The Consequences of Great Testing

At the moment, the tests are making headlines mainly because they only work in a bumpy manner in most federal states. The Vienna system is to be applied to the whole of Austria – where, however, completely different logistical problems await. For individuals and individuals, easy access to tests has enormous advantages – especially when you consider the effort involved in testing in other countries. But why don’t all other countries do the same as Austria does?

Very early on in the pandemic, Austria took the path of testing as much as possible: In autumn 2020, between 20,000 and 30,000 PCR tests per day were registered, sometimes more. Little by little, the quick antigen tests were added. The government also planned – more or less mandatory – mass tests around the Christmas holidays. The plan was not particularly successful.

From PCR to antigen – and back again

Nevertheless: The number of voluntary antigen tests increased steadily. When this was added to the official dashboard on January 13, 2021, the number of reported tests exploded. Soon there were 200,000 and more every day. The next increase came with the rollout of the gargle tests in Vienna in the spring and the nationwide tests in schools.

Reuters/Leonhard Foeger

The Wiener Stadthalle served as a huge test street

Between 250,000 and 500,000 tests per day were recorded on average during the summer. With the expansion of the gargle programs to the other federal states, the number has increased again significantly in the past few weeks – even though the logistics are jarring in all federal states except Vienna.

High costs, little benefit?

Other countries do not follow this strategy: only Cyprus tested more on the total population. Behind Austria, only Greece has recently expanded its test system and is catching up. Behind them is Denmark already beaten – and then nothing comes for a long time.

Graphic of the CoV tests carried out in different countries

ourworldindata.org

Tests on a seven-day average in selected countries

In fact, in spring and early summer, voices were also heard in Germany and Switzerland that tests should be carried out across the board in schools as in Austria. After all, Austria managed to reduce the number of infections in the spring relatively quickly – which was at least partially due to the many tests.

The verdict of the German experts and authorities: Costs and benefits would be disproportionate. It makes more sense to only test potentially infected people – and then to isolate discovered cases quickly. And: to protect particularly vulnerable groups with tests, for example in hospitals and old people’s and nursing homes.

Hardly any cases in early summer: criticism of school tests

In May and June, criticism of the school tests became louder in Austria too: the costs would be enormous and the money could be better used in the school system. In times when there are fewer infections, you have to look for positive cases with a magnifying glass; instead, the “nose bur tests” used produce a great many – sometimes around 30 percent – false, usually false-positive, results. Proponents, especially the Ministry of Education, point out that schools must be a safe place. Logically, it was also about the parents’ subjective feeling of security.

Billions in costs

The costs of the tests are hardly an issue in domestic politics, only the estimated 67 million euros for the mass screenings for Christmas 2020 let the waves go up for a short time. There are now around 106 million tests recorded in the AGES dashboard. The tests in pharmacies, which are also reimbursed by the government, are not included.

The “nose drill tests” are also not included. In any case, the costs are in the billions; in the summer there were talk of two. With the rollout of the gargle tests, which are now replacing the less precise antigen tests across the board, it will probably be a lot more.

The low-threshold and, above all, free system is practical for the population – such a luxury can be found in a few other European countries. Apart from fewer offers, in most countries the tests without suspicion of infection are chargeable – between 50 and 120 euros can be charged for a PCR test. Antigen tests cost between ten and 30 euros on average.

Testing instead of vaccinating?

The price that Austria has to pay for this offer is not only reflected in the budget: with the introduction of the 3-G rule – throughout Europe – the test was virtually equated with vaccination and recovery. With the wide range of tests available – compared to other countries – this equation probably worked differently in Austria than in large parts of Europe. And although it was repeatedly pointed out that a test is only a snapshot and not a protection, in some people the test is established as a vaccine substitute. At least those who have not been vaccinated keep arguing that they have to keep testing anyway.

The abolition of the free tests in late summer was briefly an issue, but in view of the fourth wave, the debate immediately disappeared again. Nevertheless, the Austrian test solution may also have contributed to the low vaccination rate.

More tests, more cases

Tests that are as broad as possible are basically intended to detect more infected people as early as possible, i.e. people without symptoms on the one hand and infected people on the other, before symptoms develop and they also become infectious. This creates a paradox: to prevent the spread, more cases are discovered.

This is exactly what needs to be considered with the number of cases and epidemic curves: The first wave of 2020 appears tiny in the epidemic curve – because it was hardly possible to test and the number of unreported cases was far higher than later. Even with the second wave in autumn 2020, no comprehensive tests were available. Even actually clear cases were not always included in the statistics: In some regions infected people were not PCR-tested despite symptoms, but were immediately sent to quarantine. Incidentally, they also overturned their certificate of recovery.

Hospital data prove the seriousness of the situation

So if the fourth wave appears much higher in the representation, then this is also an effect of the many tests – and Austria perhaps has earlier and more precise – and thus higher case numbers – compared to other countries. Of course, there can be no question of a “labortunami”: The number of deposits in the hospitals and especially in the intensive care units speak for themselves of how serious the situation is.

The fact that more cases are found where there are more tests is also reflected in the domestic figures: at the latest since the widespread introduction of the gargle tests in schools, it can be assumed that the number of unreported cases is low there. This is one of the reasons that in the group of five to 14-year-olds the 7-day incidence, i.e. those who tested positive in one week per 100,000 of the age group, has been by far the highest – along with the fact that the group is the least vaccinated because of the later approval (from the age of twelve) or the current approval (from the age of five).

Child makes gargle test in school

Reuters/Leonhard Foeger

In the spring, nose-drilling was carried out in schools, and they are now also rinsing

Around 35 percent asymptomatic

Research, most recently in a meta study published in the summer, assumes that around 35 to 40 percent of all infections are asymptomatic. Also symptomatic is a broad term that ranges from sore throat and slight cough to severe and life-threatening illness. Studies show that the proportion of infections without symptoms is more common in younger people.

This is also proven by data from AGES in Austria, which are published as part of the investigations into vaccination breakthroughs. Among the twelve to 17 year olds there are 44 percent without symptoms this year – mind you, with an almost complete testing of the age group.

Who tests and who doesn’t?

The geographical differences in tests in Austria could at least be seen in a similar way: Vienna was initially with its test offers with the antigen test streets and then with the “everything gurgles” system plus the pharmacy tests with hardly any region in Europe in terms of test density comparable.

But whoever accepts the offer and who does not have a major influence on the effectiveness: Those who are cautious anyway and also get vaccinated early tend to test more regularly, according to survey data from the CoV panel of the University of Vienna a few months ago. A new survey shows that the unvaccinated recently tested more and more often – probably also because of the 3-G rule. But even here there are 20 percent who said they never test. Conversely, a large number of those vaccinated continue to test regularly.

Test metropolis Vienna

The fact that Vienna still has the lowest incidence in a comparison of the federal states may be due to the enormous test possibilities in addition to stricter measures in the summer. It is possible that so much was tested, at least among those willing to test, that the rule “more tests, more cases” was broken. Until recently, almost two million tests were reported per week in Vienna – roughly the same as the number of residents. Currently there are 85,000 tests per 100,000 inhabitants due to the lockdown.

Laboratory workers evaluate gargle tests

AP/Lisa Leutner

With the pooling method, thousands of tests can be evaluated quickly

Salzburg is currently in second place with 45,000 tests per 100,000 people. In Styria, Upper Austria and Burgenland, the test rate per week is a quarter of the population, in Tyrol, Lower Austria and Carinthia 15 percent and in Vorarlberg around ten percent – more on this in ORF.at/corona/daten.

These are of course snapshots of the current status of the pandemic and the test offers. And the numbers do not mean that an equally large percentage of the population actually takes a test every week: frequent testers increase the average, those who refuse to test lower it.

More cases discovered before infectivity

Whether the multitude of tests – apart from the individual case – also works in the fight against pandemics is a difficult question to answer. An indication is the curve of the detected symptomatic cases. As long as the data are not yet complete, this has mostly shown a sharp downward trend in the past few days – but with the data corrections, the course is changed and the curve rises. One explanation for this is that the infected people were still asymptomatic at the time of the test and symptoms and the stronger infectivity only set in later – which are then corrected in the data. The tests would have done their job.

However, the effort for this seems enormous. According to the traffic light commission, the percentage of (still) symptom-free cases varies greatly depending on the federal state: in Vienna it is 58 percent, in Tyrol one percent and in Vorarlberg two. In the national average, 24 percent of those infected are without symptoms when the test is taken.

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