Adapting to Covid-19 is a challenge for all healthcare settings at the moment. You might be fine today but what about next week or next month? How will you know when your risks increase and you need to take different steps? Will you be able to notice a new source of infection in good time? This is where regular and methodical testing can help.
It is important to understand that testing can only help if it is effective, and that means being part of a concerted effort with a systematic plan.
Right now, it is a confusing topic and good advice is hard to find. Until the government offers specific guidelines, you need to use your common sense and do the best you can.
So, what practical steps can you take to manage testing in your clinical or other healthcare setting?
First of all, the best advice is still to ask staff to monitor symptoms and be aware of what additional risks each staff member may be exposed to. For example, are they living in a communal environment like a house-share, are they part of a large family with most members working and using public transport, do they use public transport themselves to come to work? All of these will increase their risk. This doesn’t mean they shouldn’t come to work – it’s simply something to be aware of and bear in mind when working out your testing plan.
There are a number of issues to consider when setting up a testing programme and you need to be very careful about some of the hidden implications. It is not simply a medical or clinical question, the personal privacy aspects are just as important.
When designing a testing programme ensure it is:
- Planned and documented
- Systematic (even if you are doing random checks, you need to make it clear who is tested, when and how)
- Actionable: you need to know what specific action you will take if certain results are found
- Follows Public Health England (PHE) guidelines and if possible is carried out under clinical supervision. The latter may not be possible, although many occupational health physicians can provide this as a service.
The testing programme must also avoid these pitfalls:
- Improvising/introducing the latest test available without considering the implications
- Testing must not lead to discrimination or the perception of discrimination
- Once the data is no longer needed it needs to be destroyed and the process documented
- Using tests that are not approved by the Medicines and Healthcare products Regulatory Agency (MHRA)
- Interpreting results to one’s own purposes
- Using a system where security of data cannot be guaranteed (e.g. Excel)
In addition, there are number of questions you need to ask when creating a testing programme:
- What type of information will you be collecting and what action will you follow if you found it? For example: Will it lead to more testing of a specific group? How will PPE use need to change? Will shift patterns or workflow etc. need to change?
- What other information will you need to record in order to give context to the testing? For example, this could be linked to risk factors like ethnicity or sharing a household with a person who is at higher risk.
Example questions, with possible answers, might be:
Why are you in isolation or being tested?
- I have symptoms (go to symptoms checker)
- I have tested positive but have no symptoms
- Someone else in my household has symptoms
- Some in my household tested positive but has no symptoms
If you have symptoms, did they start:
- Less than 7 days ago
- Between 7 and 14 days ago
What type of Covid-19 testing needs to be carried out in relation to any symptoms? Will tests need to be repeated and, if so, at what intervals?
How will you manage repeated testing? How long is the information valid?
The timing of these questions and answers as well as the related test result is really important; each test is only effective for a very precise period. Test at the wrong time, and the results will lose their meaning. However, the combination of the test result in relation to timing of the symptoms is really meaningful. This is why it’s important to capture these together.
All of these questions need to be asked and answered. Unfortunately, it is unlikely that your current system for recording HR data is ready for the challenge, so a new system of Covid-19 testing is needed.
For example, Thomson Covid-19 Test Manager is a new software platform that manages the testing process, irrespective of where, how and what test is carried out. By using a dedicated testing platform to manage the process, it will be much easier to track the results, know what actions to take, and ensure that everyone who needs to be tested is tested.
There are also some common myths that need to be busted.
- Don’t wait for test results to decide whether you should self-isolate; you should self-isolate as soon as you have symptoms.
- Previous infections do not always produce anti-bodies. For example, the entire Hungarian national swimming team testing positive for the virus. Later they offered their plasma to help others in recovery. However, to everybody’s surprise, none of them produced any antibodies.
- According to the WHO, the so called ‘Immunity Passports’ should not be encouraged; we simply do not know how long immunity lasts and it can create a false sense of security.
There is some evidence that people with a BAME background may be at higher risk. This may mean that they need to be treated differently (for example, testing more regularly, or shorter intervals between tests), however it is essential that you avoid any form of discrimination.
So, how can you best manage this? My advice is to be open and transparent about why and how you want to manage the testing, and, if necessary, get some advice/training about sensitive communication with employees at risk.
You will also need to talk to your team about a) the reporting procedure if a member of staff is found to have Covid-19; b) how testing will change or increase if a visitor or supplier reports they have Covid-19, and c) what actions will be taken if a test is positive. These elements need to be considered and decided in advance of the testing programme commencing.
A final and crucial issue is ensuring that you can undertake your ‘duty of care’ and that your testing programme does not conflict with UK employment law. The lack of government guidelines, and difficulty accessing good information isn’t helping here so getting specific legal advice is important.
About the author
Marta Kalas is co-founder of Thomson Screening, developers of the Thomson Covid-19 Test Manager software platform that enables testing providers to scale irrespective of where, how and what testing is carried out. Functions include automated reporting at local and national level for bodies including Public Health, Community Health and Employers with data reporting into other systems, as required.
A separate module using questionnaire and risk assessment methodology enables local residents to self-report Covid-19 symptoms with automated reporting to local (or national) Public Health and the ability to automatically push out messaging specific to the individual with symptoms.
Thomson Covid-19 Test Manager is designed to adapt rapidly to fast changing requirements and is fully scalable. The Innovate UK grant enables Thomson Screening to utilise investments made in the core functionality of the company’s products used in the NHS, especially its SchoolScreener Imms product, to rapidly repurpose and deploy the software.
