Testing capability pushed to the limit around the world

The surge in COVID-19 cases driven by the highly transmissible Omicron variant – in conjunction with the Christmas holidays and the reopening of domestic and international borders – has stretched Australia’s testing capability to its limit.

With many pathology facilities closed over the holidays, and negative tests a requirement for travel and work for many people, lines for PCR tests snaked around the blocks of our major cities. People were reported to have queued for up to six hours to get the swab done, and many found they were still sent away untested.

While it has typically taken less than 24 hours for patients to receive their results, the high demand overwhelmed many labs. Significant delays have seen some people wait for up to five days to find out if they have COVID-19.

As a consequence, the National Cabinet has recently radically changed the rules around testing, now requiring only those with COVID-19 symptoms to get a PCR test. At-home rapid antigen tests (RATs), suggested by numerous authorities as a viable alternative, are in desperately short supply, and finding them has become akin to a treasure hunt.

Most states – for instance Victoria, New South Wales, South Australia and Tasmania – have introduced mandatory reporting of positive RATs. Some have announced there will be fines levied for non-compliance – but that hasn’t made it immediately easier to get a RAT.

Australia isn’t the only country struggling with COVID-19 testing. Omicron has broken the testing system in many parts of the world

Americans are experiencing similar difficulties, with PCR testing facilities in many US states characterised by long lines and RATs, even for those willing and able to pay for them, in short supply and hard to find.

In the UK, where hundreds of thousands of people are currently isolated due to COVID-19, the government has been forced to change PCR testing requirements: from 11 January, people who test positive on a RAT do not need follow-up PCR tests. Only people experiencing COVID symptoms (high temperature; a new, continuous cough; and a loss or change to the sense of smell or taste) are still expected to get a PCR. The new approach allows asymptomatic people – about 40% of cases – to return to work more quickly.

Italy has also seen a dramatic increase in COVID-19 test demand, with cases soaring across the country. People there can wait for days after booking for a test – and then wait up to a week to receive the results.

“I receive many text and phone calls every day from family and friends needing to book an appointment or waiting for their results – they are all asking for help,” says Simona Galgani, a frontline nurse. She spent the first year of the pandemic taking COVID-19 swabs and the second administering COVID-19 vaccines in Pistoia, Italy.

While at-home rapid tests are officially unrecognised in Italy, professionally taken RATs can now substitute for a PCR, a decision taken to alleviate the pressure on PCR swab collection centres and pathology facilities, Galgani explains. But that first appointment at the local pharmacist can often be days away.

“When I had the first COVID symptoms, I had no problems about what to do,” says Galgani, who caught the infection over the Christmas holidays. “But the system can be quite complicated to navigate for those who are not insiders, and the rules are often confusing.”

She says that back in 2020, getting tested for COVID-19 was simpler and quicker, but the enormous demand driven by the rapid spread of Omicron has brought the system to the brink.

“After two years of the pandemic, it is as if we have gone backwards instead of moving forward.”