Expert: Current testing regime rational, not ideal

Ljubljana, 20 March - Alojz Ihan, a recognised expert in immunology, believes Slovenia's current regime of testing for coronavirus is clinically rational, however, he says that many of the infected are undetected. He proposes for temperature screening for health workers coming to work.

Alojz Ihan, an export in immunology.
Photo: Daniel Novakovič/STA
File Photo

Under the new protocol swabs are being taken from everyone in need of a check-up for potential admission to hospital and those already admitted to hospital.

Also tested are health workers and residents of nursing homes or social care institutions with respiratory infections, with or without a fever regardless of whether they need hospitalisation or not.

By 2pm Thursday, 9,860 tests had been taken in Slovenia with 319 coming back positive.

Talking with the STA, Ihan said that such a testing protocol allowed the most rational use of tests for optimum effects of treatment. However, China's experience shows that 80% of infections go undetected.

"In an ideal situation with a new epidemic, every expert would obviously wish to test every suspicious case.

"However, in reality such a broad testing would not contribute to better clinical treatment of the disease, while it would engage many more health workers, protective equipment, entry points, tests, lab capacities."

Ihan notes that many of those are in short supply even now and once the epidemic expands such testing would have to be suspended to allow the rest of the health system to work and to prevent people start dying from other acute conditions.

"The Slovenian health system is so thin staff- and material-wise, without reserves (which is reflected in wait times) that it cannot afford a major diversion of personnel and funds."

With European countries stocking up on health equipment in panic, a shortage may mean that without economising, equipment, tests and everything else may run out in a few weeks even for emergency cases.

Ihan says that everyone should cooperate with the health system if the community is to overcome the epidemic - by following instructions on social distancing or those in case of symptoms such as a cold or fever.

"If people stick to that, the current testing system is optimal for the health of Slovenians over the next two months, which will depend not only on the management of the epidemic but also on the functioning of healthcare for other 'normal' diseases."

Being the key is for health institutions to actually remain functioning, Ihan says "everything must be done to prevent the epidemic spreading into them, and to detect every health worker that might be contagious as soon as possible and remove them from their post."

So the rule of thumb should be better test too much than too little. Ihan believes health workers should be tested for every symptom that might indicate Covid-19.

"Unfortunately, we know that a person may be contagious even before the symptoms occur. This is why health workers who are in good health but have been in a risky contact must start wearing protective equipment on the spot as if they were contagious, and then get tested after a week."

If the contact was a high risk the health worker should self-isolate for a fortnight and the same rules for testing should apply as for everyone else, Ihan proposes.

He believes that health workers should be under strict and objective daily control for their potential signs of illness because "the are often inattentive to their own health and often don't even notice their own signs of a cold".

This "blind spot" in the given situation may be lethal. A single health worker who neglects to notice their cold and fail to get tested many infect dozens of their patients and colleagues.

This is why Ihan proposes following the example of the US where health workers coming into work are required daily to measure their body temperature and fill in a form about potential symptoms. This report then needs to be looked into daily by their superior.

"The motive in the US is obviously that of insurance, however, this is an objective safety measure against health workers 'forgetting' their illness as they had been used to before the epidemic."

© STA, 2020