Test Labs can handle more, but this competition is in the way

And again there is a hassle around the testing policy. Today the GGDs even reported that at half of the test sites people can’t get to them within 48 hours. Minister Hugo de Jonge is even moving to German labs in order to be able to do the Dutch tests, something that the government did not want for months.

Why will a cotton swab from a test street in Amsterdam go all the way to Germany, when it can also be examined at a lab around the corner? One of the causes that the system crashes is the way in which the tests are distributed among the laboratories, according to research by Nieuwsuur. As a result, large labs are still not fully used, while smaller labs regularly ‘overflow’ and have to forward their tests to other labs. This makes the already complex puzzle surrounding the testing policy even more complicated.

Even before the corona crisis, there were relatively many laboratories in the Netherlands: a number of large ones and many smaller ones. They compete fiercely with each other. And that battle became clearly visible during the corona crisis.

Swipe through the pictures below to understand the difference between the different laboratories:

In March, corona appeared in the world of those competing laboratories. While it’s a huge puzzle to get the test capacity (with test kits, devices and personnel) in order, a battle for power in the diagnostic market rages in the background.

The established hospital laboratories fear for their position and income if they have to compete with large independent labs. This is also evident from a letter sent in July by the association of doctor-microbiologists, the specialist doctors working in laboratories, to its members. The association writes in this letter that it fears that the large independent laboratories will be attracted to the discussion about economies of scale with the argument of ‘cheap testing’ during the corona crisis.

One of the largest central labs in the Netherlands, Sanquin in Amsterdam, also feels the competition. The company can carry out the largest number of tests in the Netherlands per day, but is not used on a large scale.

Sanquin notices that their large capacity is being looked at with suspicion and is surprised about this. “I think it’s important to keep in mind that we have a pandemic that we have to tackle together and in which the speed of testing and the large scale are important,” says Van Weert.

1 June: testing possible for everyone

While all this plays out in the background, the ministry decides to scale up the testing capacity. From 1 June, not only patients and health care personnel will be tested, but anyone with complaints will be allowed to report to the GGD’s test streets. This will also give the test another goal: to ensure that corona cannot spread.

Behind the scenes in the summer months, there is a lot of discussion about the best distribution of the tests, with major interests at stake. For example, the 25 GGDs all have their own (contractual) agreements with laboratories with whom they normally already work, and these are agreements that they would like to keep.

Large test lines linked to large labs

The National Diagnostic Chain Coordination Team (LCDK) of the Ministry of Health has to divide all tests over 64 laboratories. In a letter to the labs and GGDs they write in early June that the tests will be divided according to the size of the lab and the expected number of people who will be tested in a test street. The existing relationships between laboratories and GGD’s will be respected ‘as much as possible’.

The ministry apparently expects resistance, and also writes: “We realise that the outcome of the schedule does not always offer you the solution you might have chosen yourself

The Dutch Association of Medical Microbiologists (NVMM), the specialist doctors who mainly work in hospital labs, is not happy about this. In a letter they send a month later, they write that they want to determine the distribution of the tests in the region together with the GGDs themselves.

Two weeks later, the LCDK writes in a newsletter that the proposed adjustment will not take place anyway. The distribution of the tests will run according to “current contracts and flows”.

The chairman of the NVMM, Ann Vossen, explains the views expressed in the letter in an interview with Nieuwsuur. “There are major advantages to arranging everything in the region, for example the turnaround time. If you keep something in the region, a car will be on the road for fifteen minutes or half an hour. The turnaround time is a big advantage for logistics, but we also know that it is important for combating. There is a lot of demand to hear your results in the short term, which is also important for the Municipal Health Service (GGD)

Nevertheless, Sanquin also claims to be able to give these results in the short term. “We are now testing for various GGDs in the country, from Veenendaal to Venlo and Dordrecht to Amersfoort and Amsterdam. We collect all these tests from the test sites and everyone receives a result within 24 hours of taking the test”

According to care economist Xander Koolman, the way in which the tests are now distributed is indeed not logical. “What you want is for there to be competition on price, quality and accessibility, and in this case it’s also about speed. That you can get to such a test line quickly and that there is a quick result, that’s essential”, he says. “Actually, the larger laboratories should get a larger share of the market. That is now prevented by this distribution system.”

It also happens regularly now that smaller laboratories are unable to cope with the proliferation of tests, which means that test lanes have to change their entire logistics in order to get to another lab. To do this, other tubes have to be supplied, labels have to be changed and the time of transport has to be changed. Sanquin has to deal with this several times a month.

Quality or quantity?

Ann Vossen understands the reluctance of medical microbiologists to transfer the coronavirus tests to large laboratories. “It is a difficult situation. Laboratories hold the quality of their work in high esteem and there is of course a fear that it will suffer if it is arranged in a different way. It makes a lot of sense that people feel that.”

She stresses that the quality of the tests must be paramount, but is open to the use of large central laboratories. “Look, if it has to be because we all can’t handle it, we have to talk about it. And then we also have to talk about the quality and how we can organise that in the best possible way.”