Coronavirus testing capacity under strain as demand surges

There is a simple reason for the alarming rise in confirmed cases of coronavirus in recent days, a trend that will only accelerate as this week progresses.

The number of positive tests is surging because more tests are being carried out, in more locations, with a simplified process for accessing them.

What is alarming, of course, is the underlying evidence of widespread circulation of the virus that these positive tests reveal.

This is not surprising; we have known since March 5th, almost two weeks ago, that the virus was circulating independently of any travel back from Italy or contact with confirmed cases.

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Prof Liam Glynn of University of Limerick Medical School has estimated the true number of cases at 2,000 and rising

That first instance of community transmission has been joined by others since. Doctors have been saying for weeks they suspect the disease is far more prevalent than was known from the limited official testing then ongoing.

No one knows exactly how many people have the virus in Ireland, though Prof Liam Glynn of University of Limerick Medical School has estimated the true number of cases at 2,000 and rising.

It certainly feels that way given the number of people I personally know, including healthcare workers and journalists, who have tested positive. This is just anecdote, I know.

Demand for tests

On the positive side, the growing demand for testing is evidence that the message about the virus, and about testing for symptoms, is getting out there. But it has also put a nascent system under incredible pressure.

There were reports of up to 800 suspected cases awaiting callback at the end of last week, and of people – including healthcare workers – waiting over two days to be tested.

A move to direct referral by GPs (who, before this, had to refer suspect cases to public health staff) and online ordering of tests have been accompanied by IT glitches.

Further confusion saw people wrongly ringing 999/112 seeking a test (instead of their GP) and even calling to the doors of hospitals in Galway.

These problems, hopefully, will be shortlived, though it remains to be seen whether the capacity of the system is up to meeting demand as it surges.

An individual concerned they might have the virus will obviously want a test. The symptoms to watch out for are a new fever or cough.

The system too wants people tested, but its priorities may be different, especially when the number of people seeking to be tested exceeds available capacity.

It doesn't help that staff report a shortage of personal protective equipment, or that sectors such as dentistry or homecare workers say they don't have clear guidelines

People cannot expect, therefore, that they will be given a test, or that they will be given a test ahead of others. What they do need to do immediately, on experiencing symptoms, is to self-isolate. This, if done effectively, removes the threat of the disease being passed on.

And while the person might be understandably anxious to get tested, so long as their symptoms are mild, they do not need to worry unduly. Public health doctors will prioritise other patients with greater clinical need.

Healthcare workers

Consideration will also have to be given to prioritising the testing of healthcare workers. Efforts to fight the virus in China were badly stymied as doctors and nurses fell ill, and many infected fellow staff before showing symptoms. The same scenario is playing out, in equally stark terms, in Italy at present.

It doesn’t help that staff report a shortage of personal protective equipment, or that sectors such as dentistry or homecare workers say they don’t have clear guidelines to follow. Again, hopefully, these gaps will be rectified shortly.

Testing is only one half of the two-pronged approach needed now. Once confirmed cases are identified, any people they have been in close contact with have to be tracked down as quickly as possible and told to self-quarantine.

We haven’t heard much about this work, though large numbers of staff from other areas of the public service are being trained up to carry out this vital activity. If we are to arrest the spread of the virus, at least 70 per cent of these contacts have to be tracked down; for the virus to be “pushed back”, so it will eventually fizzle out, at least 90 per cent have to be tracked down.