Coronavirus testing regime may be scaled back significantly under Nphet plans

Nphet considers much more selective testing as vaccination mitigates harm from virus

Stewards near Croke Park testing centre. Photograph: Dara Mac Dónaill

Stewards near Croke Park testing centre. Photograph: Dara Mac Dónaill

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Testing for Covid-19 would be radically scaled back under plans being considered by the National Public Health Emergency Team (Nphet), as harm associated with the virus is reduced.

A paper on transitioning away from the “unprecedented” mass testing regime that has been put in place details a “stepwise” approach away from the current system.

Among the first steps would be advising against testing vaccinated people with mild respiratory symptoms, and testing of children under 13 with mild symptoms to be discouraged if they do not deteriorate over 48 hours.

“The success of the vaccination programme requires a fundamental revaluation of the approach to testing for Sars-CoV-2 and how it links to the evolving public health response,” according the discussion paper, which was submitted to Nphet in late July and released under the Freedom of Information Act.

With Covid likely to become endemic in the global population, alongside reduced harm due to vaccines, “we need to begin to consider how we plan to transition towards placing testing … back in the framework within which we test for other infections,” the paper’s author, Prof Martin Cormican, argues.

Prof Cormican, who is the HSE’s leading expert on infection control, says this will mean testing for coronavirus “much more selectively”. This would mean usually testing only when requested by a healthcare professional, as part of managing an outbreak, or surveillance testing for the disease more in line with how the prevalence of other respiratory viruses is monitored.

“Planning for a transition from open access or mass scale… testing is important because as [harm] declines, the negative impacts of testing on the current scale are likely to become disproportionate to the benefits to human health.”

‘Medicalising daily life’

It outlines a range of drawbacks associated with the current regime, including “medicalising daily life” in ways that have “significant social consequences” such as the exclusion of children from school, or delays in accessing healthcare for asymptomatic people or those with residual virus in their system following earlier infection.

A continuing focus on Covid that is “disproportionate to its clinical and public health impact can result in diagnostic tunnel vision/confirmatory bias”, and that mass testing is uncomfortable, inconvenient and entails social and financial costs, it says.

The paper does not outline a timeframe for changing the system, but suggests early steps could proceed soon. The structure of the testing regime, including plans to reduce the need for asymptomatic close contacts of confirmed cases in schools to be excluded from classes, is expected to be discussed when Nphet meets this week.

Ultimately the paper suggests that testing of all people with mild symptoms, including the unvaccinated, would stop. A system where testing was available at the request of a doctor or in a range of other circumstances would be retained, as would approaches such as sewage surveillance. The paper was presented at a meeting of Nphet on July 27th, and referred to its secretariat.

On Sunday, HSE chief executive Paul Reid said the rule in relation to schools was “probably unnecessary”. There was a need to balance “what is necessary and what is proportionate” in the public health advice for children being obliged to stay home from school as close contacts, he said.

A further 1,346 cases of Covid-19 were confirmed in the State on Sunday with 315 Covid-positive patients in hospital, of whom 59 were in intensive care.

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