After a quiet June and July, the number of new cases in Slovakia started rising again in August. Between 18 September 2020 and 18 October 2020, the 7-day average of new cases increased by a factor of 10, from 140 to 1,400.
In response, Slovakia implemented non-pharmaceutical interventions (NPIs) throughout October (masks, social distancing, school and business closures etc) and planned a mass rapid testing program to be implemented over consecutive weekends, in early November.
The goal was to identify the asymptomatic individuals who were the most infectious. Removing those people from the population was seen to be the best way to reduce transmission and therefore to lower the overall public health risk, without resorting to extreme civilian interventions.
Trust me, this is the only way to avoid a total lockdown and the inevitable economic damage linked to it
Prime Minister, Igor Matovic
The Slovakian government spent €100 million on the Biosensor Standard Q antigen tests used to test the population twice, which was roughly the same amount of revenue the economy was losing for every day of lockdown.
Around 20,000 medical staff and 40,000 non-medical staff were involved in the administration of the tests over the three weekends of the program. Those workers included soldiers, police officers, firefighters, health-care workers, administrative staff, and volunteers. Slovakia also received help from the Austrian armed forces, which sent 33 medics, and Hungary, which sent 200 health care staff to help administer the tests.
The Testing Protocol
Slovakia asked every resident older than 10 and younger than 65 to get tested twice before 8 November 2020. In a country of 5.5 million, this equated to an affected population of 4.4 million. Those over 65 were exempt, but were invited to take part.
Testing was not obligatory, but those who refused to be tested were asked to stay at home for 10 days, or else face fines of up to €1,650 euros if they did not. Employers were not allowed to let employees work unless they held a valid medical certificate with a negative test result.
Individuals testing positive were asked to quarantine for 10 days, along with all members of the same household and their self-traced contacts. Alternatively, they could go to a quarantine facility provided by the state. Their full salary was paid for the 10 day period.
A negative test result allowed people to work, but it was not regarded as proof that the individual was not infected. So, for example, the negative rapid test result was insufficient on its own to allow entry to a care home.
Slovakia ran a pilot scheme in the four worst-affected Districts in the north of the country over the weekend of the 24th / 25th of October. On the following weekend, the first round of testing took place for the age-eligible population. The second round of testing took place the weekend after that, but it only included the Regions with the highest prevalence from the first round.
New NPIs: mandatory masks • gatherings limited to 50 • universities switch to distance learning • restaurants and bars close at 10pm.
New NPIs: gatherings limited to 6 people (some exceptions) • pubs, clubs, and bars closed • gyms and swimming pools closed • restaurants can only serve outdoors • high schools switch to distance learning • national stay at home order between 24 Oct and 1 Nov.
Oct 23 - 25
Pilot scheme: 141,000 tested, 5,594 positive (3.97%). 87% participation. Included only four districts in the northern Regions of Žilina and Prešov.
Primary schools switch to distance learning. All other NPIs continue through testing periods.
Oct 31 - Nov 1
Round 1: 3.62 million tested, 38,359 positive (1.06%). 83% participation. Included whole population between 10 and 65.
Nov 7 - 8
Round 2: 2.04 million tested, 13,509 positive (0.66%). 84% participation. Included only high infection Districts from Round 1.
The program had high participation levels, with over 80% of the age-eligible population coming forward for testing in every round.
Over the three weekends of the program, 57,500 infections were found. Up to that point, Slovakia’s PCR testing had found about 50,000 cases total. The 7-day average of daily cases peaked at 2,547 on 4 November 2020, and bottomed at 1,270 on 24 November 2020 (source: worldometers).
These results reflect the effects of the NPIs as well as the mass testing program, and it is likely that both contributed significantly to the results described above.
However cases were still above 1,000 a day when the program ended and as soon as that happened, cases started rising again. Slovakia returned to extreme lockdown in December 2020.
National emergencies need national responses. Slovakia’s mass testing program targeted everyone in the country and was a good example of a national response. The plan displayed ambition and some good thinking, but overall, it was totally inadequate in the face of such a large outbreak and the benefits of the program were short-lived.
This plan was put together at short notice, and it showed. The government struggled to hire enough medical workers in advance, and there were long queues outside testing centres in populated areas during the first round of testing. Some sites ran out of the medical forms needed to confirm the public’s attendance and their test result. There were many areas that could have been improved with more foresight and greater planning.
That said, the Slovakians got quite a few policies right. They acquired resources from friends and neighbours abroad. They ran a pilot program first, and that offered two benefits: it establishes the viability of the project, and it allowed policymakers and workers to get some practice. They learned as they went: the long queues on the Saturday of the first weekend were addressed, and the overall performance of the plan improved the following weekend. Finally, Slovakia put generous financial packages in place to encourage people to come forward for testing and to support them if they tested positive. Ireland should include all of these measures in its elimination plan.
Ultimately though, this was not an elimination strategy. This was a ‘two Rennie washed down with Alka-Seltzer’ approach to fire-fighting the outbreak. It served its purpose in the short-term, but it didn’t solve the underlying problem. A comprehensive elimination strategy would need a better structure, greater management from policymakers, and greater engagement from society.