How could actor Idris Elba get tested for coronavirus in the U.K. even if he didn’t have symptoms, while some health care workers can’t?
As the number of confirmed cases of coronavirus has skyrocketed in Europe, access to testing has sparked tensions among ordinary citizens and disagreement among national and international health officials.
At issue is that most European countries prioritize testing only for the most severe cases and tend to focus on those admitted to hospital, so medical staff know how to treat them and ensure the infection doesn’t spread. But the World Health Organization (WHO) still advises that countries test as widely as possible, even if the virus has spread in the community.
Some health experts, however, think the window for widespread testing to make a difference has closed.
“We will not get that disease out of the world anymore,” said Mika Salminen, the director of health at the Finnish National Institute for Health and Welfare (THL), at a government briefing on March 19, Helsingin Sanomat reported.
But since infected people can spread the virus before symptoms show, more and more Europeans want to get tested. This sentiment has only grown amid stories of people with serious symptoms who have gone without testing.
The case of an academic in the U.K. who was refused a test got widespread attention on social media. Then there is the story of a Hungarian woman whose doctor told her remotely she didn’t have the virus even though she had a fever for days. One of her sons recounted his family’s struggle via YouTube videos from his hospital quarantine. His mother eventually tested positive, as did his brother.
Meanwhile, health care workers in Britain who think they might be infected are initially told to self-isolate, without testing. That precaution could change, however, when the country ramps up its testing capacity, Patrick Vallance, the U.K. government chief scientific adviser, told a parliament inquiry.
The lack of access across Europe has sparked complaints about government preparedness and inequalities, compounded by celebrities and politicians having access to testing when showing mild or no symptoms.
While Finland’s Salminen said he understood people’s wish to be tested, those who can ride out the virus at home don’t benefit from it, he said.
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“The test is not a cure,” he said.
More cases = fewer tests
In the early days of the outbreak, when Europe’s first confirmed cases were imported, many countries tested people who had been exposed to those carriers.
The gold standard test is based on health care workers using swabs to take samples from the respiratory tract and sending them to government-designated labs.
But with numbers exploding every day in recent weeks, that model is now under severe strain.
European countries are running out of laboratory testing materials and capacity. By extension, governments have to prioritize resources, said Maria-Rosa Capobianchi, the director of the Virology Laboratory at Italy’s National Institute for Infectious Diseases and one of the members of the European Commission’s coronavirus advisory group.
For now, testing suppliers are ramping up their production. But major companies that provide the reagents that labs need to analyze tests are reaching “the maximum of their capacity,” said Capobianchi, noting there’s also a need for more swabs for collecting samples. “I don’t know how long they would require to scale up their capacity,” she said of reagent producers.
At the same time, it would be dangerous to flood labs with tests for people who don’t need urgent diagnosis, she warned.
Furthermore, most of the so-called rapid tests now on the market may not detect the virus in the early stages, she cautioned, since they measure antibodies that people can develop to fight the virus. These appear later than symptoms and can give false negative results.
A survey by the European Centre for Disease Prevention and Control (ECDC) launched at the beginning of March showed laboratories were already running out of test kits, reagents, personnel and personal protective equipment, one spokesperson said.
To address these shortfalls, the Commission launched a public procurement process for laboratory equipment on March 19, with suppliers expected to submit their offers by March 31, according to a Commission official.
And last Thursday, it recommended that countries prioritize testing based on the severity of the cases, starting with people hospitalized with severe acute respiratory infections and ending with those with milder forms of respiratory infections, if resources allow.
People without symptoms who’ve been exposed to confirmed cases could also be tested, the Commission said. But with tens of thousands of such cases in some EU countries, many are recommending that those exposed self-isolate.
“I understand the frustrations of those who want a test,” British Health Secretary Matt Hancock told the House of Commons on March 16. “[But] we’ve got to make sure we use those tests on the people who need them most and that means saving lives in hospital.”
As of March 25, the U.K. had tested some 97,000 people, out of which 9,529 were positive.
The government hopes to be able to increase testing capacity to 25,000 hospital patients per day, in about a month, it said on March 18.
Testing has also been an issue in France due to limited resources, the president of the country’s Scientific Coronavirus Committee, Jean-François Delfraissy, told La Croix on March 20.
The country has the capacity to do some 5,000 tests a day, with 60,000 done from the beginning of the crisis until March 23, the health ministry told POLITICO.
But some of the needed testing products come from China and the U.S. and aren’t in sufficient supply, Delfraissy said. The authorities are in the process of taking “industrial measures” to procure these products so they can implement a massive testing strategy.
The government is also setting up a scientific committee to look into moving from limited testing to a wider approach.
Belgium, one of the first countries to take a conservative approach to testing, is also now looking to increase its capacity.
Belgian Prime Minister Sophie Wilmès announced on Sunday a task force to increase testing from the current 2,000-plus tests per day. At present, not everyone who experiences symptoms — including health care workers — get tested.
Austria and Spain are also working hard to be able to test more widely.
Wider testing = lower death rates?
Germany seemed to be the outlier on testing so far. Germany tested approximately 200,000 people between March 16 and 22, up from 160,000 the prior week, a spokesperson of the federal health ministry said on March 25.
Testing is crucial in an epidemic, Richard Pebody, WHO Europe Team Lead for High Threat Pathogens, told POLITICO.
“At each stage, [what’s] really, really important is finding your cases rapidly, investigating them, testing them, isolating them, identify their contacts, quarantine the contacts, test them and try to prevent onward spread,” he said.
Authorities in some German, French and Spanish regions have also set up drive-through testing sites, similar to South Korea, which is seen as an example of how widespread testing can help contain the virus.
South Korea also quickly identified the religious group where the infection’s spread started, which helped its tracing efforts, according to WHO’s Pebody. And while the country is indeed an example for how massive testing helped trace and isolate infected people — without trapping the entire population — they also tracked citizens to find out who may have come in contact with an infected person, France’s Delfraissy said.
“This type of technology poses very serious ethical questions, in particular regarding the use of personal data,” he added.
Back in Europe, the difference between targeted and widespread testing — which may catch people with milder forms of COVID-19 — may be one reason Germany has a lower death toll compared to France, for example.
As of March 26, Germany had 36,508 confirmed cases, out of which 198 people had died. By contrast, France had more than 25,000 cases, which include 1331 deaths.
In Italy, the head of the Italian Civil Protection Agency Angelo Borrelli told La Repubblica that it’s possible 10 people have gone undetected for each person confirmed positive. Italy had some 73,000 cases as of March 25, out of some 324,000 tests.
This uncertainty is dangerous, warns WHO boss Tedros Adhanom Ghebreyesus, who has cautioned that not knowing the real numbers means authorities may be flying blind.
To win against the fight, “we need to attack the virus with aggressive and targeted tactics — testing every suspected case, isolating and caring for every confirmed case, and tracing and quarantining every close contact,” he said on Monday.
Many European countries are moving toward using so-called high-throughput machines that allow up to 5,000 testing samples to be processed per day, said Mike Ryan, the WHO executive director for emergencies program.
Until it gets there, the Continent has chosen to restrict people’s movements and tell them to keep their distance when they absolutely need to get out. That’s a defensive measure that can buy time, Tedros said.
Massive testing will be the way out of these confinement measures, according to Delfraissy.
“In 30 or 40 days, when the containment begins to be loosened, the population will have to be massively tested,” he said.“If treatment has emerged by then, all those who test positive for COVID-19 should also be treated systematically.”
This story has been updated.
Barbara Moens, Lili Bayer, Ashleigh Furlong, Cristina Gallardo, Elisa Braun, Silvia Sciorilli Borrelli, Judith Mischke, Eddy Wax, Jan Cienski and Andrew Gray contributed reporting.
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