Testing the Waters

Whichever way you look at it, and especially if you’re looking at it from overseas, Australia has done an enviable job in containing what has proved to be a nasty, destructive viral pandemic.

The unity of the early days of the Australian response has started to fragment as understandably each state deals with its own set of circumstances and conditions. However, one fundamental area that is far from consistent, and arguably should be, is testing.

In this regard, WA is very much at the low end of the scale. While other states are in the hundreds of thousands, in Victoria more than 100,000 in the space of a week, WA recorded a total of just over 67,000 as of May 20. The genuine fears of PPE and testing kit shortages several months ago have long abated, so why is WA not doing more strategic asymptomatic testing?

It is a question the AMA WA president Dr Andrew Miller has been asking for some weeks now. He is not advocating a free-for-all but he is particularly concerned that with the inevitable lifting of interstate borders, WA will see flare-ups that will need to be managed especially for vulnerable patients in hospitals and aged care facilities and key, frontline workers.

“The testing is a puzzle to me. I still don't feel like I have a complete understanding of why the restrictions on testing were in place at the start, or on private pathology being involved, when they weren't held back in other states,” he said. “And I still don't understand why doctors can't just order COVID tests as they would for any other test – to eliminate as much as confirm. We must have very high testing rates targeted towards at-risk populations as we ease restrictions. Clearly schools are one area as are health care workers and pre-operative or pre-admission patients.

“We know that people who have procedures when they're in the prodromal phase of COVID-19 have very bad outcomes. With seemingly low community spread, it's unlikely we're going to find a positive asymptomatic patient in the community but this targeted testing before patients go into a hospital would be worthwhile.”

Cost v Risk Dr Miller said that for the cost of a $100 test, it would be a small price for a hospital to pay if it avoided having to evacuate patients and shut down and deep clean wards, as was the case in north-west Tasmania.

“A deep clean and shut down could cost millions of dollars. So, this pre-surgical, pre-admission testing would be a small insurance for facilities. And we shouldn’t leave it up to patients to decide if they need testing. Humans aren't always honest, even with themselves, particularly if it may mean them missing out on their procedure, or having to go into quarantine for 14 days. It would be naïve to think everyone will come forward if they've got symptoms.” Department of WA a series of questions around testing. Its full response is on our website (www.mforum.com.au). It is clear that COVID testing is very much a controlled activity with penalties for non-compliance.

The spokesperson said the testing in WA reflected both population size and COVID activity in the population:

“In the setting of very limited community transmission that WA has achieved thus far, it is not a priority in and of itself to try to match testing rates … from other jurisdictions that are experiencing outbreaks.”

HoDWA said that it was abiding by the Australian Health Protection Principal Committee suggestion to test “people at risk of exposure who present with atypical symptoms, such as health care workers and residential aged care facility workers”.

In terms of strategic and sustained workforce testing for health care workers (including aged care) and workers in essential industries such as education and mining, HoDWA offered: “We may consider shortterm wider testing in the future.”

Regarding pre-surgical testing, HoDWA said: “Testing of asymptomatic patients prior to surgery is only approved for a limited number of patients undergoing specific aerodigestive procedures where prolonged aerosol exposure is expected.”

of the pandemic response. Being declared an essential service by the Premier, Mark McGowan, it has continued to turn the wheels of the state’s economy and has created an important beach-head on the testing front.

Workplace focus On May 6, a few days after the government announced its DETECT Schools research testing project (with Telethon Kids to do the science), it announced that the mining sector would be involved in a similar testing program (through Curtin University and the Perkins Institute) called DETECT FIFO.

Medical Forum spoke to Rob Carruthers, the director of policy and advocacy at the Chamber of Minerals and Energy WA, who has been involved in the DETECT FIFO negotiations between the mining companies and the DoH WA.

Given the fly-in, fly-out nature of the workforce, mining companies were screening their workers themselves in various ways in the early stages of the COVID outbreak to “ensure that people were as healthy as they thought they were”, said Mr Carruthers.

From pre-work questionnaires, health assessments and temperature screening, some of the mining companies moved early to PCR antigen testing and one prominent iron ore miner moved to point of care (POC) serology tests at the airport. ensure that there's a consolidated approach to both cohort testing and research which will underpin future strategy,” he said.

“We've done a tremendous job in WA to see ourselves through the first few months of COVID-19, but our ability and effectiveness to continue to manage industry and businesses during this time is really going to turn on how important the DETECT program, more broadly, and the FIFO component particularly, is to keep our mines safely and effectively operating.”

Mr Carruthers said the pandemic would fundamentally change the way the industry operated.

“For an industry that operates in remote regional parts of the state and relies on being able to move workers from A to B and do it in a safe way, screening as part of this transit will be with us for the foreseeable future. Similarly face masks and other protective equipment may become a standard control for people on aircraft. That's yet to be determined, but both government and industry are looking into that.”

Relocating workers The closing of the interstate borders created challenges for the mining companies where the quarantining of eastern states and overseas workers for 14 days before every shift would be unviable as well as unacceptable. Mr Carruthers said that a number of companies decided to relocate entire families to WA – more than 2000 at last count. funded by industry participants, and as Mr Carruthers describes it, they now have “skin in the game” to ensure it delivers on the expected outcomes.

“And we're really pleased that it is a true partnership in that respect,” he said. “The cohort testing will be voluntary, but some companies will seek to supplement and go above and beyond that to require the broader workforce to be screened and be cleared to work before they return to site.

“DETECT FIFO gives us the opportunity to look at the accuracy, reliability and sensitivity of different testing methods for early detection and diagnosis. A lot of the technologies that have been applied in COVID screening were not necessarily designed for that purpose. So, DETECT will give us, in the mid-term, a really strong level of competence and confidence that we're applying the right level of screening techniques.

“I've been in the industry a long time, and I've never seen cooperation levels, the likes of which have come together in response to this crisis. And that's not just being between the companies, but also at the government level. There is, again, very strong alignment on the scope and intent of the industry and the government.”

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