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Professor tells SvD, “It’s unnecessary to test everyone who wants to be tested”
SvD has reported on increased waiting times in Stockholm and Skåne – which can run the risk of missing cases. According to the Karolinska University Hospital, responsible for coordinating testing in the Stockholm region, those who order a testing kit may have to wait five days. And for drive-in units, waiting times can total four to seven days
Karin Tegmark Wisell, Head of Department at Folkhälsomyndigheten, earlier told SvD about the importance of early-stage PCR testing.
– The highest probability of getting accurate testing results are seen in the first week of sickness. And the recommendation is taking the test before day four or five.
Other regions have decided to limit who can take a test. Control questions greet those living in Gävle, logging in to 1177.se to schedule an appointment. If you don’t have any relevant symptoms to COVID-19, like coughing or fever, you’re informed that you’re not allowed testing. The same is true if you’ve had symptoms for less than 48 hours.
– We manage sample taking from a socio-economic standpoint to reduce the regular care pressure, says Simon Nilsson, the Development Manager in Region Gävleborg.
According to the company Platform24, a subsidiary to the online doctor Doktor24, who runs the IT-platform for the region’s testing, around 22 percent of unnecessary testing are screened out in the process. This equals 9000 individuals in the area. Folkhälsomyndigheten reimburses regions with 750 SEK per test, which means that Gävleborg alone has saved 6,8 million SEK to screen out what is deemed as unnecessary tests.
Statistics from Folkhälsomyndigheten show that 520 000 PCR tests have been done in Sweden, most in regions that allow everyone to test themselves. This means that Folkhälsomyndigheten has reimbursed regions with about 390 million SEK so far.
Simon Nilsson doesn’t want to speculate on how many of these tests have been unnecessary. Still, he states that it’s reasonable to believe that regions will have some over-testing, without filtering who is eligible for testing.
Do you think there’s a risk that society spends an unnecessary amount of money on testing if you let anyone test themselves?
– Yes, I agree.
Simon Nilsson is supported by Anders Björkman, professor at Biomedicum at Karolinska Institutet in Solna.
– It’s doubtful to test everyone who, by varying reasons, wants to be tested. If one has symptoms of some kind that are consistent with a COVID-19 infection, it’s critical to test yourself. And it must happen fast, easily, and effectively, says Anders Björkman.
– But if one has just come into contact with another infected person, the value of testing is doubtful. The test results can then be negative and change to positive just a few days later. In these cases, quarantine is more critical. When the government pays for testing, it should be in value for society, to help fight the epidemic.
The ones responsible for Västra Götaland’s region disagree that the extra tests could be an unnecessary cost.
– We try to test anyone who shows symptoms. Our priority is to slow the spread of infection, says Kristine Rygge, Chief Physician and Medical Advisor in the Västra Götaland region.
Why isn’t it enough to test a smaller group, where you can see a real need for testing?
– Right now, we’re in the middle of a pandemic. Common cold symptoms can be COVID-19. Because it’s an illness that we contact trace, we must find as many infected as possible to protect risk groups and slow the spread of infection.
Not even the growing queues have made the region consider rationing the tests.
– We’re prioritizing that as many as possible should get the opportunity for testing because we need to slow the spread of infection. Longer response times are possible, but in most cases, you get an answer within three days, says Kristine Rygge.
Region Stockholm reasons in the same way. They state that it’s still possible to get a testing kit delivered home within 24 hours.
“The current widespread testing shows that Region Stockholm who has been hit hard by the pandemic, can follow the development of number of cases, which is crucial. Smittskydd Stockholm can contact trace each individual case and help slow the rate of spread,” says Maria Rotzén Östlund, Assistant Infection Control Doctor at Smittskydd Stockholm, in an email to SvD.
Region Stockholm asks everyone who wants to get a test to answer a series of questions about how they’re feeling through an app, but when SvD tests the app, you can order a test no matter what your answers are.
Kristine Rygge says that the region continuously reconsiders its strategy. If there would be a very high demand from individuals with common cold symptoms, all tests can be reconsidered.
– If we see a waiting time upwards a week, we have to rethink.
“Digital Hälsa” in Sweden: Regions significantly relieved by digital corona clinic
The industry magazine “Digital Hälsa” in Sweden writes about early results for our digital corona clinic:
Platform24 has analyzed the data from the first few weeks of using the solution for triaging patients who have experienced corona symptoms. The healthtech company delivered the solution to the healthcare in the three counties of Norrbotten, Gävleborg and Jämtland Härjedalen.
– Our data analysis shows that our digital triaging tool provides significant relief for healthcare staff and increased access to medical information and care for patients, says Sara Dannborg, Head of Communications at Platform24, to Digital Hälsa.
This information is confirmed by Ida Kedling, business developer in the Gävleborg Region, regarding the region where she works. “There is a high burden on healthcare now, but with this digital entrance we can increase accessibility and the patients are prioritized already in the queue according to how severe the problems are. Even hearing impaired patients can easily get help this way “, says Ida Kedling.
The web-based corona clinic is part of a concept with a so-called single digital entrance to healthcare. The care seeker logs in via Bank ID and can answer automatically created questions according to medical protocols and is then guided to the relevant level of care. The care seeker is offered self-care advice and information about their condition. Among the alternatives are also chat conversations in the form of a care visit online with a nurse or doctor, as well as a reference to 112. There is currently a great deal of interest in Platform24’s service. – During April, several regions will implement our digital access to healthcare and the integrated corona clinic, says Sara Dannborg.
New figures: digital corona clinic provides noticeable relieve
Region after region is now rapidly launching a “central digital entrance”, where the possibility of a “digital corona clinic” is particularly relevant. There is a very intense work period at Platform24 and in just a few days, a region can have an automated guide to digital care, including the” digital corona clinic”, in place.
For the healthcare regions that have implemented the digital corona clinic, a clear reduction of the strain on the healthcare system has been noticeable after only a few weeks.
Of the patients who have searched for “corona” in the system:
- 10 percent were satisfied after receiving the initial information about Coronavirus and chose not to look for more information
- 32 percent were guided to the automatic self-care advice, out of these 42 percent chose NOT to proceed to contact with healthcare personnel. In other words, they received the advice they needed without placing an additional strain on healthcare resources.
“After just a few weeks it is already clear that the corona clinic clearly relieves and makes the handling of the patient more effective in that patients with bigger and more urgent needs get help quickly, while the healthcare can provide fast and accurate information to those wdho are worried and have questions. Contact with healthcare staff, are not always necessary, information and customized self-care advice are often enough” says Tobias Perdahl, Chief Medical Officer at Platform24.
The solution is integrated with the health care counseling call center and can also be reached via the primary care unit’s telephone and digital channels. Residents have easy access to updated information, advice and care. The solution provides automated self-care advice and information and sorts and prioritises according to patient’s need of care. The patient can chat with a nurse who can also guide the patient further in the healthcare system, digitally or physically based on needs.
Swedish National TV: Gävleborg Region opens digital corona clinic
From SVT 2020-03-23:
During the weekend, another eight cases of corona were found in Gävleborg, the total number is now 24.
There is still no high pressure on the county’s intensive care units, but the Gävleborg Region receives many questions about corona by telephone. Therefore, as of today, a digital corona reception opens via 1177.se.
There, the patient can answer questions and chat with a nurse. The purpose is to reduce the load on the 1177’s telephone and at the same time facilitate the identification of suspected corona cases.
– 1177 has far too long queues, patients do not even get through, and in the queue there may be a lady with huge problems with her breathing who does not reach the nurse. Here you instead have the opportunity to write about your problems, then you end up at the top of the queue and are taken care of at once and referred correctly, says Ida Kedling, business developer.