BGS Scotland: Response to COVID-19 testing

 

1. What role should testing play in helping to tackle the pandemic?
 

Older people who become infected with COVID-19 often present with less typical symptoms. Therefore testing for older patients should not be limited to those presenting with a cough or fever and should be offered to all older people presenting at hospital.

 

When tests are carried out the results should be rapidly available. Where the result is negative and out of keeping with the patient’s clinical symptoms there should be a low threshold for repeating the test. This is because testing currently has a high false negative rate which is a problem for the accurate diagnosis of COVID-19. Work on refining testing should continue as the ideal test should have a low false negative rate (high sensitivity) to ensure cases are not missed.
 

Testing should also include residents and staff in care homes as there is a particular issue around the diagnosis of COVID-19 in care homes. However, this needs to be handled carefully as there is the potential for such tests to cause distress, particularly in older people who lack capacity. There will also be issues around obtaining consent in such individuals. The benefits and harms of testing these people must be balanced to ensure that testing is in the best interests of the individual concerned and other residents and staff at the care home.

 

Testing and contact tracing of symptomatic hospital and other healthcare staff should be readily available.
 

Where feasible there should be access to a population-based testing system (regardless of age) with a test that has a low false negative rate (high sensitivity). This requires follow up with contact tracing, testing and isolation. This approach has been demonstrated to limit the spread of COVID-19 in countries that have adopted this system.
 

It is important that testing does not cause harm, and that testing pathways are clear. There should also be access to clearly described actions that require to be followed where a positive test is obtained in different patient groups.

 

 

Rapid access to testing delivered by trained individuals to obtain consistent test results in hospitals, care homes and the community. In care homes, outreach teams should be available to rapidly test residents and staff. Testing facilities must be established in locations that are readily accessible to those likely to be using them.
 

Increased laboratory capacity will be needed to cope with the volume of tests required or the development of near patient testing facilities. Test results must be available quickly to allow decisions about treatment and care to be made and implemented.
 

A system needs to be in place to allow all positive tests to be followed up by tracing and contacting those who had contact with people who have tested positive for the virus. Reliable mechanisms need to be established to allow the secure passing of information to allow for contact tracing.
 

At present it is not possible to determine if someone has previously had COVID-19 and recovered without a diagnosis. It would be useful to know this information to understand more about how the virus operates and any immunity that people who have had the virus have developed. Reliable antibody testing is necessary to facilitate this.