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Dublin: 4°C Thursday 4 March 2021

Explainer: How testing for Covid-19 works now and why you still need to isolate when sick - even if not tested

Around 20,000 people a day have been seeking a test – now the scope has been narrowed down to focus on priority groups.

IT WAS ANNOUNCED on Tuesday evening that health officials had decided to change the case definition for Covid-19 tests, narrowing down the focus on particular groups.

Chief Medical Officer Dr Tony Holohan said there had been a very significant increase in the number of people seeking tests since the case definition was widened almost two weeks ago to include anyone who had any of the main symptoms (fever, cough, shortness of breath).

“If we were to test at that regime, we would, by a considerable distance become the number one country in the world for testing,” he said. 

Around 20,000 people a day have been seeking a test and Dr Holohan acknowledged that the net may have been cast too widely “in good faith”.

However he said it was not feasible to continue in this way, particularly since the vast majority of people are testing negative and it is not the best use of resources.

What has changed?

Previously, anyone who had any of the main symptoms was advised to contact their GP and the doctor would assess whether the person should be referred to have  sample taken for testing.

Now, GPs are advised to only refer people for a test if they have a fever (38 degrees or above) or chills AND one of the following symptoms:

  • a cough – this can be any kind of cough, not just dry
  • shortness of breath

On top of this, in order to get tested you would have to be in one of a number of priority groups.

These include:

  • Close contacts of a confirmed case
  • Healthcare workers who are on the frontline and have regular patient contact
  • Those most at risk of severe infection such as people with diabetes, immunosuppressed, chronic lung disease, chronic heart disease, cerebrovascular disease, chronic renal disease, chronic liver disease and smoker
  • People who live with those in the above groups
  • Staff and residents of nursing homes and other residential care settings and those in direct provision, homeless, Roma and travelling community settings where symptom management is difficult
  • Pregnant women to ensure they are managed safely in hospital.

What if I’ve already been referred for a test or already have an appointment for one?

If you had already had your swab sample taken, you will still receive your results – by text if it was negative and over the phone if it was positive. If you test positive, a public health doctor will call you – your GP will not know your result before you do so there is no need to call them in the meantime.

Anyone with an appointment for a test today will still have their sample taken at the arranged location.

However, if you have an appointment for any day after today, that appointment is now cancelled, aside from those for healthcare workers. 

If you have a fever and a cough or a fever and shortness of breath AND you are in a priority group you should call your GP to arrange a new test. 

While you’re waiting to have your sample taken and while you’re waiting for your results, you still need to self-isolate. 

What if my doctor thinks I have it but I don’t fit the new criteria?

If you have any symptoms such as a sore throat, runny nose, blocked nose, cough or wheezing, you should behave as if you have the virus. 

The advice is still to self-isolate for 14 days to help stop the spread of the disease. The people in your household will also need to restrict their movements. 

Health officials have stressed it is important for people to follow this advice on self-isolation and restricting movements for 14 days, even if they are not going to be tested.

Why was this decision made?

Cillian De Gascun, chair of the HSE’s coronavirus expert advisory group said the positivity rate of the samples is currently 6% and this suggests there could be viral illnesses that are not Covid-19. 

Dr Holohan also explained this at last night’s briefing, stating that GPs had seen a very significant increase in the rate of influenza-like symptoms in the last week.

He said usually when there is a spike in that rate, it is accompanied by a significant increase in the percentage of positive cases in the population. This hasn’t happened in Ireland.

“It hasn’t been the disease driving that, it’s other behaviours,” he said, suggesting that the broad case definition almost two weeks ago led to worry among members of the public who then sought tests they probably did not need. 

Dr Holohan said there needs to be a focus now on people with a higher probability of having this particular infection. 

Does this not mean they’ll miss loads of positive cases and their contacts?

It is likely that the change in case definition will mean some cases are not tested and not included in the official numbers.

However, Dr Colm Henry explained that the  purpose of the test is to detect the virus, not necessarily for somebody’s health reasons “because it makes no difference to the course that they’re in this is to improve our detection rates so we can instigate contact tracing”.

“So the the fact that they haven’t got a test makes no difference to the course of their illness.”

He advised people not to let the absence of a test or delay in test lead them to delay seeking medical help if that’s what is needed. 

The number of contacts confirmed cases have had has dropped from 20 to around five and the CMO said this is generally limited to household contacts.

This means transmission can be limited if people continue to follow the general public health guidelines and if households in which a person has symptoms continue to restrict their movements.   

The situation is evolving rapidly and this case definition may well change again in the coming weeks. In the meantime, the health service expects to get to a capacity of up to 16,000 test a day over the next four weeks. 

Last night Dr Ronan Glynn, Deputy Chief Medical Officer, said the strategy is still to test as many people as possible – that’s why capacity is continuing to increase – but in the short-term he said the decision was to prioritise these groups. 

Glynn said by tightening the case definition it will be more likely that tests pick up the people who actually have the disease and that their contacts can be traced. 

He said the case definition is being looked at on an ongoing basis and “as capacity increased that will change and more people will be tested”.  

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