Testing the waters Strategic testing, and plenty of it, maybe to be WA's best chance of managing future outbreaks of SARS CoV2.
Jan Hallam reports.
Whichever way you look at it, and especially if you’re looking at it from overseas, Australia has done an enviable job in containing what has proved to be a nasty, destructive viral pandemic. The unity of the early days of the Australian response has started to fragment as understandably each state deals with its own set of circumstances and conditions. However, one fundamental area that is far from consistent, and arguably should be, is testing. In this regard, WA is very much at the low end of the scale. While other states are in the hundreds of thousands, in Victoria more than 100,000 in the space of a week, WA recorded a total of just over 67,000 as of May 20. The genuine fears of PPE and testing kit shortages several months ago have long abated, so why is WA not doing more strategic asymptomatic testing? It is a question the AMA WA president Dr Andrew Miller has been asking for some weeks now. He is not advocating a free-for-all but he is particularly concerned that with the inevitable lifting of interstate borders, WA will see flare-ups that will need to be managed especially for vulnerable patients in hospitals and aged care facilities and key, frontline workers. “The testing is a puzzle to me. I still don't feel like I have a complete understanding of why the restrictions on testing were in place at the start, or on private pathology being involved, when they weren't held back in other states,” he said. 20 | JUNE 2020
“And I still don't understand why doctors can't just order COVID tests as they would for any other test – to eliminate as much as confirm. We must have very high testing rates targeted towards at-risk populations as we ease restrictions. Clearly schools are one area as are health care workers and pre-operative or pre-admission patients. “We know that people who have procedures when they're in the prodromal phase of COVID-19 have very bad outcomes. With seemingly low community spread, it's unlikely we're going to find a positive asymptomatic patient in the community but this targeted testing before patients go into a hospital would be worthwhile.”
Cost v Risk Dr Miller said that for the cost of a $100 test, it would be a small price for a hospital to pay if it avoided having to evacuate patients and shut down and deep clean wards, as was the case in north-west Tasmania. “A deep clean and shut down could cost millions of dollars. So, this pre-surgical, pre-admission testing would be a small insurance for facilities. And we shouldn’t leave it up to patients to decide if they need testing. Humans aren't always honest, even with themselves, particularly if it may mean them missing out on their procedure, or having to go into quarantine for 14 days. It would be naïve to think everyone will come forward if they've got symptoms.” Medical Forum asked the Health
Department of WA a series of questions around testing. Its full response is on our website (www.mforum.com.au). It is clear that COVID testing is very much a controlled activity with penalties for non-compliance. The spokesperson said the testing in WA reflected both population size and COVID activity in the population: “In the setting of very limited community transmission that WA has achieved thus far, it is not a priority in and of itself to try to match testing rates … from other jurisdictions that are experiencing outbreaks.” HoDWA said that it was abiding by the Australian Health Protection Principal Committee suggestion to test “people at risk of exposure who present with atypical symptoms, such as health care workers and residential aged care facility workers”. In terms of strategic and sustained workforce testing for health care workers (including aged care) and workers in essential industries such as education and mining, HoDWA offered: “We may consider shortterm wider testing in the future.” Regarding pre-surgical testing, HoDWA said: “Testing of asymptomatic patients prior to surgery is only approved for a limited number of patients undergoing specific aerodigestive procedures where prolonged aerosol exposure is expected.” The mining industry has taken the front step during the first phase
MEDICAL FORUM | MENTAL HEALTH ISSUE
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