Fighting a fire blindfolded? COVID-19 testing in Northern Ireland

Fighting a fire blindfolded? COVID-19 testing in Northern Ireland
by Jenny McENEANEY for FactCheckNI
8 April 2020

“You cannot fight a fire blindfolded… test, test, test.” That’s a summary of the World Health Organization’s (WHO) guidance to countries battling the global outbreak of COVID-19. Globally, there has been a variance in the rate of testing as countries battle to suppress and/or mitigate the spread of the virus. How does Northern Ireland fit into the global picture? How have we fared on testing to date and what is the target going forward?

Why is testing important?

If large-scale testing is introduced early enough into the epidemic, it is suggested that it allows health services to quickly identify who has the disease, arrange for them to receive the care they need, and isolate cases to slow the rate of transmission. This was the World Health Organisation’s position and one that South Korea and Germany adopted.

Testing in the UK

As of 5 April 2020, the UK government has tested 195,524 people for COVID-19, of which 47,806 were confirmed positive.

In the UK, the focus is on two different types of tests:

  1. a diagnostic swab test, which assesses whether someone currently has the virus
  2. an antibodies blood test, which assesses whether someone has had the virus and therefore has a degree of immunity

The government has been criticised for the delay in rolling out mass community testing. In light of limited capacity, they have prioritised those with underlying health conditions who are more likely to be seriously affected by the virus.

The UK Minister for Health, Matt Hancock, on 2 April pledged that 100,000 daily tests — a target that included both testing for the presence of the virus and testing for presence of the antibodies — would be carried out by the end of April, with key workers included as a priority. As of 4 April, there were 10,000 tests being carried out per day on average.

According to Michael Le Page, writing in the New Scientist and speaking on BBC Radio 5 Live (at 8:00), there are concerns regarding the reliability of the antibody tests, whether they’re appropriate at this stage, and how achieving the target of 100,000 daily tests may mask a relatively low level of diagnostic swab tests.

The UK Government stressed that the delay in rolling out testing is primarily attributed to laboratory capacity and the absence of key materials required. The Telegraph reported a claim that UK laboratories have the capacity to process 100,000 tests per day, but are now facing a global shortage of materials required to undertake the tests.

Northern Ireland to date

So, how is testing for COVID-19 going in Northern Ireland? Between 23 March and 5 April 2020, a total of 8,486 people were tested in Northern Ireland.

In the course of writing this article, FactCheckNI investigated a claim about the current capacity for testing made by the Health Minister Robin Swann MLA to the Assembly on Tuesday 24 March:

“The most recent update, which I received yesterday, is that we are now doing over 600 tests per day in the regional virus reference laboratory. This laboratory will be doing 900 tests per day by early next week. Two other trusts will commence testing this week, which will add another 250 tests per day. That will bring our testing capability to over 1,100 tests per day.”

The Public Health Agency (PHA) publishes daily COVID-19 Surveillance Reports on their website, with the first published on Tuesday 24 March.

There has been a variance in figures cited for the daily rate of testing in Northern Ireland. In the COVID-19 Surveillance Report published on 24 March, the PHA included a figure of 297 tests completed in the previous 24 hours, less than half of the tests that Minister Swann had announced for the same day. According to the PHA report, that figure was based on twice daily laboratory reports.

The same COVID-19 Surveillance Report of 24 March explained that this figure would be revised:

“Prior to the 13th March, total tests included only individuals that met the case definition (travel and clinical criteria). However, during this time wider testing was also being conducted across all Trusts in Northern Ireland. These individuals are now included in the overall virology total resulting in an overnight increase of approximately 400 tests which affected the total number of tests and total number of negative reports.”

In the COVID-19 Surveillance Report published a week later on 2 April with figures for the same date of 23 March, includes a graph that shows that over 400 tests were carried out on 23 March.

Also, in response to FactCheckNI, the PHA stated that with “real time reporting of statistics, there is a lag in reporting. The PHA can initially only report on the completed test results it receives for a particular day.” [emphasis added]

In response to the difference in PHA testing figures reported on 24th March and 2nd April, and the Minister’s figures, the PHA stated:

“This number refers to tests taken on that day for which the completed result is available. There will be other tests taken that day but as the result is not yet available they will not be included. When they become available they are added to the total and reported in later bulletins in assigned to the date of testing. That is why on 2nd April, the report for that day states there were 400 tests in Northern Ireland on 23rd March. The difference is accounted for by the later reporting of the other tests.

“It is important to note that PHA reports on the number of individuals who have been tested and results received, and not the number of tests completed. Other figures reported around testing may refer to the total number of tests completed.” [emphasis added]

Up until 23 March, the Belfast Trust Regional Viral Laboratory was the only lab processing COVID-19 tests. The Northern Trust laboratory started testing on 23 March and the Southern Trust Laboratory began on 28 March. Data from these laboratories were not included in the PHA figures until 30 March. The Western Trust began testing on 3 April and its figures will be included in the PHA figures from 7 April.

Graph: 1. Surveillance of SARS-CoV-2 (coronavirus) Laboratory Testing; Source: HSC Public Health Agency (6/4/2020)

As of 5 April, laboratory testing has not reached the 1,100 target outlined by the Minister of Health and, as evidenced in the bar lines of the graph above published by the PHA, there has not been a consistent upward trend. The testing supply shortages faced by the UK as a whole also apply to Northern Ireland, complicated by the inability of the Department of Health NI to directly order COVID-19 tests from Randox.

In summary:

  • As of 5 April 2020, the cumulative figure since 23 March 2020 for the number of people tested in Northern Ireland is 8,486
  • The PHA has stated that there is a lag in reporting real time statistics; the PHA can initially only report on the completed test results it receives for a particular day
  • It is important to note that PHA reports on number of individuals who have been tested and results received, and not the number of tests completed
  • As of 5 April 2020, laboratory testing has not been reaching the 1,100 target outlined by the Minister of Health and there has not been a consistent increase.

Image: Testing kit for nCov by Joseph Dilag used by license Dreamstime.com