Testing for the early detection and treatment of persons infected with SARS-CoV-2 virus, to contain further spread, has been the cornerstone of Malta's COVID-19 strategy. The availability of point-of-care rapid antigen tests (RAT) further consolidates this approach through broader testing and containment. Recent legislation (L.N. 49 of 2021 MEDICINES ACT (CAP. 458) Delivery and Testing of COVID-19 using Point-of-Care Rapid Testing, Regulations 2021) has been issued to regulate testing locations, types of tests to be used, who can perform tests and reporting obligations. The Superintendence of Public Health has also issued standards entitled “COVID-19 – Standards on the use of Point-of-Care Rapid Antigen Tests for SARS-CoV-2”, under the Public Health Act Chapter 465 of the Laws of Malta and the Prevention of Disease Ordinance Chapter 36. These standards outline the protocols that need to be adhered to in the administration of these tests; an approved list of recommended rapid antigen tests; and the main criteria and indications for RAT testing and their interpretation.
Testing with RATs is indicated in the following situations:
1. Symptomatic close contacts of ALL persons who have been informed that they are positive from a RT-PC (immediate booking of swab).
2. Asymptomatic close contacts of ‘notified’ positive cases, if indicated (pre-booking of contacts within 5-7 days of contact with positive case).
3. Persons with early symptoms (up to 5 days from symptom onset)
4. Persons from specific settings for outbreak investigation and rapid isolation of persons when ‘presumed positive’ by a rapid test, e.g. long-term care facilities, correctional and detention facilities, outbreaks in schools. This will be carried out at the discretion of the Public Health Authorities following risk assessments of specific situations.
Only trained and registered health care professionals, or trained health care workers under the supervision of a registered healthcare professional may administer the RAT in designated premises as per Standards on the use of Point-of-Care Rapid Antigen Tests for SARS-CoV-2; an application is to be submitted to the Medicines Authority (available at http://www.medicinesauthority.gov.mt/mdforms) in order to obtain approval for the designation of a premises for the carrying out of point of care tests.
Self-testing is currently not used and not allowed in Malta and the outcomes of such kits are not considered for diagnostic purposes or public health action.
The test administrator is legally bound to provide a result to the patient and also provide both reactive and non-reactive outcomes to the PH COVID-19 response team using a specific web application within 24-36 hours. In this way the outcomes of testing are collated as reported at a national level providing recent data and a current epidemiological picture.
Update 16th September 2020
Up to 16th September 2020, 221, 162 nasopharyngeal RT-PCR swab tests have been performed, with the number of daily tests increasing to over 2000 tests daily. Six testing centres are currently operational, including one at Mater Dei Hospital (for health care professionals), with two additional swabbing centres being set up in collaboration with the private sector. All tests are processed by a central laboratory at Mater Dei Hospital.
Laboratory tests for COVID-19 take place in two laboratories in Malta, with Mater Dei Hospital Laboratory serving as the reference laboratory. Testing capacity has increased to enable 500 polymerase chain reaction (PCR) tests for COVID-19 to be performed daily, divided into four laboratory ‘runs’ at present, with the potential to further increase these in the future.
Currently there are three separate drive-through testing areas, in addition to the one dedicated solely for testing of health care professionals. The suspected case definition, which has now been broadened to include any persons with any symptoms known to be found in coronavirus infection, are asked to attend by appointment. There are also provisions for testing persons who do not have their own transport. Initially, this used up a lot of resources when paired doctors in protective personal equipment (PPE) were being driven around to carry out these tests in the home. However, this was consuming significant PPEs and human resources; as a result, the use of ‘dirty’ cabs has been implemented recently where patients are brought to testing centres and cabs are decontaminated after each use.
Within community health centres and acute hospitals, a swab tested for COVID-19 is taken for all those who present with respiratory symptoms. This is also being extended as a pre-operative test for partners of parturient women and prior to emergency surgeries. To date over 10, 000 tests per million inhabitants have been carried out, placing Malta as one of highest rated countries in Europe with respect to the number of tests performed per capita.
Up to 2nd May 2020, 35117 swab tests for SARS-CoV2 have been performed. At a point over the last period a trend was noted whereby persons who were given an appointment for swabbing failed to turn up for their swab test. Although generally around 1000 tests were performed daily for a while, this has slightly declined. Information campaigns and the media were guided to emphasise the importance of turning up for one’s appointment and utilising this resource to its fullest. Another factor that increased the uptake of testing was initiating a new policy to extend testing for asymptomatic persons in large companies on a voluntary basis. This has immediately had positive outcomes whereby a number of asymptomatic cases were identified and contact tracing was extended to their close contacts (https://www.maltatoday.com.mt/news/national/101828/health_authorities_worried_about_people_not_turning_up_for_covid19_tests#.XqwrtS2B1QI).
Another factor that may have increased the uptake of nasal swab tests is the new COVID Symptom Checker unveiled on the 30th April 2020. The COVID Symptoms Checker is a new application which can be accessed from any electronic device by inputting https://covid19check.gov.mt. This is a short self-assessment test which asks a number of questions related to one’s symptoms and guides the user to further actions if any are necessary including calling the helpline if any of the inputted symptoms are indicative of COVID. This self-assessment test serves as a tool for syndromic surveillance to enable authorities to correlate the number of cases to the reports of symptoms through this app. It is completely anonymous and requires no name or form of identification to be inputted making this very acceptable to the user (https://timesofmalta.com/articles/view/health-minister-invites-people-to-test-covid-19-symptoms-app.788906).
The Maltese Government is looking into the possibility to acquire new technologies such as mobile apps to facilitate contact tracing. Any technology used in this regard would not impinge on civil rights or personal privacy. (https://timesofmalta.com/articles/view/covid-19-restrictions-could-be-eased-in-the-coming-days-fearne.787310)