Former MoH Guntis Belēvičs: We need an intelligent strategy for the use of rapid Covid tests

The first conversation with Guntis Belēvičs, Doctor of Biology, doctor-biophysicist, pharmacist, entrepreneur, former Minister of Health
18.01.2021. MKMāris Krautmanis

When I met Guntis Belēvičs, we first performed rapid tests to find out if we were Covid infected. This was the first time I had done this procedure. I had heard that this was something particularly unpleasant and painful. But it wasn't that bad. The former Minister of Health gave me a kind of thin plastic stick that had to be put in my nose to a certain mark. It was strange that I felt the stick bump something and stop, but Mr. Belēvičs just urged me to push deeper, until the mark. Then there were uncontrollable sneezes, but it was also the most unpleasant part. I didn't feel any severe pain. I watched with interest as the interviewee did it, but he only grimaced and then sneezed a little in his elbow.

We waited ten minutes for the result - the material of the sample had to be transferred to a plastic tube with liquid, then dropped on a strip and watched for the appearance of a second colored stripe. The second stripe did not appear and we congratulated each other that we were not infected. Well, not with a 100% probability, but with an 80% probability that we are not Covid infected.

Then we could start the conversation. The first question, of course, is how Mr. Belēvičs views what is happening now, whether the government is doing the right thing, what needs to be done to limit the spread of the infection.

Currently, politicians, the public, and the media have only tackled the topic of vaccination, rapid vaccination. But the question is really different in essence - how can a nation survive until herd immunity, until a large enough part of the population is vaccinated? I would like to emphasize that, which is something we do not talk about or talk about too little.

There are two types of Covid-19 tests. The "gold standard" is the so-called PCR test or polymerase chain reaction test. It is very specific, very precise, and it is necessary for doctors to make a diagnosis - whether it is Covid or not. But there are also rapid tests - they are also very specific. Each test has two parameters - specificity and sensitivity. Specificity - this is how precisely it is determined that it is a Covid virus. The specificity of the rapid test is 98%. This means that if a rapid test determines that a patient is Covid positive, the PCR test will also confirm it in 98% of cases.

There is also sensitivity. The rapid test is not as sensitive as the PCR test. There are two institutes in Germany that deal with these matters: the Paul Ehrlich Institute and the Robert Koch Institute. In them, scientists have developed conditions on which rapid tests can be used to combat the spread of Covid infection. The specificity must be 97% to 98% and the sensitivity must be at least 80%.

The essence of the polymerase chain reaction is to double the genetic material, double the double, double it again, and so on dozens of times. This is necessary for the genetic material of the Covid virus to be propagated in a quantity that is measurable.

In the case of a rapid test, the material is only taken, and after ten minutes, the test shows whether or not it is Covid in 80 percent of cases. In 20% of cases, the rapid test may not show it.

Nevertheless, the rapid test is applicable. This was decided by the European Council last December, and the European Commission issued a recommendation on 18 December.

The rapid test can be used to stop the spread of Covid. There are a lot of people who have Covid but who don't feel sick. They are asymptomatic but they still spread Covid. An intelligent testing strategy using rapid tests is needed. This rapid test, despite its 80% sensitivity, has its advantages.

It's been 10 minutes and we can already see that we don't have Covid! Although this is with 80% probability.

The accurate PCR test, which is the "gold standard" for doctors to make a diagnosis, also has its drawbacks - it is disproportionately expensive, it is materially consuming, and it takes a very long time to find out the answer. The main thing is that the testing capacity with PCR testing in each country is limited. On the other hand, the rapid test is cheap, the answer is known after only 10 minutes, all cases when the rapid test shows a positive result can also be checked with a PCR test.

Society needs to emerge from the crisis as quickly as possible. There are countries that have already developed national strategies for the use of rapid tests, and they were ready a few days before the European Commission issued a recommendation for rapid testing. These countries are Austria and Germany.

The first country to test the population en masse with rapid tests in one weekend was Slovakia. Approximately 70% of the population was tested and received confirmations. Those who tested positive were sent home to quarantine. But this is an insufficient strategy.

The Austrians approached the case in a smarter way - at first, they wanted to do the test in November, but as Christmas approached, they moved the mass state-paid rapid testing to early December and mid-December. This was intended so that those who tested positive could quarantine and only then visit their parents to celebrate Christmas. It was clear that a lot of people would break the rules anyway. This is not about bars and clubs, but about meeting close people - parents, brothers, sisters.

But life also made adjustments in Austria - initially, the response was very low and only 15% did the rapid tests. But in the very last days before Christmas, when the government announced the immediate end of the state-funded test program, the "testing streets" (many tents next to each other, on both sides of the street) were full - people were standing in lines and measures had to be devised to increase testing capacity.

What is this test called?

This is a rapid test. In Latvia, for example, rapid tests of the Swiss company Roche are already available. There are other manufacturers of rapid tests available in Europe.

The demand for this type of test in Austria and Germany, as well as in other countries, was and is huge.

What has Austria included in its national rapid testing strategy? They have a lockdown, just as we have until January 25. They have made preparations so that all students can return to school after the holidays on 18 January. Students have a simpler test - it is not pushed that deep inside their nose - just two centimeters. They are shown a video on television that it is as simple as poking their finger in their nose. Once a week, parents will help first-graders do the test. Senior students will be able to take the test themselves once a week, either at school or at home. In Austria, it was very thought-through - people had to apply for a rapid test online. After applying, everyone received a QR code, which was then very easy to use. It is very important not to spend extra time identifying a person before performing a test. So there are countries that have already developed a plan for how to survive until herd immunity develops.

If international passenger transport is allowed, it means that people will sit in the vehicle close to each other or next to each other. If this is the case, then we can also open the opera and theater - if a person has been tested today and it has not been positive. There are many other places that we can open. The Austrians will send all the children to school on Monday. But in Latvia, there is talk only about vaccination and its pace, which would be nonsensical to speed up if the vaccine has not yet been delivered. But what to do for people who will reach the vaccination queue in the summer, fall, or next winter?

The row in the plan called "everyone else" said that they will be vaccinated sometime in August...

Waiting just for herd immunity is not enough. In addition to that, Covid spread should be stopped by early diagnosis.

From mid-November, all Lufthansa passengers on the Hamburg-Munich and Munich-Hamburg flights are only boarded if they have done the test before the flight. That is the PCR test. As long as the state generously pays for the expensive tests, they will also be done. The Germans are rich and have a significantly higher capacity to perform PCR tests. With us, however, this capacity has been exhausted. In Germany, all airports have test points.

In Germany, state-funded rapid tests are carried out in old age homes - up to 20 tests per month per resident, if necessary.

Let's get back to the rapid tests. Such rapid tests can limit the spread of the infection in areas where a cluster of patients has formed - China has just closed a city of 11 million people and all people were screened in one day. This was done through rapid tests. The aim is to trace the contacts of Covid positive people in order to stop the spread of the disease - to find out the infected, their contacts, to send them to quarantine because there is a possibility that they are infected.

We were in a completely different situation in the spring when there were no tests, no medicines, no vaccines.

There are now vaccines, but it is not known how to make people get vaccinated. Rapid tests are available, but they are pretending that they still do not exist.

Distinguished professor Uga Dumpis has suggested that teachers take a saliva test once a week. It is validated in Latvia, but it is the same expensive PCR test. In Austria, there is a completely different approach - once a week all students will be tested. Austrian schools have already received the first five million tests. If the children are at school, the parents can work.

How do you assess the fact that at the time when the officials of the Ministry of Health had to work on the vaccination plan, they were working on the reform of pharmacies? Do pharmacies have problems bigger than the Covid-19 pandemic?

For me, this is just an indicator… Will the new Minister of Health Daniels Pavļuts really continue what Ilze Viņķele started, as he promised.

They are talking about the criteria for the location of pharmacies. Because it can't be the case that during a pandemic the ministry only deals with Covid-related matters. Covid is, of course, a key issue, but there are others.

Could it not be the case that small and local pharmacies will be strangled a bit?

No, on the contrary, Minister Viņķele's intention was for an individual pharmacist to regain hope under the new criteria.

I do not know where Mrs. Viņķele was inspired to change the criteria for the location of pharmacies, but from the point of view of an individual pharmacist, that would be welcome. But from the point of view of the pharmacy chains already in Latvia - no.

Should the new Minister of Health involve private medical institutions in vaccination?

Our hospitals have already been reformed to the point that there is nowhere to put patients in the case of problems such as the current pandemic. Then the only solution is as it is now - to reduce other health care services.

What do the government and the Ministry of Health care most about? Remember that Krišjānis Kariņš said that there is now more money than ever before!

Then I have a question in this regard: why did we stop providing services to patients. Maybe the services could be paid for by the state and diverted to the private sector? The capacity is there.

I do not think we will be able to increase the rate of vaccination so easily, at least not as originally intended. The idea was very simple - to vaccinate doctors in medical institutions and general practitioners so that general practitioners would vaccinate everyone else.

But GPs have to do all sorts of other things - their practices include babies, pregnant women, chronic patients. No one can take their work off them and set it aside. I believe that all those who know how to vaccinate should be involved in vaccination. In 18 countries of the European Union, vaccination also takes place in pharmacies, and there are countries where pharmacies also vaccinate against Covid. Vaccination regulations allow us to do that. This can be done under certain conditions, and many pharmacies can meet these conditions.

The same applies to rapid tests - pharmacies can perform vaccinations or testing. There is no need to overload medical personnel with work that can be performed by other trained specialists.

I can give an example of how we overload ourselves. In our country, the patient must do a PCR Covid test before being admitted to a hospital.

And so a patient with a broken leg has to wait for the analysis results?

Not just with a broken leg. The patient is in contact with other patients while waiting, who are also waiting for the test results. Maybe he himself is not, but others might be Covid positive. The person has to wait in the hospital for six to 12 hours. This test is no longer performed individually - you have to wait until the cassette of the device is full, and then after six or ten hours the answer will come.

I have a former fellow student who lives in Russia and has just recovered from Covid. I asked him how these things were handled there. He said it was known within ten minutes whether the patient should go right or left, as all patients undergo rapid tests before being admitted to the hospital. That is a solution.

In my opinion, vaccination should also be carried out in private medical institutions. But we have started somewhat too cautious - started with university hospitals, general practitioners have to go there to get vaccinated. And then some can't understand how it can be that only about 200 GPs have come to Riga during the weekend to get vaccinated.

We will not be able to do without the involvement of the private sector and pharmacies in vaccination and testing. We must survive until herd immunity.

The continuation of the interview can be found here.