Luxembourg’s Large Scale Testing Strategy
On April 28, the COVID-19 Task Force announced a "Large Scale Testing Strategy" that aims to test the entire population of Luxembourg of about 626,000 people. The strategy is based on a voluntary diagnostic test accessible to the population, including cross-border commuters of the Greater Region. This will ensure that Luxembourg can better and in an informed manner accompany the lifting of restrictions from the lockdown. The more people participate, the more protection this will mean for the entire population. The overall objective is to monitor the evolution of the COVID 19 pandemic in Luxembourg at all times and to provide a basis for decisions on the scope of testing and the introduction of relaxation or restriction measures. With the large scale testing it is aimed to avoid a second wave of infected people in the context of exit measures and thus the introduction of a new lockdown.
The testing started in the week of April 27: about 6,000 high school graduates and 2,500 teachers have the opportunity to get tested before they go back to school from May 4, 2020. The testing strategy consists of expanding the capacity to 20,000 tests per day. Up to 17 test stations will be set up in the country, where the inhabitants of Luxembourg, but also cross-border commuters, can be tested. The objective is to be able to test the entire population, progressively and in contingents, in some cases several times.
In the large-scale virus testing the population is not considered as a whole, but divided into different contingents. The tests per contingent are carried out in 3 stages:
Stage 1: a representative population of a contingent is tested. The results of these tests give an indication of when the contingent can be freed from restrictions and when it should be tested on a large scale
Stage 2: All persons in the contingent are invited to be tested on a voluntary basis.
Stage 3: A representative group is selected shortly after the exit measures in order to be tested a second time. This allows monitoring of whether and how the virus is spreading within the contingent.
For people tested negative, the restrictions of the lockdown are lifted. Positive tested people must enter isolation. Their contacts are traced, tested and quarantined to break the chain of infection.
This project, which primarily serves a public health objective, will also enable research to gain a better understanding of the virus in the medium term - which is important in order to learn how we can better live with the virus in the future. In addition, the experience gained now will in the long term also serve to be better prepared as a country in the event of another pandemic.
The COVID-19 Task Force was set up by Research Luxembourg (LIH, LISER, LIST, LNS, Luxinnovation, University of Luxembourg and FNR, under the coordination of the Ministry of Higher Education and Research) in order to better implement relevant initiatives. Based on a list of priorities elaborated by ministries and other partners, a number of work packages have been defined, which the COVID-19 Task Force will work on in the coming weeks and months. In cooperation with the government, the COVID-19 Task Force sees its role in providing scientific input to enable the government to work on a fact-based EXIT strategy. To this end, the COVID-19 Task Force is continuously working on updates on the development of the pandemic in Luxembourg and submits concepts and recommendations from a scientific perspective so that they can be incorporated into the political decision-making process.
On July 21, Luxembourg’s Parliament unanimously approved a continuation of the large scale testing programme that was due to expire on July 27. At a cost of EUR 60.7 million and providing 1.6 million tests over more than 30 weeks, the Ministry of Health aims to test between 40,000 to 53,000 people per week and will target its testing strategy on four axes:
• Vulnerable individuals that are increasingly at risk of exposure such as hospital staff, police officers, military officials and pharmacists
• People entering the country at airports or train stations
• People from the general population to monitor any larger outbreaks
• People from groups that have potential to be superspreaders
Second testing phase (September - March 2021)
On September 16, the second phase of Luxembourg’s COVID-19 testing program began. The new capacity sits at 53,000 tests per week, which is down from the previous strategy of testing 20,000 per day in the first phase. Also notable is that in the first phase of testing, 307,751 tests were carried out on residents, representing roughly 50% of the country’s resident population. According to figures from the Minister of Health on September 14, Luxembourg conducted 117 tests for every 100,000 inhabitants.
The second phase runs from September 2020 until March 2021. It is meant to be more flexible to also expand weekly testing numbers in times of need. It will be more targeted and will focus on sample groups from different regions of the country, different socio-economic backgrounds and from different professions. Only when the virus spread is found to gain speed in these sample groups will testing be expanded to larger parts of the population. Simultaneously, professionals in health care, hospitality and teaching will be tested regularly and those returning from holiday will also continue being able to get tested for free. The price tag of the second phase comes to EUR 60 million, and will also include 1,000 antibody tests per week (in addition to the foreseen 53,000 PCR tests per week).
Testing for travellers
As of May 29, people arriving at Luxembourg's Airport can ask to be tested for COVID-19 on site or get a voucher for a test later. The voucher is valid several days after arrival. In case the test is positive, quarantine will be directed and tracing of contacts in Luxembourg will start. Authorities in the country of residence will equally be informed about the positive test result. The joint project between the government and the airport will last one month. In this period, it will be evaluated if the new testing strategy will be implemented at other “entrances” of the country.
Since July 17, Luxembourg’s government is providing citizens the option to get a “Corona” certificate, which can be printed and shown at a testing center for citizens to guarantee a clean bill of health when traveling to countries that require a negative COVID-19 test until August 2. Germany, for example, is one of the European nations to consider Luxembourg a risky area and requires a 14 days quarantine or a negative test result (no older than 48 hours) (see also Section 6.1). However, it remains unclear if this policy is also required from children entering Germany, although that may differ per German federal state.
On July 28 the Luxembourg Institute of Health (LIH) announced the end of the first phae of the mass testing program, and that the second phase would begin in September. The second phase will be a more targeted strategy but between the end of the first phase and the beginning of the second phase, Luxembourg will close seven testing stations during the summer holidays in August. LIH announced that during the first phase the country tested roughly 16,000 people per day.
Given that some European countries are asking for a 14-day quarantine or a recent negative COVID-19 test for residents coming from the Grand Duchy of Luxembourg, the State offers one free COVID-19 test per person ahead of a trip or stay abroad – this within the limit of a quota that does not affect strategic testing capabilities during the summer holiday period. To this end, a new procedure will be put in place to make it easier for Luxembourg residents to obtain a COVID-19 test before their departure. From 31 July onwards, citizens are requested to submit requests for a COVID-19 test exclusively online via www.covid19.lu. This platform will speed up the process by directing the citizens directly to the form to make an appointment at one of the country's test centres.
For the week July 20-27 (calendar week 30), Luxembourg recorded by far the highest per capita testing capacity in Europe. 10,659 tests per 100,000 residents were processed during the week, which alone was 5.7 times higher than the next closest country. On 2 August, Luxembourg’s 14-day case notification rate was the highest ever reported at 209.5 per 100 000. The announcement came from the European Centre for Disease Prevention and Control (ECDC) in a report issued on August 10.
On August 14, a summer screening plan was announced by the Health Ministry that focuses on primary care, consultation centers for suspected positive cases and advanced care centers. While Luxembourg’s second testing phase will officially begin in September and run until the first quarter of 2021, returning travelers can already have access to a free test at Luxembourg airport. Starting August 17, those returning by other means of transport will have the option to take a free test by first registering at MyGuichet.lu, which is also the resource for those traveling to countries where showing a recent negative test is a prerequisite to entry.
With the governmental measures of March 12, the recommendations for testing of COVID-19 were adapted. The systematic diagnostic test for any suspected infection is no longer recommended. The test is reserved for serious or complicated cases. In this context, the concept of a risk zone is no longer relevant to define an indication for testing.
A number of drive-in testing facilities have been set up. Provided they have been given a medical prescription from a general practitioner, people showing symptoms and those at risk of developing complications will be tested in these testing facilities. Test are also performed at four advanced treatment centres that are dedicated to COVID-19 cases but a medical prescription is not required (see Section 3.2).
Since the beginning of the crisis and until April 2, the total number of tests performed was 25,060 (latest update: 16 April) in Luxembourg.
On April 8, the Research Luxembourg COVID-19 task force announced the launch of “CON-VINCE” study which aims to evaluate the dynamics of the spread of the COVID-19 disease. The study will test about 1,500 people for the presence of the SARS-CoV-2 virus and follow-up only the asymptomatic and mildly symptomatic individuals. This will generate accurate data on the transmission of the disease, ultimately assisting policymakers in taking evidence-based decisions over the course of the coming weeks.
Until May 11, in total 55,250 persons have been tested in Luxembourg with about 7% having positive results (3,886 persons with confirmed COVID-19 test).