Testing failings mean we do not know exactly where the virus is circulating

The next two weeks will be make-or-break ones in Ireland’s struggle to stop the spread of coronavirus.

Over this time cases will soar and deaths will multiply – we know this already as the virus is transmitting in the community and has probably already infected many of its future victims.

The difference between success and failure will be measured by the health system’s ability to cope with the surge that is coming. If this is kept within the capacity of our hospitals, and specifically the capacity of our intensive care units (ICUs), then patients will have been given the best possible shot at surviving this virus.

If it far exceeds the capacity we have ramped up in recent weeks, scores of patients will die because they were unable to get the treatment they needed.

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Meanwhile, non-Covid-19 patients who require urgent medical attention will have worse outcomes, including death, because the hospitals are clogged.

Among the casualties of such a system overload will be healthcare workers, forced to work in overcrowded conditions or who are unable to access protective equipment.

Given the enormous stakes it was not entirely surprising the Government last week opted for a third set of restrictive measures, amounting to a lockdown in all but name.

Among the justifications for these measures were that ICU cases were increasing, that clusters had emerged in nursing homes, and the disease was circulating in the community.

These are all valid concerns but they go back to a common cause; we simply don’t know with sufficient accuracy where this disease is circulating. And the reason we don’t know is because of the failures of our testing system.

Criteria

First we were too restrictive with testing, denying people tests simply because they had not been abroad.

Then we were too liberal, and the system was flooded by the “worried well”. So we changed the criteria again, and thousands had their tests cancelled.

All along the process has been marred by delays in getting a test, having it processed and reported back. These delays were understandable, but still reduce the likelihood of compliance, and are likely to lead to more false negatives.

So the reason Ministers told us last Friday not to go more than 2km from our house, and not at all if we are over 70, is because we can’t say with certainty where the disease is.

And if we can’t do that, the most effective way of stopping it spreading is to lock everyone in - virtually.

These are draconian measures. They are most likely to be heeded by that part of the population already doing everything it can to maintain social distancing. The public will buy into them for the most part, but for how long?

And while the population is told to stay close to home, there was little mention of travel across international borders, particularly our border with the UK.

This is hard to understand. We are still importing cases. The UK was the country from which we imported the largest number of cases, with 23 confirmed last week. These figures might seem small but they are huge underestimates because so little testing is being done. However, on Monday Taoiseach Leo Varadkar signalled additional restrictions could soon be applied to travellers from abroad.

Screening

Iceland, in contrast, started screening high-risk or sick people long before it had a positive test, and has now tested over 3 per cent of the population. On the face of it Iceland has a high rate of cases, but only because it has tested so widely. It knows better than most countries where the chains of transmission are, including asymptomatic cases. There is no lockdown, and its schools remain open.

Our best hope now is that while frontline staff are coping with the surge in hospitals, we use the next two weeks to get the testing and contact tracing systems properly up and running.