Policy responses for Czech Republic - HSRM

Czech Republic


Policy responses for Czech Republic

1.5 Testing

Spring and summer 2020:

Initially, people with at least one of the three main symptoms (fever above 37,5 °C, dry cough, shortness of breath) or people who came into contact with confirmed cases were recommended for testing [1]. Prior to March 25, having a fever below 38.0 °C was not an indicating symptom. Later with a big surge in new cases, only symptomatic people were recommended for testing, which changed back again when testing and lab capacities improved. Furthermore, since April 10, staff at senior homes and long-term care facilities were required to be tested every 14 days [3]. Testing is also required to end a quarantine. Tests relying on nasopharyngeal samples were later (last week of April) prioritized for rapid blood tests in being distributed to general practitioners. The GPs, however, were reluctant to perform these tests in their offices arguing that the limited amount of personal protective equipment and the difficulties of organizing patients in waiting rooms caused too great of a burden.

Tests for COVID-19 are covered by the social health insurance only if recommended by a physician (general practitioners, paediatricians, pneumologists, or attending physicians in hospitals) or by Regional Public Health Authority officers [1]. Private testing for other individuals, i.e. testing without physician’s recommendation, has been allowed since the second week of March, however people must pay out-of-pocket. At first, private tests could be requested only in a limited number of sample collection (testing) points, but currently (June 25), most of the sample collection points offer this option [4].

During March and April, COVID-19 testing occurred mostly in testing pods located on the premises of health care facilities, mainly hospitals. Many of them had drive-through option. As of June 25, there are 87 sample collection points; a full list is provided on the MoH webpage [5]. Though there were issues with testing capacities in the first two months of the pandemic, the collecting points had declared enough capacity and mostly no waiting lines or the option to reserve a same-day  time slots by the beginning of May.

During the state of Emergency, there were also mobile teams visiting people at home if they were quarantined as suspected cases. With the introduction of smart quarantine, there was an extensive effort to build capacity for these mobile teams. Besides the emergency rescue service, the army was called in to provide additional mobile sample collection teams around the country. The change in approach to testing suspected cases on June 1 led to a decreased need for these mobile teams. If necessary, the emergency rescue service provides the service now.

Initially, only the National Reference Laboratory of the National Institute of Public Health, i.e. a public body, could carry out tests on the presence of COVID-19. Even though some private laboratories carried out COVID-19 tests, their results were not accepted by the state authorities and patients had to be re-tested by the National Reference Laboratory. From the second week of March, private laboratories were also contracted, as long as external quality assessment requirements were fulfilled. The number of laboratories has been steadily increasing.

Previously used rapid tests were replaced with PCR tests at the end of May and general practitioners are no longer required to directly test people, but they have the option to send them to test centres. In certain cases, a mobile testing team can also be dispatched.

As of June 25, the declared testing capacity wasis approximately 15 000 tests a day, way above the number of tests on average performed on weekdays (around 4 000 people on weekdays, including repeated tests for the same patients) [6]. There are 105 laboratories performing tests for COVID-19 [7].

Autumn 2020:

Testing capacity increased twofold from September to mid-October, also using university and research centres capacities. The system’s bottleneck is still viewed to be rather in the tracking system.

All PCR tests are collected in designated sample collection points around the country, with new points still being opened with continuing infection surge. Collected samples are managed in a common electronic system that enables redistribution of samples among laboratories depending on their free capacity. The target to provide test result to a patient within 48 hours from the test is met (generally, the result is available within 24 hours – Oct 16). Originally, only negative test results were provided directly to patients and positive test results were reported to Regional Public Health Authorities who then called detected cases. However, this system proved unsustainable when many people were waiting for authority’s call for several days from the test and was changed on September 17. Now, laboratories inform patients of either results. Patients are advised to inform their GPs, because Regional Public Health Authorities do not manage to call them (according to the smart quarantine dashboard, they stopped completely calling the GPs at the beginning of October).

Some regions provided people with a central system to register for a test at one of the many sample collection points (e.g. Karlovarský region). Other regions do not have centralised system and people must seek availability of sample collection points individually. Almost all points run a reservation system and in most cases the registration process avoids gatherings and extensive time queuing. 

In mid-August, the MoH published an expert committee’s draft of the National COVID-19 Testing Strategy. It is a complex report including suggestions for a laboratory network and precision for test requirement. The strategy was finalized in late September.    
 
For details on testing algorithm with regard to isolation and quarantine, please see section 1.3.

Sources:
[1] https://koronavirus.mzcr.cz/wp-content/uploads/2020/03/Doporu%C4%8Den%C3%BD-postup-k-testov%C3%A1n%C3%AD-na-COVID-19.pdf
[2] https://www.mzcr.cz/dokumenty/laboratorni-vysetreni-pro-prukaz-pritomnosti-viru-sars-cov-2_18606_1.html
[3] https://www.mzcr.cz/dokumenty/ministerstvo-zdravotnictvi-spousti-plosne-testovani-pracovniku-domovu-senioru-a-_18972_1.html
[4] https://koronavirus.mzcr.cz/mam-zdravotni-potize-co-mam-delat/
[5]  https://koronavirus.mzcr.cz/seznam-odberovych-center/
[6] https://onemocneni-aktualne.mzcr.cz/covid-19
[7] https://koronavirus.mzcr.cz/seznam-laboratori/