Michael Clifford: Give us the story with testing, warts and all

The first week has gone well. The latest restrictions introduced eight days ago by Leo Varadkar appear to have been borne stoically by nearly everybody. It’s not life as we know it but duty calls at this point in an existential crisis.
Michael Clifford: Give us the story with testing, warts and all

The first week has gone well. The latest restrictions introduced eight days ago by Leo Varadkar appear to have been borne stoically by nearly everybody. It’s not life as we know it but duty calls at this point in an existential crisis.

We now have the evidence that restrictions work. During the week it was revealed that the initial measures have elicited positive results in terms of “flattening the curve”. Lives have been saved. That is not to at all minimise the loss of those whole loved ones have been taken by the virus, but the reality is that it could have been a lot worse. The news that drastically curtailing lifestyles and work has actually saved lives is enough to provide a shot in the arm to the national mood for solidarity.

But for how long? Is it possible that the great efforts being made — by the health authorities, health workers and politicians — might ultimately end with complacency or fatigue setting in among the general populace? All the indications are that these restrictions will have to be endured for the some time yet, so there a bit of a way to go.

Against that background, further responsibility is heaped on the authorities. Social distancing, we have been told, works best in conjunction with testing and contact tracing. The general public is doing its bit in relation to the social distancing. How are things measuring up with the other two elements?

Test, test, test, the country was told by the World Health Organisation’s (WHO) Mike Ryan. And by and large that has been the aim. A number of questions, however, do arise about how the testing has been conducted, particularly in relation to consistency and communication.

The criteria for testing has now changed twice. Prior to March 12 you were eligible for a test if you displayed symptoms and either had close contact with a confirmed case or had travelled from an infected area. These criteria appeared sound but were greatly loosened on March 12. The new position was that eligibility was down to displaying just one symptom.

Immediately, demand shot through the roof. Within five days, results were released that showed there was a 5% positive return from tests. Such a low positive rate would be acceptable if there was no limit to the supply of testing equipment.

But it should have been obvious then that there were going to be constraints in the market. Yet at the time neither the department nor the HSE gave any indication whatsoever that there would be any issue with capacity.

The high demand for tests under the loosened criteria inevitably led to greater waiting times for results. Delays fed into problems with contact tracing, which ideally is carried out once a result is confirmed. There would have been little point in attempting contact tracing before results were confirmed, as only 5% of the cases were relevant.

The testing regime finally did change on March 25, switching to the WHO’s criteria of eligibility for testing, which is displaying two symptoms. The rate for positive tests has now risen to 16%. Why was this standard not adopted from the outset?

The delay in obtaining results is an ongoing issue. Anybody who suspects they have the virus is obliged to immediately self-isolate. This is a logical policy for the common good. But a large proportion of these cases will ultimately turn out not to be infected. Tests are taking up to two weeks to process.

The fear is a time will come when patience will begin to wear thin among those self-isolating, particularly as an indeterminate number of them won’t have the infection. On Thursday it was announced that a laboratory in Germany has been retained to process the tests, a welcome development, albeit late in the day.

All of this is against a background in which official figures appear to be treated with an element of spin. Officially, the target is to conduct 15,000 tests a day. This week it was reported that around 5,000 tests were being completed daily. In fact, this referred only to the taking of swabs and not the processing of results, and in any case the real figure for swabs was between 2,000 and 3,000. Meanwhile, just over 1,500 results a day were emerging from the laboratories, creating a serious backlog.

“Perfection is the enemy of the good when it comes to emergency management,” Mike Ryan said, just as the pandemic was spreading out across Europe. “Speed trumps perfection, and the problem in society we have at the moment is that everyone is afraid of making a mistake — everyone is afraid of the consequence of error. But the greatest error is not to move.”

Mistakes have been made and they are understandable in light of Ryan’s astute assessment. But the key is how well recovery or redirection from a mistake is negotiated. In that respect, the handling of testing has seen mixed results.

Communication is another kettle of fish. On one level the health and political authorities may be operating on the basis that they don’t want to say anything that might affect confidence. Yet at a time when everybody is, in their own way,putting the shoulder to the wheel in a trying environment, it is vital that the public is kept up-to-date with accurate information.

Testing is going to be with us for some time, long after the current restrictions are loosened. It will play a vital role in attempts to renormalise society, particularly for the most vulnerable groups. New methods of testing will have to be developed.

One interesting aspect to testing emerged in the UK during the week. In contrast to this country, the UK has flip flopped in its strategy to deal with the virus but on Thursday the health secretary announced that the government would greatly involve industry in developing tests in order to reach a target of 100,000 a day. Why are real efforts not being made in this country to properly exploit industry in developing and producing tests? Apart from the pharmaceutical industry there are major possibilities right across the likes of the agri food and dairy sectors. There is no indication that all these options have been explored.

As reported in this newspaper, major efforts are afoot in engineering to develop ventilators to assist in what is expected to be a shortfall. The same kind of innovation in industry could make great strides in developing a proper, and possibly transformative, testing regime.

One way or the other, the public deserves to know the full story, warts and all, at a time when reserves of national solidarity are being called upon to serve the greater good.


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