Should Ireland implement a population-based Covid-19 testing programme?

PAUL MULHOLLAND

As winter approaches, the need to develop strategies to combat Covid-19 takes on fresh urgency. The reopening of society from lockdown in the absence of a vaccine, plus the added complication of cold and flu season, means the health service is again at risk of being overwhelmed unless decisive action is taken.

One posited strategy, which is being implemented in some regions, is ‘population-based’, or ‘mass’ testing. Critics of the approach say it is expensive and impractical, a waste of valuable resources. Even proponents are not blind to the challenges of such a programme. If it is to be undertaken, it needs to be done in the right way.

A recent editorial in the British Medical Journal on the subject stated: “A key lesson from screening is that the entire system must be well coordinated, have quality assurance built in for each element, and be backed by the right information technology. Without a good system the benefits are unlikely to be realised and the main outcomes will be harms from unwarranted intervention, confusion, mistrust, and diversion of laboratory and other resources away from more beneficial activities.”

It continues: “The system must ensure that testing is accessible, trusted, and tailored to all sections of society (especially ethnic minority groups and those at disadvantage) – otherwise those who most need testing will not be reached.”

A feature in this issue of the Medical Independent explores population-based Covid-19 testing from an Irish perspective. The HSE says it has capacity to perform 100,000 tests a week. However, speaking before the Oireachtas special committee on Covid-19 recently, HSE CEO Mr Paul Reid said it does not make economic sense to do so.

Dr Tomás Ryan, Assistant Professor at the School of Biochemistry and Immunology, Trinity College Dublin (TCD), said it is a “mystery” why Ireland is not performing 100,000 tests a week. He stresses though that the turnaround time for test results is perhaps even more important than capacity. In the feature, Prof Kingston Mills, Professor of Experimental Immunology at TCD, points out rapid testing, which is being rolled out in many jurisdictions, is a vital measure, particularly for people coming from abroad.

What Dr Ryan is most critical about is the lack of an Irish strategy regarding Covid-19. Even the UK, which was rightly criticised for its slow response to the pandemic, has been clearer about its plans of late.

It was recently reported that the British government is to trial routine weekly Covid-19 testing of the population as part of preparations to tackle a second wave this winter. The new community-wide trial in Salford will assess the benefits of repeat population testing by focusing initially on a specific ‘high-footfall’ location in the city.

Back home, while the Minister for Health Stephen Donnelly’s announcement that an expanded influenza vaccination programme will roll out this autumn, is to be welcomed, much more is needed given the scale of the threat Covid-19 poses. Too many questions still remain about what the Government strategy is, despite the rise in cases in recent weeks.

Communication too has left a lot to be desired and that is being generous. Although these challenges are not unique to Ireland, the chronic lack of capacity in our health system makes it even more important for the Government to plan a coherent way forward as soon as possible.