Policy responses for Luxembourg - HSRM


Policy responses for Luxembourg

1.5 Testing

From 9 April, all travellers arriving in the Grand Duchy of Luxembourg by air will again be able to benefit from a free PCR test at Findel airport. Passengers must be tested on the day of their arrival at the COVID-19 testing station at Lux-Airport, by presenting their voucher (available at the baggage claim area) and flight ticket. The PCR test results are usually available within 24 hours.

Rapid antigen tests

Certified rapid antigen tests can be performed in the first pharmacies starting 12 May, 2021. These include rapid antigen tests (RATs) by nose swab, as well as self-tests, can be performed and certified in the first pharmacies. The participating pharmacies will provide specially equipped areas for the public and will themselves define the various modalities, such as mandatory appointments or the walk-in system with the possibility of attending at specific times. After the test, the person tested will receive a certificate indicating the result. This certificate, which includes the signature of the health professional and the logo of the Health Directorate, is valid as proof of a negative result required for certain trips, activities or entries (e.g. restaurants, cafés, concerts, etc.). A positive result is immediately reported by the health professional to the Health Directorate to ensure the follow-up of the patient and initiate contact tracing. The cost of the test is charged to the person wishing to be tested.

Restaurant and cafe owners in Luxembourg’s capital began receiving vouchers on May 18, 2021, to distribute to customers for free COVID-19 antigen tests to be performed at pharmacies. The results are valid for 24 hours and are required (based on a May 16 policy) to dine and drink inside. There are 14 participating pharmacies available to process the tests.

New COVID-19 test strategy

In addition to PCR tests carried out by medical laboratories on prescription or via Large Scale Testing and rapid antigen tests carried out by health professionals, the government's testing strategy also includes the extensive distribution of rapid antigen self-tests. The distribution of rapid antigen self-tests is built on 5 pillars:

(1) A regular supply for priority sectors in the fight against the virus which include hospitals and specialised institutions; COPAS, FEDAS and other activities in the fields of the elderly and people with disabilities; social sector, in particular state-approved structures; and national and higher education

(2) Distribution of a starter kit to the working population, including private companies, self-employed, seasonal workers and public institutions (from 17 May); civil service (from 17 May); municipal civil service (from 15 May); European and international civil service (from 18 May)

(3) Distribution of vouchers to the rest of the population (per household): retired persons, social welfare beneficiaries, recipients of unemployment benefits Each eligible household will receive a secure voucher allowing the beneficiary to collect a box of tests together with an information flyer. The dispatch of the vouchers is spread over 2 weeks and started on 14 May. Please note that only one voucher will be sent per household, even if more than one person belongs to the same household. The self-tests (Wondfo Test Antigene Rapid nCoV) will be available for pick-up at pharmacies in Luxembourg from 20 May onwards upon presentation of the voucher. Self-tests will also be provided to senior clubs, senior activities and meals-on-wheels services.

(4) One-time distribution of rapid antigen self-tests in the context of a progressive opening, including Horeca sector, culture sector and sports sector.

(5) In order to be able to react promptly in the event of a rapid increase in infections, a national reserve of self-tests is planned. The aim of this pillar is to reduce, if necessary, the spread of the virus through rapid intervention on a large part of the population, instead of putting in place new restrictions.

Superficial swabs can be carried out by any person on others, and even on oneself in the context of a self-test, without any specific training.The result of the rapid tests can be certified by a) any health professional (physician, pharmacist, nursing assistant, nurse, anaesthetist nurse, paediatric nurse, psychiatric nurse, midwife, laboratory technician, masseur-physiotherapist, osteopath), authorised to practice in Luxembourg, or b) civil servants or public employee designated for this purpose by the Director of Health. These persons can only certify the results of rapid tests performed by the test person under their direct supervision.

Testing in schools

Pupils and teachers gained the option to take one rapid test per week on April 19, 2021. The Ministry of Education has estimated that roughly 1.6 million tests are necessary to provide this option until the summer holidays.

Luxembourg’s Large Scale Testing Strategy

On April 28, 2020, 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 2020: 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 2020, 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 2020, 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 2020, 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 2020, 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 2020, 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 2020. 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 2020 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 2020 (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 2020, 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 2020, 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 2020, 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.

Sources: https://gouvernement.lu/en/actualites/toutes_actualites/communiques/2020/04-avril/28-strategie-deconfinement-sante-recherche.html

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).