On July 10, the Ministry of Health created the Commission for Evaluating and Following the Plan of Expansion of National Laboratory Capacity (https://dre.pt/web/guest/home/-/dre/137602111/details/2/maximized?serie=II&parte_filter=31&day=2020-07-10&date=2020-07-01&dreId=137571473). Acknowledging the crucial role of laboratory diagnosis of SARS-CoV-2, the Ministry of Health aims to further expand lab capacity within the NHS. The Commission must undertake an assessment of the current network of laboratories and present a plan for expanding the laboratory capacity, conducting a cost-benefit analysis, and considering both investments in the current infrastructure and creation of new labs.
The results of the expansion of testing capacity were already observed in September 2020: during that month, the NHS performed an average of 8,750 daily tests (compared to an average of 5,603 daily tests in June 2020). Overall, Portugal performed an average of 18,867 daily tests in September (compared to an average of 11,830 daily tests in June).
Between March 2 2020 and January 24 2021, Portugal performed 6,903,380 tests for diagnosis of SARS-CoV-2 in public and private laboratories, including 347,434 rapid antigen tests, which places the country in 6th place among the EU countries regarding testing rate, with 678,142 tests per million population (https://covid19.min-saude.pt/ponto-de-situacao-atual-em-portugal/). Portugal performed an average of 43,549 daily tests, between January 1 and 24.
The National Testing Strategy for SARS-CoV-2 was published on October 26 (https://www.dgs.pt/normas-orientacoes-e-informacoes/normas-e-circulares-normativas/norma-n-0192020-de-26102020-pdf.aspx). Molecular tests remain the first option for COVID-19 diagnosis, while rapid antigen tests should be used if a molecular test is not available or if the result will take longer than 12 hours in the following situations:
- Patients without criteria for hospitalization, isolating at home;
- Patients with criteria for hospitalization, with additional testing for influenza A and B, and also for sincitial respiratory virus in children under the age of 2 years;
- Diagnosis of COVID-19 in asymptomatic persons with close contact with a confirmed case;
- Healthcare units, before admission of patients or procedures generating aerosols;
- Institutions for vulnerable populations, including nursing homes and shelters for refugees and migrants.
For cancer patients, molecular test remains the only option.
Rapid antigen tests can also be used, as first option, in situation of outbreaks and also periodic testing (7 to 14 day) of healthcare workers highly exposed to the infection.
Following the peak of the third wave by the end of January, the number of tests in Portugal declined due to less suspected cases and less high risk contacts to be tested. In order to prepare an adequate level of testing prior to the lifting of lockdown measures, the National Testing Strategy for SARS-CoV-2 was updated on 26 February (https://covid19.min-saude.pt/wp-content/uploads/2021/03/Norma_019_2020_act_26_02_2021.pdf). The updated version established:
• Testing all contacts irrespective of their high or low risk exposure
• Screening in educational settings
• Screening in high-risk work settings
• The possible use of saliva as sample for PCR tests.
As a result, 82.425 tests (rapid antigen testing) were carried out between 16-21 March to personnel of schools and nurseries (81 positives identified).
Between 2 March 2020 and 31 August 2021, Portugal performed more than 17 million tests for diagnosis of SARS-CoV-2 in public and private laboratories, including around 4.1 million rapid antigen tests. Portugal performed an average of 54,005 daily tests/day in August 2021.