Testing contingency plans discussed amid Covid third wave

Public health officials discussed contingency plans last month in case the Covid-19 testing system was overwhelmed as the State faced into a third wave of disease at the start of the year.

The segmentation of different parts of the population who would still qualify for testing if it had to be rationed was also discussed, records show.

Minutes from the meeting on January 7th of the National Public Health Emergency Team (Nphet) show that the Health Service Executive (HSE) gave a paper on “public health prioritisation of testing in [the] current epidemiological context”.

The paper, which was given in the days after the HSE made the decision to stop testing close contacts as the pandemic surged out of control after Christmas, outlined “an approach for prioritisation of PCR testing should testing capacity be overwhelmed” – the paper also examined the potential role for antigen testing amid the surge.

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If demand for testing – currently about 24,850 tests per day, including capacity to test samples overseas – were to exceed capacity, tests would firstly be made available for symptomatic healthcare workers and then asymptomatic healthcare workers who are close contacts of confirmed cases.

People with symptoms who live in the same household as healthcare workers, or people in high-risk categories would then be prioritised, before acute hospital admissions. For hospital admissions, the minutes show that the use of antigen testing “with PCR confirmation of negative results” would be considered.

That would be followed by symptomatic people at risk of developing sever disease, or who work or live in closed settings or are part of vulnerable communities like residents in long-term care facilities, members of the travelling community, homeless people and members of the Roma community.

Risk assessments

Wider testing would be considered for asymptomatic people caught up in outbreaks when determined by public health risk assessments. The next priority group would be those in a suspected outbreak, and people with a recent travel history from the UK or South Africa – then variants of concern in the two locations were being assessed by Nphet.

The paper assessed antigen testing and found that “there are significant operational and logistical challenges in introducing antigen detection tests”. These included that they are not intended to be delivered in large numbers and the paper pointed out that while each test requires about 20 minutes to prepare and process, in many hospitals rapid PCR tests are available in 3-4 hours and the addition of rapid antigen testing “may slow down the testing process”.

Nonetheless, some members, the minutes show, suggested “that the introducing of [rapid antigen tests] as part of a suite of measures could be helpful”. Nphet agreed to endorse the recommendations of the paper and stated that it is “open to the incorporation of additional testing strategies or modalities once their role is supported by evidence”.

The minutes, which were written before recent supply shortages emerged around vaccines, show that the Department of Health suggested that "the prospect of supplies increasing as other vaccines become available will increase the challenge as well as the opportunity".

“The system must be ready to respond with the requisite steps and workforce in place to meet the challenges as soon as new products arrive.”