Coronavirus: Testing capacity there but faster results and tracing needed

With reproduction number tamed, focus on dealing with flare-ups vital

Henry Street in Dublin: It is taking 1.3 days to be referred for a testing appointment. The average wait from the time a swab is taken to the lab result is 1.4 days.  Photograph: Brian Lawless/PA

Henry Street in Dublin: It is taking 1.3 days to be referred for a testing appointment. The average wait from the time a swab is taken to the lab result is 1.4 days. Photograph: Brian Lawless/PA

 

Even in advance of the decision to be taken at Friday’s Cabinet meeting, it is clear Ireland has done enough to be able to move to the second phase of the Government’s roadmap next Monday.

The number of new cases each day has remained under 100 for the last 12 days. The knock-on effect of this reduction in cases is that fewer patients are being hospitalised – fewer than 40 were in intensive care on Wednesday. We are well within our capacity to cope within the health system at present.

The reproduction number, a measure of the number of other people a case goes on to infect, has risen, but it remains well below 1. When the reproduction number is below 1, an epidemic dies out; when it goes above that number – when the average case infects more than one other person – it takes off.

The increase in the reproduction number was to be expected, given the increased activity allowed for in the first phase of easing, which began late last month. As we move around more, the virus has the potential to move around more too.

Yet we have flattened the curve rather than crushing it, as many experts would have preferred. Almost 40 per cent of the admittedly smaller daily number of cases involve community transmission, meaning we don’t know where they originated.

The other 60 per cent arise from close contact with cases, which means they can be followed up. But as we move around, the number of contacts we have will increase, and so the potential for more spread arises.

Delicate balance

Throughout the summer, in this middle phase of the epidemic, the focus is likely to be on extinguishing any new flare-ups of the disease while slowly trying to get back to normal in society, or at least the “new normal” of socially distanced life.

It’s a delicate balance, christened “the hammer and the dance” by one US analyst. The virus cannot be controlled unless we test people with symptoms promptly (and we could also test some groups of people who are not displaying symptoms) and then trace their contacts promptly.

Unfortunately, the turnaround times for testing and tracing still don’t seem to be up to scratch.

It is taking an average of 1.3 days at present to be referred for a testing appointment; one in six people has to wait more than 48 hours. Then, the average wait from the time a swab is taken to the lab result is 1.4 days.

But even this figure masks a big difference in the turnaround time between hospitals and in the community. Staff and patients in hospital are waiting an average 16.8 hours from swabbing to a result; those in the community have to wait almost three times as long – 46.3 hours.

Minister for Health Simon Harris had to wait for three days after his test last week for a result; this writer waited four days, from Monday to Friday, also last week.

Inconvenience vs danger

If the result is negative, the delay is just personally inconvenient. But if the test is positive, the ensuing process of contact tracing is delayed, potentially leaving the virus free to circulate for longer than is necessary.

According to the latest Health Service Executive figures, it is taking all of 5.2 days on average to trace all the contacts of a known case. The median wait is just one day, and the median number of contacts per case has been between two and three since April, so it is likely a small number of complex contact tracings, which are taking many days, is pushing up the average.

The latest international evidence points to the outsized role played by a minority of “superspreaders” in transmitting the virus. Researchers have found that out of five people who have contracted the disease, say four might play little or no role in passing it on, while the fifth will be responsible for most of the spread. Why this is the case is not clear as yet.

We can expect the average number of contacts per case to rise as we get out and about more, so the need to speed up testing and tracing becomes even more urgent; some experts say the entire process needs to be completed within 24 hours in order to stifle any further surges. This will become even more challenging if tourism restarts and cross-Border contact tracing is required.

At least the capacity to test more people is there; currently, less than one-fifth of the 15,000 per day capacity in the system is being used.

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