GPs warn Covid-19 testing systems must improve to avoid repeat of delays

Expanded criteria will lead to more testing for coronavirus, but doctors have warned the system for testing and contact tracing must be more robust to avoid a repeat of long waiting times for results seen last month.

The Irish College of General Pracitioners (ICGP) said that the widened criteria, in place since Tuesday morning, will see more people becoming eligible for testing for the disease. Patients now need to have just one of three symptoms – fever, cough or shortness of breath – and be part of a priority group to be eligible for testing, such as working in the healthcare sector, or having a condition that may make them more vulnerable.

While the GPs' representative organisation welcomed the move, ICGP president Dr Mary Favier said: "the HSE must ensure the capacity is there within the system to accommodate and manage the ramping up in the number of tests performed each week."

The State’s capacity to carry out swabbing of people in the community, as well as laboratory analysis of samples, was severely curtailed in recent weeks due to a shortage of vital supplies. While sampling and analysis capacity has been built up in recent weeks, the restrictive criteria and an emphasis on testing residents and staff in nursing homes has limited the number of samples being taken in the community.

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Senior HSE officials raised concerns last week with the Department of Health over plans to expand testing to a level of 15,000 per day, or 100,000 per week. While a framework agreement between the two was agreed, the original aim to have built capacity to test at that level by last week has now been replaced by a goal to achieve it by the middle of May.

‘Modest widening’

Calling the adjustment to testing criteria a “modest widening”, Dr Favier also said the process of tracing close contacts of confirmed cases needed to function effectively in order for the State’s wider strategy to work. Contact tracing was also affected by issues in March and early April, with technical issues delaying the start of work at some contact tracing centres. Delays between samples being taken and results being delivered also limited effectiveness of the contact tracing process.

“Contact tracing needs to be timely and appropriately organised in order to deal with the anticipated rise in new cases revealed by increased testing. If a test result is positive, Public Health must ensure they have the resources to quickly trace that person’s contacts to ensure we are then managing the ongoing spread of the disease.

“Without this resource being widely and consistently available, we will see a further inevitable surge in infection rates. Such a surge will place significant additional pressures on general practice and the wider healthcare services.”

Last week, Dr Tony Holohan, the chief medical officer, said he believed the testing system had the capacity to deal with increased numbers of cases. A rapid testing system, which moves quickly from sampling to lab results and contact tracing, is seen as a vital step to relaxing restrictions.

Frontline GPs expressed the belief that they would be able to deal with increased numbers of cases coming forward for referral. Dr Tom O'Dowd, who works as a GP in Tallaght, said that in a four-hour stint on Tuesday morning he referred just one person who would not have been eligible for testing under the previous criteria.

“In my own practice, we were very anxious and overwhelmed in the early stages [of the pandemic] ... if there is an upswing, I do think we’ll be better at it this time. We have the systems in place now.” During a short period when patients needed just one symptom to be eligible for testing, online referral systems crashed and the system was swamped by more than 15,000 referrals a day. Combined with the equipment shortages, this led to significant delays in sending results to people who had been tested.

Anyone who suspects they may have symptoms of the virus, also known as Covid-19, is advised to contact their GP free of charge for an assessment.