The National COVID-19 Testing Strategy comprehensively solves the approach to testing and defines the backbone network of laboratories and testing sites

A team of leading experts has prepared the National COVID-19 Testing Strategy, which presents a framework of measures and recommendations for the effective use of laboratory testing capacities in the Czech Republic.

The Strategy provides a comprehensive approach to testing for COVID-19 at the present moment, with an outlook for potential further waves of the disease. It defines the individual target groups for testing and used methods. The key element is to define corresponding capacities, their digitalisation and rational use in the case of a gradual growth of demands. Testing in the Czech Republic is centrally coordinated by the Integrated Central Management Team and the Laboratory Group in the Czech MoH.

“The Czech Republic has a clear strategy for how to approach testing, how to distribute and manage testing capacities, how the process should function from the taking of samples to the disclosure of results, and who we will test. These are the key issues which experts have answered and specified in this document,” says Minister of Health Adam Vojtěch.

“The plan is a model example of how to define a system for other potential biological threats in the future, which can never be entirely eliminated and often even foreseen. It is not a static document. We expect it to be updated regularly in connection to increased knowledge of this disease and the epidemiological situation in the Czech Republic and abroad,” explained the head of the Laboratory Group in the Czech MoH, who is also one of the authors, Marián Hajdúch. The document will now be available for 14 days on the website koronavirus.mzcr.cz for public consultation. The public can send its comments to the authors until 14 August 2020 to strategietestovani@mzcr.cz.

The Strategy stipulated the structure of laboratories in the Czech Republic. A backbone network of laboratories will be created, which will serve as a key group of laboratories linked directly to controlled organisations or regional hospitals. This is an active group of laboratories that will be in continuous

operation, even if there is no epidemic. The backbone laboratories will primarily serve backbone testing sites, which ensure examinations also on weekends and holidays in the minimum scope of eight working hours. The testing sites will be stationary and mobile, or alternatively drive through. Their minimum number is stipulated at one mobile and one stationary testing site per region, with respect to the size and area of the region. As for the City of Prague, the operation of at least three backbone testing sites is expected.

Another group will comprise standard laboratories, those being medical laboratories or extra-departmental laboratories. The last group will consist of so-called backup laboratories. This group of laboratories is prepared to ensure testing if the epidemiological situation worsens, meaning if the capacities of the backbone and standard laboratories are not sufficient due to increased demands on the daily number of performed tests.

“It must never again happen that when the regional public health authority traces a large number of contacts indicated for testing, the testing capacities will not be ready. A network of testing sites will be clearly stipulated, which will operate every day so that citizens know exactly where to go,” emphasized Minister Vojtěch.

The Strategy stipulates a key time limit for processing samples, that being no later than within 48 hours from receiving the sample. If the laboratory is unable to process the sample within 48 hours of receiving it for any reason, the sample must be redistributed to another processor with an available testing capacity. This measure is essential to ensure the effective testing process, the aim of which is to implement anti-epidemic measures.

“The backbone network of testing sites and laboratories must be evenly distributed across settlements in the entire Czech Republic, so as to ensure the local and time availability of provided healthcare services,” added Jarmila Rážová, Chief Hygienist of the Czech Republic. The priority allocation of this network will be among healthcare services providers who provide bed care, where routine preventive testing is expected in connection to the planned hospitalisation of patients, especially with urgent medical care.

From March to May 2020, a total of 105 diagnostic laboratories were included in the testing for the COVID-19 disease. By decision of the MoH of the Czech Republic, all the laboratories must be connected to the system for reporting the issued results to the Infectious Disease Information System. Furthermore, all the diagnostic laboratories must report the number of tested samples and their available testing capacity to the Integrated Central Control Team via the COVID Forms App, which is a part of the Smart Quarantine system.

“Over the course of several days in March, electronic application forms were introduced, which serve to indicate a patient for tests and are recorded in the central information system. This is a key element of managing testing and its records. This ensures full control of the flow of samples through the system, which also enables the monitoring of the individual laboratories’ capacities,” said Minister Vojtěch.

The National Strategy thus defines the population risk group which has absolute testing priority, because it is crucial to diagnose COVID-19 disease among these persons in time. The same testing priority applies for those who are in close contact with the high-risk individual and may become a source of contagion for them (family members sharing the same household, medical and other staff taking care of high-risk individuals, etc.).

The high-risk groups of persons, among whom a severe course of COVID-19 disease may be expected, include patients with hemato-oncological diseases, immunosuppressive therapy which requires treatment at specialised workplaces, radiotherapy or chemotherapy, patients after the transplantation of solid organs or bone marrow, patients with severe and very severe class II and class III obesity and a BMI of over 35-39.9, respectively over 40 kg/m2, patients using home oxygen therapy, patients undergoing extensive surgery with planned post-surgical care at a ARD/ICU ward, patients with decompensated diabetes, hypertension, heart or lung diseases, patients with severe genetic diseases.

In general, apart from the high-risk population group, testing for COVID-19 is indicated for symptomatic individuals and individuals who may be in the incubation period or individuals included in the risk group for preventive reasons.