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Testing strategy adapted

The Inter-ministerial Conference on Public Health met again on 19 October 2020 to discuss the management of the COVID-19 pandemic. The points of note and decisions of the 16 October Coordination Committee were discussed, with a greater focus on health aspects.

PCR testing policy priorities

In recent months, the capacity for sampling and laboratory analysis has increased significantly with close cooperation between the country’s authorities. Whereas at the beginning of the COVID-19 crisis, we were doing around 4,000 PCR tests per day, in the last few days we have been doing more than 60,000 PCR tests per day. We are one of the leading countries in Europe in terms of test numbers. Initiatives have been taken to further increase this PCR testing capacity, in terms of both the laboratory and sample collection.

Despite these efforts, we have found that in recent days, more and more problems have arisen in terms of laboratory response times for PCR test results, putting pressure on the screening and contact tracing policy. In addition, general practitioners are also under great pressure due to the combination of normal patient care and sample collection. The exponential increase in the number of COVID-19 cases in Europe is also jeopardising the supply of the reagents needed for testing.

In view of all these facts, priorities need to be set for screening and laboratory analysis that will best serve public health and contain the epidemic. The screening policy will also be extended in the coming weeks with the addition of new techniques, mainly rapid antigen tests, for which the necessary coordination initiatives were taken very recently by the Government Commissioner for COVID-19.

The following priorities have been determined with regard to sampling and laboratory analysis:

  • The capacity of the laboratories in Belgium must primarily serve public health. Laboratories should always give priority to the following:
  • With regard to sampling and laboratory analysis, the highest priority at all times is given to symptomatic patients, with particular attention to critically ill patients, health professionals and people over 65 years of age and suffering from co-morbidities.
  • The second priority is sample collection and laboratory analysis from clusters/homes within communities, both within and outside care institutions.
  • The third priority concerns the preventive screening of the following target groups: new residents in care institutions for the elderly, new residents with a risk profile (over 65 years of age or co-morbidities) in other care institutions, hospitalised persons.

All other preventative screening will be suspended until 15 November.

This also means that the screening of asymptomatic people on an individual basis following high-risk contact is suspended until 15 November. This mainly involves high-risk contacts (outside cluster/home monitoring) and people returning from red zones identified using the self-assessment tool.

One exception is health professionals: high-risk contacts working in the healthcare field can be tested. However, asymptomatic healthcare professionals who have a positive PCR test will be able to continue working if their presence is necessary for continuity of care (based on a risk analysis specific to their environment). This exception is currently limited to their presence in COVID-19 care areas or without direct contact with patients.

  • Various initiatives are underway within the framework of the testing policy and will influence the evolution of the policy, target groups and priorities:

    • Assessment of how new diagnostic and screening techniques, in particular rapid antigen tests, can be incorporated into the testing policy, including operational aspects, reimbursement, and the exchange of test result data.
    • Development of a dashboard to better monitor laboratory capacity and optimise mutual cooperation and sample identification.
    • Operationalisation of an electronic application for booking sample collections, in particular in sorting and sample collection centres, and the possibility for occupational physicians and school doctors to provide activation codes for access to sorting and sample collection centres in the event of clusters in these communities.

The following rules have been established for isolation and quarantine:

  • the isolation period for those with a positive PCR test:
  1. For symptomatic patients with a positive PCR test, isolation remains in force for at least seven days after the onset of symptoms AND up to at least three days without fever AND with an improvement in respiratory symptoms.
  2. For asymptomatic individuals with a positive PCR test, the seven-day isolation begins from the date of collection.
  • The quarantine period for asymptomatic high-risk contacts that are not tested is ten days, followed by four days of vigilance. Quarantine begins on the date of the last high-risk contact, or the last day of residence in a red zone. If that person develops symptoms, however, they will be tested.

These decisions are widely communicated to general practitioners, triage and sample collection centres, hospitals and other healthcare institutions, traditional laboratories and the national platform. In addition, appropriate communication on the screening policy and the resulting priorities is given to the population in the short term.

The Government Commissioner and the Inter-Ministerial Conference would like to thank all health professionals, healthcare institutions, laboratories and the population for their participation in this strategy and its priorities.

Psychological and mental pressure on health professionals

ICD members are strongly concerned by the severe physical and mental pressure to which health professionals are subjected. The causes are the exponential growth of the COVID-19 pandemic and the influx of patients needing COVID-19 care, testing, insufficient recovery after the “first wave”, accompanied by fatigue and absenteeism, the impact of delayed (and therefore sometimes more complex) care catch-up, etc. This applies to doctors, hospital workers, home-care nurses and nurses in rest (and care) homes, etc.

However, these professionals are an essential component of the COVID-19 policy and the guarantee of quality, accessible care. It is therefore essential to obtain sufficient and adequate support from the relevant authorities.

Since the beginning of the pandemic, all governments and relevant ministers have taken initiatives and measures to minimise the burden on this workforce and support it in carrying out its tasks. But this is not enough. The ICD therefore decided to develop an action-oriented Health Workforce Support Plan with clear priorities and missions for all the entities involved. The Government Commissioner for COVID-19 has been mandated to coordinate this plan.

In the meantime, in view of the urgent needs on the ground, the ICD will develop a number of concrete measures relating to sampling capacity. Midwives and speech therapists should soon be able to take samples under certain conditions. The possibility of using medical/nursing students as student workers, or other professions, for test samples will also be explored.

Psychosocial wellbeing

ICD Public Health wishes to pay more attention to the impact the crisis is having on psychosocial wellbeing. Several measures have been taken in this area, but greater efforts and inter-federal coordination are needed. ICD Public Health will therefore take additional measures based on expert advice.

This press release has been written jointly on behalf of Pedro Facon, Government Commissioner for COVID-19, and the Ministers forming the Inter-ministerial Conference on Public Health:

  • Wouter Beke - Flemish Government, ICD President
  • Frank Vandenbroucke - Federal Government
  • Christie Morreale - Walloon Government
  • Valérie Glatigny - Government of the French Community
  • Bénédicte Linard - Government of the French Community
  • Alain Maron - Joint Community Commission and French Community Commission
  • Elke Van den Brandt - Joint Community Commission and Flemish Community Commission
  • Antonios Antoniadis - Government of the German-speaking Community

The Inter-ministerial Conference on Public Health Conference is organised and supported by the DG Healthcare of the FPS Public Health, Food Chain Safety and Environment.