Policy responses for Hungary - HSRM


Policy responses for Hungary

1.5 Testing

The National Public Health Center published its latest procedure for COVID-19 testing on the 16th of March [1]. If at least one of the following three categories is met, the patient is a suspected case and laboratory test should be done.

• Category A: A patient with acute respiratory illness who has at least one of the following symptoms: fever (≥38°C), cough, shortness of breath AND has a history of travel abroad during the 14 days prior to symptom onset.
• Category B: A patient with acute respiratory illness AND having been in close contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset.
• A patient with severe acute respiratory illness who has fever (≥38°C) and at least one symptom/sign of respiratory disease (e.g. cough, shortness of breath, clinical or radiological sign of pneumonia) AND requires hospitalization.
• In addition, any patient exhibiting respiratory symptoms can be considered a suspected case by the family doctor or the attending specialist, or the public health agency on the basis of the assessment of clinical and epidemiological data, such as the occurrence of multiple respiratory diseases in small communities, like hospital wards, workplaces, families or among friends.

Lower or upper respiratory tract (nasal, pharyngeal) secretions should be sent to one of the seven designated, accredited laboratories for direct detection of the virus. Tests are carried out based on the WHO’s relevant recommendation.

After the health check by phone, the GP will notify the National Emergency Ambulance Service and ask to take the sample. The National Emergency Ambulance Service takes and delivers the sample to the lab (the suspected case can stay at home). The result is reported to the patient by the GP.

On the 21st of September, Bence Rétvári, the Parliamentary Secretary of The Ministry of Human Capacities, announced that 17 outpatient sampling points will be established. If someone needs to be tested due to contact tracing, the GP may request an appointment at one of the 17 outpatient sampling points if the applicant is asymptomatic. In this case, people don’t have to wait for the ambulance, and they can use the appointment from their GP to go to the sampling points themselves where workers of the National Emergency Ambulance Service take the sample [12].

The testing of the patients in the hospitals is done in a pre-examination room in the triage area.

It is possible to do a test in a private laboratory as well, but the National Public Health Center does not accept it as an official result. Anybody can request this test, at a cost of HUF 31 000 (the delivery is HUF 15 000). If it is positive, the laboratory notifies the National Public Health Center and sends the sample to them in order to do a confirmatory test. The private labs can do 40-50 tests/day in three locations nationwide [2]. From September 21st, the maximum price for the test is set at HUF 19,500 (see Section 4.2 – Entitlement and Coverage for more details).

The Local Government will screen healthcare and social workers in Budapest in a private laboratory for coronavirus, according to the Mayor of Budapest on the 29th of March [3].

Since the 1st of April there are 10 designated, accredited laboratories according to the new procedure of the National Public Health Center [4].

From 30th of April all patients who are entering or leaving the hospital should be tested for the coronavirus and it is mandatory to test those who are working in a nursing home [5].

On the 1st of May the HUNgarian COronaVirus disease-19 Epidemiological Research (H-UNCOVER) was initiated in order to get an accurate picture of the extent of the epidemic and the actual number and dynamics of those infected with SARS-CoV-2. The representative sample involves 17 778 people from every age group above 14 years old, with voluntary participation. The research includes a survey, a PCR test and a blood samples. GPs, outpatient clinics and screening buses will serve as sampling locations, but the samples elderly, over 65, will be taken at their homes. Mobile screening units are going to help the research to ensure that seniors and those with chronic illness do not have to leave their homes. H-UNCOVER is led by the Semmelweis University, with all medical universities taking part in it, and the Hungarian Central Statistical Office is involved as well by selecting the national representative sample for the study [6]. Nationwide, 67.7 percent of the invited citizens (about 10 474 people) participated in the study between May 1st and 16th. The study was representative for the Hungarian population over 14 years of age and living in private households. Three of the tested individuals had positive PCR tests showing an active infection, and 70 had positive serological tests, indicating a previous SARS-CoV-2 infection. This means that at the time of the study, the estimated number of active cases in the sampled population was 2,421, while 56,439 had been previously exposed to the virus. The research will be conducted again in September [7, 8, 11].

The National Office for Research, Development and Innovation provides a separate fund for research on COVID-19. Meanwhile, a special research program has begun for the development of the new coronavirus vaccine in cooperation with the National Public Health Center and the University of Debrecen [9, 10].

On the 28th of October, the National Emergency Ambulance Service announced that within days, 200 new testing locations will be established. The locations will be staffed by graduate medical and dental students, the vehicles will be provided by the Ministry of Interior, and the training will be conducted by the National Emergency Ambulance Service [13].

According to Karácsony Gergely, the Mayor of Budapest, the city will purchase 100,000 antigen tests. These tests will be used to test all of the employees of educational institutes of the city [14].

Based on the National Public Health Center’s latest procedure (published on the 7th of November), the testing for suspected cases can be done with rapid antigen tests (RAT). If the RAT is positive, the infection is determined, but if the result is negative, a PCR test should be done as well. For the asymptomatic close contacts in the health care sector and in the social care sector (people working/living in long term care institutions) a RAT should be done, if it is negative, a PCR test is mandatory as well. For this population a PCR test should be done after the 10-day quarantine as well [17].

It was announced on the 11th of November that hospital and social care workers, teachers, as well as the staff of nurseries and kindergartens will be tested weekly. [15] The testing is done with rapid antigen tests, and participation is voluntary. The testing started on the 20th of November. University students participating in medical and health training are involved in the testing procedure as well.

From the 13th of November, screening buses will support the testing procedure in the Central-Hungarian region. The screening buses will test those eligible for testing, including people who previously contacted their GP and who have been contacted by the ambulance service. Ambulance service employees will do a rapid test in the bus, and if it is positive, the infection is determined. If the rapid test result is negative, a PCR test will be done in the bus as well [16].

[6] https://semmelweis.hu/hirek/2020/04/28/kozlemeny-orszagos-vizsgalatsorozatba-kezdenek-a-semmelweis-egyetem-vezetesevel-a-hazai-orvoskepzok/ 
[7] https://semmelweis.hu/hirek/2020/05/18/h-uncover-reprezentativ-lett-az-orszagos-koronavirus-szurovizsgalat-eredmenye/
[8] https://semmelweis.hu/english/2020/05/h-uncover-half-of-the-screening-tests-have-been-taken/
[9] https://koronavirus.gov.hu/cikkek/kulon-forrast-kapnak-jarvanyugyi-kutatasok
[10] https://koronavirus.gov.hu/cikkek/megkezdodott-hazai-koronavirus-vakcina-fejlesztese
[11] https://semmelweis.hu/english/2020/07/h-uncover-results-an-estimated-56000-people-had-prior-exposure-to-the-novel-coronavirus-through-the-end-of-the-nationwide-study/
[12] https://koronavirus.gov.hu/cikkek/retvari-orszagosan-17-ambulans-mintaveteli-pont-segiti-az-ingyenes-tesztelest
[13] https://koronavirus.gov.hu/cikkek/napokon-belul-meg-200-mintaveteli-egyseget-allitanak-be
[14] https://index.hu/belfold/2020/11/04/karacsony_szazezer_tesztet_szerez_be_onkent_a_fovaros/
[15] http://abouthungary.hu/blog/pm-orban-announces-new-restrictions-aimed-at-slowing-the-spread-of-the-coronavirus-heres-a-complete-list/
[16] https://index.hu/belfold/2020/11/13/szurobusz_csepel_retvari_koronavirus/ 
[16] https://index.hu/belfold/2020/11/13/szurobusz_csepel_retvari_koronavirus/