If Ukrainians manage to get checks on Covid-19, it often takes weeks to wait for their results. Some patients, however, are notified that their tests were not received in the laboratory at all.
Does the country have enough tests, what is the reason for the hiccups with their results and how to achieve verification if you need it?
What tests do they do in Ukraine?
There are several different types of tests for coronavirus. Basically, our country purchases rapid tests, which involve the search for antibodies M and G in a blood sample. But the reliability of such a test is only about 30%. The fact is that antibodies begin to be produced in the body after about 5-6 days from the moment of infection, so that at the beginning of the disease a check will show a negative result. Sometimes, such antibodies can also be produced not on Covid-19, but on another virus, so the test can be false positive.
Therefore, more often rapid tests are used only for mass screening. And then, the effectiveness of such testing is doubtful.
PCR tests (polymerase chain reaction method) are much more reliable. For them, doctors take scrapings from the mucosa of the upper respiratory tract. The scraping is sent to local laboratories, and then to the virology laboratory at the Public Health Center in the capital for final confirmation. Some tests are rechecked in European laboratories. Ideally, you need to do three tests: the first will confirm the disease, the second will show the course of treatment and the third will confirm recovery.
This method does not give a 100 percent diagnosis, but is one of the most accurate. In addition, it all depends on the specific test. For example, every third result of Russian PCR tests is false. There is also a method of serological testing, but it most often allows you to identify already ill in a hidden form. Ideally, it also should be done in Ukraine for a complete picture of the incidence, but we do not yet have the right equipment. There is also an active development of "molecular" tests, for which it is enough to put a smear of the patient in the cartridge - and the result will be in half an hour.
“You can’t replace the PCR test with anything,” says immunologist, candidate of biological sciences Boris Donskoy. “It is done in Ukraine for those who returned from abroad, as well as those with whom such a person contacted. But testing could be more widespread, there were all the possibilities for this."
The chief sanitary doctor of Ukraine Viktor Lyashko does not think so. He is sure that it’s “pointless” and economically unreasonable to test for coronavirus not only all who want, but also those who returned from abroad, without fail. It is not surprising that Ukraine has rather low rates for testing the population, even though the chief sanitary doctor says that they are average. As of April 9, the country has done about 5.5 tests per 10 000 people.
Test coverage in the United States is lower than in Ukraine - less than 1 in 10 000 people, as there are often not enough tests or they turn out to be defective. In Japan, the figure is about the same. But in some parts of Italy, tests are done even for supermarket employees who could be in contact with patients. There is almost the highest level of testing: 25 checks per 10 000 people. In China, tests are also done at the slightest suspicion, the average is about the same. But in Germany people were tested directly in cars, there are tents on the streets where anyone can go.
The Ukrainian policy of low testing leads to the fact that those who need them often can’t get checks.
Are there enough tests in Ukraine?
Sometimes coronavirus is established after sudden deaths. There was a case in Ivano-Frankivsk, when a couple refused to do the tests. A woman did a PCR test only after her husband died. In the Ternopil region, a coronavirus was found in a deceased 83-year-old woman from the Monastyrsky district. She was not tested for a disease for 5 days due to their absence.
Some Ukrainians wait weeks for a reanalysis.
In Ukraine, according to the chief medical officer, we have 250 000 PCR tests. In his firm conviction, our country is not much inferior to the countries of Europe in their numbers. One test system can be used for about 90 people. According to rough estimates, the country has 1 test for 1700 people.
The stock of tests is systematically replenished thanks to the supply of hundreds of tests from China and South Korea. More than 100 000 tests were distributed by patrons in the country. Doctors say that so far the situation is controlled, although there is a risk that in the event of a large-scale epidemic, these tests may not be enough. As for the tests from China, Golovkin was told that they have no certification.
In Ukraine, it is possible to produce its own tests. The Institute of Molecular Biology and Genetics of the National Academy of Sciences has long declared its readiness to produce the tests they created as soon as funding is received. Recall that earlier scientists were sent on vacation at their own expense. A month after the presentation of the development, Lyashko said that Ukrainian PCR tests are much cheaper. It will be produced from 2 to 7 000 daily (although scientists talked about the possibility of producing up to 20 000 tests per day).
“Ukrainian tests could be made 2 months ago. I don’t know if they are good or not, but they could be checked and agreed to manufacture a long time ago. And then the tests would not be carried out in intensive care, but in a taxi from Boryspil. But the bureaucrat does not want to give up his right to sign on importing reagents and permit systems to stay in the country. Now they want to make only a few thousand tests a day. The numbers are quite strange, I agree," Donskoy says.
Given the situation, there may actually be much more cases of Covid-19 patients in Ukraine.
How long do you have to wait for the test result?
In addition to the fact that in Ukraine it is difficult to achieve testing, a separate quest is to get its result. According to the procedure, the result of PCR testing should be provided no more than 4 days later. Vadym under the nickname "Optimist" on Facebook was treated in the 1st city hospital in Zhytomyr. He received official confirmation of his illness only on the 8th day after passing the test. Verification showed a positive result.
A new test was done to him on March 31, and it again turned out to be positive.
A doctor in one of the capital’s hospitals, who wished to remain anonymous, says that if you take the analysis incorrectly, it may not give an accurate result. So the doctor is directly responsible for the test result. But the timing of the delivery of the result depends on the laboratories that conduct the tests.
If we talk about the speed of testing, then in Ukraine in each region they deal with this differently. In the Luhansk region, laboratories can perform 12-15 PCR tests per day. According to Lyashko, a total of 1.5 thousand samples are tested daily in the country. For comparison: in France, 5 thousand tests are done per day, and this figure in the world is considered low.
First of all, the testing speed in Ukraine depends on the number of laboratories. At first, the Ministry of Health stated that tests across the country were carried out in only 11 laboratories. Then they began to be massively launched in the regions. In Lviv, authorities reported on the launch of two additional laboratories, and one more in Siverodonetsk. In Kharkiv, they plan to open a communal laboratory for testing on Covid-19.
As of early April, the number of laboratories capable of doing tests has increased to 37. In addition, 547 mobile teams testing Ukrainians have been deployed near hospitals. But this is still not enough. Where there are no laboratories of their own, there are delivery problems.
Those who do not have the opportunity to do test in the area are forced to look for vehicles to send samples to Kyiv. The administration of the Berdyansk Territorial Medical Association even directly asked citizens to help with the transportation of tests in a special container. Of course, such a proposal is risky, since the PCR system is very sensitive to conditions, including transportation and storage.
The laboratories themselves also have enough problems. Somewhere there are not enough additional consumables: sticks, test tubes, reagents, solvents. For the test, you need a device that provides a quick temperature difference - an amplifier. In the Donetsk region, for example, there are tests, but there are no amplifiers. The result also depends on the quality of the equipment itself.
“Until recently, there was only one apparatus for research in the Zhytomyr region, and it’s very old and buggy. Now they’ve bought a new one, Chinese, but they can’t translate the instruction, it is written in “Chinese English.” Secondly (and most importantly), there are no specialists who know how to work on this equipment,"- Vadym "Optimist "shares information received from doctors.
Doctors agree that the main problem of laboratories is really a lack of people.
Usually, only one shift works in laboratories. For the entire Zhytomyr region, there are only two virologists who can do testing. If the equipment can be urgently purchased, upgraded, then this will not work with people. Theoretically, it would be possible to introduce express virology courses and form round-the-clock teams. This would increase the throughput of laboratories and, accordingly, the speed of testing. But the personnel issue had to be dealt with earlier. Especially considering that in some regions there is also no funds to pay doctors.
But the chief sanitary doctor sees the problem not in this, but in "sample delivery algorithms."
“I don’t want to blame anyone. The question is that we are reviewing where there might be a failure in sampling for delivery to the study,” Lyashko said.
Reference laboratory "out of reach"
Yelyzaveta Romanchuk underwent PCR tests with an interval of 1.5-2 hours in the capital's Oleksandrivska Hospital. The result was "neither positive nor negative." So the smear was sent to a reference laboratory, which officially confirms the diagnoses of patients.
Two weeks later, Romanchuk sent a request for the results of her test to the Ministry of Health. She was told that as of April 6, the samples had not arrived at the laboratory.
"The physician came on Monday, March 23rd, and said that I had a negative result on Covid-19. In the extract, I was assigned false symptoms and a false final diagnosis. That is, maybe I left the hospital without, and maybe with Covid- 19. Yes, I’ve been quarantined at home all these weeks, but once a week I go out to the supermarket and talk to my neighbors," she writes on social networks.
If in the regions the testing situation can be explained by local problems, then the difficulties with diagnostics in the capital are suspicious. Especially considering the fact that Kyiv placed several express laboratories in the Oleksandrivska Hospital, where Romanenko was treated. How and why the test turned out to be "neutral" is unknown.
If we talk about the virology laboratory of the Center for Public Health, then tests and reagents, in particular from the World Health Organization, are systematically delivered there. Another thing is that the Center is littered with work. As early as April 6, the Center received 521 messages about suspected coronavirus, April 8 - already 696 messages.
The head physician of the Kharkiv Regional Infectious Diseases Clinical Hospital Pavlo Nartov said that since the end of March he has been waiting for the results of checks from the Kyiv laboratory. More than 31 patients with suspected coronavirus still do not know their diagnoses. By the way, a part of samples is expected in the Mykolayiv area, in which not a single case has yet been officially recorded.
However, it is interesting that neither the regional nor the reference laboratory, it turns out, check all the smears that come to them.
“I would like to recall that the number of suspicions that the Public Health Center or regional laboratory centers receive does not equal the number of studies. They examine samples of people who have been identified as suspicious, contacts and those who have recovered,” said the Acting General Director of the Center for Public Health Igor Kuzin.
The wording is rather dubious: they will not check everyone they suspect, but only those who are officially suspected.
Infectionist Borys Donskoy says that mass diagnostics are artificially inhibited. Diagnosis means fixing cases, and their growth fuels panic among the population.
“There are enough people, equipment and even materials for tests that would be enough for hundreds of examinations. For some reason, nobody really needs it. What are the hidden interests - think for yourself. If we talk about a doctor who came across a patient with pneumonia, then for him, with a clinical point of view, testing is no longer interesting, because both coronavirus and ordinary flu are treated equally. Epidemiologists are also not interested, because a person is already at the stage of the disease when he is in the hospital. Nobody wants to take responsibility for the tests, "the expert says.
What to do if you are denied testing or don't receive the result?
The situation is somewhat mitigated by the fact that PCR testing for coronavirus has recently been allowed to private clinics. But with one condition: they must report on each case of coronavirus disease. This does not mean that now all private clinics will begin testing. The room for the collection of biological materials must have a bactericidal irradiator, special ventilation, and the staff should have protective clothing. Not all clinics have such conditions.
True, private tinning is not always faster. In one of the clinics, they are only sampling the material, but it is still checked in the state laboratory. So money will help, but not in all cases.
What to do those who do not have money, as well as everyone who wants to realize their right to free medicine?
Patients must fight for their right to be diagnosed, they say in the Ministry of Health.
“Please inform us about each refusal of testing on the hotline. We will consider each such appeal at the national and regional levels in order to provide testing to all who fall under the testing algorithm,” Lyashko said.
In case of doctors’ refusal to test, lawyers advise to take written confirmation of this. With such confirmation, you can go to court or at least warn the doctor about such a desire.
As for delays in getting the results, lawyer Yuri Belous advises to write complaints to the Ministry of Health, appealing to the fact that such irresponsibility can lead to the spread of the disease. According to him, it is not known whether there will be a corpus delicti in such a situation, but this is already a matter of investigation.
“The perpetrator may face administrative or criminal liability under article 325“ Violation of sanitary rules and norms on the prevention of infectious diseases. ”The fine will be from 17 to 51 thousand UAH (1821 USD). Or there will be imprisonment up to 3 years. If such actions entail death or serious consequences the prison term is from 5 to 8 years,” he says.
The lack of tests, laboratories, reagents and qualified personnel are not the problems that should fall on the shoulders of Ukrainians during an epidemic. But, unfortunately, fighting for the provision of services that should be basic is the only way to protect not only themselves, but also other citizens who are at risk.