Policy responses for Austria - HSRM


Policy responses for Austria

1.5 Testing

Early start of mass testing

Austria plans to introduce mass testing for COVID-19 and a municipality in the state of Salzburg (with ca. 2000 inhabitants) launched mass tests at the beginning of December. According to a draft federal framework, teachers and kindergarten teachers would be tested first, in the first week of December. Police officers are to be tested subsequently followed by the general population on the 19th and 20th of December. Since the announcement, several states have set their own timelines for when testing will take place. The testing phases had originally been staggered in order to ensure enough testing capacity. The western states of Tyrol and Vorarlberg, which have been most affected by the second wave of the pandemic, announced that they were launching voluntary mass testing campaigns on the first weekend of December, followed by the state of Salzburg one week later. Mass testing will be carried out with support from civil service and the military service.

The Austrian Government announced that on 16th and 17th January 2021 a second round of mass testing will take place. For people not participating in a rapid antigen test in this period, it is envisaged that the regulations of the third lockdown may continue to apply until 24th January. However, a formal decision in this regard is still outstanding.

Testing strategy in January 2021

Austria plans to shift from occasionally holding mass screening campaigns to establishing permanent free testing centres throughout the country after the end of the lockdown on January 24. After 24th January, there will be a mandate for rapid testing of guests at hotels and cultural or sports events. Debates are ongoing whether testing will be mandated also for restaurants.
With potentially more infectious mutation variants of SARS-CoV-2 having been detected during December 2020 and January 2021 in Austria, as of 25th January, the following regulations apply in every-day life.
Regular (weekly) voluntary screening tests are being introduced for the following professions. Those not participating in tests need to wear an FFP2 mask:
• Employees with customer contact (e.g. shops, services, transport)
• School and kindergarten teachers if they are in contact with      pupils/students
• Logistics employees (e.g. in warehouses) where the minimum      distance of 2 metres cannot be kept on a regular basis
• Public services with customer contact
• Professional sportsmen and sportswomen when training in   teams or with physical contact
Regular testing is obligatory for health and care professionals with patient contact or contact with care home residents.

Austria has introduced several measures to increase testing possibilities at the beginning of 2021.
First, screening is ongoing in care homes and schools (see Section 6.1 Measures in other sectors), with younger school children being tested twice a week with antigen tests, and older school children at least once a week (as the latter do not attend school continuously).
Second, mass testing possibilities are accessible for free (after registration) across the country, as are free antigen tests in a large number of pharmacies (also accessible after registration). In addition, an innovative pilot study is ongoing using free gargling tests for Vienna residents, to be rolled out and freely accessible for all citizens in Vienna from March onwards, funded by the city. People who got tested receive a certificate which must be shown when visiting hairdressers or other services where distance cannot be kept (e.g. pedicure, massage).
In addition, regular contact tracing continues to take place, using primarily PCR testing (via mobile testing teams organised by the hotline 1450) and quarantine regulations continue to apply for contact persons.

Austrian comprehensive testing strategy based on three pillars

In early March, the Ministry for Social Affairs, Health, Care and Consumer Protection issued a comprehensive testing strategy for SARS-CoV2 that comprises three pillars (11th March 2021) (see updated information on oesterreich.gv.at):
1. Tests initiated by a public authority (for suspected SARS CoV2 cases and contact persons): People can either call the corona hotline 1450 and the staff working at the hotline decides whether or not a test is to be initiated. This happens either in special testing sites (without appointment) or via mobile teams carrying out a test in the home of the person with symptoms. Alternatively, they can visit an ambulatory care provider, in particular GPs, who offer tests for suspected SARS CoV2 cases. A previous appointment via phone is necessary to access these tests. Contact persons of confirmed SARS CoV2 cases have to do at least one test, depending on the current contact tracing regulations, and as indicated by the respective local authority that contacts these persons. In this pillar, PCR tests are being used.

2.Specific screening programmes (vulnerable groups, their carers/care staff, and professionals with elevated exposure to infection risk (in particular health and care staff, and people working in services with close contact)). In this pillar, mainly rapid antigen tests are used, and some pilot programs exist using RT qPCR gargling tests (project “Alles gurgelt”, see below). Tests take place at testing sites or e.g. directly at the workplace such as in a care home or hospital.

3. Population-wide monitoring and screening with easy access to free testing possibilities for everyone and at all times. The main objective is to detect asymptomatic persons early on and isolate them. This pillar includes entry tests for certain services (e.g. hairdresser) or places (e.g. hospitals, care homes). Free testing possibilities are widely rolled out in testing sites, enterprises and pharmacies. In some enterprises a member of health care personnel carries out tests. Moreover, there are self-tests for personal use.
• Entry tests to access services with physical contact have to be carried out by qualified staff e.g. in pharmacies (see above). These rapid antigen tests are available for free in the whole country, but an appointment needs to be made beforehand.
• In schools, self-sampling anterior-nasal antigen tests are carried out twice a week by teachers and students (see above). It is being discussed to increase frequency to three times a week given low sensitivity of these rapid antigen tests.
• Starting in March 2021, five self-sampling kits (per month) are distributed at pharmacies for free to each insured person. These kits can also be acquired at a low cost (approx. EUR 8). However, self-sampling kits are not acknowledged as entry tests for e.g. hairdressers.
The third pillar comprises mainly antigen tests, but PCR tests are also possible e.g. gargling test programs using RT qPCR are being rolled out: the project “Alles gurgelt” is being piloted at a large scale with several 100.000 participants already (including schools and firms/enterprises): https://coronavirus.wien.gv.at/alles-gurgelt-testprogramm-fuer-betriebe/ 

Processing of test results

Currently, both positive antigen tests and PCR tests are recorded in the national epidemiological reporting system. Negative test results are not recorded. Self-sampling test results are not recorded, as a positive self-sampling rapid antigen test result needs to be followed up by a PCR test.
According to the epidemiological law it is obligatory to inform public health authorities immediately in case of a positive test result (e.g. calling corona hotline 1450), and enter a self-monitored home quarantine.
While in the beginning, almost no genetic sequencing took place (mainly based on own initiatives of researchers at the Austrian Academy of Sciences), some research projects were launched as the pandemic continued (see e.g. CEMM, https://cemm.at/research/groups/andreas-bergthaler-group/). Slowly, capacities are being increased, but public financing still remains scarce. In addition, collaborations are taking place to analyse sewage/waste-water, see e.g. the Coron-A Project: https://www.coron-a.at/

Sources: https://www.derstandard.at/story/2000122129252/massentest-pilotversuch-im-salzburger-skiort-annaberg)

To strengthen the Austria tourism, the Ministry of Tourism started a nationwide COVID-19 testing initiative for the staff of accommodation providers. As of July 1, the testing for employees in tourist accommodation is voluntary and the Federal Government covers the costs till the end of the summer season (end of October).

Sources: https://www.bmlrt.gv.at/tourismus/tourismuspolitische-themen/testungen.html https://www.oehv.at/themen-recht/corona/flaechendeckende-covid-19-tests/

Currently the criteria for testing are as followed:

- persons with acute symptoms (cough, fever, respiratory problems) and,
- person was in a high-risk area during the past 14 days or had  direct contact with a confirmed COVID-19 case

People who meet these criteria have to contact the hotline 1450 which initiates further steps such as home visits and testing.
Furthermore, doctors may recommend testing upon assessment of a patient’s clinical status. Testing is mainly conducted at home. Some drive-through stations have also been implemented.

Testing capacity has been extended from a few hundred tests per day at the end of February to up to 6,000 tests per day at the end of March. Up to April 8, in total about 115,000 tests had been conducted. To increase testing capacity tests are evaluated in different laboratories. By March 30, more than 40 laboratories provided analyses of COVID-19 tests. The target is to increase testing capacity up to 15,000 tests per day.

Random sample tests will be conducted to obtain a more accurate picture of the spread of COVID-19 among health workers as well as in the general Austrian population. In early April, 2,000 randomly selected people have been tested, results will be published in mid-April. The random tests were conducted by the SORA Institute who contacted 2,000 randomly selected candidates in regions affected by the virus; 1544 of the candidates were tested. Based on the study, the prevalence of the infection in the non-hospitalized population was recalculated, resulting in an estimate around 0.33%. The results were announced on April 10.

On April 16, the Minister of Health announced plans to test all personnel and inhabitants in the nation's retirement and nursing homes, as part of an increase and targeting in their testing strategy. He cited both medical studies and international experience showing that nursing homes are at greater risk as justification for this policy, which would test around 130,000 people in 918 retirement and care facilities. As of April 11, Austria had already run 140,000 tests within the general population.

Since mid-April a stay in a high-risk area in the preceding 14 days is no longer obligatory to be tested. Currently the criteria considered to confirm cases are as follows:

- Clinical criteria: persons with acute symptoms with or without fever with at least one of the following symptoms for which there is no other plausible explanation: cough, sore throat, respiratory problems (cough, fever, respiratory problems) and loss of sense of smell,
- Diagnostic criteria: Proof of SARS-CoV-2 via PCR testing
- Suspected cases are all those who fulfil clinical criteria. With respective diagnosis (laboratory or X-ray) and/or other infectious-epidemiological indicators present (e.g. preceding contact with a SARS-CoV-2 case, person visited an area with virus activity in the past 14 days), also other symptoms are considered as relevant (e.g. nausea, diarrhea).