As Victoria undertakes a coronavirus testing blitz, what more can Australia do to prepare for surge testing?
With scenes of gridlocked carparks dominating news reports, Kumarini knew he’d have to strategise.
The drive-through testing clinic at his local shopping centre in Melbourne opened at 9:00am, and so it stood to reason that turning up five minutes after opening was a safe bet — or so he thought.
“They told us to go to Chadstone. At Chadstone we waited for 3.5 hours and finally got into the carpark,” he said.
“Moments later we were told they were done for the day despite the hours stating they were running until 7:00pm.”
It’s a quandary facing thousands of Victorians living in Melbourne’s so-called coronavirus “hot spots”, as rising case numbers spark fears of a second wave of infections.
While people are being urged to present for testing, there are concerns Australia isn’t well-enough equipped to cope with surging demand.
“Considering the numbers over the week, [they] should have planned for this,” Kumarini said.
Why do mass testing?
With daily case numbers again in the double digits, the Victorian Government has announced a new testing blitz that will target up to half the population in suburbs where a “community transmission challenge” has been identified.
It’s a novel approach, but far from an anomaly given steps being taken in other countries.
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In Wuhan, China, for example — where the virus is thought to have emerged — authorities claim to have tested nine million people within just 10 days as part of their own mass testing regime.
While that figure is comparatively smaller in Victoria — which is aiming to carry out 100,000 tests in 10 days — the campaign is similarly being targeted at asymptomatic carriers: those who are infected but who show no signs of illness.
“You’d be testing to flush out what we do know, which is the proportion of cases who are asymptomatic can be as high as 18 per cent,” says Marylouise McLaws, a professor of infectious diseases at UNSW and member of the World Health Organization’s COVID-19 advisory panel.
“When you add that to the pre-symptomatic cases … you’ve got at least 40 per cent of cases not presenting with a symptom.
“[So] we have a large proportion in the hot spot areas who could be, potentially, a driver for infection.”
What can we learn from China?
Professor McLaws, who describes Australia’s response to mass testing as “reactive rather than proactive”, believes there are lessons to be learnt from the international experience: “Hot spots should be ring-fenced and tested,” she says.
In Wuhan, officials set up more than 230 testing booths in neighbourhoods across the city, combing through areas such as construction sites and markets for those not yet tested.
For residents unable to leave their homes, authorities did door-to-door visits (In Melbourne, about 1,000 people will doorknock homes with information about COVID-19 and testing).
“Australia has never experienced a pandemic before but Hong Kong, Taiwan, Vietnam South Korea and China all have, and it’s the sort of thing where we should be sharing information,” McLaws says.
“We can learn so much from our Asian neighbours and how they coped with the surge of testing.”
Professor McLaws also points to the importance of retesting of those who have already returned a negative result.
This may be particularly pertinent in light of the situation in Victoria, where about half of all new coronavirus cases since April are a result of family-to-family transmission.
“[China] initially put families together that had a case and found that, in small apartments, it’s hard to prevent a cluster, so they then built purpose-built facilities,” Professor McLaws says.
Do we have the resources?
Australia’s “reactive” response aside, do we even have the resources to facilitate mass testing?
According to infectious diseases physician and microbiologist Paul Griffin, while Australia has fared comparatively well to date, there have been “slight limitations” due to logistical issues.
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“In Australia, it’s long been identified that our laboratories are really good quality, but we weren’t prepared for this sort of thing,” he says.
“We saw lots of access issues with bad flu years in the past, and when things do ramp up, there are some issues getting those tests done.”
And while authorities are confident there are enough testing kits, Professor McLaws adds, “What has been holding us back is the [lack of] resources to be able to test”.
“Pathology is working 24/7 to get results back within 24 hours,” she says.
In response to Victoria’s new testing blitz, New South Wales, Tasmania, Queensland and South Australia have agreed to help process the extra swabs, while the Australian Defence Force will help fly the tests to those states’ capital cities for processing.
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Dr Griffin says while there have been a lot of claims about rapid tests and antibody tests, “they’re just not reliable”.
“The tests that we’re using are good, they are reliable, but they take a bit longer,” he says.
“PCR-based tests can turn around in a few hours, but that’s once the specimen is in the lab, so it takes time to get from where it’s collected to the laboratory and get the result out.
“They’re subject to volume, so when the volume goes up like we’ve seen in Victoria … the turnaround time can extend out a little bit.”
While authorities in Wuhan reportedly implemented batch or pool testing — where samples from 10 people or fewer are combined into one test, and individually tested only if a positive results occurs — the strategy has its own limitations.
However, from next week Victorian authorities will introduce a new saliva test sample, developed by Melbourne’s Doherty Institute.
According to Premier Daniel Andrews, it won’t replace the use of nasopharyngeal testing (a swab of the nose and mouth) or reduce the amount of time required to analyse the results. But it will reduce the time it takes to conduct the test.
It’s sure to be a welcome addition to the arsenal of an 800-strong team of health workers, who will run mobile testing vans at the end of residential streets, among other measures.