New Zealand is at less than half of the Government's stated "baseline" for Covid-19 PCR testing, but long delays for results are already a problem. Sam Sachdeva reports on the gap between expectation and reality, and the potential flow-on effects if nothing changes
Testing laboratories face potential staff burnout and delays to cancer diagnoses if a surge in demand for Covid-19 tests does not drop off, the Government has been warned.
Questions have also been raised about why labs are already under such strain well below New Zealand's stated maximum testing capacity, with the Opposition accusing the Government of using misleading figures to overstate the state of play.
In late January, Associate Health Minister Ayesha Verrall announced the Government had increased the nationwide capacity for Covid PCR tests “from a maximum of 39,000 tests a day to a baseline of 58,000 tests”.
While the rolling seven-day testing average is 28,567 – less than half of that “baseline” – the Ministry of Health has warned of “exceptional demand” on testing laboratories, with some people in Auckland and Waikato reporting waits of up to five days for a Covid result.
The gap between the stated capacity and the real-time processing ability is largely due to the fact that the higher number relies on being able to “pool” tests: running samples in batches and individually re-testing any with a positive result, something which is only possible with a relatively low number of Covid cases in the community.
Terry Taylor, the president of the New Zealand Institute of Medical Laboratory Science, told Newsroom that laboratories in Auckland had stopped pooling Covid swabs early last week, and others were set to follow.
“Even though it seems a bit of an oxymoron, our capacity actually drops as the surge increases…we just do not have the resources, the staffing, the consumables to actually be able to maintain anything more than around about that 25 to 30-odd thousand.”
“I am a little bit frustrated, in a way, that figures that were not helpful have been bandied around – you can imagine what it's like for the workforce on the ground when they hear what I would call just unreasonable expectations put on them, to do that sort of level of work for any period of time.”
– Terry Taylor
Taylor was unsure where the 58,000 figure had come from, as the institute had not been approached by the Government about it.
“I am a little bit frustrated, in a way, that figures that were not helpful have been bandied around – you can imagine what it's like for the workforce on the ground when they hear what I would call just unreasonable expectations put on them, to do that sort of level of work for any period of time.”
Taylor said the surge in demand for PCR tests affected the ability of labs to process the 200,000 non-Covid tests they usually performed every day; lab tests were used for almost all cancer diagnoses, as well as monitoring autoimmune diseases and other conditions.
Delays in the processing of such tests in Auckland were already a reality, with the Government and others seemingly caught off-guard by the rapid escalation of the Omicron outbreak to the second phase of the response plan.
Taylor said the Government needed to continue the rollout of rapid antigen tests (or RATs) across the country, while there needed to be much more selective criteria for who should seek PCR tests.
“One of the things that diagnostic laboratories are very good at is diagnosing patients, so when we look at it, why are we doing a test where we're not actually going to be diagnosing anyone so to speak, they might just have a cold or flu-like symptoms?
“If they’re not going to be in the hospital or health setting, or clinically affected in such a way that we're going to need more than just basic care, [they may not need a PCR test]– that's what it's going to come to over the next two weeks for our services.”
Prime Minister Jacinda Ardern and other ministers needed to provide clear communication to the public about the need to ease demand on testing laboratories and the path ahead, he said.
“It's just not acceptable to run one health service into the ground to try and save other parts of the health service, because the flow-on effects if we’re run into the ground reverberate through every part of the health system in New Zealand.”
'Misleading figures'
National Party Covid response spokesman Chris Bishop told Newsroom the Government had been “using misleading figures to give an appearance of greater capacity than actually exists”, and needed to legalise the sale of RATS over the counter as well as contracting Rako Science to boost PCR testing capacity.
“A lot of people turning up for PCR tests are just people a bit worried about having Covid. The easy way to triage them is to let them take care of their own health through rapid tests from pharmacies – reserve PCR capacity for people who actually need it.”
In a written response to questions from Newsroom, Associate Health Minister Ayesha Verrall did not directly address the matter of whether it had been misleading to use the 58,000 figure when capacity was always likely to drop as cases surged.
Verrall said the use of pooling “has been a feature of our testing throughout our Covid response, and was particularly relevant in the early stages of the Omicron outbreak.
“However, it has always been clear that as case numbers rise and positivity rates increase, pooling becomes less useful.”
That fact was one of the reasons why a transition to greater use of RATs had been included in the public health response for Omicron, with the move already underway in Auckland (where demand was greatest) and set to roll out to other regions in the coming days.
Director-General of Health Ashley Bloomfield told Newsroom the inability of laboratories to pool samples meant there was a current baseline capacity of 31,000 PCR tests per day, compared with the 58,000 figure offered earlier in the year.
The growing positivity rates had made pooling unviable: on Monday, 15 of the 20 district health boards had recorded rates of five percent or higher, a figure which had never been reached before February 7 this year.
However, Bloomfield said the ministry had been "consistent" in how it described pooled and surge testing capacity, and had been expanding the rollout of RATS around the country.
From Wednesday, all Covid tests at community testing centres in Auckland would take the form of RATs to address the current demand. That change meant symptomatic people, and asymptomatic close contacts, who returned a positive RAT result would be considered a probable case without the need for verification via a follow-up PCR test.
Bloomfield said there were currently 7.3 million RATS in the health system, with a further 22.5 million expected by the end of February.
"Although there are still significant global supply constraints, we have secured the delivery of enough RATs to help New Zealand through a widespread Omicron outbreak in the coming months."
The ministry was unaware of any delays in the analysis or reporting of non-Covid tests being processed by labs, he said.
* This article has been updated with a response from the Ministry of Health which had not been received at the time of initial publication.
