Policy responses for Czech Republic - HSRM

Czech Republic


Policy responses for Czech Republic

1.5 Testing

Testing capacity increased twofold from September to mid-October. 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. If necessary, a mobile team is sent to collect sample from a patient at home. 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 anymore (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. The Laboratory expert committee has also published a statement on the possibility to use point-of-care (POC) antigen tests.  

Starting on November 4, LTC and senior homes’ clients and their caregivers are to be regularly tested every 5 days using the POC antigen tests (8). A person is not tested if released from isolation in the last 90 days or in the case of a negative PCR test  within last 5 days. For a POC antigen-positive patient with clinical symptoms, the algorithm for isolation is the same as for the PCR-positive patient. In case of positive POC antigen test and no clinical symptoms, or negative POC antigen test and demonstrated clinical symptoms, result must be confirmed using a PCR test.

For details on testing algorithm with regard to isolation and quarantine, please see section 1.3.

In December, experts expressed concerns about the decreasing number of performed tests in late November and the relatively low number of PCR tests in December, which was attributed to two aspects: first, people not wanting to get tested even when having symptoms (because the resulting mandatory quarantine could mean a potential loss of earnings), and second, detected cases do not report all of their contacts (because the contacts would also have to be quarantined and lose income). There have been calls for the introduction of full earnings compensation for those who are quarantined to solve this issue (current sick leave allowance is limited to 60% of employee’s average earnings, with the self-employed generally not being covered). After government reluctance and difficulties in agreeing on the exact form of compensation, a special compensation scheme (on top of the standard sick leave allowance) of up to CZK 370 (EUR 14) per day for quarantined and isolated employees was put in place for March and April 2021 (9) with the self-employed being entitled to an allowance of CZK 500 per day (EUR 19).

On December 4, the test positivity rate was above 25%, increasing to above 40% by the end of year.

In early December, the government launched voluntary testing using antigen tests. The testing was at first available to teachers, later in December to the whole population. It is provided by the network of the main PCR sample taking points and covered from SHI funds. The testing is voluntary, not conditional and no special benefits are granted from getting tested. A prior reservation is necessary for most places and people are allowed to retake the test every five days, conditional on testing capacity. No antigen testing is provided to those less than 90 days after a recovery from a COVID-19 infection. Antigen testing is also provided by some GPs who voluntarily sign up for providing it to their registered patients only.

Antigen testing opened for the general population on December 16 (two days earlier than originally planned) due to high demand. Reservation slots for testing were quickly taken, likely due to people traveling over the holidays. Originally, the mass antigen testing period was scheduled to last only until January 15, but due to high demand it was prolonged indefinitely. Originally, people were entitled to one test every five days, but this was shortened to every three days on February 1st , i.e. one test every 3 days is covered by the SHI.

In January, experts called for introducing regular antigen testing in schools and factories. It took another month for the government to start planning the introduction of regular testing to schools, and antigen tests were quickly purchased at the end of February. As schools stayed closed, however, they were later used for government employees.

During March, an obligation for the regular antigen testing of employees was gradually introduced. First, large sized employers (250+ employees) began on March 3, then employers with 50-249 employees on March 8, followed by public employers with 50+ employees on March 10, employers with 10-49 employees on March 19, and then all public employers on March 23 (10). By April 6 the same obligation applies also on small companies and self-employed who are in personal contact with their clients. The testing takes place once every seven days and does not apply to employees in home office. Employers are responsible for securing sufficient tests for their employees either through contracting a healthcare provider or providing self-administered tests; some however direct their employees to public testing pods. For the self-tests, employers can only choose from the MoH’s list of approved producers/distributors to whom it granted a self-administration exception (including saliva tests). Experts, however, complain that the quality of tests varies significantly as the MoH does not certify or approve their quality. This testing strategy has also been criticized for only testing once a week and not more often (every two days, for instance) (11). The test positivity rate on March 18 for companies testing was between 0.5 and 1.5 %. Employers must provide their testing results to the Regional Public Health Authorities and noncompliance with employer-provided testing obligations is subject to fine.

After the obligation to provide tests for their employees came into effect, employers were ordered not to allow anyone to work on their premises without a negative test no older than seven days. Employers are to be reimbursed CZK 60 (EUR 2.3) per a self-test/per employee/per week by the SHI funds; for tests administered by healthcare providers, these are covered directly by the SHI funds.   


Sources:
(8) MZDR 47828/2020-4/MIN/KAN
(8) MZDR 47828/2020-4/MIN/KAN
(9) https://www.mpsv.cz/web/cz/izolacka
(10) https://covid.gov.cz/opatreni/antigenni-testovani-na-koronavirus/opatreni-k-povinnemu-testovani-ve-firmach
(11) https://zpravy.aktualne.cz/domaci/rozhovor-imunolozka-zuzana-kratka/r~037152cc866211eb89ccac1f6b220ee8/?utm_source=centrumHP&utm_medium=dynamicleadbox&utm_content=c2-zena&utm_term=position-2&utm_campaign=Aktualne

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 was 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.

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 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 was 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].

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/