Last weekend, Slovakian authorities completed the second round of a massive operation to test its entire population for Covid-19. If successful, it will be the first non-micronation in the world to do so.
It’s looking like it will. In the first round of testing, authorities managed to test two-thirds of the country’s population of 5.45 million (roughly the same population as South Carolina), with another 1.9 million tests taken in the second round. 1 percent and 0.66 percent of tests came back positive respectively, well below the 31 percent positivity rate seen in the neighboring Czech Republic.
The ambitious “Operation Shared Responsibility” (Spoločná zodpovednosť) is part military logistics mission and part public health intervention. The operation is also being primarily conducted by the Slovakian Armed Forces and volunteers from the public sector, all under the supervision of Minister of Defence Jaroslav Naď. On Monday, he congratulated those involved for their efforts.
“The Armed Forces of the Slovakian Republic once again held up Slovakia,” he said in a statement, “In a short amount of time, they were able to prepare the largest logistics operation in our history. I am extremely proud of every soldier who gave an incredible performance–they worked basically non-stop. I also take off my imaginary hat for everyone who contributed to this success alongside our armed forces–police, firefighters, rescuers, members of the financial administration, volunteers and especially paramedics, without whom this would have not been possible.”
While certainly logistically impressive, Slovakia’s operation is not the largest mass testing program. In May, China tested the entire city of Wuhan (11 million people) in ten days and Qingdao (9 million) in five.
It also doesn’t come without its dissenters, including the country’s own president, who criticized the mandatory quarantine for Slovakians who refused to get tested as unnecessarily divisive.
Another potential issue with the scheme is its reliance on rapid antigen tests, which, depending on the test, can be far less accurate than the traditional—but slower and more expensive—PCR test.
Michael Edelstein is a professor specializing in epidemiology and infectious diseases at Bar-Ilan university. While he thinks mass testing regimes like Slovakia’s can provide some useful information, he also believes that there are a number of issues with the strategy.
“It’s difficult to say how effective this mass testing strategy is,” he wrote in an email to Motherboard. “The sensitivity and specificity of rapid antigen tests is problematic in this scenario. If the purpose was to simply estimate the spread at the population level than this would be less of an issue. But, since here it is about managing individual cases, a high proportion of false positives and false negatives means that a) some cases and their contacts will be missed and b) some people will be forced to be isolated unnecessarily.”
Instead, he advocates for a more focused approach that uses mass testing to target viral clusters—similar to South Korea and Singapore—and even more importantly, robust track-and-trace programs to back it up.
But, logistical difficulties and lacking capacity make it difficult for larger European nations to achieve either a wide or focused approach. The United Kingdom, for example, recently missed its own testing targets and the Netherlands has practically halted contact-tracing altogether. If they want to pursue more ambitious strategies, then they also need to improve the bread and butter infrastructure needed to facilitate them. Not just for the current surge in cases, but also for the prospect of an eventual vaccine.
“All eyes are on a Covid-19 vaccine and we saw just yesterday the first efficacy results of the Pfizer vaccine,” Edelstein said. “This is a tremendously exciting prospect, but we also need to be pragmatic and understand that a vaccine is not going to be a magic bullet that will stop the pandemic overnight. Strengthening the basic–testing, contact-tracing, social distancing, masks–remains essential for the foreseeable future.”