When Kyiv resident Anna Kushnir’s coworker was diagnosed with COVID‑19, she decided to get tested herself. Her company recommended a private laboratory that offered the cheapest polymerase chain reaction (PCR) test for Hr 715 ($25).
What Kushnir, 37, saw when she arrived at the lab on the chilly morning of Oct. 19 disturbed her.
The lab worked on a first-come, first-served basis. People self-organized by signing up on a sheet of paper. By the time Kushnir arrived at the lab at around 10 a. m., the list had 457 names on it.
It was cold outside. Some people stood aside trying to maintain social distance, but many others clustered together in front of the entrance. Kushnir waited for her turn for about two hours sitting in her car.
“I felt really uncomfortable to be in that line. I thought that everyone in it could catch the virus,” she told the Kyiv Post.
The place where the laboratory conducted the test and the way they did it further raised her doubts. There was no hand sanitizer, the door to the room did not close and personnel wore ordinary nurse gowns and disposable masks, not heavy-duty respirators or protective suits. In addition, they only took a nasal swab.
When the test result came back positive, Kushnir did not trust it. She was 24 weeks pregnant, so she needed to know for sure. She took another PCR test — this one over two times more expensive than the first — in another private lab that she found better organized for the pandemic. It showed that she did not have the novel coronavirus.
As COVID‑19 spreads rapidly through Ukraine, demand for tests has outstripped the capacities of Ukrainian labs. More people are contracting COVID‑19 and more people are coming into contact with them. Additionally, a negative test result is required at some workplaces, to travel abroad and to undergo chemotherapy or surgery.
Unlike in other countries, like the United States or Germany, whose governments outsourced testing to private lab networks, Ukraine chose to rely on its weak public laboratory infrastructure. It quickly became overwhelmed.
As of Oct. 28, state and municipal laboratories had nearly 43,000 specimens in backlog, more than they can test in a single day. Moreover, getting a free test at a public lab requires meeting certain criteria, and citizens have complained about having to wait between five and 14 days for a result.
PCR tests at private labs are available to anyone regardless of whether they have symptoms or not, and results come in 24 or 48 hours. While these test results are counted in the country’s official COVID‑19 statistics, citizens pay for the tests themselves. The cost ranges from Hr 715 ($25) to Hr 2,500 ($88) and the quality of service varies.
Today, private labs account for 24% of all PCR tests across Ukraine. In some regions, however, their share is bigger: Kyiv (72%), Luhansk Oblast (64%), Kharkiv Oblast (32%), Lviv Oblast (27%) and Odesa Oblast (27%).
In order to tackle the backlogs and delays, Ukraine’s Ministry of Health announced that the government would pay private laboratories for testing and allocated Hr 100 million ($3.5 million) for this purpose. However, there is no information on when the program will start and how specimens will be distributed for testing between public and private labs.
Health Minister Maksym Stepanov did not reply to the Kyiv Post’s questions.
Meanwhile, private laboratories face their own struggles with shortages of testing supplies and qualified personnel.
People stand in a line outside of a private laboratory on Oct. 29, 2020 in Kyiv. (Oleg Petrasiuk)
Public labs
A PCR test in a public laboratory is free of charge, but the patient must show symptoms and have a referral from a physician.
Olesya Mygal, 37, an employee at a non-governmental organization in Kyiv, was referred for a COVID‑19 test by her physician. She had a cough that did not go away for three weeks after what appeared to be a common cold.
According to state protocol, a mobile team had to come to her home and conduct the test. In reality, however, Mygal was told that the mobile crews were overloaded and she had to come to the primary care center. She had to wait for 5 days for the test itself and then for 4 days for the result.
“Had I been more sick, I would have gone to a private lab,” Mygal said.
Yevhen Piskun from Dnipro said his 60-year-old diabetic father had to show up in person for a test and wait in line for 4 hours, despite having a fever. Several days after he got tested on Sept. 30, he developed pneumonia and was taken to a hospital for patients suspected of having COVID‑19, but waiting for test confirmation.
The positive result came on Oct. 14. The next day, Piskun’s father, who was already feeling well, was discharged from the hospital.
Asked why his father did not go to a private lab, Piskun replied: “What’s the point? There’s no specific treatment. The test is just to know whether it is COVID‑19 or not.”
The director of one of Kyiv’s 28 primary care centers told the Kyiv Post that, due to a surge of infections, her center’s three mobile crews can’t make a house call to every patient with suspected COVID‑19 to collect specimens, which are then sent to the public laboratory. As a result, those without fever and with mild symptoms are asked to come in.
The director asked not to be identified for this story, as she is not authorized to speak to the press.
“We collect samples from over 100 people on some days,” she told the Kyiv Post. “The delays with results can be up to 10 days. But regardless of whether there is a result or not, if a person shows clinical symptoms, they are prescribed treatment.”
In an interview with the Ukrainian service of RFE/RL, Ihor Kuzin, acting head of the state Center of Public Health, blamed backlogs and delays on technical issues and the failure of doctors to prioritize which specimens should be tested first.
But the problem appears more basic: Public labs still have a low capacity. They still carry out between 20,000 to 29,000 tests per day. For instance, Kyiv City Laboratory and Kyiv Oblast Laboratory tested 1,128 and 1,606 specimens, respectively, on Oct. 28, and they still have 4,260 and 3,333 specimens in their backlogs, according to the data of the Center of Public Health. Kharkiv, Sumy, Poltava, Donetsk, and Cherkasy Oblasts also have serious testing backlogs.
In order to reduce this burden, the health ministry removed the requirement for two negative PCR tests to confirm that someone has recovered from COVID‑19.
Lab technicians carry out COVID-19 tests at a private laboratory in Kyiv on June 5, 2020. (Oleg Petrasiuk)
Scaling up testing
Researchers at the Health Economics Center of the Kyiv School of Economics calculated that Ukraine has to carry out 120,000 tests per day with the current number of new daily cases in order to control the spread of the disease.
Since the beginning of the outbreak, Ukraine has recorded 370,417 confirmed COVID‑19 cases, out of which 211,917 are active at the moment. So far, 6,868 people have died from the disease.
Minister Stepanov recently said that the government’s goal is to scale up testing to 75,000 PCR tests a day by the end of the year. To do so, the government plans to contract private laboratories that have more developed infrastructure and to build more public laboratories.
“I see that it is more rational to involve private companies and pay them for completed work,” said Oleksiy Babych, general director of Dila, one of the major laboratory networks in Ukraine. “It is impossible to open a PCR laboratory quickly. There are specific requirements for the building, ventilation, zoning. Plus, finding qualified personnel is a challenge.”
Dila has conducted over 200,000 PCR tests since April. During the pandemic, the company has invested 700,000 euros into its COVID‑19 program, which allowed Dila to go from conducting 800 PCR tests a day to the current 2,500–3,500.
Babych said Dila is ready to work by contract with the government and conduct COVID‑19 tests for below the market price — currently at Hr 1,800 ($63) for a PCR test — but he could not say how many tests it would be willing to do.
Synevo, another leading laboratory network in Ukraine, invested 300,000 euros into its new 24/7 COVID‑19 center in Kyiv. Since October, it has offered PCR tests for Hr 990 ($35) in seven Ukrainian cities and has already carried out over 26,000 tests. The company plans to double its current capacity of 2,500 tests per day in the next few weeks.
Synevo is also ready to join the government initiative, commercial director Mykola Skavronsky said, if the pay will cover testing expenses. For now, the company can offer a quota of 3,000 PCR tests per day for the government for Hr 700 per test.
“We are not planning to make a profit on this project,” he said in a written reply.
But while public and private labs may want to increase testing, desire and capability are sometimes completely different things.
As demand for COVID‑19 tests continues to grow and overloaded private labs plan further increase to their capacities, they are reporting shortages of testing supplies, reagents and qualified staff.
The laboratory where Kushnir got her first test recently announced it was limiting the number of PCR tests due to a capacity overload. It did not respond to the Kyiv Post’s request for comment for this story.
Read more: COVID-19, spurring emphasis on testing, boosts laboratories
