Testing for the virus — mixed messages and missed targets
WHY did Ireland fall so far behind on its ambition to test as many of the population as possible?
Beyond the obfuscations and mixed messages on missed targets and delays, there is an explanation and it is not just down to a global shortage of reagents.
In early March, the National Virus Reference Laboratory (NVRL) started looking around for spare capacity for testing. Anyone who had a symptom was to be tested. The NVRL is a highly specialised facility that is not designed for mass testing — managing a maximum of 1,300 Covid-19 tests as well as regular tests. Even in early March, the plan was to test 15,000 a day.
The only lab that came close to taking on that scale of testing was a state-of-the-art veterinary laboratory in Co Kildare, contracted by the Department of Agriculture. Enfer, owned by Co Tipperary farmer Louis Ronan, a cousin of property developer Johnny Ronan, tests thousands of livestock for BSE and BVE in 24- to 48-hour turnarounds. Speed is of the essence. “Farmers need to sell their animals,” said one informed source.
Enfer signed up in early to mid-March. According to Cillian de Gascun, director of NVRL, it was always going to take six to eight weeks to ramp up testing to 15,000 a day. But Health Minister Simon Harris predicted on March 19 that Ireland could be doing that number in days — a promise that returned to haunt him.
By then the unrestricted testing had led to huge demand for tests, leading to urgent demand for extra testing capacity just as global demand for supplies took hold. That was the first setback.
Testing is done on systems or platforms which are geared up to use certain types of products manufactured by big pharma firms. Enfer used Roche, a global multinational with a base in Ireland that was experiencing a run on its extraction kits for Covid-19 testing.
One of the key Roche products in short supply was an extraction kit which contained a chemical reagent used in a crucial second stage of the lab test, that enables the virus to be detected if it is present on the swab.
For Roche platforms, there is no alternative. “The extraction step uses reagents that are built into a cassette that slots into the machine. It’s not as simple as replacing or making the reagent. It’s like an ink cartridge for a printer — we can make the ink, but we need the cartridge that it goes into in order for the printer to work,” the source said.
Roche had announced to Irish customers on March 13 that it would have to “prioritise” its products.
“We didn’t know at the beginning what the [Ireland’s] ration would be. But the rationing per country would only give Ireland the equivalent of around 1,200 or 1,300 a day for the population,” said an informed source.
That supply was earmarked for Irish hospital labs and the NVRL — which also used Roche.
The HSE negotiated with
Roche. At one point, Taoiseach Leo Varadkar got involved.
Enfer ditched the Roche compatible platform to “re-kit the entire laboratory with a different system altogether”, said the source. “It’s the equivalent of going from BMW to Mercedes.”
Enfer’s new system was sourced and paid for by the HSE and the NVRL.
The second setback came after the deal was signed. It emerged that the manufacturers announced a two-week lead-in period before the machines would be delivered. The new system took days to install and a further couple of days to ensure it was validated or aligned with the NVRL’s, sources said.
Meanwhile, with burgeoning demand for tests, a backlog soared to 40,000 and public health advisers had to narrow the testing criteria dramatically. At that point, the German laboratory Eurofins was brought in to help clear the 40,000-strong testing backlog.
On Friday, April 10, Enfer finally became fully operation as a Covid-19 test lab, with
100 UCD student volunteers working 24/7.
Dr Tony Holohan, the chief medical officer, announced Ireland had now increased its capacity to process 4,500 tests a day.
In fact, little happened in its first week in operation — the restrictive criteria for swabbing patients meant there were far fewer specimens to test than expected. That changed on April 17 when the Government announced that staff and residents of all nursing homes would be tested.
There were other delays. An electronic record charted a patient’s testing experience from the point of GP referral right through to NVRL and on to the contact tracing teams.
But the journey was interrupted by the NVRL, which didn’t have any slots for patient phone numbers in its system. Its scientists didn’t usually ring patients. Fixing that took days.
There were also delays in uploading data on to a communications system used by contact tracers — on occasion the delays were up to six days. The various steps involved in transferring test data to the system also contributed to delays, which in turn impacted on contact tracing times. The process times have since been shortened, and the system partially automated. From a low of 1,500 to 2,000, the system is now processing around 8,000 tests a day — with 5,500 in Enfer, mostly on nursing homes.
Roche has delivered a new machine to the NVRL to increase its capacity, with a second on the way.
Enfer declined to comment but is expected to engage with media later this week.