Covid 19 Omicron outbreak: Derek Cheng – The testing failure hangover from Delta and why it matters

OPINION

It was only Monday last week when Prime Minister Jacinda Ardern assured the country that there was no issue with testing capacity.

Contrast that with yesterday’s apology from health boss Ashley Bloomfield,target=”_blank”>to the 32,000-odd people who are still waiting five days or more for a test result.

Ardern wasn’t incorrect in saying that the issue wasn’t capacity, but rather the demand across Auckland.

If health officials had realised what was happening – and it’s a wonder they didn’t, given the questions journalists were asking before the problem was apparently recognised -the backlog could have been avoided by sending samples to labs outside Auckland, or even to Australia, where 9000 samples were sent over the weekend.

It could have also been avoided if there’d been more rapid antigen tests (RATs) sooner, a shortfall that the Government has been hammered over for weeks. But there weren’t enough RATs, and instead the backlog hit 50,000.

This was at a time when the Omicron wave had really started to build, a time when people really wanted to know their test results quickly, instead of being forced to wait for days.

And it’s not the first time a lack of testing capacity has stifled the Covid response.

In the first weeks of the Delta outbreak, as the Government implored people with symptoms to get a test, frustrated Aucklanders waited all day in long queues that snaked around several lanes. Meanwhile, a request to ease the burden by private provider Rako Science, which could have tested up to 10,000 PCR saliva samples a day, went inexplicably unanswered.

The consequence was that people weren’t tested in a timely way who really needed to be tested, which slowed down all the flow-on actions to encircle contacts and contain the outbreak as much as possible.

In the aftermath the Government – controversially – gave itself powers to requisition Rako’s services to test PCR saliva samples in a future outbreak, but the new power was useless in the past week because the backlog wasn’t saliva samples, but nasopharyngeal ones.

Why saliva testing isn’t playing a prominent role in the testing strategy, despite repeatedly being raised by independent experts as well as Covid-19 Response Minister Chris Hipkins, is unclear. The Ministry of Health has even acknowledged that PCR saliva tests are as good – and less invasive – as nasopharyngeal ones.

The upshot is that the Government, in the Delta outbreak and now with Omicron, is not making use of all of the country’s testing capacity.

Does this really matter? We’re no longer on an elimination path where we’re trying to find every case.

But we still want to find every case when it comes to the vulnerable, or workers who maintain critical infrastructure. Timely test results mean quick support for the vulnerable, or quick action to keep infrastructure running.

“To do this, testing remains a cornerstone of our response,” Associate Health Minister Ayesha Verrall said in late January.

The backlog makes it more likely that such people have fallen through the cracks, though how many there are among the 32,000 is unclear.

The delay also muddies Bloomfield’s claim that the daily case numbers paint a “pretty good picture” of what is happening in the outbreak.

Fortunately, we already know there are far more infections across the country than positive test results, and because the goal is to keep the Omicron wave small enough to save the health system from crumbling, the key statistic is not case numbers but hospitalisations.

But the balls-up taints the Government’s chest-thumping in late January about its testing readiness for Omicron with capacity for 58,000 tests a day – roughly double the demand so far – and surge capacity up to 77,600 tests a day.

What wasn’t made clear, but what Bloomfield was at pains to explain yesterday, was that this was based on pooling – when several samples are combined and, if the combined sample returns a positive result, all of them are retested individually.

Pooling doesn’t increase testing capacity by much when there’s such a high proportion of positives that most of the individual samples end up needing to be tested anyway. A high positivity rate should have been anticipated, especially as we moved into the “living with Covid” phase 3 last week.

The impression it leaves is of a Government that’s been caught off-guard by how quickly Omicron has spread – which should have also been anticipated, given the luxury of watching the rest of the world’s experience in the Omicron furnace before it landed here.

It dents the Government’s credibility when it is relying, more than ever, on people to do the right thing when it comes to getting tested, reporting positive results and informing contacts.

The impression is reinforced by the lag in ditching isolation for overseas arrivals, which ideally should have started at the same time as phase 3.

Ardern was quick to defend the Government’s preparedness when asked about this lag on Monday: “We’ve moved very quickly.”

The Government has, at times, been quick and agile in its response to a fast-moving pandemic.

But given the scramble for more RATs, the mad surge in the vaccine rollout only after Delta landed, and the several months it took to properly support Māori health providers last year, a listener might have amended this to: “We acted very quickly, once we realised we hadn’t acted quickly enough”.

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