Ongoing delays threaten to derail loosening up of restrictions

Months into this crisis, continuing delays around the testing and contract tracing processes threaten to derail the planned loosening up of restrictions from later this month.

The HSE says it takes an average of 2.4 days to get a test result, well above the 24 hours recommended by most experts. But even this figure is at odds with the experiences of some patients reporting long delays.

Galway woman Bernadette O’Sullivan, for example, told The Irish Times on Monday she was still waiting for test results 42 days after giving a sample on March 30th.

“I’ve contacted the HSE helpline a number of times; they gave me a direct line which doesn’t pick up. The practice nurse at my GP’s has also made several attempts to get a response. Apparently my test number is in the system but no result.”

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Cork GP Nick Flynn says that while the capacity of the system to test for the virus has increased, "the efficiency and speed are not there".

And while most of his tests are turned around in a number of days, some patients endure lengthy and often unexplained waits for their results. Two weeks ago, a healthcare worker had to wait weeks for her test result to be delivered, and it took Flynn numerous lengthy phone calls to different labs to obtain it.

“Even if 1 per cent of the planned 100,000 tests a week are like that, the system can’t work as it is planned to do. It has to end-to-end work. If we don’t get this bit right, we could well end up under lockdown again.”

It isn't just individual doctors who say some of their patients are waiting long periods for results; even the Mental Health Commission, a State body, complained on Monday about delays in testing for staff working in mental health units.

Some of the issues that have arisen have been well flagged – shortage of reagents, or swabbing kits, for example, which are heavily in demand across the world. These, we are told, have been solved for now, but there are other factors causing delays in the process that appear still to be holding back improvement.

Like any system built up quickly at a time of crisis, the testing process is a patchwork quilt of different labs, pieces of equipment and staff, many of whom have been seconded from other parts of the public service. There are numerous stages in the process, and overall performance is dependent on turnaround times in each of these stages.

In the background, non-core issues such as indemnity and intellectual property around equipment caused delays as the system was being set up.

There is a huge disparity in turnaround times in hospitals, where tests on healthcare workers can be delivered in about six hours, and the community, where it takes days for results to be delivered. The reason for the disparity is not entirely clear.

Grunt work

Another factor causing delays up to now is the high level of grunt work involved in each stage, with samples having to be transported from one location to another and data having to be manually entered and re-entered because IT systems are not talking to each other effectively. In some cases, results have gone missing, or been misdirected – according to the HSE, this is because the wrong phone numbers were given in some instances.

Delays in testing lead to knock-on delays in contact tracing, and this means cases will be missed and the virus will continue spreading.

To understand why, consider an imaginary scenario posited by experts in which Mary is infected at day zero, becomes infectious at day three but does not show symptoms until day five.

Along the way, she meets Mick on day four and unwittingly transmits the disease to him. Mick, in turn, infects Jean at day eight, and so on.

In order to break the chain of transmission, Mick needs to be told to quarantine by day seven. This requires Mary to get tested on day five, the day she develops symptoms.

This tight timeline suggests there is a 48-hour window after a case develops symptoms to test and alert contacts. Although the HSE is now talking about a 24-hour turnaround time for tracing contacts, this has to come on top of an efficient testing system, which still sounds as if it is some way off.