Policy responses for Slovakia - HSRM


Policy responses for Slovakia

1.5 Testing

Any person meeting the criteria of a suspected case should be laboratory tested for SARS-CoV-2 as a part of an active case search. The specific groups indicated for testing are specified more in detail by the clinical testing protocol issued by the National Crisis Clinical Team (NaKriKT) on the website of the Ministry of Health and www.standardnepostupy.sk.

Diagnostic tests are carried out upon the recommendation from the GP in agreement with the responsible hygienists, if there is a suspicion of infection.

If a GP or medical specialists suspect COVID-19 after an assessment of the clinical and epidemiological criteria, with an emphasis on the traveler's medical history, the patient is referred to the appropriate infectology center to determine the next course of treatment.

In addition to state laboratories, private laboratories started to offer testing for SARS-CoV-2 (charged ca. 60 EUR for a test). Since March 26, capacity of testing rapidly increased to approximately 1000 tests per day. The capacity reached 2000 in April and is expected to grow up to 3000 per day. 
Samples are collected at the special tents (external testings points) at the hospital entrance (altogether 78 hospitals in Slovakia), as of April 21, 55 testing points were functional.

Since Apri 1l, 4 laboratories are performing the analysis of coronavirus SARS-CoV-2 within the Slovak Republic (based in Bratislava, Košice, Banská Bystrica and Trenčín).

In total, nine crews of emergency ambulances have been designated for collection of biological materials for testing in the Slovak Republic. Each region has one designated crew that can provide the collection of biological material (mucosal swabs) from patients at home who are suspected to have COVID-19. An infectologist trained crew personnel to collect material. The Ministry of Health designated the emergency ambulance stations for the collection of biological material.

After mobility restrictions and measures announced on March 24 and 27 were implemented, the effect of lower peak and slower onset of disease is more visible.

Anyone with symptoms or suspect of the disease can request testing via an electronic form.

From April 26 until further notice, COVID-19 samples may be taken in the households of an immobile patient through the ambulance service.

Samples collection will be performed in cases where the patient does not have the opportunity to travel by car to the mobile testing points and his condition does not require a medical examination or hospitalization.

The capacity of testing rapidly increased to approximately 4000-5000 tests per day.

Pilot mass rapid antigen testing in Slovakia

Prime Minister Matovič decided singlehandedly (without prior consultations with national experts) on 17 October that 13 million antigen rapid tests were to be used for mass testing of Slovakia. The financial resources for procuring the tests have come from moveable reserves.

The process started with a pilot in 4 regions: Bardejov, Námestovo, Trstená and Dolný Kubín. These regions are in the northern part of Slovakia and were selected because they feature the highest infection rates in Slovakia. The pilot took place over the weekend of 23-25 of October and everybody between the ages of 10 to 65 years were invited to participate in the testing.

Even though testing was not mandatory, 10 days in quarantine has been requested from those who did not test. The tests were free of charge and the logistics of the whole program were delegated to the army. Each region set up several sampling points which opened at 7am and closed at 10pm.  On average, 35 patients per hour were tested per station. A station was staffed with 4 medically trained personnel (not necessarily doctors; also nurses and other health professionals), 3 administrative staff, a soldier and a police officer. Data was collected and processed by the army. While the tests were distributed by the army, protective gear was to be supplied by municipalities and the Ministry of Health.

Out of the total of 139,969 tests taken at the pilot test sampling points, the highest number, 48,320, was carried out in Bardejov. A total of   1,569 people had positive antigen tests (translating into a rate of 3.25%).

The most critical situation was in the Tvrdošín district, where 4.85% were tested positively (followed by  the district of Námestovo- 4.77%; and the lowest rate in  Dolný Kubín-  3.12%, ie 916 persons).
Based on the inhabitants of Orava and Bardejov, with a total of  155,000 people, the real participation rate was roughly 91%. However, this figure included people who came from other regions, so “real” attendance was expected to be lower. Most people in Orava and Bardejov came to the collection points to test on Friday, a total of 61,905 people. On Saturday, 59,613 people took the test at sampling points and on Sunday 18,451 inhabitants.

However, despite public pressure, no validation of the antigen rapid tests was conducted. Yet at the same time, Czech hospitals conduct these validations and sensitivity in laboratory conditions was 63-67%, specificity 98.5 – 100%. In field use, these numbers were expected to decrease below 50% for sensitivity. Without the validation, experts warned that pilot test results could be potentially misleading.

First round of mass testing

Despite several public statements of leading experts, including the president, not to extend mass testing to all regions, the prime minister pushed his idea during the weekend of 31 October – 1 November.
Despite the logistical success of the pilot testing, the army did not have sufficient resources to cover the process and hence the government shifted significant burden of responsibilities to municipalities that had been not prepared for such tasks and expressed their concerns. Testing stations were open  only on Saturday and Sunday.

A total of 3,625,332 people participated in the mass testing (or 91%). Of these, 38,359, or 1.06 %, were tested positively. However, considering the concerns about the specificity of tests, only 23 – 25,000 are expected to be actually positive. The lowest share of positive tests was in the Revúca district, at 0.27%. It was followed by the district of Banská Štiavnica (0.28%) and Rožňava (0.29 %).
The highest share of positive tests was recorded in  Čadca ( 3.22%), followed by the district of Stará Ľubovňa (2.8%) and the district of Púchov (2.65%; see Map 1 linked in the sources) Attendance varied from 48 – 76%, depending on region and commuting patterns, as can be seen in Map 2 (see sources).

The Prime minister decided to continue with the mass testing. This time, however, it will be only in regions that had a prevalence in the first round greater than 7%. The council of national experts recommended to test only if prevalence was greater than 1.5%, but this was overruled by the prime minister. This translated into 45 regions being tested, all other parameters being equal. The second round of testing took place 7-8 November.

Cernicka (2020) Pilotné testovanie dopadlo dobre. Ale nie bez chýb (The pilot testing turned out well. But not without mistakes). Pravda. Available online: https://spravy.pravda.sk/domace/clanok/566844-pilotne-testovanie-dopadlo-dobre-ale-nie-bez-chyb/ [accessed on 8th November 2020]

TAS (2020) Konzílium odborníkov neodporúča druhé kolo celoplošného testovania (The Council of Experts does not recommend a second round of comprehensive testing). Denník N. Available online from: https://dennikn.sk/minuta/2121518/?ref=mpm&fbclid=IwAR0Hm5HYMRJ0JZKADO6TJPAzslhbLF1vtYONCPX38tCqR0e4SY-Qn2vdiM0 [accessed on 8th November, 2020]

Source for the maps:
Kerekes and Folentová (2020) Najvyššiu účasť na testovaní hlási západné Slovensko. V Galante sa na odberových miestach zapotili najviac, pretestovali 76 percent obyvateľov (Western Slovakia reports the highest participation in testing. In Galanta, 76 percent of the population sweated the most at the sampling points, testing it). Dennik N. Available online from: https://dennikn.sk/2122691/najvyssiu-ucast-na-testovani-hlasi-zapadne-slovensko-v-galante-sa-na-odberovych-miestach-zapotili-najviac-pretestovali-76-percent-obyvatelov/?ref=tit [accessed on 8th November, 2020]