Millions of Slovaks will take part in an ambitious experiment aimed at regaining control of the pandemic this weekend as the country sets out to test almost everyone aged over 10 in its 5.4m-strong population for the disease.
Slovakia was one of the most successful countries in the EU in dealing with the first wave, after locking down rapidly in March. But in recent weeks cases have skyrocketed. Some 80 per cent of its 55,091 total infections were recorded this month and the pressure on its under-resourced health system is intense. The country is also eyeing its neighbour, the Czech Republic, which has the EU’s second fastest-growing outbreak in per capita terms, with caution.
“Our health system is not suited to such an enormous [number of infections],” said Milos, a project manager from northern Slovakia, who asked that his full name not be used. “We’ve seen in the Czech Republic how devastating it might become. It is a huge worry . . . the sooner we put a brake on it the better. So that’s one of the reasons I want to be tested.”
Igor Matovic, the prime minister, has billed the mass testing, which will take place at around 5,000 sites this weekend and be repeated next, as a chance to regain control, and set an example for other countries. “If we pull this off, we can be a model for the whole world.” he said.
Iceland, with a population of only about 360,000, has carried out mass testing, and China recently tested the entire population of Kashgar, a 4.7m-strong city in Xinjiang, in days. But no other EU nation has tried anything similar, and experts say it would be hard for bigger countries to test their entire population so quickly.
“If bigger countries like Germany tried to do this, they would have to do it step by step over a longer period. Logistically it would not be possible to do it in 2 or 3 days,” said Vladimir Krcmery, an expert on tropical and infectious diseases and a fellow of the UK’s Royal College of Physicians.
Slovak authorities hope the exercise will achieve three things: slow the spread; avert a second full lockdown; and give them a better overview. To incentivise the public, those who refuse to take part will have to undergo a strict quarantine.
The undertaking has not been without critics. Mr Matovic’s plan was announced out of the blue, drawing accusations it was not properly thought through. President Zuzana Caputova has been vocal, and criticised the fact that although the testing has been billed as voluntary, refuseniks will face tough restrictions.
A pilot exercise last weekend in Bardejov and Orava, the two regions with the highest number of cases, was deemed a success. About 140,000 people — 91 per cent of the eligible population — took part. Four per cent were found to be infected and have been quarantined.
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But the question is whether the nationwide effort will run as smoothly. One big problem is logistics: less than 24 hours before the start, it was still not clear whether enough medical staff would be available to conduct the programme. Mr Matovic said on Friday that only 63 per cent of testing teams had enough personnel and urged healthcare staff to join the initiative.
Another concern is whether the tests will deliver useful results. The programme is using antigen tests which are much quicker than PCR tests, with results available in as little as 15 minutes. But they have a much lower level of accuracy, ranging between 50 and 90 per cent.
PCR tests require a swab sample from the back of the throat and are generally considered the “gold standard” in diagnostics. Antigen tests tend to be quicker and rather than capturing the whole genetic sequence of the virus, they look for antigens that sit on a pathogen’s surface.
Julian Peto, professor of epidemiology at the London School of Hygiene and Tropical Medicine and one of the most outspoken advocates of a weekly, population-wide testing strategy in the UK, said antigen tests were the only viable way to test the whole population quickly.
“If most [who test positive] observe household quarantine, it should reduce the prevalence despite the limited sensitivity of antigen tests,” he said.
But others are more wary. “Restrictions on those who test positive will be more severe, and this is a problem if many people are likely to test positive even if they aren’t sick ,” said Rowland Kao, professor of veterinary epidemiology at the University of Edinburgh.
“False negatives . . . are the other obvious problem and if they are high, then the system won’t work.”
The Slovak authorities are hoping that two rounds of testing will mitigate the lack of accuracy, catching people in the second round with false negatives from the first time. But experts are clear mass testing is only part of the solution.
“This is one step. To escape from the pandemic we need to go up the whole staircase,” said Prof Krcmery, adding that mask-wearing, handwashing, travel limitations and testing on the border with the Czech Republic would also be needed.
Despite the caveats, Slovaks are hoping the exercise will avert the complete lockdown Mr Matovic has raised as the alternative if the rate of infection continues to spiral.
“My expectation is that people will be more free after this test. Not totally . . . I believe you will still have to wear a face mask outside your house. You will have to have limits in bars and restaurants,” said Milos.
“But I hope it will mean that we somehow get the people who are infectious [off the street], and slow down the spread of the virus.”