Netherlands not hitting coronavirus testing target; Rejects 16 rapid tests, starts app development
With reporting by Janene Pieters & Jamie de Geir.
Over three weeks after Prime Minister Mark Rutte and Health Minister Hugo de Jonge held a press conference pledging that the Netherlands would conduct about 17,500 coronavirus tests every day, the country has barely been able to reach 40 percent of that target. An investigation into rapid tests, which use a drop of blood to determine if someone was infected with the virus, determined that none of the 16 different products available had the accuracy needed to further expand national testing, De Jonge said in a letter to Parliament.
Eventually, the goal is to test 29 thousand people per day, but so far health officials in the Netherlands have only managed to process seven thousand tests on two different dates, April 9 and April 15, according to preliminary data from health agency RIVM. Last week, the Netherlands handled an average of under 5,700 tests per day, and by Wednesday roughly 181 thousand tests had been administered in total.
The problem, according to a review of several documents submitted to Parliament this week, is that the Netherlands has not had enough supplies to carry out the labor-intensive tests, and a lack of laboratory capacity to process the tests.
Testing Difficulties: Too few labs, too few supplies
According to De Jonge, 45 laboratories in the Netherlands have been certified to handle coronavirus testing. Together they have the ability to conduct the short-term target of 17,500 tests per normal working day, and up to 29 thousand tests per day if they run a full 24-hour period.
The fact that the actual number of tests done is still far below the target was linked to a shortage of laboratories and of testing supplies. "Test capacity will increase as more laboratories allow themselves to be validated, and capacity in some already-validated labs will be expanded by additional equipment, said Sjaak de Gouw, the head of the GGD network of regional health offices.
Another problem was a shortage of a lysis buffer - a solution that allows scientists to break open cells and to study their contents more closely - essential for coronavirus testing. Even with the buffer solution there were not enough cotton swabs and shallow trays to carry out the tests, De Jonge said.
All three of these items are to be produced in the Netherlands, with cotton swab production having started on Tuesday. "The first batch of swabs produced in the Netherlands was delivered on Tuesday, April 21. Current production stands at 17,500 swabs per day, and will scale up to 30,000 per day by the end of April," De Jonge said.
At that rate it would take over one and a half years to test everyone living in the Netherlands.
According to De Jonge, the Ministry and the Special Envoy for coronavirus issues managed to obtain "clear commitments" from the four largest suppliers of laboratory materials for the coming months. "This gives me confidence that the laboratories will be able to perform more tests structurally," he said. He also expects that the Netherlands can start its own production of some critical products, including the lysis buffer and cotton swabs, in the coming weeks.
Rapid tests are just not accurate to an acceptable degree: De Jonge
Another factor in the below-capacity testing is the fact that the Netherlands is still using the original coronavirus tests, involving swabs taken from the nasal cavity or throat which then go through an entire laboratory procedure to screen for the virus. These tests are relatively labor intensive, said De Gouw.
While he was optimistic about the prospect of using quick finger-prick tests to increase diagnostic capacity, the government's Outbreak Management Team rejected all available rapid blood tests for being too inaccurate, De Jonge said. The tests check a drop of blood for antibodies developed after a coronavirus infection, and promise to deliver results in ten minutes.
"After investigating 16 different rapid tests, the OMT concludes that these rapid tests are not suitable for use in individual diagnostics. Since I think it is important that the reliability is sufficiently high, I am taking this advice from the OMT. Of course I will follow developments closely and will reconsider this decision if more reliable rapid tests become available," De Jonge said.
App development to move in-house
Expanded testing was to be one part of a collection of data the government wanted to obtain in order to make more educated decisions. Another was the use of apps which could be used to trace clusters of infected individuals.
The Health Minister also revealed that the Ministry plans to develop its own coronavirus tracking app, after none of the seven apps that took part in the Ministry's "appathon" met the requirements. The idea behind the app is that it will replace the so-called "contact investigation" health service GGD currently has to do to find out exactly who every Covid-19 patient had contact with, because they may also be infected.
According to De Jonge, the GGDs are currently working with health institute RIVM, virologists and epidemiologists to draw up a list of "epidemiological" requirements for the app. De Jonge will put together a team to work on the app. This will include "the right builders" as well as "experts in areas such as information security, privacy, fundamental rights, national security, and inclusion", he said.
The Dutch data protection authority AP, the Board of Human Rights, the National Cyber Security Center, and the national counter-terrorism and security coordinator NCTV will all be involved in the entire development process, De Jonge said. Before the app is released to the public, it will be tested for possible consequences for national security and citizens' fundamental rights, as well as for ease of use.
The Ministry is also looking into whether another app can be developed, with which doctors can keep in touch with patients and monitor their symptoms remotely.