Stay at home when you have a cold – and get yourself tested for corona. It is a “charming idea”, says Bram Diederen, director of Microvida, one of the country’s largest testing laboratories, but it is “almost impossible” in the current way. Reason for a different course, says Diederen.
This bat should go into the chicken coop once in a while, according to doctor-microbiologist Bram Diederen. Everyone testing, testing, testing is of course “a beautiful political promise”, in practice the system appears to be cracking and cracking on all sides. And then the snotty season has yet to begin.
“We are already reaching the limits. Wait three, four, five days for a test result. That’s just too long, you want to know within a day, “says Diederen. “And then we are still in September. The weather is very nice, there is nothing wrong in the hospitals. I guarantee: when we are in October, the system will crash completely. This is just going to be a disaster. ”
“Look, the goal of testing everyone with complaints is in itself clear and sympathetic. But in practice, you use the most complex logistics and testing modality that we have to screen the whole of the Netherlands. Often just to reassure citizens: no, you do not have corona. We see people who come to be screened several times a week, they already know them by first name at the test street.
“We are reaching the limits. You can see that with us, in the source and contact research, in the test streets. And so you have to ask yourself: couldn’t this be simpler? The purpose of testing is: to keep a finger on the pulse. If you want that, you have to organize it differently. We now use our heaviest, most complex drugs for all Dutch people with a snot nose, drugs that are actually intended for hospital patients. ”
Diederen is a protagonist operating in the background in the corona crisis. Since March, his laboratory organization, with four locations in West Brabant and Zeeland, has been fully engaged in processing the increasing number of corona tests.
In recent months, this has become increasingly difficult. Of the approximately 1,500 test kits he says he needs per day, he can often only get about 500, so he has to consume emergency supplies. In the meantime, his lab is plagued by overload – from over-tired employees to jammed equipment, as the Volkskrant turned out to visit him.
Diederen interprets a sound that can be heard in many laboratories. “Everyone feels that testing has brought us a lot. But just saying that there is a lot more to be tested is a clincher, “says physician-microbiologist Anton Buiting of the Elizabeth Two-Cities Hospital in Tilburg. “Where is the limit? With a hundred thousand tests a day? Two hundred thousand? ”
“There are limits, I have said that before,” says virology professor Marion Koopmans. “What is being completely forgotten is the objective: to protect people at greatest risk,” says her Utrecht colleague, professor of medical microbiology Marc Bonten. “Something like: more testing is always better. That is not true. To put it bluntly, if the virus spreads among 20-year-olds, there is actually not much going on. ”
‘Good question. I think we have a different situation here. We have traditionally opted to organize microbiology in the Netherlands on a small scale and close to the patient in the hospital. When we had an outbreak of multi-resistant klebsiella (a dangerous gut bacteria, ed.) A few years ago, one of the conclusions was that this system is indeed very useful.
“Now you see it turning against us. The large mega laboratories in Germany have an enormous bulk capacity. What I do not understand in the meantime is that the number of tests with us is stalling, while the large labs apparently do not experience a shortage. Perhaps that reflects the greater market position of the German megalabs. If you take a lot, you have a lot to say. ”
“I hope that works, it would save us a lot of headaches. But I have yet to see it. You have to link the entire logistics, the equipment, the software, the data of patients, the helpdesk for the GGD. That requires an incredible amount of arranging. I don’t think we’ll get this sorted out within a month. Moreover, the problem remains that a result is not available within a working day. Bringing a sample from Amsterdam to Antwerp also easily takes four, five hours. ”
“To begin with, we need to move towards rapid tests. They are not very good at predicting who is positive, but they are good at predicting who is negative. If you can use it before a PCR test (the current cotton swab test, ed.), You can probably make a rough pre-selection: this person in any case does not have the virus, but beware, this person may. You then use the PCR test for the latter category. And meanwhile you say: maybe you are infected, so stay at home, watch your contacts. ”
“The road the government has taken, with people you give priority, you have to expand with more categories and professions. This way you stop the large current. As a result, fewer people will be tested and results will be available much faster. But it does concern the people with the greatest consequences of corona, both in terms of spread and social disruption. Think of healthcare workers, teachers, contact professions. ”
“That’s right. But you may wonder whether that is not possible with hard parameters: the number of hospital admissions per region, testing the sewage water, or more GP stations where you test everyone with respiratory complaints – a thousand instead of 50. That is much easier to organize than this, on patient level. ‘
“That’s what I mean by: more prioritization. Some people can work from home just fine. For people who cannot do that, you have to make it go faster. ”
“Fat, fat nonsense. We are simply called upon from hospitals, nursing homes and the GGDs. What has happened next is that the demand for care has increased and we have expanded the capacity, in close consultation with our partners. The fact that this situation is now emerging is not something we have chosen. It’s really not that we want to actively keep others out. ”
“I actually want everything less. Screen with an inexpensive test. And then test what remains well and super fast. “
