Policy responses for North Macedonia - HSRM

North Macedonia

Policy responses for North Macedonia

1.5 Testing

The Institute of Public Health is in charge of COVID-19 testing through its virology and molecular diagnostics laboratory that was designated in 2019 by WHO as the national influenza laboratory after long years of preparations. The national reference laboratory for virology meets adequate biosafety standards to work with pathogens such in COVID-19. Although the national reference laboratory is adequately equipped with trained staff, there was initially a lack of testing kits, swabs for sampling and personal protective equipment (PPE). The reagents donated by WHO Europe ran out after increased testing activities due to a larger than expected number of suspected COVID-19 cases. The overall testing capacity was about 200 tests per day due to the limited number of trained technicians, but could be stretched to 300 tests a day with potential private sector involvement. The lab technicians worked non-stop in 3 shifts.

The testing was initially performed only in the laboratory of the National Public Health Institute. However, upon a Ministry of Health request, other national laboratories were assessed for inclusion and were gradually added. Two private laboratories offered testing funded by out-of-pocket payments by patients who wanted to be tested without referral, although the Ministry of Health required confirmation at the national virology lab. Significant increases were reported in the price of coronavirus test in at least one private clinic (Zan Mitrev), which the clinic blamed on supply shortages.
The Laboratory for Virology and Molecular Diagnosis at the Institute of Public Health  is the only reference laboratory for COVID-19 in the country. It operates in accordance with WHO laboratory testing protocols for COVID-19 with WHO-distributed tests. The national infectious diseases commission recommended not to extend testing capacity to other institutions in order to reduce the risk of spreading infection to health facilities.

On 18 March 2020, new COVID-19 testing guidelines were adopted whereby testing is performed only on persons who have symptoms of an acute respiratory infection, or who meet the WHO suspected case definition of COVID-19.  All contacts of a confirmed COVID-19 case are tested, regardless of whether they have symptoms or not.
Testing is supported by the Association of General Practitioners and nearly 1200 GPs are involved in the identification and early detection of cases, increasing access of citizens to diagnostics by referral to the screening outposts. GPs use the electronic health records platform “Moj Termin” to schedule appointments for testing at one of the 14 testing outlets that take swabs and send them to the national virology laboratory. Any citizen with or without symptoms can call their GP, be checked for symptoms and referred for testing if needed. Ministry of Health mobile teams have existed since the end of March but are designated primarily for older people

As of 12 April 2020, 8,000 tests had been done in the country, equivalent to about 4,000 tests per 1 million people. This was the highest testing coverage in the region. At that point, mass testing was not considered necessary, and only symptomatic COVID-19 cases were being tested, in line with WHO recommendations.
In April, the health authorities announced that 20-30% of the population in Debar, in the areas where the restrictive measures are in place, would be screened using COVID-19 antibody tests. The goal was to assess the immunity of the people in that region which would contribute to framing the expectations for the rest of the country for using antibody tests nationally.

In addition, army medical teams were enlisted to help with coronavirus testing due to the increased workload of the teams that take swabs for testing for coronavirus.

The President of the Doctor's Chamber of Macedonia (DCM) urged doctors who do not believe in coronavirus to put aside their personal beliefs and act upon the recommendations of WHO and the country's health authorities. The DCM had documented that some doctors did not believe in the existence of coronavirus and thus were not sending patients for SARS-CoV-2 testing. Some doctors had publicly announced on their social media profiles that COVID-19 does not exist.

As of 29 June 2020, the Ministry of Health had procured rapid tests that will be used prior to hospital admission of patients. Results were issued within 45 minutes to assist with patient triage. The tests were distributed to the laboratory of Institute of Public Health, Infectious Diseases Clinic and the Clinic for Gynecology and Obstetrics.  On 3 July 2020, the Health Minister and the Association of Journalists agreed to implement free COVID-19 screening among journalists and media workers. The goal wa to test 500 journalists and media workers in an initial 3-day phase and, depending on the outcomes, a second phase would be planned. 

As of 27 October 2020, in the Institute of Public Health a new COVID-19 testing admission point was opened with the aim to speed up the procedure for taking tests for Covid-19. The opening of the new testing point was intended to increase the number of tests performed in the National Public Health Institute to 1000 tests per day, about 150 tests more than before.  A plan to increase the testing capacities in other testing sites has also been presented, with an aim to achieve a daily number of up to 2000 COVID-19 tests in the public health institutions.

As of 2 November, rapid SARS-CoV-2 tests from the company “Abbott” are available in public health institutions. With these additional tests it is expected that the daily testing capacity in the public health facilities will exceed 2,000 tests per day.

As of 26 November, testing with rapid COVID-19 tests began in the General Hospitals in Kochani and Kavadarci, the PHC Centers in Veles, Kumanovo, Bitola and Delcevo. The tests are free of charge and testing can be scheduled only by the family doctor if the patient has had symptoms for no more than five days.
On 27 November 2020, Norway donated 13,500 rapid tests for COVID-19. On 27 November 2020, the Ministry of Health also initiated a procedure for the procurement of rapid tests for COVID-19.