As Ukraine prepares to fight the COVID-19 pandemic, it has been slow to put together a comprehensive national testing strategy.
Doctors and former health officials say that Ukraine’s quickly-changing COVID-19 protocols aren’t specific enough on testing methodology. The government has also done a poor job of communicating these protocols, leading to confusion among the public and medical workers.
Disorganization and supply shortages at the local level make the problem worse.
“A national policy needs to be articulated for doctors, patients and administrators,” said Volodymyr Kurpita, the former head of the Center for Public Health on March 26. “Unfortunately, this policy does not exist.”
Without a proper policy, testing efforts will be inefficient, the most critically ill patients may not receive priority and COVID-19 cases could overwhelm Ukrainian hospitals.
Policy updates
Ihor Kuzin, the acting director of the Center for Public Health, explained that Ukraine’s testing policy has been spelled out in the health ministry’s order 663, adopted March 13. As of the last week of March, it was superseded by order 772. These orders explain how to respond to the various aspects of the epidemic.
“As the outbreak evolves rapidly, the testing algorithms should be adjusted accordingly. We observe that the Ukrainian government is stepping up to ensure updated protocols,” WHO spokeswoman Tatyana Dolhova wrote in an email.
Yevhenii Cherenok, director at the Boryspil city primary care center outside Kyiv, had a note of caution, saying the constant rapid changes likely mean that all the kinks haven’t been worked out.
Asked about the primary changes in order 772 compared to its predecessor, Kuzin said it has more up-to-date information on the use of protective gear, hospitalization procedures, home quarantine, procedures for contact with symptomatic people and procedures for pregnant women. Kurpita added that it provides some clarity on the question of who is supposed to administer coronavirus tests.
However, Kurpita and other experts say that this order is insufficient to be considered a unified national strategy. “When we talk about a national protocol, it needs to define three things: who is being tested, where they’re being tested and how they’re being tested,” said Kurpita. And order 772 does not spell out what kind of tests should be done in which situation. It’s especially vague on rapid tests.
What’s worse, Cherenok said, the order also has an insufficient flowchart of cooperation between various government bodies, hospitals and emergency services.
Basic procedure
The Center for Public Health’s Kuzin outlines basic testing policy as several approaches. A polymerase chain reaction (PCR) test — the most accurate method of testing for COVID-19 — is given to people suspected of having symptoms and who had contact with another suspected COVID-19 patient or who came from a country where coronavirus is widespread.
Symptomatic people who had close contact with a confirmed COVID-19 patient, as well as medical workers who have encountered people with the disease also get a PCR test.
Healthy people do not currently require PCR screening except in special situations. The use of rapid tests is an additional option in situations where a decision needs to be taken quickly. For example, rapid tests might be given to people who flew on the same plane as a symptomatic person.
In regions with a high incidence of infection, or in outlying villages, mass screening using rapid tests is quicker and cheaper than mass PCR screening, as current PCR supplies and daily testing capacities are limited.
Currently, any positive rapid test must be confirmed by PCR, which some have called a mistake. “This tactic is absolutely wrong and it is a wasteful use of expensive PCR tests,” said Olha Stefanishyna, a former deputy health minister and current lawmaker.
Tests are administered by hospitals, family doctors and emergency medical services. Chief state sanitary doctor Viktor Lyashko said last week that Ukraine has created mobile response brigades to collect samples for laboratories — over 567 such groups have already been created.
In practice
In practice, the procedure has been a lot more muddled, according to Pavlo Kovtoniuk, a former deputy health minister.
A person with symptoms can call an ambulance or a family doctor. Most will eventually end up in a hospital or clinic to give a sample. This is sent to the nearest regional lab center, not all of which are fully operational.
“There are many problems in this model,” said Kovtoniuk. First of all, “if a person lacks symptoms, this limits testing capacity.”
The fact that the burden of taking samples falls disproportionately on hospitals is not good either, he said. This threatens to overwhelm hospitals, which should be for people in serious condition. Ukraine has insufficient ventilators, life support systems and other equipment and its hospitals are poorly prepared for a massive future outbreak.
“If we wait for people to just show up at the hospitals, at some point, our system will just choke,” he said. “People will start dying.”
“People need to have access to early testing and our capabilities have to be very broad, like in Korea, which had drive-through testing.” Meanwhile, Ukraine’s system “is completely passive.”
What comes next
What happens to people who test positive is just as disorganized and inconsistent, doctors and health experts told the Kyiv Post.
Sometimes, a person with very mild symptoms is hauled off to a hospital isolation room. In many other cases, a very sick person is told to quarantine themself at home.
“There is no exact protocol,” said Kovtoniuk. “It might be there, written down, but in practice it is not being used.”
Cherenok knows this better than most. He recently had a patient with COVID-19, who was supposed to be taken by ambulance to a hospital.
However, several hospitals refused to take him and the ambulance service was reluctant to carry the patient because the responders lacked protective suits. Cherenok had to personally look up phone numbers for Kyiv hospitals and ask around where this patient could go.
One hospital finally accepted him but changed its mind shortly thereafter. The patient ended up having to go home.
“What if instead of one patient, I had 10?” he said.
