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COVID19: to test or not to test?

That is the question! COVID19 was a completely new infection for the human race and up until 8 months ago, we had never heard of it. There are still so many unknown factors to consider when it comes to testing for the virus. This creates a lot of debate about the value of COVID19 testing for both staff and patients prior to IVF.

COVID19 meant the mandatory suspension of fertility treatments causing much despair and heartache for patients. Even though services have now resumed, it is still a very challenging time for clinics. The reintroduction of fertility treatment had to be measured to ensure that the spread of the virus was minimised in a clinic setting.

The Association of Reproductive and Clinical Scientists and the British Fertility Society produced best practice guidelines. These recommended patient questionnaire screening and antigen testing. As our understanding of the virus evolves, so do those guidelines and we are eagerly awaiting the latest update specifically about testing.

The Progress Educational Trust, raise public understanding of science, law and ethics in the fields of human genetics, assisted reproduction, embryology and stem cell research. They held a webinar last month that addressed the many questions surrounding COVID19 testing in an IVF clinic. This webinar addressed many concerns surrounding testing for both patients and questions. The full webinar will be available to watch again and I will share that with you as soon as it’s ready.

The ups and downs of COVID19 testing in an IVF unit

Firstly, testing is not mandatory. It is currently a recommendation in the guidelines, therefore across the UK some clinics are insisting on it and others are not. This leads to patient confusion and wondering whether they should choose treatment at a different clinic. The general consensus is that there should be some form of screening. But if it’s only a questionnaire then asymptomatic patients could put staff and other patients at risk.

So, to mitigate that risk, then an actual COVID19 test should be used. The next question is should that test be a PCR swab test or antigen test to see if the patient is currently infected? That seems the most sensible route to eliminate the danger to staff and other patients. If the patient tests positive then treatment would be suspended. Depending on the patient recovery then treatment can be rescheduled.

Does infection provide immunity?

However, the million-dollar question is does infection provide immunity and if so, for how long? Obviously, with this being a new virus only time will tell and researchers are keeping a very close eye as the virus progresses. The feeling is that some level of immunity is provided after infection, but what is important is how long that immunity lasts.

That leads us on to antibody testing and the problem of securing a reliable antibody test without a huge investment for already cash strapped clinics. When the pandemic had taken a hold and the UK was placed on full lock down, I was very interested in antibody testing and did a lot of research on what was available on the market.

It was an exhausting process! The market was flooded with tests from China, it made sense as they had a head start on the virus and were first out with antibody tests. But, after the UK government bought 100,000 that were found to be unreliable, this didn’t seem like a viable option to secure a reader offer for clinics to get a discount.

Pricing

The next problem was pricing. The tests I looked at varied in price from £3 a test to £35 a test. Then there was a minimum purchase of thousands of tests. I spent many hours on Zoom calls with various suppliers and tried to explain that even a large clinic would usually do 1000 IVF cycles per year. And with social distancing, there would be less patients in clinic to adhere to social distancing, so we could halve that number to only 500 cycles. Therefore, a minimum purchase of over 2000 tests was not going to work, especially at those prices. I very much doubted any clinic was going to invest £50,000 in antibody tests, especially after no revenue stream for 2 months!

We did eventually find a reliable test with a low price point and a low minimum purchase, please see details here.

The upside to antibody testing is that it gives some peace of mind to both patients and staff that the patient knows to protect themselves if they have no antibodies should treatment be successful.

Antibody level dropping after infection

But a positive result leaves more questions, as we don’t know how long a patient will have immunity for, will it last the duration of pregnancy? That is then down to the treating physician to advise on how best to proceed. There is also the issue of false positives. The worry is that if someone believes they have already been infected when in fact they haven’t, and even if they have, we don’t know how long the antibodies will last. Latest research is showing the antibody level is falling after infection, so someone who contracted the virus in March is already seeing the antibody level fall off.

The other upside is that clinics can create another revenue stream during the crisis, the general public are keen to know if they have previously been infected. As the types of tests used in clinics are for healthcare use only, clinics can be offering antibody testing to their wider community and not just their IVF patients and staff.

Charging for tests

The next issue is who pays for the test? Should that be the clinic or the patient? There has been some very bad press here in the UK about clinics charging £500 for a PCR swab test, when patients could have had this for free on the NHS! I think the word of advice here is be sensible, patients have had enough trauma with cycles being postponed. And IVF treatment is already an expensive procedure, so try to keep costs to a minimum when passing on to the patient. Cover the cost of the test and your staff time to administer the test.

As the crisis continues to evolve, we will monitor the debate on COVID19 testing and keep you updated as soon as more guidance is published.

Next seminar

In this series of blogs on Crisis Management, Marketing and Communications for IVF clinics, you can sign up to our next free seminar on Sept 8th at 5pm UK time, where we will look at best practice on your website, how IT can enhance your marketing efforts, strategy and the impact of COVID19 on media buying and planning.

I am always pleased to share my experience and talk to you about the challenges that your clinic is facing, so if you have any questions then please reach out to me here.

Veronica Montgomery, Patient and Clinic Liaison Consultant

The Fertility Hub

Previous blogs in this series

Part one – COVID19 Crisis Management for IVF Clinics

Part two – Marketing and Communications During COVID19

Part three – Financial Implications of COVID19

Part four – The use of PR during the COVID19 pandemic

Part five – Protecting your brand during COVID19

Part six – Online marketing during COVID19

Part seven – Using online seminars to build trust.

Part eight – The power of newsletters during the COVID19 crisis.

Part nine – Video marketing tips during COVID19.

Part ten – Covid19 – The Indian Perspective.

Part eleven – The use of podcasts.

Part twelve – Cost effective marketing.

Part thirteen – Digital marketing during COVID19

Part fourteen – Best practice on your website

Part fifteen – How I.T can enhance your marketing efforts

Part sixteen – Let’s talk strategy

Part seventeen – The impact of COVID19 on media buying