NIPH: Norway’s test strategy should be updated

Last week, more than 85,000 people were tested for the coronavirus. Not sustainable, writes FHI in a new risk assessment.

According to the Norwegian Institute of Public Health (NIPH), there are several challenges with testing in Norway:

• It is not known if it is sufficiently targeted.
• The purposes of the test should be better described.
• There is a mismatch between demand and capacity in the municipalities.
• Attrition hazard for healthcare professionals.
• Response time can be so long that usefulness almost disappears.

An “unsustainable” situation

The number of people testing in Norway has increased considerably since July. Last week, 85,364 people underwent the test, while the previous week (24-30 August) a weekly record was set with 86,606 coronary tests performed.

“The current situation is not sustainable and should be quickly improved,” FHI wrote in its new risk assessment on Friday.

It is noted that the mismatch between how many people want to test themselves and testability needs to be rectified so that current testing criteria can be followed (see data box). Today, it is recommended that anyone who suspects they are infected with Covid-19 have the opportunity to get tested.

You want clearer criteria, but not stricter

The chief infection control physician, Preben Aavitsland at FHI, tells Aftenposten that the strategy needs to be updated so that the capacity throughout the testing chain, from sampling to analysis, is large enough to meet the need. This is especially important for winter, when many people have symptoms that can resemble corona symptoms.

– Can it be relevant with new test criteria?

– Yes, it is relevant with clearer criteria, but not stricter, for those who have symptoms or have been exposed to infections. We want more tests and trials with a clear purpose, says Aavitsland.

Remember that a test by itself does not contribute to infection control and that it is important to find and treat those infected as quickly as possible.

– We assume that we now find approximately two out of three infected. This is fine, but if we can manage at least the same amount in a simpler way, it is a step forward.

Will avoid prolonged isolation

– It is noted in the report that the current situation is not sustainable and needs to be quickly improved. Has NIPH provided advice on specific measures and improvements that have not yet been implemented?

– This is work that is now underway in a project led by the Norwegian Health Directorate, and we contribute to the ongoing discussions there, says Aavitsland.

He says an important purpose of testing in the future will likely be to clarify whether people with symptoms have coronary heart disease. If they don’t, they can go back to school and work after an illness and without the long isolation.

According to Aavitsland, the mismatch between demand and capacity will be remedied with several different measures, such as more test stations in municipalities, expansion of laboratories, new procedures in the laboratories and, eventually, perhaps new technologies.

Aftenposten has previously written about promising results with saliva samples that give hope for simplified and more efficient tests.

Deputy Health Director Espen Rostrup Nakstad then stated that if the new studies this fall prove successful, health authorities will recommend that such tests be used in people with mild symptoms.

Media coverage of the infection can contribute to unnecessary testing

The report also points to challenges with the population’s perception of the tests.

The media reports that the epidemic is increasing and the constant encouragement to get tested, possibly leading to “many people worry and get tested for no clear reason,” writes FHI.

It is also possible for people without symptoms to misinterpret a negative test as clearing the infection, even though it takes a few days from exposure for the test to come back positive.

Especially at port and airport sampling stations, FHI believes this can be a problem.