WIDESPREAD testing for COVID-19, as part of the strategy for the complete lockdown exit and a "new normal" life with the virus is recommended by all well-known world organizations, including the World Health Organization, the American Center for Disease Control (CDC), and The Organisation for Economic Co-operation and Development (OECD).
For example, OECD presents an extensive text on its webpage under the title: "Testing for COVID-19: A Way to Lift Confinement Restrictions."
In summary, its authors wrote:
"This policy brief discusses the role of testing for COVID‑19 as part of any plan to lift confinement restrictions and prepare for a possible new wave of viral infections. If all confinement restrictions are lifted before a vaccine or effective treatments are developed without other measures to suppress new infections, the infection rate is expected to rebound rapidly. Crucially, quick suppression of infections requires testing more people to identify who is infected; tracking them to make sure they do not spread the disease further; and tracing with whom they have been in contact. This brief discusses how testing strategies can be used to achieve three main goals: 1) suppressing the resurgence of local outbreaks; 2) identifying people who have developed some form of immunity and can safely return to work; and 3) gaining intelligence on the evolution of the epidemic, including on when a threshold for herd immunity has been reached."
OECD the, in the chapter Key Messages, stated:
"A key question behind any strategy to ease confinement restrictions and re-open economic activities is how to avoid a new spread of the SARS‑CoV‑2 virus that would necessitate further lockdowns. Once the number of infected people has successfully been brought sufficiently down, quick suppression of new waves of viral infections will be key. Testing strategies are central to achieve this."
The WHO Regional Office for Europe similarly stated on its website:
"As restrictions are eased, it is important for countries to recognize that it may be necessary to reintroduce physical distancing measures to manage outbreaks. This fluid approach is known as bi-directionality.
A rigorous surveillance program to identify, test, and isolate all cases and to trace and quarantine their contacts is vital to ensure that localized outbreaks do not get out of control. When measures are eased, cases should not exceed a sustained reproductive factor of 1, and should ideally remain below 1. It means that a person with confirmed COVID-19 does not pass the disease on to more than 1 other person to keep the number of cases flat.
A trend showing increases in the number of new cases would require a quick reintroduction of physical distancing measures to contain the outbreak. As a result, the easing of lockdown restrictions is prone to short-term change."
Testing within "the hammer and the dance" strategy
These statements remind of the concept of the strategy of a French engineer Tomas Pueyo, the creator of an application with more than 20 million users, a successful businessman educated on the École Centrale Paris, Stanford University, and Higher Technical School of Engineering (ICAI), which in March became famous and went viral under the title "The Hammer and the Dance." Many epidemiologists approved this strategy.
According to the strategy, the governments firstly implement strict measures of a hammer, such as a lockdown for a couple of weeks, to quickly suppress the virus and reduce the R0 below 1 to buy time for a more qualitative organization and equipping the health care system. Thereby, the curve is flattened, i.e., the number of the infected is reduced, which leads to avoiding an overwhelmed healthcare system, the growth of collateral damage, and eliminating many medical experts.
When the number of the infected is reduced to a relatively small number using the hammer approach, countries can exit the lockdown and enter the new dance phase in which "a new normal" life continues with certain restrictions such as banning large gatherings, keeping social distance, and focusing on contact tracing, testing, isolating, and putting the infected into quarantine. The proponents of the strategy are in favor of the widespread testing to reveal the possible hotspots on time, even among people that are in the early phase of the infection, without symptoms, in order to isolate them before they infect a large number of people. Such testing can also be used to closely monitor the basic reproduction number with an idea to keep it under 1 as long as possible with the most optimal and economically most cost-effective counter-epidemic measures (efficiency of which we are just acquiring knowledge about). If a larger hotspot appears somewhere, the measures will again be stricter in accordance with the situation. The main idea of this phase is to buy time with as little damage as possible until there are drugs or vaccination.
The example of the Dance in Europe and Germany
One of the countries that conducts widespread testing and regularly monitors the changes in the reproduction R0 number is Germany. That country reduced its R0 below 1 in May, but a few days ago, the Robert Koch Institute published that the number had risen to around 2.88. The increased number of the infected is especially manifested in Berlin, Magdeburg, and Neukölln, and the most in the provinces of the North Rhine-Westphalia where more than 1,330 Tönnies slaughterhouse workers have been infected. The government had a fast reaction to this change and imposed certain lockdown measures in critical areas again. The slaughterhouse was closed, and all workers and their families were put in quarantine. Schools and kindergartens are closed until the beginning of a new school year on August 11.
Croatia is testing far too little
Croatia has successfully gotten through the first phase in fighting off the virus (the Hammer). We're currently in the more demanding phase (the Dance), which we should maintain as long as possible without imposing more drastic measures again. However, for keeping the favorable epidemiological situation, as many experts agree on, widespread testing is necessary. Here we encounter a problem since Croatia is still among countries with the lowest number of testings per million residents in Europe. Moreover, we test even less than the neighboring countries on the Balkans. The low number of testing perhaps made sense when we were in the hammer phase - in a complete lockdown and with a low number of the infected, but surely not in this new phase.
Bernard Kaic, the manager of the Department of Epidemiology at the Croatian Public Health Institute, told Index that testing itself is not an anti-epidemic measure, and cannot cure anyone.
"But testing in the largest number possible when there is the slightest suspicion of the disease is very important to reveal all of the infected on time, thus isolating their contacts and putting them in quarantine," he said.
"It's especially important now when more people are coming from abroad. Our epidemiological situation is still relatively good, although the number of infected is increasing. Testing should be made easier for everyone, including foreigners, based on the slightest suspicion of the disease. Of course, it's not possible to walk down the road and test everyone, but doctors should suspect coronavirus whenever the body temperature is elevated, or there are symptoms of respiratory diseases, except when it's clear that the cause is something else, for example, if someone else has an infection of a throat. Even for mild diseases of an unknown cause, the doctors should recommend testing," he explained.
Should we be afraid and test in case of a sore throat?
We are encountering another problem here. Since the flu season in winter is behind us, it's to be expected that people who feel any respiratory difficulties will more often suspect the possibility of contracting coronavirus. Kaic said that there is a reasonable ground for that, but also pointed out that viruses that cause similar symptoms also circulate during the warmer periods of the year.
"It's true, when there is no flu, and a person exhibits symptoms of respiratory disease, the probability for COVID-19 is increasing, but it doesn't mean that the probability is significantly larger. There are other diseases with the symptoms of respiratory diseases in the warmer periods. For example, diseases caused by enteroviruses with the body temperature slightly elevated and with respiratory symptoms," our epidemiologist explained.
Possible obstacles to widespread testing
Health organizations point out potential obstacles to large-scale testing, such as the lack of reagent, caused by the pandemic. The lack of qualified staff and capacities could also represent a problem because the PCR test, which reveals the presence of the virus, is quite demanding - a well-trained person should take swab samples, and the analysis could last for hours. Transport to the place with equipment could also cause some difficulties, as well as the expensiveness of the equipment.
Some experts consider that one of the problems - financing massive testing - can be solved by collecting more swab samples per group of people, for example, in families or offices, which could then be analyzed together.
Kaic admits that the lack of qualified staff can really represent a problem.
"Back when we did 1,500-2,000 tests per day, that was really demanding. We were working in three shifts and we had to use people who would usually do other jobs in order to do the testing. It's possible for the staff problem to re-appear when the number of testing increases again to more than 1,000 per day. Then we should again have to work in two shifts, but I think it's necessary," said Kaic.
Our epidemiologist isn't satisfied with the fact that Croatia is among countries with the EU's lowest testing rate. He thinks that room for testing should be made again.
"I think that COVID-19 clinics were an excellent thing. As coronavirus ceased to appear, the people there were on duty for no reason, so the clinics started to close. But it's important to provide an alternative for them. In each place with a closed clinic, in every county or health care center, people should know where to go to get tested. I think it's still not organized well, although it is necessary. In some places, the clinics are re-opening, for example, in Dubrovnik. I think it's very, very good, and commendable," said Klaic.
The price for testing at your own request wasn't changed in the meantime, and it's still near 200 euros.
To conclude, in the end, along with being relaxed too much and disciplined too little on every level, Croatia also faces the problem of the lack of testing.