Government flags expanding coronavirus testing

Matt Woodley

24/03/2020 4:12:28 PM

New criteria to be brought in later this week are expected to remove the requirement for foreign travel.

Paul Kelly
Deputy Chief Medical Officer Professor Paul Kelly indicated an announcement would be made ‘in the coming days’. (Image: AAP)

Such a move would considerably widen the number of people eligible for testing, which has so far been restricted to recent overseas travellers, people who have had close contact with a confirmed case, and those displaying severe symptoms.
The development was forecast by Australian Deputy Chief Medical Officer Professor Paul Kelly, who indicated an announcement would be made ‘in the coming days’ in response to questioning on the ABC’s Q+A. The Federal Department of Health (DoH) later released a statement clarifying his comments.
‘As we learn more about the virus, we have continued to review the testing criteria,’ a DoH spokesperson said.
‘In light of our stronger travel restrictions, the focus logically moves to the community with COVID-19 [coronavirus] symptoms, on top of returned travellers and close contacts of cases.
‘Professor Kelly flagged that the Communicable Diseases Network Australia will change the testing guidelines for public health units in the near future.’
GPs have been calling for increased testing criteria since January, voicing fears public health authorities had set up an ‘artificial barrier’ by placing strict limits on who could be tested.
However, Australia’s Chief Medical Officer Professor Brendan Murphy recently defended the testing regimen and said ‘sentinel testing’ being conducted by select general practice clinics had been used to try and estimate the number of undetected cases in the community.
‘We are continually reviewing the testing criteria. We are expanding them already to look at aged care workers [and] healthcare workers where there is a serious risk of them transmitting,’ he said. ‘We’ve also set up what we call sentinel testing.
‘We have a number of general practices around the country that we contract with them to test everybody who comes in with a flu-like illness or any other respiratory illness, even if they don’t really need the test for their treatment, just to see what’s in the community.
‘We’ve added COVID-19 to those [tests]. So that range of general practices that are testing every person that comes in, and that will give us a read if we’re seeing examples of transmission that we haven’t seen.’
More than 147,000 test have been conducted so far. Professor Murphy said there has been a ‘loose’ interpretation of the guidelines in some instances and ‘the testing is done more liberally than the criteria at the moment’.
‘In a way that’s good because we still have a very low positivity rate. One of the lowest in the world,’ he said. ‘But we will need to expand our testing criteria.
‘We are getting good indications of significant expansion in testing capability and the testing is being expanded, and that’s being reviewed every day.
‘At the moment, though, we can’t test everyone with a flu-like illness. We have to be risk-stratified in our testing.’
Recent statistics provided by the Australian Health Protection Principal Committee (AHPPC) show more than half of Australia’s cases are ‘still imported from overseas or their direct contacts’ and support Professor Murphy’s position on testing.  
‘We have one of the lowest COVID-19 test positivity rates in the world –  0.9% compared to USA 13%, UK 5% and even ROK 3%). We have had only seven deaths, all in people aged 75 or over and so far, less than 20 people have needed ICU treatment,’ the AHPPC statement accompanying the statistics read.
‘This suggests that we do not have as large a proportion of undetected cases in the population, as was likely the case in the USA, Italy and other countries. Our early detection and control work was effective.’
The statement also said ‘further restrictions may be considered as necessary’ on top of current social distancing measures, and that future efforts ‘must include progressive expansion in the testing criteria, subject to availability of testing’.

Country Cases Tests Percent coronavirus positive Population Test by 100,000 population Date
Australia 1081 123,000 0.9% 25,633,000 480 As of 21 March
South Korea 8565 282,555 3.0% 51,470,000 549 As of 19 March
UK 3269 66,976 4.9% 66,440,000 101 As of 20 March
USA 4484 54,205 8.3% 327,200,000 17 As of 20 March
Austria 2013 18,545 10.9% 8,822,000 210 As of 21 March
France 6153 36,747 16.7% 66,990,000 55 As of 15 March
*Different countries have different testing regimes based on their case definition and testing capability. Australian testing rate equates approximately to testing of almost 5 people per 1000 population.
Coronavirus testing efforts of Australia and other comparable health systems. Source: AHPPC.

While Australia’s short-term supply of testing kits is secure, efforts are also being made to ensure there is a sufficient supply in future, especially as testing increases.
According to the Australian Financial Review, a further 1.5 million coronavirus test kits have been ordered, while a new ’15-minute’ test has been fast-tracked for approval by the Therapeutic Goods Administration.
Around 500,000 of the new OnSite Rapid Test Kits are expected to arrive this week, with another million to follow in the subsequent fortnight.
The tests are said to require two drops of blood from a finger pinprick, similar to home diabetes testing, and at five days of infection have 96.9% sensitivity (true positive rate) and 99.4% specificity (how well a test identifies patients who do not have a disease).
While the test is expected to be initially used in tertiary care facilities such as hospitals, in future it could be used by GPs and eventually at home.
Meanwhile, another new form of testing kit has also just received approval and is expected to give more accurate results in the early days of infection. It should produce results in 45 minutes without the need for a sample to be sent to a specialised lab.
Concerns over access to personal protective equipment (PPE) continue, but 1.5 million more masks have reportedly just arrived in Australia, with another 30 million more expected within the next two weeks and a further 24 million by the end of April. It is anticipated five million of these will be provided to GPs by the end of June.
The additional supplies follow another call from World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus for countries do to more to fight the spread of the coronavirus and protect healthcare workers.
‘It took 67 days from the first reported case to reach 100,000 cases, 11 days for the second 100,000 cases, and just four days for the third 100,000 cases,’ Dr Ghebreyesus told a coronavirus press briefing.
‘We need unity among the G20 countries who have more than 80% of the global GDP.
‘If we don’t prioritise protecting health workers, many people will die because the health worker who could have saved their lives is sick.’
The RACGP has more information on coronavirus available on its website.
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Dr Heidi Andersen-Dalheim   24/03/2020 5:02:15 PM

A member of my extended family today with a fever of 39, headache, difficulty breathing/worsening asthma was told she did not fulfill criteria for testing.
This is crazy. We must broaden the testing. SHe may yet need to attend ED for assistance as no GP clinic can have this type of patient walk through the door.

Dr Matt   25/03/2020 7:05:15 AM

As a sentinel testing doctor I was asked to increase testing of patients with symptoms but who don’t meet criteria for testing, but with no PPE, it’s not safe to do that because by the time I find one case and that gets reported I’ll have had contact with goodness knows how many people, including my family, and then best case scenario I’m quarantined for 2 weeks, worst case I’m dead. We need more PPE from the government stockpile now, not once we’ve detected community transmission.

Dr Dannielle Maria Kolos   25/03/2020 10:43:19 AM

Why is it that there is so much panic about this virus? There have been other pandemics with higher mortality and in my 71 years of life, I have never experienced such ACCELERATION OF 'PROTECTIVE MEASURES'! This virus has been around for much longer than Dec 2019 when reported by china who could not keep it a secret any longer as it had to shut down its cities. By that time the virus had already spread over the world, and we are picking up the latent carriers. Corona virus had not been suspected as being a cause of Viral pneumonia until the annoucement by the chinese.