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Dr Rizwan Khan Speech - 4 May 2020

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Thank you Chief Minister and Minister Ashford for inviting me to today’s briefing to share the COVID19 testing strategy. Since the first confirmed case on the island over 6 weeks ago, this is an evolving strategy revisited with every piece of good evidence that becomes available to us.

I will begin by sharing a timeline of where we started and where we are today followed by an overview of the test itself. At the end, I will touch on the next steps of COVID19 testing on the island.

The testing criteria are based on Public Health England’s case definitions that continue to evolve with the spread of COVID-19. Initially, the case definition was acute respiratory infection of any degree of severity and a recent history of travel to specified countries. On 13 March, the travel component of this case definition was removed, focussing instead on symptoms of a new continuous cough and/or high temperature only.

In the beginning, all tests were referred to Manchester Public Health Laboratory for Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) with a turnaround time ranging from 48-72 hours, depending on Manchester’s capacity. Samples were collected by dedicated swabbing teams who visited people at their homes and the hospital’s Emergency Department (ED).

On 20 March, the ‘Drive Thru’ at the Grand Stand became operational along with COVID111 helpline and the opening of CATU (COVID Assessment & Therapy Unit). At this point the swabbing teams were collecting specimens from homes, ED, CATU and the Grand Stand. We were sending over a 100 swabs a day, 7 days a week to Manchester.

On 6 April, we extended testing to all non-COVID hospital admissions. All patients presenting to the hospital for an overnight stay would be tested and that included maternity admissions, paediatric admissions, elective and emergency surgical admissions. England has only started testing these patient types from last week.

The first positive case in a nursing home was confirmed on 12April. We responded by testing all symptomatic residents and members of staff as part of the outbreak management plan. It has now been agreed to test all residents and staff as part of the overall response when one or more confirmed positive cases are reported at a residential home.

On 19 April, a plan for pre-discharge COVID testing was discussed following the recent intake of residential home patients at the Newlands ward. I am pleased to say that this plan is now in action.

For Essential Workers returning to work, we have developed two testing pathways. The first pathway responds to symptomatic essential worker and the second pathway responds to symptomatic household contacts. Any symptomatic essential worker is offered a test through COVID111 and the relevant pathway is followed.

Coming to the test itself - I am very lucky to have a committed, motivated, and hardworking laboratory team who have worked tirelessly day and night to develop on-island testing. We are following a two pronged approach to ensure high quality testing:

The first is a development of a high throughput RT-PCR using the same machine used by Manchester Public Health Laboratory. This platform currently has capacity to perform up to 200 tests per day with a provision to double the number of tests if required. Prior to the launch of this method on 20 April, we ran 172 tests in parallel with Manchester’s Public Health Laboratory with 99% concordance.

For the second method, we have procured two rapid Cepheid GeneXpert cartridge based machines. These machines have the capacity to return urgent results in 60 minutes with a maximum of 40 tests per day. To be able to perform these tests, we are awaiting test cartridges from the UK.

Where do we see ourselves in future - We have explored several avenues to enhance testing in the future. For example, screening of asymptomatic essential workers and shifting to wider community testing. We feel there is currently insufficient evidence, and too many uncertainties to implement these approaches at this stage.

Due to the high demand of testing resources around the world, we are taking a pragmatic approach ensuring these resources fit within the framework of our testing strategy. We are continuously monitoring all avenues of further testing and will act as soon as stronger evidence becomes available.

More long term, we have expressed our interest to participate in the proposed Genomics and Serology Strategy devised for UK Overseas Territories (UKOT) and supported by Public Health England. This study will give better understanding of the virus and its likely route of transmission within communities. We look forward to hearing further about the practicalities for taking this forward. 

While testing is integral to fighting COVID19, continuing to follow protocols to minimise the spread of the virus is just as important. I encourage you all to maintain hand hygiene, continue practising social distancing and where necessary, self-isolation.

Thank you.