EXPERT REACTION: Coronavirus - Answers to your latest questions on testing

• What's the consensus around testing - is Australia doing enough testing or not? And how long is reasonable for people to wait for results?  There are reports of delays of six days etc. Is this normal and understandable? Or a problem?

"Ultimately, we are testing the most high risk groups. This just takes time and there is a little bit of a backlog because of the number of people that need to be test. It’s a numbers game – we can’t test the whole population and need to focus on the ones who have the highest probability of contracting the virus.

• What's the consensus around testing - is Australia doing enough testing or not? And how long is reasonable for people to wait for results?  There are reports of delays of six days etc. Is this normal and understandable? Or a problem?

"I don’t think Australia is doing enough testing – but we also have to be pragmatic. We do not currently have infinite resources to test everyone. So there needs to be some criteria in order for people to be tested. There is huge demand for testing capacity globally and – like toilet paper – limited testing kits. I think 6 days is too long to wait.

• What's the consensus around testing - is Australia doing enough testing or not? And how long is reasonable for people to wait for results?  There are reports of delays of six days etc. Is this normal and understandable? Or a problem?

"It is not possible to test everyone. Therefore, limits have been imposed based on risk. The AHPPC recommends:

Your doctor will tell you if you should be tested. They will arrange for the test.

You will only be tested if your doctor decides you meet the criteria:

·         You have returned from overseas in the past 14 days and you develop respiratory illness with or without fever

·         You have been in close contact with a confirmed COVID-19 case in the past 14 days and you develop respiratory illness with or without fever

·         You have severe community-acquired pneumonia and there is no clear cause

·         You are a healthcare worker who works directly with patients and you have a respiratory illness and a fever

There is a global shortage of the test kits that pathologists use to diagnose COVID-19. This is why we are doing targeted testing instead of widespread testing.

The US CDC recommends:

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:

·         Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

·         Other symptomatic individuals such as older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

·         Any persons including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas (see below) within 14 days of their symptom onset.

There are epidemiologic factors that may also help guide decisions about COVID-19 testing. Documented COVID-19 infections in a jurisdiction and known community transmission may contribute to an epidemiologic risk assessment to inform testing decisions. Clinicians are strongly encouraged to test for other causes of respiratory illness (e.g., influenza).

Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management. Patients who have severe symptoms, such as difficulty breathing, should seek care immediately. Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness.