With just a handful of the novel coronavirus cases confirmed, Ukraine may seem safer than other countries with COVID-19 outbreaks. However, Ukraine has been dragging behind on testing for the virus.
While other nations test tens of thousands of people daily for COVID-19, Ukraine has tested a total of some 640 people since January. It has confirmed 16 cases so far, and two deaths, while the virus has infected over 218,000 and killed 8,800 people in a pandemic worldwide.
The government says it has been following the World Health Organization’s approach to diagnosing COVID-19, a disease caused by the virus, and increasing its testing capacity. But the reality of testing and diagnosis in Ukraine does not follow any standardized approach.
The reason may be fear.
Some infected patients are afraid to go to the doctor, and some doctors are afraid to examine such patients. This creates additional obstacles both to diagnosing COVID-19 and to assessing the true spread of the virus in Ukraine.
Having recently traveled from Greece and met people who had visited Austria, Kyiv resident Dana Yarovaya was worried she might have COVID-19 after she felt dizzy and started to have a fever. So she called an ambulance and described her symptoms and travel history, since both Greece and Austria have been hit by the coronavirus.
The ambulance told her to see a general practitioner at a state clinic. She called three, but none agreed to come and examine her in person, Yarovaya told the Kyiv Post. One of the doctors told her to take antibiotics, a prescription with which Yarovaya disagreed.
The Ukrainian government’s approach advises doctors to diagnose “suspicion of COVID-19” when a patient both has the symptoms of the disease, such as a fever, and has had close contact with infected people, perhaps during travels.
A sample of mucus from the patient’s nose and throat is then sent to a laboratory for a test to confirm or refute the diagnosis. If the patient has COVID-19, she fills out a form specifying everyone she has recently contacted, and these people are also tested. The patient then receives treatment and is isolated from others.
After being denied treatment by general practitioners, Yarovaya took the initiative and called a state clinic that tests for COVID-19. But she got a surprising response, she said.
“They told me over the phone, ‘You do not have coronavirus’,” Yarovaya said.
After she repeated her story, she was advised to get a chest X-ray.
“It was the most shocking conversation for me that day,” she said.
Yarovaya self-isolated from her husband and three kids and shared her story in an emotional Facebook post, which got 13,000 shares. A Facebook friend then helped her get a test for coronavirus.
Yarovaya tested negative, but decided to remain in self-isolation and test again in two days if she does not get better. She argues that there is a lack of communication from the state and that her case was left with zero attention.
The state of testing
So far, Ukraine has only 16 confirmed cases of COVID-19, among the lowest numbers in Europe. Ten cases were reported in Chernivtsi Oblast, two in Kyiv, two in Kyiv Oblast, one in Zhytomyr Oblast, and one in Donetsk Oblast. Two people died from the disease: a 71-year-old woman in Zhytomyr Oblast, and a 33-year-old woman in Chernivtsi Oblast. The first person, diagnosed in Chernivtsi in early March, has been recovering from the disease. If he tests negative for the virus once more, he will be released.
But while many European countries have tested hundreds of people daily, the Ukrainian government has tested a total of some 640 people since January. 255 of these had the diagnosis “suspicion of COVID-19.” The rest of the 640 only had close contact with infected patients, but no symptoms.
The government has not tested people who only have symptoms and did not have close contact with infected patients, because such people may have milder illnesses like the flu.
The World Health Organization (WHO) recommends this approach in part because there was a limited number of test kits in the early weeks of the pandemic. Besides, tests in state medical institutions in Ukraine should be free.
Until this week, Ukraine only had the capacity to reliably test around 1,000 people for COVID-19 in one Kyiv laboratory. But more test systems have been delivered to labs in the regions, allowing more testing locally. Additionally, over 20,000 faster but less reliable rapid test systems have been delivered to the regions.
There are also private clinics that have procured testing kits and now offer tests for COVID-19. While one rapid test kit costs Hr 340 ($12.80), one Kyiv clinic offered rapid testing for Hr 1,500 ($56.50). Its first stock of kits ran out in less than a week.
The reliable test
The Ukrainian government initially procured a few so-called PCR test systems from a German manufacturer certified by the WHO for a laboratory in Kyiv.
The PCR (polymerase chain reaction) test is, so far, the only reliable way to diagnose COVID-19, and it can even diagnose the disease in the early stages. It can detect tiny amounts of SARS-CoV-2, the virus that causes COVID-19, in a sample taken from a person’s nose and throat. The process takes several hours and requires a lab professional.
PCR test systems also need special reagents, and the government initially procured enough to test 960 people. Considering that some 640 people were already tested, there are about 320 tests remaining in the Kyiv laboratory.
But since March 12, the government has delivered 15 more PCR test systems to eight oblast centers: Kyiv, Dnipro, Zaporizhia, Lviv, Vinnytsia, Zhytomyr, Rivne and Ternopil. The government also allocated Hr 1 million ($33,330) to each of these regions to buy the required reagents.
The rapid test
Since the second week of March, Ukraine has started to use the new Chinese rapid test kits for signs of COVID-19. These detect only indirect signs of coronavirus that a body produces five to seven days after infection – the immunoglobulins, more commonly known as antibodies. Rapid tests take about 15 minutes and can be conducted by most medics.
There is no shortage of rapid test kits in Ukraine. The government bought 19,600 on March 11 and has been distributing them to medical institutions and border checkpoints in 15 regions. Kyiv bought an additional 2,500. Another million rapid test kits will be delivered to Ukraine shortly.
But rapid test kits are reportedly less reliable and detect signs of coronavirus only five to seven days after the symptoms are showing. The U.K. Department of Health said there is “little information on the accuracy of the tests” and that “it’s not known whether a positive or negative result is reliable.”
In Ukraine, when a rapid test shows a positive result, the authorities send the sample to a laboratory for a PCR test to determine whether the patient actually has COVID-19.
Ukrainians meet arrivals wearing medical masks at the Igor Sikorsky Kyiv International Airport (Zhuliany) on March 16, 2020. Most of Ukraine’s international flights have been canceled to prevent the spread of the new coronavirus. Starting on March 17, the Ukrainian government banned all international flights in Ukraine. On March 18, Ukraine will ban all its domestic flights, too. (Volodymyr Petrov)
Errors in testing
The problems with proper testing for COVID-19 start at the borders. People crossing the border or arriving by plane can take fever-reducing pills to pass screenings by border guards without delay. This way, even if they are sick with COVID-19, they may not get the rapid test for signs of the virus.
Ukraine has canceled all passenger flights since midnight on March 17, banned entry for most foreign citizens and is closing all but 89 of its border checkpoints on land. This means there will be many fewer people crossing the border.
Still, there was an influx of Ukrainians trying to return home from affected countries before March 17 by plane, and there will be more returning by land. They will have to be screened mostly by border guards, since only the largest checkpoints have teams of medics on duty.
Some of them can carry the virus into Ukraine, bypassing the testing.
There may also be people sick with COVID-19, but who are afraid to go to the doctor, hoping that they have a mild form of the disease. Many of them are afraid of ostracism by family, neighbors and colleagues.
For example, the elderly woman who died of the disease in Radomyshl, a city some 110 kilometers to the west of Kyiv in Zhytomyr Oblast, failed to report she felt sick for over a week.
Doctors, on the other hand, may be afraid to see the patients with the disease. They also may not want to diagnose “suspicion of COVID-19” so as not to attract the attention of their colleagues and the media, says Ihor Kuzin, acting director of Ukraine’s Public Health Center.
The fact that PCR tests are now also available in regional labs will help increase the frequency of testing locally. This way, doctors may be less intimidated about sending the samples to Kyiv, Kuzin told the Novoye Vremya news site.
The Kyiv lab currently tests four to five people daily with a “suspicion of COVID-19” diagnosis, but Kuzin says there should be around 40-50. Since it’s a flu season, there must be a lot more people who, if not infected with COVID-19, have the common flu and have been crossing the border.
Ukraine is by far not the only country where there are problems with properly diagnosing and testing for COVID-19. That’s why medics are monitoring statistics for how many people are sick with acute respiratory diseases, like the flu and COVID-19, and how many were hospitalized with complications, like pneumonia.
According to Ukraine’s Ministry of Health, the statistics for acute respiratory diseases are currently at the same level as in the last five years and are not increasing rapidly.
“We have no reason to suspect a hidden epidemic. This means that the system of epidemiological control is working,” Kuzin says.
