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the healthcare canary

'Ireland hasn't got the basics right yet': How is Covid-19 testing going for GPs?

“If we don’t have it for [this] level, we don’t have it for a surge,” one GP said.

AT THE MOMENT, it’s the job of GPs to refer people for a coronavirus test.

Their experience of testing so far hasn’t been good: when the “floodgates were opened” for testing, as one GP put it, there was a huge number of people who were anxiously waiting for a test result.

Although there are some signs that sampling and test result speed is slowly gathering pace, we’re not near the 24-48 hour turnaround we were promised.

And as long as Ireland’s testing capacity hasn’t yet reached 100,000 per week, the general consensus from GPs is that restrictions should remain in place.

To be considered for a test you need to be in a priority group, which includes: people aged over 70, people with certain medical conditions, healthcare workers, pregnant women; and to have displayed one of the various symptoms

Ireland’s testing capacity – or its ability to test as many people as possible – is a major factor when it comes to assessing when the current Covid-19 restrictions can be lifted substantially. 

The testing criteria is an important part of this equation too – without the right testing capacity, the government can’t set the criteria to be tested too wide, or else we’ll end up with a backlog of people waiting to be tested, or of people waiting for their results (or both).

This is what happened after the government widened the testing criteria from people who had been to an affected area or in contact with a confirmed case, to anyone who had both a fever and a persistent cough.

Widening the criteria out like this led to a backlog of 40,000 people waiting to be tested (to have a sample taken), which caused many people stress and anxiety. It also skewed the daily figures of how many confirmed cases there were in Ireland.

The backlog had to be eradicted by sending samples to Germany to be tested.

It had been announced that the testing criteria would be widened this week – but after the HSE raised concerns that it wouldn’t be able to carry out 100,000 tests a week by 27 April, as had been signalled by Chief Medical Officer Dr Tony Holohan and other health figures, this was rolled back to just a tweak of the current criteria.

At the most recent Department of Health briefing, Dr Tony Holohan said that there had been an increase in referrals since the latest tweak, but that they would decide today whether they would widen them out further.

We’ll make a decision [...] on whether we need to stick with the existing prioritisation criteria or whether we can remove them… we want to make sure it won’t have an effect beyond our capacity.

Cillian De Gascun, the director of the National Virus Reference Laboratory at UCD, said its current lab capacity is 60,000, that it will reach a capacity of 70,000 tests per week by the end of next week, and 100,000 by the week of 18 May.

The current wait time between when a sample is sent to the lab, and when a result is sent back is 24-48 hours, De Gascun said.

In all of this, general practitioners are the canary in the mine, as one Glasnevin GP put it.

Maitiú Ó Tuathail, another GP based in Dublin, said that GPs and the rest of the healthcare service had been “preparing for a surge that never came”.

He said that it was “unnerving”, in a way, as it could mean a surge will come later on, but added that even without a surge, it was “difficult to get a test and contact tracing is slow”.

He said that on Tuesday, he had a patient who was deemed suitable for testing at 8am, and by 4pm the patient was tested, which shows that they are speeding things up – but the reaction is mixed.

Three weeks ago people were waiting 10 days for a test [sample]. Now, it takes around 3-4 days to get a test result. It used to take two weeks [to get a result], but it’s still not 24-48 hours.

On the symptoms needed to get a test, Ó Tuathail said that they’ve been “tinkering with the edges”, and it won’t make a massive difference to GPs workload.

He said that the change for GPs “is minimal”, because the big limitation is the priority catagory for testing. Of those who come to him with Covid-19 symptoms, 80-90% of people are not in the priority group for testing.

In order for the lockdown to be lifted, Ó Tuathail says, we’d need a testing system similar to South Korea, where the result of a Covid-19 test is given 12-14 hours after a swab is taken, and once that result is given, tracing the contacts of that confirmed case begins immediately.

Although there was a general feeling that restrictions would be lifted by 5 May after Dr Tony Holahan and government figures announced that we had “flattened the curve to the point that there was no surge”, the fact that testing capacity isn’t where it should be is still a cause for concern.

Ó Tuathail said:

People want to see a change on 5 May, but there won’t be because we haven’t got the basics right yet. It’s helpful that they’ve come out and said that now. 

Lucia Gannon, a GP based in Killenaule, Co Tipperary, said that there were “huge delays” in receiving test results at the beginning.

“The results were very delayed, and people that had the test were anxious,” she said.

We spent a lot of time reassuring them that the test results didn’t really matter, that it was more the clinical diagnosis.

“We haven’t encouraged them to be looking for them, we haven’t emphasised the results of the test, unless they had to get back to work, or something like that. If they were symptomatic, we just said ‘Look, that’s it, we think you have Covid, you need to self isolate’.”

She said she was more concerned about at-risk patients whose health might decline quickly, and added that robust testing was needed to get out of lockdown.

“The testing has to be broadened out so that we can get a picture of what we’re dealing with, and so we can open things up again. Until we can test as many as we possibly can, we have to stay in lockdown.”

Eamonn Shanahan, is a Kerry GP based in Farranfore, who also works as a medical officer in a community nursing unit in Killarney. Because of this, he was tested along with the other staff this week as part of the new strategy announced last week to test all residents and staff on long-term residental care settings.

He said that the last time testing criteria was widened out, or “the floodgates were opened” as he put it, the services weren’t at all prepared for it.

“There was a Monday early on that this thing was horrific. I mean, the whole system crashed. There just wasn’t the capacity to accept the orders for the tests, not to mind even the test themselves.”

“And so, the system crashed and crashed badly at that stage, and I think they’ve been slowly ramping things up since then.” 

He said that although testing capacity has increased dramatically in recent weeks, he hasn’t had that many patients in the recent past that would have met the “very strict criteria” to be tested.

Previously, we would have been waiting four a weeks for a result to come back… [but] I am aware of the fact that the services have ramped up very substantially.

“My sense is that the results are coming back quicker,” he added.

Ray Walley, a GP in Glasnevin, Dublin, says that we need an “accessible, coherent, effective” testing service in order to lift restrictions.

He says that the results are coming back at mixed timeframes at the moment – sometimes they’re back quickly, sometimes they’re not.

“GPs have the most computerised system in the healthcare sector, so it makes sense that we would get the results first,” he said, adding that it’s the quickest way for patients to get a negative or positive result, which is important for contact tracing.

He said that from what he’s seen, positive tests seem to be coming back faster, but that’s just one casual observation. 

The changes to the testing criteria this week represents “a modest widening” of testing, he said, which is a good way of ramping up the system before the criteria for testing is expanded further.

“We need an acceptable test-wait time and result time,” he said.

If we don’t have it for [this] level, we don’t have it for a surge.

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