Autumn move to new Covid-19 testing system ‘challenging’

Ministers have been warned it will be “challenging” to phase out Covid-19 testing for the general population and replace it with a new surveillance system in time for the autumn.

The Cabinet last week approved a new plan to stand down Covid-19 testing centres and phase out general testing. Tests will only be given where a GP decides it is clinically necessary.

The new plan will see a new nationwide system surveillance prioritised, with 89 new staff to be recruited into the Health Protection Surveillance Centre (HPSC) with a permanent modelling group to be set up.

However sources have confirmed that Ministers were warned that the timelines for the transition from widespread testing to the new surveillance system will be “challenging”, with sources saying that there is concern around whether the structures will be ready in time for any winter surge.

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Ministers were told that Covid-19 would represent a significant public health challenge in Ireland and internationally for the foreseeable future. They were also told that while scaling back mass swabbing and contract tracing was relatively straight-forward, the proposal to set up a reliable surveillance programme in the HPSC may take more time.

Surveillance system

The establishment of the new surveillance system is one of the most fundamental parts of the future plan for dealing with Covid-19 because of the importance of monitoring the path of the virus and any new variants, which then will inform any change in public health advice.

This is considered to be particularly important going into the winter period. The new surveillance system is supposed to directly complement the new system that will see GPs offer tests if needed.

Under the new plan, there will be 89 permanent specialist posts created in the HPSC, 200 additional permanent posts in the National Ambulance Service and 200 short-term posts in the contact management programme.

The investment in the HPSC will see the expansion of the GP sentinel surveillance programme, which monitors infectious diseases in the community. Sources confirmed the Government intended to increase this surveillance from the current level of 60 GP practices to 100, while respiratory admissions at emergency departments in four chosen hospitals will be monitored over a two-year period. Ministers were told these four hospitals would be representative of the population.

A new biostatistical and modelling unit in the HPSC will replace the work previously done by the National Public Health Emergency Team (Nphet) modelling group which the Cabinet was told is no longer available. The new group will be permanent.

ICU admissions

The HPSC will also monitor disease severity, ICU admissions and deaths, perform whole genome sequencing and population surveillance including wastewater. They will also monitor vaccine uptake, impact and effectiveness.

Ministers were also told continuing the current testing programme was no longer viable as self-referrals for tests would cost considerable sums. They were also informed during that meeting that, in the 13 weeks leading to the end of June, there was €6.5 million a week spent on testing. The cost of Covid-19 in 2022 will reach €395 million which includes the costs associated with replacing the mass testing programme.

The Cabinet was also told of the Health Service Executive’s new Covid-19 workforce plan, which will see a reduction from 3,000 to between 400 and 500 staff.

Under the new winter emergency plan, National Ambulance Service mobile teams will be so-called swabbing first responders in the event of a surge or if an emergency response is required, and they will deployed in mobile units. There will be funding for eight new vehicles as part of the Cabinet decision, it is understood.

In an emergency situation, temporary testing centres will be rolled out across the country and a contact tracing model would be stood up. Under this plan, there would be 100,000 PCR tests a week rising to 150,000 a week by week eight of an emergency. Up to 300,000 antigen tests could also be sent out every week.

It is understood that the National Virus Reference Laboratory (NVRL) will only have the capacity to analyse 28,000 tests a week and the rest will have to be supplemented by private labs, with contracts to be activated. The HSE is currently conducting a review of the NVRL. There is understood to be a push to strengthen capacity, which could feed into Budget 2023 discussions.

Meanwhile, there will be 200 contact tracers left who can do 1,500 calls a day. It is understood Ministers were told that if an emergency goes into a third week and beyond this may have to be increased to 390 staff, some of whom may be drawn from government departments.