As COVID-19 is reportedly only approaching its peak in Ukraine, the local testing capacity is lagging behind.
Accurate and widespread testing is key to containing the spread and deadliness of the novel coronavirus that has infected 850,000 people around the world and at least 804 in Ukraine as of the afternoon of April 2.
While Ukraine is moving to scale up its nationwide testing capacity, current and former officials, doctors and medical insiders say that the government has greatly overstated its laboratories’ daily testing capacity.
Many regional laboratory centers lacked the equipment to start doing their own tests until the end of March. Some are still plagued by crippling supply, equipment and manpower shortages and have to rely on Kyiv.
“Everyone should understand that large-scale, properly organized testing is the only way to stop a pandemic,” said Olha Stefanishyna, a lawmaker and former deputy health minister. “Failure to do so will make the situation even worse than in Italy and Spain.”
The country has also been slow to put together a comprehensive national testing strategy. The current Ministry of Health order that governs contact with coronavirus still has major gaps. It has also not been well-communicated.
Sources among former officials, health consultants and doctors told the Kyiv Post that the government has been reluctant to cooperate with private labs, even though this could enhance countrywide testing capacity.
And most agree that improving capacity is a top priority.
Slow start
As of March 20, Ukraine tested just 7.3 people per million according to Statista and 316 suspected cases in total, according to Our World In Data. Both sites were referencing public information from the Ministry of Health.
Our World in Data found that as of March 20, Ukraine’s neighbor Poland had done over 13,000. Italy, which had been one of the earliest hit European countries tested over 200,000 suspected cases as of March 20. The U. S., criticized for disorganized testing, conducted 120,000 tests as of the same date, according to the Covid tracking project. It has since surpassed a million.
As of April 2, 3,824 PCR (polymerase chain reaction) tests have been conducted on suspected cases of COVID19 in Ukraine, according to state statistics. That number had been 2,642 a week ago. Ihor Kuzin, the acting director of the Center for Public Health, said that the total number of completed PCR tests is more than 5,000 as of March 27, including tests on non-suspected people. Now, one week later, that figure is likely to be higher. The statistics also don’t include the number of rapid tests, which is significantly higher.
The PCR test is, so far, the only reliable way to diagnose COVID-19 even in the early stages. By replicating DNA samples, it can detect tiny amounts of SARS-CoV-2, the virus that causes COVID-19, in a sample taken from a person’s nose and throat. Analysis requires a lab professional and can take hours to complete.
There are also so-called rapid tests, which take only 15 minutes and can be performed by most medics. However, they are less accurate. The widespread rapid tests used in Ukraine detect antibodies to the virus, which only works after an incubation period of about a week.
Ramp-up
The country is in the middle of a three-pronged ramp-up of its coronavirus testing capacity, according to Kuzin.
The first prong is regional labs. Before mid-March, Ukraine only had the capacity to conduct 1,000 tests in the Kyiv virological reference lab. Since March 12, the government delivered PCR test systems to eight regional centers, including Kyiv, Dnipro, Zaporizhia, Lviv, Vinnytsia, Zhytomyr, Rivne and Ternopil, and allocated Hr 1 million to each for buying reagents.
Some regional governments used local budgets and donors to acquire limited numbers of testing materials. Sergey Dmitriev, head of policy at CO 100% Life, cautioned that decentralized COVID-19 supply procurement by regional authorities can mask embezzlement schemes.
On March 22, Ukraine received material for 50,000 PCR tests from China, which have been dispensed throughout the regions, as well. This gave each region a capacity to conduct up to 1,700 tests. China also supplied 250,000 rapid tests to Ukraine.
Last week, Spain and Turkey said that rapid tests made by Chinese company Shenzhen Bioeasy Biotechnology were defective and had an accuracy rate of 30–40% instead of the 80% they are supposed to have. Kyiv also bought Bioeasy tests, but Kuzin said Chinese PCR tests have a different manufacturer.
On March 31, 100,000 testing kits were bought from South Korea by business tycoon Vadym Novinski. The president’s office said they’re being distributed. Another 100,000 has been promised from China in the near future.
The second prong involves repurposing some of Ukraine’s HIV centers, which have a total of 10 machines made by American pharmaceutical Abbott. Half of the available machines can be repurposed for coronavirus detection.
The third will be the use of GeneXpert, tools made by the American pharmaceutical company Cepheid, which have been used to test for tuberculosis in Ukraine. The country has 150 GeneXpert devices spread across the regions. They can analyze samples in under an hour. Kuzin said that GeneXpert cartridges will be available no earlier than mid-April.
Dmitriev said that Ukraine was the second country to queue up for receiving these cartridges and may receive them in the near future.
Delayed equipment
Kuzin said lab centers in 12 regions have started conducting tests as of March 27, with that number then growing to 18. Others are still sending samples to Kyiv. The Center for Public Health did not disclose which regions are doing the testing.
Regional lab centers started conducting their own testing at different times. The lab in Vinnytsia started on March 12, whereas the lab in Zaporizhia only started on March 24, laboratory technicians there told the Kyiv Post. The labs used a combination of tests that were bought by state and local budgets as well as donated by humanitarian aid.
Some have set up equipment for local tests only recently, thanks to donations. The Poltava regional state administration had lacked high tech testing equipment until a machine was donated by businesses on March 25. In Chernihiv, laboratory equipment was set up on March 25, following contributions from regional residents.
According to Volodymr Kurpita, the former head of the Public Health Center, many laboratories still lack the equipment or the consumable materials to actually perform them. Others lacked the trained personnel.
Donetsk and Luhansk oblasts told investigative reporters at Slidstvo that they still lacked the necessary equipment as of the end of March. They received PCR tests that they could not actually use. Some cities lack testing materials entirely.
“People are told on TV: come in and get tested but there are no tests,” said Yevhenii Cherenok, director at the Boryspil city primary care center.
Cherenok and other doctors also said there’s a massive shortage of swabs, test tubes and other material required to actually take samples from patients.
“We spent a week calling all over Ukraine, we barely managed to get those test tubes and they’re still on their way,” said Cherenok. British citizen Jonathan Rainey said that he saw almost no equipment while he was staying at the Infectious Diseases Clinical Hospital in Lviv.
Overstated
Kuzin said that a single lab center can conduct about 200 tests in a span of 24 hours, and Ukraine’s chief sanitary doctor said some labs can do up to 2,000. Kuzin added that once testing ramps up to full capacity, Ukraine will be able to provide tens of thousands of diagnoses each week.
But these figures are very unlikely, experts told the Kyiv Post. Kurpita said that his current estimate is that all government labs in Ukraine will have a combined daily testing capacity of about 2,000. Pavlo Kovtonyuk, the former deputy minister of health, agreed with this estimate.
“According to my personal contacts, [the labs] are not all working and not all of [the lab technicians] are trained,” said Kovtonyuk.
Kurpita said that the level of equipment in each center is different, with some of the best-equipped regions including Chernovtsy, Ternopil, Odesa and Kyiv, he said. The Ternopil lab, with its two PCR testing machines and two shifts of technicians reported that working around the clock allows them to go through 100 tests per day.
Other centers may have significantly lower capacity and are not likely to produce more than several dozen results per day.
Private labs
A source with knowledge of COVID-19 testing, close to WHO officials who visited Ukraine, said that the organization sent an advance team to the country to try and establish cooperation with several laboratories and the authorities in order to enhance Ukraine’s testing capacity. Private labs are usually better-equipped and funded.
However, the plan got a cold reception in Lviv, Ternopil and Kyiv, because the state wanted to keep control of both the testing procedures and public information, the source said, asking not to be named because the person is not authorized to speak with the press. Eventually, nothing came of this planned cooperation.
The laboratories in question have not confirmed the plan. The WHO said that it is currently cooperating solely with the state reference laboratory in Kyiv.
Kuzin said that private labs are welcome to conduct tests but they need to send their first five positive and first 10 negative results to the virological reference lab in Kyiv for quality control. But multiple sources told the Kyiv Post that private labs have yet to be plugged into the national testing strategy and that the government does not like working with private labs, period.
“We once went to an employee of the Center for Public Health responsible for tuberculosis diagnosis and asked to broaden diagnostic capability by connecting private laboratories,” Vladislav Denysenko, a phthisiologist, told the Kyiv Post.
“We got a response that no, we will not be doing that because there is no control mechanism over diagnostic quality in private labs,” he said. “Possibly the same situation arose with the coronavirus.”
Denysenko believes that a post-Soviet worldview has more to do with the refusal than an absence of standards, which can be easily created. Another possible reason is that government labs’ consumables are supplied by the government budget or from donors and global funds. Ukraine lacks a mechanism to transfer these consumables into private hands.
“And they don’t want to change anything,” he said. “It could easily be done with the political composition, but they simply don’t want to do it.”
Kovtonyuk confirmed that the state has not seen eye to eye with private labs for many years and has disproportionally targeted them with inspections and, in some cases, attempted extortion.
“There were a few prior precedents for cooperation but they all ended poorly,” he said.
Kyiv Post staff writer Jack Laurenson contributed to this story
