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Our approach to COVID-19 testing in Wales.

Organisation:
First published:
7 April 2020
Last updated:

Introduction

Testing is a vital part of how we are working to protect the public, optimise the outcomes for our patients and keep essential services running in Wales.  

Our national testing plan has 2 key objectives: 

  1. to reduce the harm caused by COVID-19
  2. to help the public and professionals get back to their normal daily lives

Types of test

Testing serves 2 purposes:

  • to identify those who are currently infected by the virus (swab test). This will enable us to prioritise care and identify which of our key frontline staff are able to come back to work early, and
  • to identify those that have had COVID-19 and have developed an immune response (antibody test)

We have, and will, use these 2 types of tests in different ways to help inform how we tackle COVID-19.

Delivering the right test

Unfortunately, it is not as simple as buying as many tests as possible.

We have to:

  • be confident about the accuracy of tests, and that can only be done through careful validation
  • understand which types of test are most effective in different settings
  • ensure that the processing of samples is done in a safe and robust way
  • ensure that tests can be requested and the results shared in a safe and timely manner
  • prioritise testing of symptomatic people based on need and operational capacity

In developing this test plan for Wales we have been led by evidence and have prioritised based on both need and impact.  

Our testing capacity is dependent on several important factors, including availability of kits, increasing laboratory activities in a safe way, ensuring appropriate staffing with specialist staff (e.g. Biomedical Scientists) and connection of Laboratory Information Management Systems (LIMS) so that the right patient gets the right result.

Welsh Government, in conjunction with Public Health Wales, has developed a COVID-19 technical test plan to deliver the right tests, to the right people at the right time such that it has maximum impact.

How testing is being delivered

Tests taken at the mass drive-through testing centres and mobile testing units in Wales involve a single dry swab taken from the back of the throat and are performed by our Public Health laboratories in NHS Wales. The number of diagnostic hubs and satellite laboratories will increase in line with demand. We started testing returning travellers in Wales on 29 January, and we have been testing front line staff, as well as inpatients, for the virus (Antigen testing) since 7 March. The new introduction of home testing kits which involve a combination throat and nose swab, are processed in Public Health England Laboratories and have enabled us to increase testing capacity further.

We are working around the clock to rapidly increase the number of tests in Wales. At the time of writing, the turnaround time for results is 24 hours from the time that the sample arrives in the laboratory, and this will improve as more automation, sampling transport and digital systems are rapidly deployed and connected.  

As we move towards the delivery of mass population as part of our recently published, our priority now is to ramp up testing  

to help the public and professionals in Wales get back to their normal daily lives whilst limiting the spread of the disease. Our plan is to have the right number of tests available to deliver our plan effectively. We are also validating Point of Care Testing – where results are given within a matter of minutes of the test being taken. This will transform how we care for patients as they present to the NHS. We are working with our specialists scientists and clinicians to validate antibody tests to understand whether people who test positive for COVID-19 antibodies are immune to re-infection. We are working to secure and verify these tests to ensure they perform as expected. This includes development of a finger-prick blood test and laboratory blood tests for COVID-19 antibodies.

Who gets tested and when

We developed guidance on a testing criteria for NHS and non-NHS workers defined as ‘Coronavirus Critical Workers’. In Wales, we have identified approximately 483,000 ‘Coronavirus Critical Workers; this includes approximately 168,500 health care workers, and approximately 9,900 police and prison staff.  It will be important that we work to target resources to the areas of most need to support our public health response to the epidemic in Wales whilst new systems are put in place and capacity increases. So whilst our aim is to ramp up testing to members of the public, patients in hospitals and residents in care homes, and critical workers will be prioritised according to daily testing capacity.

In Wales there are approximately 483,000 Critical Workers; this includes approximately168,500 Healthcare workers and approximately 9,900 police and prison staff.

Understanding more about the virus

Understanding how the virus works is a key element to helping us fight COVID-19. This will help us to detect those at highest risk and inform the development of new therapeutic innovations. 

Studying the DNA of people who have been infected with coronavirus may help us understand what genetic factors make one person more likely to suffer a worse reaction to the disease than another person.

In Wales, we are also working to understand how the virus is changing as it moves from person to person. To do this we are using genomic analysis of the virus. Wales is in the top 10 in the world for the amount of viral DNA information that has been made publicly available. This work will help us understand and manage the epidemic in Wales and beyond. 

Wales also benefits from hosting one of the world’s best privacy protecting data linkage systems called SAIL at Swansea University. Combining anonymised information on COVID-19 and other anonymous information about our population will provide us with a much greater depth of knowledge about the epidemic, enabling us to respond more effectively.

Who is involved

Welsh Government are leading a consortium of stakeholders to deliver our national plan for COVID-19 testing. This consortium includes Public Health Wales, health boards, Shared Services Partnership, NHS Wales Informatics Service, Life Sciences Hub, Health Technology Wales, Genomics Partnership Wales and academic partners.

We are working with all the home nations to share best practice and find common solutions. Our national testing plan in Wales for COVID-19 works alongside the UK Testing Strategy announced recently by the Secretary of State for Health and Social Care. 

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