Here’s why we are failing the Covid testing test

Dr Eric Crampton
The Dominion Post
15 November, 2021

The Ministry of Health’s approach to Covid testing is going to kill people.

For all of the past year, the Ministry has been horribly wrong about Covid testing systems. It has ignored substantial reviews of testing policy. And it has allowed petty resentment against the only appropriately validated provider of rapid saliva-based PCR testing to drive its procurement policies.

This week, the Auditor General damned the Ministry’s Covid testing procurement process.

Fixing the testing system is desperately urgent.

Good testing is critical if there is to be any hope of getting back on top of the Covid outbreak.

It is also incredibly important as newer therapeutic treatments come into use.

These treatments sharply reduce the risk of a Covid case winding up in hospital or ICU, if administered early. They reduce suffering and ease the burden on the health system.

But antivirals often need to be administered early to be effective.

Early treatment requires knowing whether someone has Covid, or just a sniffle.

Knowing whether someone has Covid requires that testing be available. It also requires that test results be available quickly.

If instead symptomatic people are turned away from testing centres for two days straight, as Jo Moir reported from Taranaki yesterday, everything gets harder. Moir reported that testing centres in Taranaki closed at 1 o’clock Saturday afternoon, turning people away.

The problem is hardly restricted to Taranaki.

This Sunday, no testing was available anywhere in Wellington before 10 am or after 4 pm. If you do not have a car and if you do not live within walking distance of Bedford Street in Porirua, Taranaki Street downtown, or Coastlands in Paraparaumu, good luck finding a test. On a weekday, getting a test after 5pm can be a challenge too.

Long queues for Covid testing or difficulty in getting to testing stations are a deterrent to being tested in the first place. Lengthy waits for results after being tested are dangerous as well. People are less likely to get tested for a sniffle if they know they will have to isolate at home for days while waiting on a result.

Nothing has been reported on why the family in Stratford delayed being tested for so long. But making testing a hassle with long queues and longer delays doesn’t help.

If someone with Covid delays getting tested while symptoms are mild, because the testing queues are long and because there are long delays in getting results, they are likely to pass it on to more people. And, when the better pharmaceuticals are here available, they risk missing out on treatment at the point at which it is most effective.

As Covid works its inexorable way southwards, being able to rapidly stand up testing centres matters.

Inadequate test availability and slow test results are not inevitable. They are a consequence of policy decisions by the Ministry of Health to rely on swab-based testing. If your testing system relies on collecting swabs, you will need trained nurses to collect samples. Trained nurses are in short supply. Having a nurse stand around at a testing station, on the off chance that someone might show up, is costly. So testing stations run limited hours.

Getting reliable saliva samples also requires trained staff at collection stations, but it does not require nurses. The training is far less complex. It is consequently much easier to rapidly roll out a lot of testing stations that can be open for longer hours. And it provides results more quickly as well.

For all of the past year, the Ministry of Health has disparaged saliva-based PCR testing – despite its being at least as accurate as the Ministry’s preferred swab-based methods.

When Covid cases were only found in MIQ, the Ministry’s position was frustrating. Everyone in the MIQ system could have been tested far more regularly. Cases could have been caught before they were infectious, and before they leaked out of MIQ.

Now, the Ministry’s position is more directly hazardous to public health.

Rapid antigen tests, which are less reliable than PCR tests but are good at confirming that a case of the sniffles really is Covid, remain generally banned – barring a small number of trials and workplace-based tests.

The government’s position has been that, because these rapid tests are less reliable than PCR tests, rapid tests should be banned. But PCR tests are not readily available when and where they are needed. The ban on rapid antigen testing is a ban on getting tested at all for anyone who does not have ready access to an operating Covid testing station.

The testing system that was barely adequate before Covid became established in Auckland is completely incapable of dealing with what is needed as Covid now spreads.

The Ministry of Health is failing a critical test, and all of us will bear the cost.

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