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)
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 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.



Sources:
1. Helsingin Sanomat (30/03/2020) https://www.hfi/talous/art-2000006458259.html?share=b05ca24cee88e063c87c142a4a395511     
2. THL (08/04/2020) https://thl.fi/en/web/thlfi-en/-/finnish-institute-for-health-and-welfare-to-investigate-the-spread-of-coronavirus-in-the-population-using-antibody-assays  
3. Mehiläinen (30/04/2020) https://share.geckoboard.com/dashboards/4BCOFKAYZPKGVDSB/  
4. Terveystalo  (30/04/2020) https://avoinraportointi.terveystalo.com/korona/ 
5. Ministry of Social Affairs and Health (09/04/2020) https://stm.fi/en/artikkeli/-/asset_publisher/krista-kiuru-suomi-lisaa-koronavirustestausta-merkittavasti  
6. THL (16/04/2020) https://thl.fi/en/web/infectious-diseases/what-s-new/coronavirus-covid-19-latest-updates/situation-update-on-coronavirus 
7. THL (15/04/2020) https://thl.fi/fi/web/infektiotaudit-ja-rokotukset/taudit-ja-torjunta/taudit-ja-taudinaiheuttajat-a-o/koronavirus-covid-19/toimenpideohje-epailtaessa-koronaviruksen-covid-19-aiheuttamaa-infektiota 
8. THL (23/4/2020) https://thl.fi/fi/-/thl-tampereen-yliopisto-ja-ita-suomen-yliopisto-jarjestavat-koulutusta-tartuntaketjujen-selvittamisesta-?redirect=%2Ffi%2F
9. Helsingin Sanomat (24/4/2020) https://www.hs.fi/kotimaa/art-2000006486511.html
10. SiunSote (20/4/2020)https://www.siunsote.fi/-/koronanaytteenottoa-laajennetaan-valtakunnallisten-ohjeistusten-mukaisesti
11. THL (29/04/2020) https://thl.fi/fi/-/uudenmaan-vaestossa-vain-harvalla-esiintyy-uuden-koronaviruksen-vasta-aineita?redirect=%2Ffi%2F
12. THL (5/5/2020) Lentokentällä tehtävän oireseulonnan avulla on löytynyt vain vähän koronavirustartuntoja. https://thl.fi/fi/-/lentokentalla-tehtavan-oireseulonnan-avulla-on-loytynyt-vain-vahan-koronavirustartuntoja-
13. Communicable diseases Act 1227/2016. https://www.finlex.fi/fi/laki/alkup/2016/20161227#Pidp446231184 
14. COVID-19 testing available to arriving passengers at Helsinki Airport. Press release Aug 3, 2020, FINAVIA https://www.finavia.fi/en/newsroom/2020/covid-19-testing-available-arriving-passengers-helsinki-airport
15.  Reuters Press release (10/08/2020) https://www.reuters.com/article/us-health-coronavirus-finland-travel/scared-by-skopje-flight-finland-to-mandate-covid-19-tests-for-travellers-idUSKCN256296
16. Ministry of Social Affairs and Health (19/08/2020) https://stm.fi/documents/1271139/21429433/TestausstrategianPaivitysSTM.pdf/7c9b1924-e61b-ccf2-fe7a-a9568a2793df/TestausstrategianPaivitysSTM.pdf?t=1597847532234 
17. THL (25/8/2020)https://thl.fi/fi/web/infektiotaudit-ja-rokotukset/ajankohtaista/ajankohtaista-koronaviruksesta-covid-19/lapset-ja-koronavirus
18. Koronakoirat aloittavat pian Helsinki-Vantaan lento­kentällä, mutta matkustajat eivät pääse näkemään niitä –näin testaus koiran kanssa tapahtuu (22/08/2020) https://www.hs.fi/kotimaa/art-2000006610779.html
19. Ilta-Sanomat. Koronan haistavat koirat löysivät jo ensimmäiset tartunnat Helsinki-Vantaalla. https://www.is.fi/kotimaa/art-2000006647376.html 
20. New York Times. The Nose Needed for This Coronavirus Test Isn’t Yours. It’s a Dog’s. 20.09.2020. https://www.nytimes.com/2020/09/23/world/europe/finland-dogs-airport-coronavirus.html ; Guardian  (24.09.2020) https://www.theguardian.com/world/2020/sep/24/close-to-100-accuracy-airport-enlists-sniffer-dogs-to-test-for-covid-19
21. Ministry of Social Affairs and Health (1/10/2020) https://stm.fi/en/-/koronatestausvalmiuden-koordinaatioryhma-kirjasi-haasteet-koronatestausstrategian-toimeenpanossa