Swedish health agency: Limit Covid-19 tests for people without symptoms

Swedish health agency: Limit Covid-19 tests for people without symptoms
Regions are being asked to limit coronavirus testing. Photo: Stina Stjernkvist/TT
Sweden's Public Health Agency has advised the country's regions to impose limits on who can get tested for Covid-19 in order to free up essential testing capacity.
It is Sweden's 21 regional health authorities that manage testing procedures, but on Wednesday the agency advised these authorities to ask residents to only apply for testing if they are experiencing coronavirus symptoms, and to limit the number of tests an individual can have in a short period of time. 
“The capacity for testing for Covid-19 has increased significantly, but the demand for testing is in several regions now greater than the availability [of tests],” the agency said. 
“This is both because Covid-19 is increasing in society and also that other respiratory illnesses are at the same time common during the winter half of the year.” 
The agency suggests not offering tests for people exhibiting symptoms which disappear in less than 24 hours, and not offering tests for symptoms which have another known cause, such as migraine or allergies. 
A limit on repeated testing is also recommended to “combat repeated testing which is not motivated from a medical or infection control perspective”. 
The agency recommends that regions change booking websites to set a limit on how often residents can order tests. 

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Karin Tegmark Wisell, the head of the Public Health Agency's microbiology division, told the organisation's weekly press conference that the advice should not limit the testing of people identified through contact-tracing even if they lack symptoms. 
“If you are instructed to do your testing by an officer in your county or a medical doctor, then of course you should do the testing, but your own initiative for testing should be dependent on symptoms,” she said. 
Johan Nöjd, infectious diseases doctor for the Uppsala region, told The Local that his contact tracing division was already prioritising people who have symptoms, and would continue to test people without symptoms if they were identified as at risk by contact tracers. 
This was crucial at the moment, he added, as infections were starting to be reported in elderly care homes. 
“Cases in elderly care facilities are rising so there's more contact tracing,” he said. “If you someone tests positive there, you have to test all patients on the same floor and all the nurses.” 
This limit on repeat testing comes after infectious diseases doctors in Stockholm and Sörmland criticised young people in Sweden for a supposed “Test then party” or 'test och fest' trend, where people took tests before attending parties. 
“It's way out of line!” Signar Mäkitalo, the Sörmland infectious diseases doctor told Expressen last week. “All unnecessary tests bring an unnecessary load.” 
He said, however, that he had only heard of the trend from second-hand sources. 
There have also been reports of families without symptoms testing themselves before visiting elderly relatives. 

While it is possible to be carrying the virus and to be infectious without showing symptoms, a negative test result is not a guarantee that the person tested is free of risk. Everyone in Sweden is urged to limit their social contacts, with local recommendations in every region except Jämtland requiring people to have close contact only with people they live with, though this is not legally enforced.
The agency also recommended that regions seek to expand lab capacity by signing contracts with private actors, and informs that they can tighten requirements further if faced with a regional shortage of capacity. 
Last week, Sweden carried out 260,000 tests, equivalent to testing 2.5 percent of the population. 
The agency on Sunday also issued a tender for “national large scale testing for Covid-19”, seeking partners who can administer self-testing for the disease, and handle all the logistics. The final deadline for submissions is next Wednesday, and this would allow for state-procured lab capacity as a complement to what regions can provide.

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