Mass screening back and pharmacies to play a role

Santa Coloma de GramenetWith the downward trend in the epidemiological curve, population screening is returning to Catalonia to proactively search for and detect coronavirus infections. But now, not only using regular PCRs, but also through PCR based on nasal auto-samples and antigen tests. The Health Plan is to immediately carry out massive tests in hotspots or where a sudden increase of cases is detected; in vulnerable groups such as workers and elderly people who live in care homes, and in specific groups such as the young population in the world of sports. "We have to go back out on the streets to detect it," said Public Health Secretary Josep Maria Argimonon Friday.

Thus, the Department of Health proposes an initiative similar to the one carried out during the summer, when the diagnosis was mass screenings were used to stop the virus getting out of control in densely populated areas.However, the Department has introduced substantial changes to the new strategy: now antigen tests and PCR auto-samples will be used more, the population susceptible to be tested will be enlarged and there will be more testing points, which will be organised in a more decentralised, territorial way with mobile and temporary units

Pharmacies, which have been pushing for more responsibility in the detection of positives throughout the pandemic, will also be able to offer a service very similar to that provided for the early detection of colon cancer, by providing materials to the population for self-sampling PCR and sending respiratory samples to be analysed in laboratories. And, of course, screening will continue through schools: 300 mobile teams will be available, the same ones that have so far performed 488,000 PCRs in two months, a figure that almost meets the half a million tests to which the Government had committed at the beginning of the school year.

With the outbreak of the second wave, mass screening (except for schoolchildren) was suspended due to inefficiency in tracing the chains of contagion. So far, 2.5 million tests have been carried out as part of this type of screening throughout the country, with a positive rate (tests revealing infection) of 3.3 per cent. Now, coinciding with the improvement in indicators, as of Monday, Salud is recovering the community screening strategy to monitor and keep the R number at bay. It will start by doing PCRs to the over-50s years in Rubí and Terrassa with the collaboration of the Blood and Tissue Bank.

Auto-samples in pharmacies

Health will set up several detection points, which will be spread throughout the territory in mobile units similar to those that have been set up so far using traditional PCR. "We will aim to deploy the maximum number of workers to reach the maximum number of people in a few days," said Argimon. The other type of community screening will be the directed ones, which will have the collaboration of pharmacies and will operate on a voluntary basis like the early detection initiatives for colon cancer. In this case, the self-sampling kits will be used and not antigen tests, as had been suggested. The latter would have required the authorisation of the Spanish Ministry of Health.

"The pharmacies, which are very important agents in the health environment, have a very prepared and validated logistics", explained Argimon. It will be done in the same way as when the over-50s receive a message to have a test to detect precursor lesions of cancer - polyps - by means of a faeces sample: the person will collect the materials to do the self-sampling at the pharmacy, will do take the sample at home and will return the labelled sample to the same establishment. After 48 hours, you will receive the result of the test.

Argimon has admitted that it is likely that this route will still take a few weeks to be implemented, probably a month, since conversations and informative tasks are still needed among the pharmacists. It will also depend on the success of the campaign among the population and the demand generated whether or not this route is intensified. However, the secretary has ruled out the periodicity of this initiative and confirmed that it will only be done once.

Residences and sports environments

Salud has made it very clear that this is not a Slovakian-style mass test, in which the whole population was tested in two weeks, or comparable to the one announced with great fanfare by the Madrid region, as was clear from the statements made on Tuesday by the Minister of the Presidency and Government spokesperson, Meritxell Budó."The Slovak way has a great logistic component that in the short term we cannot propose", admitted Argimon, who added: "We do not rule anything out, but when we go out and explain a strategy it is because it is viable". Thus, the will of Salud is to intensify detection in those groups that are more vulnerable or those that have been excluded from mass screening up to now.

Healthcare professionals and those in care homes, one of the most reinforced spaces in terms of detection, will be tested once a week and not every 15 days as up to now, in order to shield the centres and avoid the proliferation of outbreaks. Testing will also be intensified among elderly people living in the care homes, including those considered green and where testing is not as frequent because no outbreaks are detected. These homes represent 70% of the centres and Argimon has acknowledged that many have not been tested for two or three weeks. According to Salud, with the regular tests it will be possible to isolate the virus much more and avoid uncontrolled outbreaks, since it will be possible to sectorise it before an asymptomatic resident can infect the rest of the residents.

One of the groups where less diagnostic efforts have been made is the population between 18 and 30 years of age, paradoxically considered the driving force behind the spread of the virus, and Argimon explained that screening will be done in adult amateur sport to find asymptomatic cases in this young group. Within the framework of a project planned jointly by the General Secretariat for Sport and Health, the Government plans to carry out antigen tests to obtain rapid results, but not because it wants to speed up the return to competition, since, unlike professional sport, amateur sport will not resume until the fourth phase of easing of restrictions. Argimon has detailed that the various clubs involved will be asked to appoint a person responsible for collecting the sample and another to collect the information from the people undergoing the rapid tests so that the results will appear in the medical records.

500 more trackers

The Minister ofHealth, Alba Vergés, announced that 500 more people will join the track and trace teams, bringing the total number of people involved in the survey and follow-up of cases, as well as the search for contacts, to 3,000. At the beginning of November, there were 1,707 primary care and hospital covid managers: 432 school managers and 120 professionals from the epidemiological surveillance services. There were also 180 contact managers; the number is now expected to grow to 250.

Vergés also announced that the SMS system is being activated to alert contacts of a positives to inform them about what they have to do (quarantine, sick leave if necessary and symptom monitoring).