Report 10: 2020-21

COVID-19: Status of WA Public Testing Systems

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Introduction, background and conclusion

Introduction

The objective of this review, which is not an audit, was to assess if WA Health[1] is effectively prepared to provide pathology testing during the COVID-19 pandemic.

A key part of WA Health’s COVID-19 response strategy is being able to quickly identify and isolate cases of COVID-19. This involves testing a large number of people and notifying them of their results as quickly as possible. We asked:

  • Is WA Health’s testing capacity sufficient to deal with a surge in COVID-19 cases?
  • Are tests and notifications done in a timely manner?

Background

Testing in Western Australia (WA) is guided by the Australian National Disease Surveillance Plan for COVID-19[2] and the Testing Framework for COVID-19 in Australia.[3] The Testing Framework prioritises the following groups for testing:

  • all people with fever or acute respiratory illness (ARI)
  • contacts of positive COVID-19 cases
  • asymptomatic testing in outbreak settings.

On 29 January 2020, the WA Minister for Health declared COVID-19 to be a notifiable, and urgently notifiable, disease under the Public Health Act 2016 (Act). This requires all pathology laboratories, public and private, who identify a case of COVID-19 to notify the WA Chief Health Officer (CHO), within 24 hours. The Office of the Chief Health Officer is a public health division within the Department of Health (Department) who advises the Director General and the Minister for Health on public health matters.

The CHO has issued a number of directions under the Act, including specifying who can request a COVID-19 test, when an individual can be tested, and which tests may be used to diagnose COVID-19[4]. These directions also required all laboratories, public and private, to notify the CHO within 24 hours of obtaining a positive or negative COVID-19 result including the patient’s information, the date of the test, and the result itself.

In addition, the Commissioner of Police in his capacity as State Emergency Coordinator can give directions for testing under the Emergency Management Act 2005. The directions are updated regularly and require various categories of people to present for testing within set timeframes following entry into WA. Examples include the Presentation Directions for people entering WA and the Transport, Freight and Logistics Directions for workers in the transport industry that regularly cross the State border.

WA also runs surveillance testing programs to examine and identify the spread of COVID-19 in the WA Community. These programs include:

  • DETECT Borders: ongoing voluntary testing program for high risk border workers without symptoms including those that work at airports, road borders, seaports and quarantine hotels
  • DETECT FIFO: ongoing testing of high risk ‘fly-in-fly-out’ and resource sector workers as part of a research program led by Curtin University and the Harry Perkins Institute of Medical Research
  • DETECT Schools (completed in September 2020): a study of over 4,700 staff and students across 79 public schools, support centres and residential colleges
  • DETECT Snapshot (completed in June 2020): a 2-week testing of 18,409 adults without symptoms from across WA.

Individuals can be tested for COVID-19 either through the public or private system. Private clinicians can request a COVID-19 test for a patient that meets the requirements of the testing direction, and this can be performed at an accredited private laboratory. People can also be tested through the public system following a request from a public clinician, as part of the WA public health surveillance programs, or due to hotel and home quarantine. These tests are generally performed by PathWest.

In WA, COVID-19 is diagnosed through polymerase chain reaction nucleic acid tests (PCR).[5] PCR tests identify the genetic material of the COVID-19 virus, and are considered by the Australian Therapeutic Goods Administration to be the gold standard for diagnosing COVID-19.[6] A test involves collection of a sample through a nasal and throat swab, laboratory processing of the sample, and then notification of the result. In WA, both public and private health providers manage these test processes. Figure 1 illustrates the testing process.

PathWest is the pathology and forensic arm of WA Health. It processes most of its COVID-19 samples at the QEII Medical Centre (QEII) or Fiona Stanley Hospital (Fiona Stanley) laboratories. PathWest also has equipment in 14 regional centres, to accommodate urgent COVID-19 testing.

When sample testing is complete, PathWest provides results to the Communicable Disease Control Directorate within the Department to fulfill its obligations to notify the CHO of COVID-19 results. PathWest also provides results to the clinicians that requested tests, which includes the Department and East Metropolitan Health Service (EMHS) for patients in the public system, who then notify test recipients of the outcome and next steps.

Testing in the public system is provided through:

  • 7 metropolitan and 3 regional COVID-19 clinics[7]
  • all regional hospitals via emergency departments
  • airport arrivals, and hotel and home quarantine
  • 14 remote communities via the Commonwealth Partnership Program for Aboriginal and Torres Strait Islander COVID-19 Point-of-Care Testing.

In WA’s private health system, 4 providers with national accreditation manage COVID-19 testing for:

  • 23 dedicated community-based COVID-19 collection centres and clinics in metropolitan and regional locations, which require a referral from a medical practitioner
  • workers subject to the Transport, Freight and Logistics Direction
  • 6 Perth/Peel and 6 regional Commonwealth respiratory clinics
  • research into asymptomatic ‘at risk’ workers in the maritime and resource sectors
  • outbreak response in Residential Aged Care Facilities under a Commonwealth contract
  • private and public/private partnership hospitals.

Conclusion

In conducting this review, which is not an audit, nothing has come to our attention to indicate that WA Health is not effectively preparing, in all material respects, to deal with an increase in demand for testing during a surge in COVID-19 cases. Preparations rely on a combination of public and private pathology providers to scale-up to more than 20,000 COVID-19 tests per day. PathWest, the State’s public pathology provider, has prepared its laboratories to process up to 8,750 of these tests per day and has procured the necessary chemicals and supplies. Private providers will process the rest.

PathWest is acutely aware of the need to maintain its wider pathology capacity to diagnose and treat other health conditions during a surge in COVID-19 cases. Within its laboratories, PathWest has taken steps to ensure delivery of all services, and has dedicated equipment for COVID-19 testing. Internal monitoring indicates that to date, other pathology services have not been negatively impacted.

PathWest tracks its test processing times, which show an overall improvement from 1 September to 20 October 2020. However, regional tests still take roughly twice as long (40 hours) to process compared to metropolitan (less than 20 hours). Our analysis supports advice from WA Health that extra time to transport the samples from regional areas accounts for much of the difference between metropolitan and regional notification times, as all tests have similar processing times once samples arrive at PathWest.

While we observed PathWest’s laboratories functioning well, with sufficient equipment to meet the COVID-19 surge plan, we identified some potential risks around swabbing and space to register incoming test samples. In particular, there were limited quality checks done by PathWest to ensure its COVID-19 swabbing teams reduced the risk of false negatives by correctly taking samples from individuals in hotel quarantine, and the Fiona Stanley laboratory is critically short on space and will find it difficult to register large numbers of samples for processing during a surge. PathWest is considering solutions for its space limitation and clinical staff will supervise swabbing now that EMHS has taken over responsibility for collection of samples.

PathWest has systems in place to notify the CHO and WA Health of test results. It provides all COVID-19 results, positive and negative, and results for other notifiable diseases, to the CHO every day, and sends daily reports to the Department of Health and EMHS on test results for individuals in hotel quarantine and airport testing programs.

Individuals generally receive their results from their clinician or through text messages. EMHS has developed an automated system to send negative test results to individuals through text. This has the potential to relieve pressure on clinicians.

Our procedures were performed as a limited assurance engagement, in accordance with the Standard on Assurance Engagements ASAE 3500 Performance Engagements, and vary in nature, timing and extent from an audit. As such, the level of assurance provided in this report is substantially lower than for an audit.

 

[1] WA Health consists of the Department of Health, Child and Adolescent Health Service, North Metropolitan Health Service, South Metropolitan Health Service, East Metropolitan Health Service, WA Country Health Service, Health Support Services, PathWest and the Quadriplegic Centre.

[2] Australian National Disease Surveillance Plan for COVID-19

[3] Ibid. Appendix 2

[4] Through the COVID Testing Reporting Directions and the Testing Criteria for SARS-CoV-2 in Western Australia.

[5] As specified by the Department of Health, Testing criteria for SARS-CoV-2 in Western Australia #15

[6] Therapeutic Goods Administration, 1 October 2020 COVID-19 testing in Australia – information for health professionals.

[7] Locations are provided on the Department website.

 
Page last updated: December 9, 2020

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