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Australian government was warned about Covid testing overburden almost a year ago | Health

Official government advice prepared almost a year ago warned that widespread community transmission could see testing sites overwhelmed and “alternative testing methods”, including rapid antigen testing, could help alleviate pressure.

Amid growing criticism of the government’s handling of the testing regime in the face of the surging Omicron variant, archived advice shows that health officials were warning federal and state governments of a scenario in which testing sites could not cope as far back as February last year.

A “testing framework strategy” prepared by the Communicable Disease Network of Australia (CDNA) and the Public Health Laboratory Network (PHLN) in February 2021 modelled three epidemiological scenarios relating to the transmission of the virus, including one of high community transmission.

In this epidemiological scenario, community transmission is “placing burden on response capacity” and resulting in “testing demand exceeding laboratory and public health capacity.”

The paper states that the “analytical performance and possible uses” of rapid antigen tests is being “evaluated as a matter of urgency”, but the group’s position is that those tests are useful in limited settings, such as when there is a strong chance of a positive result.

“For example in an outbreak setting or where community transmission is established.”

“In this epidemiological scenario, in addition to use for public health investigation purposes, this technology (rapid antigen tests) may prove useful as a screening test for individuals in high risk settings … where the pre-test probability is high,” the advice states.

“It offers rapid results in relevant settings, while reducing pressure on RT-PCR capacity.”

The CDNA is a subcommittee of the Australian Health Protection Principal Committee, and was established to provide national public health coordination for the prevention and control of communicable diseases. The PHLN is a collaborative group of laboratories that provide public health microbiology services.

The joint advice, which was prepared in consultation with the Doherty Institute, suggests that given the rapid development of new testing technology, Australia has “the opportunity to explore testing strategies that may be complementary to, although not a replacement for, the gold standard diagnostic test (the RT-PCR).”

“Using alternative tests or testing methods may help conserve the capacity of the public and private laboratory systems,” a section of the advice marked “committee in confidence” says.

The emergence of the February 2021 advice comes as the prime minister, Scott Morrison, continues to defend the government’s handling of the Omicron wave, that has seen testing clinics overwhelmed amid a national shortage of rapid antigen tests.

The prime minister, who has flagged that shortages will continue for a couple of weeks, said the federal government had secured adequate supplies of rapid antigen tests to fulfil its responsibilities, and states were responsible for securing their own supplies.

He rejected suggestions the federal government was unprepared for the current outbreak.

“There are plenty of armchair critics and people who say what could have been, but those who actually are doing it every day and the health officials who have responsibility for it every day, those who are regulating vaccines, which have very profound implications for people’s health … I don’t accept the suggestion that they haven’t been doing the job,” Morrison said.

“I think they’ve been doing their job extremely well and under extraordinary pressure in a very uncertain environment.

“There’s no guidebook to Covid. We all know that. And so I what I think is important is the country just focuses on the task ahead.”

The CDNC and PHLN paper also discussed potential barriers to Australia’s testing regime, suggesting that Australia only has the capability and capacity to meet “the current testing demands”.

“However, laboratories’ maximum daily throughput cannot increase without: procuring new platforms; training new skilled medical laboratory scientists (and) identifying additional laboratory space.”

It also highlights the concerns about workforce constraints that are now being experienced, saying it “can easily come under significant pressure in times of increased testing.”

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“Several laboratories across Australia are currently operating 24 hours a day, seven days per week. This requires laboratory staff to work 12–14 hour shifts at a time. Workforce contingency planning in the event of increased testing demand should include planning for these workforces.”

Despite the discussion of scenarios where testing demand increases, the paper suggests that the “continuity of supply into the Australian market of tests and reagents for the primary Covid-19 tests in use is assured.”

“The Australian government has also invested in securing a strategic reserve of pathology supplies should international supply lines be compromised.”

A separate paper on rapid antigen tests that was first published in October 2020 and has been twice updated, outlines many of the limitations of the tests compared to PCR testing, and says the tests should only be used in limited circumstances.

“However, significant changes in epidemiology may trigger a move to wider deployment of these devices to augment the current laboratory-based systems,” the August 2021 paper says.

The paper also suggests that a protocol for reporting test numbers be established if rapid antigen tests are used, with each jurisdiction then reporting case numbers to the federal government.

Despite the early advice that such a reporting mechanism may be needed when rapid antigen tests are in use, states and territories are now scrambling to come up with a reporting system for use by the end of the month.

On Thursday, the Victorian government announced a new system obliging anyone who returns a positive rapid test to register the result.

Morrison said that case numbers, which topped 64,000 on Thursday were becoming less important.

“What matters is how many people are in hospital, ICU and on ventilators and that’s the real measure of what the impact is,” Morrison said.

“The real issue is that people are connected to care.”

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