Boris Johnson indicated in his prime ministerial news conference on Saturday that within a very few days, there was going to be a mass testing of the whole population.  

This is clearly a major undertaking but let’s look and see whether it is being done in any other countries. 

An interesting world report in The Lancet published October 31, 2020 by Ed Holt looks at the plans to test all adults for SARS-CoV-2 in Slovakia.

Slovakia has begun a massive operation to test its entire adult population for SARS-CoV-2 in a bid to halt what its government has said is an alarming acceleration of the spread of the virus in the country.  

An initial three day pilot testing scheme in four regions in the north of the country that had become infection hotspots began on October 23, 2020.  This was ahead of testing the whole population on the two weekends of October 30 to November 1 and November 6 to 8. 

But how effective is this and how safe, particularly as this operation was only announced two weeks before it was due to begin?

The number of COVID-19 cases has risen rapidly in Slovakia since the end of the summer.  

In the last three weeks, thousands of new infections have been identified per day with the proportion of infections for the number of tested at just under 16%.  Government ministers have called this number alarming and have warned that, unless the spread of the virus is slowed, the country’s hospitals would be on the brink of collapse within weeks.  

For this mass testing, thousands of testing sites have been set up across the country and everyone over the age of 10 years, that is approximately 4 million people, will be asked to attend a testing site and take an antigen test.  This is a rapid antigen test and people will be made to wait in a separate disinfected room for around half an hour when they will be given their result.

Anyone testing positive will have to remain in strict isolation at their home for 10 days or they will be encouraged to go into a quarantine facility provided by the state.  Many shops are being closed and restrictions on movement imposed during the three-week period of testing with people subject to random spot checks by police.  

Everyone taking the test will be given a certificate to present if requested.  Failure to do so will result in a fine of €1650.  The testing is voluntary but anyone not participating will have to self-isolate in their homes for 10 days.  

Breaking the quarantine also carries a fine of €1650.  Individuals older than 65 years who spend most of their time at home have been urged not to participate, but the government has said that it will carry out testing of older people in care homes.  Testing will also be done in hospitals.  

There has been some controversy with various different opinions on the mode of testing and the actual test itself.

Scientists have questioned the use of antigen tests which WHO has said are not suitable for mass testing unless used alongside PCR tests.  The tests that have been purchased by the government include BIOCREDIT COVID-19 Ag, RapiGEN, and Standard Q COVID-19 antigen.  The test has a specificity of 99.68% and a sensitivity of 96.52% compared with PCR tests.  

There is controversy about this accuracy and it has also been pointed out that there is an increased risk of infection at testing sites and concerns over massive logistical challenges.  

The army was called in to help but the government has said that 20,000 medical staff will be needed for the nationwide mass testing and as at the date of October 25, they had not reached this target.  

There are thought to be many risks, not communicating properly to the public, the aim and process of the testing would create misunderstanding, frustration, fear and opposition as suggested by Alexandra Brazinova an epidemiologist at the Medical Facility of Comenius University in Bratislava.  She also was fearful of the risk of many false positives and false negatives, which would allow infected people to spread the disease while keeping others needlessly in quarantine.  

She suggested that this would undermine public trust towards testing.

The pilot tests initially encountered problems, some centres were unable to open because of a lack of equipment or personnel – volunteers did not turn up, or healthcare workers were found to be infected themselves.  At others, hundreds of people queued outside for hours, although social distancing was enforced by soldiers, who had been drafted in to help but by the third day officials at sites reported that testing was running smoothly.  

Over the three days, 140,951 people were tested out of an estimated maximum 155,000 people eligible to take part, with 5,594 positive cases identified.  

Beyond the potential operational difficulties there have been questions raised about its ultimate benefits.  Brazinova said that mass testing will not stop the pandemic, the best it will do is to slow the spread and get us back to where we were a few weeks ago.

The government also admitted as much, stressing that testing is not a quick fix.  The Slovak Government and state healthcare officials also sighted that the pilot testing had been a success.  

They said that it had put thousands of the most infectious people into quarantine.  There were no problems, social distancing was observed at all times and it was safe.They felt that the piIot had been a good test in preparation for the nationwide testing. 

They also said it have been able to identify 5000 in one area alone who had tested positive. 

In regard to using antigen rather than PCR test, they sighted the fact that nowhere in the world was there the capacity to use PCR test.  They suggested that antigen tests were as sensitive in the first few days with a person’s infection, which is why they were repeating a second test a week later.

This testing on a mass scale of the whole population has never been done before.  Earlier in October, Chinese authorities tested more than 7 million people in the city of Qingdao over three days.  The Chinese operation, however, used sample testing where individual samples are collected and then processed in batches of 10 at a time in a single nuclear acid test.  Similar tests were also done in Wuhan.  

Julian Peto, Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, London, UK, has been campaigning for the UK Government to adopt regular mass testing.  

He told The Lancet that the testing in Slovakia sounded like a good idea but was concerned about their operational method.  

At that time there was a call for an immediate three-week lockdown but this was discounted on economic grounds.  As with most national issues, it was felt that the Prime Minister’s decision highlighted what is thought to be a detrimental role politics is playing in the response to a country’s outbreak.  

The experts should lead the politicians not vice versa.  

The London General Practice is exploring all new testing methods for Covid-19. 

These are then reviewed by our Clinical Governance Committee and only after very careful scrutiny they are considered for use in clinical practice. 

Dr Paul Ettlinger
London General Practice

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