Policy responses for Finland - HSRM

Finland


Policy responses for Finland

1.5 Testing

Coronavirus samples are collected and analysed by numerous laboratories in both public and private sectors (see also section 1.4). THL also tests samples collected for influenza laboratory-based sample monitoring for coronavirus.

Before domestic infections were confirmed, all the probable cases and their all close contacts were tested. However, on March 12th, due to limited testing capacity THL issued a guidance on focusing testing on patients with severe respiratory tract infection symptoms and healthcare and social welfare personnel. When capacity allowed, testing was also performed on people with mild symptoms, those returning from abroad and other patient groups. Attention was given to vulnerable patient groups with an underlying condition and to people over the age of 70. Hospital districts and other actors had also the possibility to test other suspected cases of COVID-19. On April 15th, with increased testing capacity, THL and hospital districts redefined these official guidelines to promote more aggressive testing and identification of all symptomatic COVID-19 patients, including those with mild symptoms. No untargeted testing of asymptomatic population is currently conducted – only those who are suspected of being infected are tested by physicians’ discretion. In these cases, special attention is given to health care and social welfare personnel, elderly, pregnant and those whose close contact has a confirmed COVID-19 infection. (7)

A physician referral is needed for the test. In the public sector, testing of patients with symptoms occurs in drive-throughs that are linked to hospitals. Testing in the private sector occurs either in drive-throughs or at sampling points, which are separate from other services and can be accessed after an obligatory remote consultation with a physician. All these structures have been newly set up to restrict the spread of COVID-19.

As of 29th April, testing capacity currently is over 5500 samples per day (6) and efforts are made to further increase this to 7000 (5). In the Uusimaa Region, testing capacity in the public sector was approximately 250 per day in February, 500 per day at the beginning of March and over 1000 per day at the end of March. On 2th April, Uusimaa Hospital District announced that it was able to conduct 1500 tests/day. There are regional differences in testing across the country. Even though the test capacity has been increased, full capacity has not been used. Reasons for that are suggested to be the challenges in implementation of the recommended extensive testing, e.g. communicating rapidly changing information and guidance to health care professionals and public nationwide and organizing the personnel to take tests and also to tract the contacts. (9) Some hospital districts have informed that they have still difficulties in procurement of needed resources for the tests. Therefore, all tests might not be conducted the same day as the referral has been made. (10)

In the private sector, tests are conducted by large private healthcare providers, Terveystalo, Pihlajalinna, Aava and Mehiläinen. On 30th March it was also announced that 10 large private companies have put together an initiative to send the tests done by Mehiläinen to South-Korea to be analysed with the aim to test 18,000 samples in the following two weeks. The public sector can buy test capacity from Mehiläinen.(1) By 30th April these private providers had taken in total approximately 25 000 tests with a daily maximum of a little over a thousand (3,4). The private sector has criticized its limited role in the management of the crisis as it claims to have capacity for up to 4000 samples per day.

Serological testing to identify people who have already recovered from mild or symptomless COVID-19 are being set up at least by THL, Helsinki Uusimaa Hospital District and some private providers. THL announced on April 8 2020 that it is inviting Finnish citizens, based on random sampling, to participate in a study assessing the spread of the new coronavirus in the population. During the initial phase, sampling will be focused on the Metropolitan Area (currently the epidemic centre) and the working-age population, but the study will be expanded during the spring. The aim is to test around 750 participants each week.(2)  Based on the first 500 tests carried out in the Helsinki Uusimaa Hospital District, THL reported on April 29 that 11 persons were tested positive for COVID-19 antibodies but only one was confirmed positive for neutralising antibodies indicating probable immunity. The result was interpreted to reflect the early phase of the epidemic. (11)

The THL, Tampere University and University of Eastern Finland begun a collaboration to carry out an online course of contact tracing to support municipalities and hospital districts with the growing demand of contact tracing after implementing more extensive testing. The course is targeted for health and social care personnel and students but is open for all. (8) The course started on first of June with 1600 participants on June 5th .

The number of tests have been increased and first results from tests made at Helsinki-Vantaa Airport have been released indicating that symptom driven testing since 27th of March included 8837 persons and resulted in 9 covid-19 positive tests (12). The Government has announced that they will increase testing capacity to 10 000 tests per day, from the current 6000 tests per day. However, the testing capacity is under-used and the actual number of tests administered per day has well below the.  maximum capacity.

In Finland containment has been successful in regional entities as case numbers have gone down. While national policies on testing were relatively slow and contact tracing was no longer required since 12th of March, contact tracing was continued in many regional and local governments as these were able to shift personnel from other areas and numbers were relatively low. In Uusimaa capacity for contact tracing has since increased by approximately 100 persons and overall in the country by about 400. THL has responsibility for oversight on contact tracing (13), and by 1st of June it had carried out an online survey on contact tracing capacity in hospital districts and municipalities. However, the results from this survey are not yet publicly available.

On Aug 3, the City of Vantaa opened a COVID-19 health information point at the Helsinki Airport to provide health counselling to arriving passengers. The point also provides COVID-19 test for passengers who report COVID-19 symptoms. (14) The testing requirements were updated in October. If passengers have a negative test which has been taken within 72 hours or takes a test in the airport, they can shorten quarantine after 72 hours if also the second test is negative.  For very short visits an exception from quarantine has been made for persons who stay less than 72 hours in Finland and have a negative test which has been taken within 72 hours. (22) Further exceptions were made also for border measures (6) 

As people have returned to work and school testing has become critical. The high share of covid-19 cases arriving from higher risk countries caused concern and initial calls for mandatory testing for travellers (15). Interpretations of national guidelines for both testing and home care of children with mild symptoms have varied locally. This has resulted in crowding and long waiting times in testing especially in Helsinki-Uusimaa hospital district and in some other larger cities. Combined with concern over new cases, this has contributed further to MSAH to update the national testing strategy on 19th August (16). Main changes relate to overall increase in pace and effectiveness of testing with an aim of 20.000 tests per day, tests done within 24 hours, with results also in 24 hours. This is to be achieved through enhancement of action and processes in public sector and buying additional capacity from the private sector. Measures include e.g. more personnel, internal arrangements, developing new testing models and close cooperation between public and private service producers. Faster tests and antigen tests are used where possible and meaningful. New criteria for testing include persons who do not have symptoms, but could be exposed and applied in places where spreading is more likely, such as schools, prisons, institutional housing and care homes if a corona case is found. Possibility to testing will be provided on border for those coming to the country and persons returning from high risk areas may be tested more comprehensively on the ground of risk assessment (e.g. whole plane).

Finland is exploring the role of dogs in helping to detect and guide potential Covid-positive people for tests at airports with newspaper reports on initial trial and training of 16 dogs for this purpose (18) Finnish corona dogs have started working at the Helsinki-Vantaa Airport. They are the first corona dogs in real action in Europe and have already found their first positive corona cases (19), which has gained them broader international attention (20) On 18th December the use of dogs for COVID-19 detection was also expanded to Vantaa Prison, in which the turnover of pre-trial detainees is high (23). In addition, an experiment with COVID-19 dogs was implemented in upon subscription of 800 new army recruits on Jan 4 in addition to the standard testing. (24) In December another local innovation on testing was tried in Turku city and regional hospital district as a “koronabussi” - a coronabus took on the road. The bus has been used for testing and information sharing with the purpose to reach people in areas from which it might be difficult to leave for testing otherwise (26).


On Aug 25 THL updated the national guidelines for when symptomatic children should be tested and when they could return to school or early childhood education (17). This is expected to partially ease the pressure on the testing capacity. On Aug 26 the testing capacity in public health care was over 14,000 tests per day, and maximum number of tests conducted have been more than 10 000 tests per day in August. In addition, two biggest companies in private sector – Mehiläinen and Terveystalo – reported a combined 4000 tests per day. By the end of August, public health care had carried out 596 000 tests in total, while the private sector had carried out 118 000 tests. Almost half of the tests (58 000) in private sector had been carried out during August. In preparing for the second wave of the COVID-19 epidemic in Finland the aim is to increase capacity to 20 000 samples a day during the autumn. On Sep 7 the testing capacity in public health care was almost 16,000 tests per day, with an additional 3000 daily tests taken in private health care.

After the change in guidelines for testing symptomatic children, the number of daily tests has declined. At the end of August, on average approximately 13,000 daily tests were taken, while in mid-September the respective average was around 10,000. This coincides with a decline in symptom self-reports of population aged under 20 through Omaolo website. On Sep 11 THL further updated the national guidelines to require COVID-testing of every symptomatic school-aged child. For under school-aged children, testing is not required if their mild symptoms disappear during a couple of days of home-monitoring. On Sep 21 the public testing capacity was around 20,000 tests per day. In September private company Terveystalo has begun providing COVID-19 laboratory test package which includes a rapid antigen test alongside the more conventional COVID-19 test.

During Christmas holidays the test amounts halved compared to the period before the holidays (week 49: 131,100 tests, week 52: 90,600, week 1: 75,100 and week 2: 64,400). (27,28,29) COVID-19 cases decreased as well, which might reflect the decreased number of tests. The rate of positive tests fell to 1.8 % during the week 52, but returned to an earlier level  (2.4%-2.6%) in weeks 1 and 2. The officials continued encouraging people to seek testing immediately even with minor symptoms, as cases are still detected across country. (25) It seems, that in Finland the COVID-19 pandemic did not significantly worsen during the holidays. (30) With time new means to make access to testing easier has been sought by mobile testing units and advisory services in Turku and Helsinki, which in Helsinki have also served for testing in ports (31)

The national COVID-19 testing strategy - originally drafted last spring and updated in August 2020 – has been updated again on 10th of February 2021. The aim of the updates is to be able to identify new infections, transmission chains and virus variants more quickly than at present. (32)
 
• Updates to testing objectives and measures (10/02/2021):
o People must still be able to access a test within 24 hours and receive their results within one day of the test.
o A positive result must be reported as soon as possible to the party responsible for contact tracing so that the people exposed can be identified and placed in quarantine more quickly.
o All COVID-19 test referrals matching the uniform criteria are reimbursed by public healthcare services.
o If necessary, testing capacity will be expanded through regional cooperation agreements with private service providers using state funding.
o Sufficient sampling methods and sites are provided with easy access ensured.
o Mobile or targeted low-threshold testing sites are established for areas or population groups where a high level of infection has been detected and where there is a suspicion that people may not seek out conventional testing services to a sufficient extent.
o Use of rapid test will be expanded as far as this is possible and by taking the limitations of rapid tests into account
• Updates to criteria for access to testing
o Testing capacity is primarily targeted at people experiencing symptoms
o Symptomatic people should be tested whenever this is deemed appropriate
o Cases of COVID-19 that may have been caused by a modified strain of the virus must be investigated and the transmission chains must be traced without delay.
o All people arriving to Finland will be directed to tests at border crossing points.

Testing capacity in Finland on 17th Feb 2021 is approximately 30,000 samples per day including both PCR and antigen tests. According to THL guidelines, antigen tests, which often are lateral flow tests, can be used in situations or with specific target groups where the incidence of COVID-19 infections is high (over 10% of tests are positive), to test asymptomatic persons, for example in care units or nursing homes. In these cases, tests should be carried out as soon as possible, no later than 7 days after exposure. Antigen tests can also be used with discretion at border control/border crossings for persons or target groups arriving in Finland from high incidence countries. When the incidence is high, it is recommended to confirm the negative antigen test results with a PCR test or another antigen test in two to three days if the tested is asymptomatic, and with PCR test if the tested has symptoms or is over the age of 65 or belongs to a risk group. Antigen tests can be used with discretion in situations or with target groups with low incidence if PCR test capacity is not easily and rapidly available, transportation of the sample to the investigative laboratory takes time, or the response times for PCR tests are long. In this case, it is recommended to confirm the positive results with PCR tests. Only health care professionals can take, conduct and analyse the antigen tests. (33) Rapid PCR tests are used in situations where results are needed quickly. (32)

Helsinki University Hospital provides a web-based self-service where it is possible to download a certificate of a negative COVID-19 test conducted in HUS or Kymsote. The certificate includes personal details, the test date and method, and it is possible to supplement with passport details. Use of the service requires stringent identification with bank credentials or mobile authentication. (35) At the end of March 2021, two of the five university hospitals either started or increased their PCR sequencing of positive Covid-19 tests, in order to be able to identify mutations more rapidly. (36, 37)

COVID-19 antibody tests for domestic use are available in Finland. THL reminds that the antibody tests might give indication of previous COVID-19 infections but are not reliable to detect acute COVID-19 infection. (38)

In April 2021 Finland received 250,000 COVID-19 rapid antigen tests as a donation funded by the EU Emergency Support Instruments. These have been distributed to hospital districts and Defense Forces.(, but so far they had limited use in Finland, largely at the border crossings.) (39) Rapid antigen test have not been widely used in Finland since there is sufficient capacity of PCR tests. Antigen tests have been used in the Western land border.

The city of Turku and the Hospital District of Southwest Finland organize mass testing of asymptomatic population in the residential area of Varissuo with the donated rapid antigen tests. Varissuo has been most affected by the pandemic in Turku. The test is free of charge, no appointment or referral needed. (40)