Testing concerns as COVID hospitalisations hit record levels

There are now more patients in Australian hospitals with COVID-19 than ever before, recent statistics show.
 
According to the data-tracking website COVIDLive, there were 5571 cases in hospital on Tuesday 26 July, a leap of 138 compared to the previous day.
 
Both days exceeded the previous high registered six months previously on 25 January, when there 5390 patients in hospital with COVID-19.
 
The record levels come at a time when concerns have once again been raised about the efficacy of some rapid antigen tests, with the Peter Doherty Institute now helping the Department of Health (DoH) validate the tests.
 
An article in News Corp on Tuesday focused on the reliability of the tests, with the newspaper reporting that four different rapid antigen tests have been removed from the Australian Register of Therapeutic Goods (ARTG).
 
The DoH said that ‘the majority [of tests] are compliant’.
 
‘This means they met the regulatory requirements at the time they were approved by the TGA [Therapeutic Goods Administration] and then sponsors submitted ongoing data to demonstrate their test continues to perform against variants,’ a spokesperson told newsGP.
 
However, there are also questions over whether the accuracy of official case numbers – always thought to have had a very wide margin of error – could be deteriorating due to those testing concerns, non-reporting and a shrinking capacity to conduct PCR tests.
 
In Victoria, for example, even close contacts of those with a positive COVID-19 test are advised not to seek a PCR test unless they are classified as ‘at risk’.
 
While the case numbers have ranged from around 30,000–50,000 this month, they are notably fewer – officially at least – than the tallies in January, where 100,000 cases a day were recorded on several occasions.
 
It may suggest that previous patterns of rising hospitalisations following peaks in case number peaks could become harder to gauge.
 
‘Confusing’ hospitalisation data
For Professor Catherine Bennett, Chair in Epidemiology at Deakin University, the level of recorded COVID-19 hospitalisations is ‘confusing’ – and does not indicate more acute morbidity.
 
She believes there the distinction between those in hospital with COVID-19 rather than for COVID-19 may be distorting the picture, given the screening that happens in hospital. 
 
‘It suggests that a lot of the hospital numbers are people there for other reasons, and we’re talking about an indication of background prevalence,’ Professor Bennett told newsGP.
 
‘It’s a problem for hospitals because they’ve got a proportion of people now going in who have COVID even if they’re there for other reasons that you’ve got to manage.’
 
ICU levels of those with COVID-19 are also notably lower than they were in January, although the number of people dying in residential aged care facilities is likely to be contributing to that trend.  
 
Professor Bennett says there have been concerns over rapid antigen tests since they were first introduced, but believes they remain an important tool in trying to limit the spread of infection.
 
She also is unsure whether PCR testing is in practice being used according to narrower guidelines in place in some jurisdictions.
 
‘If it helps clear the queues, so that people who need a rapid, reliable test to assess them or evaluate their eligibility for antivirals, that’s really important,’ she said.
 
‘I’m not sure if there was a problem. Either there were a lot of people coming along, and they were having trouble particularly prioritising people, or those people weren’t coming along anyway.’
 
Last month, Deputy Chief Medical Officer Professor Michael Kidd urged GPs to encourage patients with symptoms to get PCR testing even if rapid antigen tests were giving a negative result.
 
‘We are recommending that if you have someone who’s at risk and who may benefit from the antivirals that they don’t rely on a negative rapid antigen test,’ he said.
 
‘If they have symptoms, and they have a negative [test], please ask for them to arrange to get a PCR test so that there is no delay in making the diagnosis and getting people onto treatment.’
 
Associate Professor Charlotte Hespe, Chair of RACGP NSW and ACT, told the Daily Telegraph it is important symptomatic people do not expose others.
 
‘We have always tried to message that it doesn’t matter that you have a negative [test], if you have symptoms you should be out of the community until you don’t have them,’ she said.
 
Death rate
In the meantime, there were 100 COVID-19 related deaths recorded in Australia on Tuesday, the second time this month the official figure has hit three figures.
 
‘What the death data tells us is it is moving through the whole community, it’s now been established right across all our states – there are very few areas with no signals of COVID,’ Professor Bennett said.
 
‘The more we keep recycling the virus through the community, particularly driven by reinfection, the harder it is to protect the vulnerable.
 
‘That’s clearly the biggest challenge.’
 
She said greater mask use and boosters will be key to addressing that – and also hopes the strain on hospitals could ease as the seasons change.
 
‘Hopefully our flu numbers will start to decline,’ Professor Bennett said. ‘This is proving to be a really, long, tough winter.
 
‘More masks on, and people taking advantage of the fourth dose – they are the messages we really want to get out there to try to take some pressure off the health system.’
 
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COVID-19 hospitalisations Rapid antigen testing