, ‘privacy’, then ‘health’. Whereas in Android devices, it can be found under ‘settings’ then ‘Google’.

Works in collaboration with health authorities

To use the system, the user needs to download the public health authority’s app, in countries they are available in.

Then it will allow you to share with the app that you have COVID-19 to help alert people that you have been in contact with.

If you’ve been exposed to someone who has shared that they have COVID-19, the app will notify you and give you further instructions.

How does it work?

Once the feature is accessed, Android phones state: “When you turn on exposure notifications within an app from your region’s government public health authority, your phone shares ‘random IDs’ with other nearby phones that also have turned on the exposure notifications system.”

As you go about your day, your phone and the devices around you exchange random IDs. When your phone detects a random ID from another device, it records and stores the ID.

If someone reports having COVID-19 and their ID is stored on your phone, the app will notify you of the next steps to take.

If the app learns that you have come into contact with someone who reports himself or herself as having the illness, the system shares specific information with the app.

For example, the day that the contact happened, how long the contact lasted for and the Bluetooth signal strength of that contact.

However, the public health authority app is not allowed to use your phone’s location.

The exposure notifications system itself does not use your location or share other users’ identities with the app, Google or Apple.

However, in order to use the feature, the app asks the user to turn on the phone’s Bluetooth as well as the phone’s location setting, stating that the system uses this to scan for Bluetooth signals.

Privacy concerns

According to the Apple website, the technology is “designed to protect your privacy”.

“We understand that the success of this approach depends on people feeling confident that their private information is protected. The Exposure Notifications System was built with your privacy and security central to the design. Your identity is not shared with other users, Google, or Apple,” the statement reads.

Currently, in the UAE, the Ministry of Health and Prevention, Abu Dhabi Health Authority, and Dubai Health Authority have provided an app named ALHOSN UAE for smart phones and devices, however it does not work with this Google feature. The UAE’s free-of-cost app alerts users if they have been in contact with a confirmed COVID-19 patient.

COVID-19: 1 in 3 survivors may suffer ‘irreversible’ lung damage: Report

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Image Credit: File

London: If you are a coronavirus survivor, read this carefully. A leaked guidance from the UK National Health Service (NHS) has warned that up to 30 per cent of COVID-19 survivors may suffer long-term lung damage which is “irreversible” along with “psychological impairments”.

The NHS guidance, reported first by The Telegraph on Tuesday, has been sent to primary care and community services, which includes doctors and district nurses.

Other deadly coronaviruses such as SARS and MERS are already known to cause “persistent” damage to the lungs.

The leaked NHS guidance read: “Approximately 30 per cent of survivors of the global SARS outbreak caused by SARS-CoV and MERS-CoV experienced persistent physiological impairment and abnormal radiology consistent with fibrotic lung disease.”

“It is envisaged that pulmonary fibrosis [lung damage and scarring] is likely to be an important sequela/condition which is the consequence of Covid-19,” it said.

However, the evidence on COVID-19 is murky as scientists spotted the novel coronavirus only six months ago in the Chinese city of Wuhan, reports Daily Mail.

So tired

The NHS guidance said that COVID-19 survivors could also face chronic fatigue syndrome.

“The guidance also reportedly warned that one in seven patients who fought for their lives in intensive care may be struck down with lasting brain damage,” according to The Daily Mail.

Seventy per cent of them will suffer delirium which will lead to “established cognitive impairment” in one in five cases.

Other studies in the recent past have shown that SARS-CoV-2 virus can attack organs such as the heart, liver, kidneys and blood vessels.

On Tuesday, India recorded 14,933 new COVID-19 cases, taking the total tally to 4,40,215.

According to the Health Ministry data, 1,78,014 cases are currently active and 2,48,189 patients have recovered.

The number of patients recovering from COVID-19 continues to rise. The recovery rate has further improved to almost 56.37 per cent among COVID-19 patients.

Saudi Arabia’s Binladin group has been missing salary payments

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Binladin Group had already gone through a major workforce reduction before the COVID-19 struck the Saudi economy.
Image Credit: Reuters

Jeddah: Saudi Binladin Group failed to pay thousands of employees as the construction giant reels under the impact of coronavirus and restructures about $15 billion of debt.

The conglomerate missed some salary payments in April and May. It’s not clear yet whether the company, which employs about 100,000 staff, will be able to pay those employees in June, people said, asking not to be identified due to the sensitivity of the matter.

Existing problems at the construction firm – for decades Saudi Arabia’s go-to developer for mega-projects such as airports and holy sites – have been compounded by the impact of the coronavirus, which has halted developments and forced the company to burn through cash without any new project mandates.

Most of the affected employees are based at Binladin’s headquarters in Jeddah and work in its construction unit.

Binladin, which is working with Houlihan Lokey Inc. to tackle its debt pile, put thousands of employees on indefinite, unpaid leave as it sought to lower costs by as much as 50 per cent in May. It also reduced pay by about a third during the holy month of Ramadan to reflect shorter working hours, which impacted about half of its 100,000 employees.

Going vocal about it

Some unpaid staff have taken to Twitter to voice their anger over the delays. One user said her family feels defeated after her husband didn’t receive a salary for May, while another said: “Do not tire yourselves. We’ve been in this situation for 6 years and nobody gave us face.” Others asked: “When will we get our salaries?”

Even before this year’s crisis, Binladin was still suffering from the oil-price slump in 2015, which forced the company to cut more than 50,000 jobs in 2016. The layoffs prompted a rare show of labor unrest in the kingdom and forced the government to put up the funds to pay salaries.

The government took a stake of about 37 per cent stake in the firm from the Binladin family to “settle outstanding dues” after Bakr Binladin was swept up in a so-called corruption crackdown in November 2017.