Oct 31, 2020
Slovak Nationwide Testing Proved What Everyone Knew Already
Slovak nationwide mandatory COVID-19 testing took place during the last weekend of October 2020. The results are interesting to say at least..
The basics:
- Population: 5.5M
- Tested: 3.5M
- Not required: kids <10yo
- Not recommended for: 65yo+
- Positivity rate: 1.6%
- Personnel: 50,000+ (army, healthcare workers, local governments, volunteers, etc.)
The idea is interesting!!
RESULTS
Results by regions I: Positivity rate 0%–2%
The Key Takeaways
The Pros
While the US probably has the best COVID-19 concise & deep “time series” data from April 2020 on,
Slovakia currently obtained the best 2-day regional snapshot in the world!
Yeah, just the test results, but still you can triangulate the infections areas down to:
- individual level (of course)
- street level (regional)
- company or school level (facility level)
- activity level (if specific activities are highly infectious or transmissible).
Quite a feat for the whole country! ;-)
Second thing is: Slovaks pulled that off — 2.5M tested the first day! #EPIC
Sound on!! ;-)
The Cons
Nationwide testing is not the way to go.
Here is the rationale for the cons:
- The COVID-19 antigen tests were previously utilised regionally or with specific screening targets in mind (e.g. hospitals, elderly care homes, etc.) in various countries.
- Stretching the whole healthcare system in the whole country for a weekend testing just puts unwanted & tremendous pressure on the already exhausted healthcare system and its workers.
- Stretching the local governments to its limits. Goes without saying 2020 was hard enough, the local tax receipts are what they are. And everyone is helping where they can year round.
- The average results are +/-1% infected (let’s say 35,000). Now “imagine” testing 3.5M people — how many false positives you expect? 0.3%-0,5% or 0.8%? Ok, that gets you to say 25k. Now what?
- What about false negatives? Let’s say sensitivity is ballpark 30–70% given lab vs large scale varied environment, 20k-25k? Now what?
- How about giving 99% people “free out of the jail card”? ;-)
How do you even interpret these test results?
And how many false negatives you just released into public giving them a “safety signal” of being non transmissible?
Is this a sound public health policy? Definitely there are some sound parts of it!
The “voluntarism”
- To ensure everyone complies — you have to “skew democracy”. There is no way democracies likes of France, UK, Germany or US would ever do #mandatory nationwide testing. It’s a political suicide. Just look to Czech Republic — Slovak neighbour (restrictions hesitation in September before the elections held in early October).
- Regionally, no problem. As the higher infection rates or growth curves have formed:
a strong consensus between the government and public.
It was sold & marketed as optional, however you could not even go to work or for a walk without having a test. Even the president opposed such an approach.
Public opinion:
The Trick I
BEFORE: Nationwide testing data.
The whole point of the large scale testing is to quickly diagnose a large mass (a region) or for the protection/screening (e.g. hospital, etc.). Therefore we can debate the goal or the overreaching objective.
What is clearly visible from the Slovak COVID-19 data, several regions of the country are peaking prior to nationwide mandatory testing.
The data to date of 30-Oct-20, a day prior to the nationwide COVID-19 testing show there are regions to be targeted and there are regions which are already undergoing a peak.
Based on both infection rates & regional curves.
*The charts are proprietary, based on Government data sets.
New Cases by Region, 7-day moving average (compared to average).
You clearly see the whole country dividing into the regions, while testing increasing as well:
New Daily Cases per Region and Rising Testing Capacity (black)
You can also call this: “the responsible” and “less responsible” however there is no such a thing. Some regions are hit harder than others. Simple.
The peak can be also observed right before the peak as number of tests is rising higher than new daily cases. Infection rates are dropping prior to peak as you’re hunting successful more & more positives then previously.
The Trick II
AFTER: nationwide testing data
Positivity Rates throughout the whole country — confirmation of BEFORE testing assumptions:
Some regions peaked, some are peaking and some are great for large scale testing.
Results by regions I: Positivity rate 0%–2%
The Results by sub-regions II: Positivity rates 0%–5%
Nationwide tests done, now what?
The Moral Hazard
Ok, so now what?
Yeah, kings will congratulate themselves how well they managed this “operation“. Throw something to their horses. Skew the numbers to the best of political optics and sell it to the world leaders ;-). Yippee Hey, that’s ok.
Findings?
Interpretation?
What did we really prove?
What did we really achieved?
How will we act based on the numbers?
What is the strategic toolkit, guiding principles?
How will we continue next months towards the amazing Spring 2021?
And you can bet the house — there will be no second wave of nationwide mandatory testing.
Regional OK, Nationwide NOK.
Regional, no problem. Nationwide, won’t happen. The whole nationwide testing in Slovakia proved what we already knew. Regional testings makes complete sense, nationwide is a huge stretch for the whole system.
The marginal benefit just may be too small. Also don’t forget the Moral Hazard.
Recommendations
- Definitely regional over nationwide.
- Focus on regions with higher infection rates > 0.5–1%.
- For larger countries: in roll-outs as the countries capacity has it’s limits (5M vs 80M vs 350M).
- Calibrate the Antigen tests in the field — all positives to be tested immediately with a PCR (3.5M+ Antigen, 35,000+ positives = 35k+ PCRs).
- I am sure there will be many more recommendations the Government releases to interested parties & countries.
- The Slovak COVID-19 Expert Council does not recommend the 2nd nationwide testing (planned for a weekend after the 1st one). The recommendation is to test again only regions with infection rates higher than 1.5%:
Voilà, the Slovak nationwide testing proved what we knew already.
Regional > Nationwide.
Let’s make it a useful exercise for us & others.
And let’s not make it an event of the pre-1989 era;-)
She is exponential..
p.s.: Slovak Prime Minister and the Minister of Defence called the mandatory nationwide COVID-19 testing as a D-DAY or Operation Normandy.
I understand the adults like to play soldiers sometimes however takings swabs and fighting for the millions of lives is a bit of over-exaggeration.
Walking through Utah, Omaha or Sword beaches you can still feel the past in the present — despite the fights are already won and bodies already lie in the cemeteries.
Don’t misrepresent the exercise for one the biggest operation that brought peace to Europe after the World War II.
Thank you.
