The recently published “Rapid Review of COVID-19 testing in Aotearoa New Zealand” was long overdue. So far testing has been tightly controlled and has been mostly applied to Public Health response testing. An example of Government control is the prohibition on the importing, manufacturing, supplying, selling, packing, or using point of care tests for SARS-CoV-2 or COVID-19 infection or immunity. Application must be made to the Director-General of Health for any of these actions.
The Rapid Review made thirteen recommendations, including:
The MoH to develop a clearly-articulated future-focused testing strategy
The MoH to facilitate test delivery using co-design and fit for purpose innovative testing
The MoH to consolidate, rationalize, and resource policies and procedures for testing
The MoH to clearly articulate the way tests are determined to be regulated and/or funded
The MoH to actively encourage, and facilitate piloting, new testing approaches
The MoH to develop a comprehensive ongoing system of new tests assessment
The MoH to develop their system of scanning for novel testing approaches
The MoH to have a strategic approach to community engagement and communication for testing
The MoH to continue to implement and expand technology solutions to support collection, testing, and reporting processes.
Consolidation of advice on testing is required. The Rapid Review Report listed no fewer than nine laboratory groups and networks associated with COVID-19 testing. There are many reasons for COVID-19 testing which vary according to the setting, eg. MIQ, symptomatic people, contract tracing, different workplaces, hospitals, and aged residential care. With the fragmentation described in the Report it is unlikely that a “whole of system" view can be formed which considers the purpose of testing in these diverse settings. The attributes of a test which make it fit for purpose for contract tracing and symptomatic testing are not necessarily needed for high frequency worker or MIQ testing when there is COVID-19 transmission in the community.
A future-focused testing strategy for COVID-19 testing and result reporting must account for the biology of SARS-CoV-2. Frequency of testing had been addressed before here but virus biology is relevant to laboratory reporting times as well. Previous variants of the virus took about 5 days for a person to become infectious. In this setting there was some leeway for contract tracing to occur to interrupt chains of transmission. If the future purposes of public health testing remain as understanding links between cases and interrupting chains of transmission then results need to be reported swiftly because the delta variant reaches infectiousness days sooner. With Delta, the target of 80% reported within 24 hours will fall short of meeting the goals of testing. Specimen transportation to the laboratory needs to be swift and frequent. Once received in the laboratory testing and reporting should be completed within 12 hours. Rako Science's saliva testing the time from collection to reporting is just over 10 hours and once received in the laboratory is under 5 hours.
Slow reporting times reduces the ability of our committed and hard-working Public Health Officers to rapidly intervene to reduce transmission.
Dr Arthur Morris.
Arthur Morris is a pathologist, clinical microbiologist, with a long-term interest in infection prevention and control. He is the supervising pathologist for IGENZ.
In January 2021, IGENZ Ltd, a contracted testing laboratory, achieved IANZ accreditation for saliva testing using the Rako Science methodology, based on validation work that used a set of contemporaneously collected paired saliva and nasopharyngeal samples.