Policy responses for Armenia - HSRM

Armenia


Policy responses for Armenia

1.5 Testing

The national testing strategy is based on WHO case definition, where symptomatic cases with travel history to affected areas, symptomatic cases with close contact with COVID-19 positive patient as well as SARI cases where the illness is not explained by other causes are tested. In addition, quarantined individuals are tested at the end of the 14 day quarantine, recovered COVID-19 cases are tested twice in 24 hours upon recovery, some symptomatic cases from risk groups including health workers, pregnant taxi drivers, public transport drivers and others are also considered eligible for testing. From the end of April, all pneumonia cases are also tested for COVID-19.

Anybody with acute respiratory symptoms can request testing through their primary health care provider or dedicated the hotline which in turn assess the need for testing. Once considered eligible the patient is transferred by emergency vehicle to the designated health facility where the testing is carried out. Testing is carried out only in those health facilities designated for managing COVID-19 patients. If needed, swabs can be taken from the patients at home. On 20 July changes were made to the categories of who can be tested for COVID-19 in medical centres. According to the new decision, patients with 37.5°C fever, as well as with respiratory diseases or other suspicious symptoms will be tested for COVID-19, instead of the previously established 38.5°C.

Testing is carried out using polymerase chain reaction in 8 laboratories including the National Reference Laboratory and some of its regional branches, the laboratory of the Infectious Disease Hospital and 2 private laboratories. As of 7 December, the total number of lab tests performed is over 530,000 and daily testing capacity is around 5000 tests, depending on the type of the tests available. The PCR tests with shorter period of performance (without extraction phase) allow more tests to be carried out. Soon PCR tests will be conducted in 4 more laboratories, in the Surb Grigor Lusavorich and Arabkir Medical Centers as well as in Ijevan and Martuni. In addition, the capacity of testing using GeneXpert machines is being considered and an order of the necessary cartridges has been placed with Cepheid. When the cartridges are available, testing capacity will be further increased. On 20 May the government announced that the Institute of Molecular Biology will produce COVID-19 tests, and on 1 June it was announced that the Institute is now capable of producing 3,000 to 5,000 tests a day, which should be sufficient to cover Armenia’s needs. By 9 February 2021, Armenia conducted about 16,000 in a week. By 24 February 2021 this increased to over 22,000 in a week.

The Minister of Health reported on 17 May that some laboratories in Armenia had started offering private coronavirus tests. Due to a lack of quality control, the ministry considered this to be unacceptable and even dangerous because unreliable results could disrupt the overall national strategy to respond to the pandemic, making it difficult to collect accurate data, organize the treatment of patients, do contact tracing and stop the spread of the virus. Therefore the Minister has instructed that COVID-19 tests be conducted only by laboratories certified by the ministry, only with a doctor’s prescription and free of charge. On 1 June, the Minister of Health informed that most laboratories are backlogged and they need to periodically stop in order to ensure that the quality of the testing is not compromised.

NCDC has distributed external quality assurance panels (EQAs) to all labs and followed up on the submission of results. This EQA program will provide a good assessment of the quality of the PCR testing in the country. The deadline for submission of the results of the panels by subnational laboratories was extended to mid-January.

There is concern about the cost of testing for COVID-19 (around $30 per test – the equivalent to USD 1Million per month) and to contain costs policy makers are exploring options for using locally produced testing kits which are cheaper, although the cost of swabs, reagent and staff time also need to factored in. With the resurgence of COVID-19 and the increased demand for testing, on 2 November WHO provided 40,000 PCR tests and the Armenian Relief Fund covered the cost of reagents.

In January 2021, WHO gave the Ministry of Health 40,000 rapid antigen tests for COVID-19. According to WHO guidance, these tests are valuable in areas where community transmission is widespread and where PCR testing is either unavailable or where test results are significantly delayed.

On 6 August the Prime Minister announced a change in the tracing and testing strategy. Previously, the health system waited for citizens to contact medical centres with COVID-19 symptoms in order to test them. Since the decrease in daily numbers, the health system is now able to be proactive and test specific risk groups, closed businesses or institutions. This means if someone working in a factory, residential care home, supermarket (for example) tests positive, the entire staff will be tested, and not only those with symptoms. This will help to isolate also those people who are infected but have no symptoms thus preventing the further spread of the virus.