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Should there be widespread Covid-19 testing for healthcare professionals?

As the number of healthcare workers in Ireland with Covid-19 continues to climb, the HSE is under growing pressure to address the issue. Priscilla Lynch reports

The HSE is facing mounting calls for increased Covid-19 testing of frontline healthcare workers, given the high number of cases being diagnosed among the group.

Data from the Health Protection Surveillance Centre (HPSC), as of midnight 15 May (23,953 cases), revealed that the number of confirmed Covid-19 cases associated with healthcare workers had hit 7,566, almost 31.6 per cent of all cases, and was climbing daily.

This is despite increased access to personal protective equipment (PPE) for healthcare staff.

In contrast, the percentage of Covid-19 cases associated with healthcare workers was 23 per cent on 28 March (578 cases out of 2,475), up from 13 per cent at the very beginning of March.

The majority of cases associated with healthcare workers in Ireland have been in nurses, healthcare assistants, and allied healthcare workers with 11.5per cent per cent of cases in doctors as of mid-April.

As of early last week, seven healthcare workers with Covid-19 had died in Ireland, 252 had been hospitalised and 41 had been admitted to ICU.

In a statement last week, the Mater Misericordiae University Hospital, Dublin, said it has carried out comprehensive contact tracing on every single member of staff who tested positive for Covid-19 through its occupational health department in line with best practice. 

“In excess of 300 staff at the Mater have tested positive for Covid-19 and a further 1,500 have self-isolated following contact tracing to protect patients, fellow staff and the public – despite the enormous impact this has had on our operations,” the hospital said.  

Ireland now has one of the highest reported infection rates of Covid-19 among healthcare workers in the world.

A recent report (April) from the European Centre for Disease Prevention and Control (ECDC) reported that 3.8 per cent (1,716/44,672) confirmed cases of Covid-19 in China were among healthcare workers, with 10 per cent of cases in Italy, with the Lombardy region reporting up to 20 per cent of cases in healthcare workers. In Spain, 20 per cent of Covid-19 cases were in healthcare workers. In the US, overall, only 3 per cent  (9282/315531) of reported cases were among healthcare workers; however, among states with more complete reporting, healthcare workers accounted for 11 per cent of reported cases.

In response to questions from the Medical Independent (MI) at the weekly HSE Covid-19 operations briefing about whether the HSE was considering carrying out more widespread testing of healthcare staff as has happened in some countries, HSE Chief Clinical Officer Dr Colm Henry said healthcare workers remain among the priority groups for testing.

Dr Henry said the Executive was conscious of the need for healthcare workers to be tested quickly if they were symptomatic or exposed to known/suspect cases and to get results back promptly, but that mass testing was not being advised at this stage.

Criticism

However, a number of doctors in Ireland have been critical of the healthcare worker testing process, saying they faced long delays to get test results back. There is also the criticism that contact tracing was not comprehensive enough or did not happen at all when positive tests were eventually confirmed, such as the case of Dublin GP Dr Nina Byrnes.

Prof John Crown, Consultant Oncologist, St Vincent’s University Hospital, Dublin, has been vocal in calling for regular testing of frontline healthcare workers since early in the pandemic.

A number of doctors, both in hospital and general practice settings, told MI last week that they were in favour of wider testing for Covid-19 among healthcare workers, especially as the current demand for testing is well below the available capacity.

Monaghan GP Dr Illona Duffy tested positive for Covid-19 back in early April and waited six days for her test results, though she acknowledged the testing system is now much faster.

Dr Duffy told MI that she “absolutely” believed there should be wider testing of healthcare workers to detect asymptomatic cases, following the recent mass testing of all staff and residents in nursing homes where some asymptomatic cases were detected.

“This is probably replicated through the health service. Therefore, we need to look at repeated testing of healthcare staff to minimise spread of Covid-19.”

Dublin GP Dr Conor McGrane also agreed that mass testing of frontline workers should happen “soon”.

“[I] would suspect a lot of GPs must have been exposed at the very least,” he said.

Dr John Duddy, trainee Neurosurgeon, Beaumont Hospital, Dublin, also said he was “most definitely” in favour of wider testing of healthcare workers, as was GP Dr Alex McVey.

Cautious approach

Other doctors, especially those working in public health, urged a more cautious approach, however, saying that if it was to work properly healthcare workers would have to be tested regularly, not just on a once-off basis. Some argued that it would be of limited value and potentially a waste of valuable resources if a very small number of cases was detected and that it could delay test results for symptomatic cases. The health service would also have to be prepared to deal with potentially numerous staff having to self-isolate if they tested positive.

Upon further questioning last week, Dr Henry told MI that while the issue of wider testing for healthcare workers was being considered, like other at-risk groups, he said the number of asymptomatic healthcare staff in nursing homes had been lower than feared and that would feed into any decision making.

He said decisions would be guided by public health and the HPSC, which is finalising a report on the lessons from the nursing home testing exercise.

Self-swabbing kits

The UK government has been sending out home testing kits to key workers and their families, care home residents and over-65s.

Responding to questions at last Thursday’s HSE briefing from MI about whether self-swabbing kits would be a useful option for testing healthcare workers en-masse, Director of the National Virus Reference Laboratory Dr Cillian De Gascun said he would be wary of introducing something new, such as self-swabbing in the setting of a pandemic, “just because it is convenient.”

Dr De Gascun said that while there is a lot of interest in the use of self-swabbing in testing, and it is more common for some diseases, he thinks it is easier someone else does the swab test for Covid-19 even for healthcare workers, as nasopharyngeal swabbing is “quite unpleasant”.

Meanwhile, Covid-19 serology testing is planned to be rolled out initially in June in Ireland (in a couple of selected settings), to try to ascertain the prevalence of Covid-19 in the wider population.

Healthcare workers might be considered to be one of the groups to receive antibody testing as a priority once a robust test is chosen for adoption here, informed sources indicated.

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