Niels Aerts (20176134) - Testing for Covid with 17 milion national coaches
Niels Aerts (20176134) - Testing for Covid with 17 milion national coaches
Niels is commissioned by the Testing Service, located in the office of the National Control Room Collaboration in Zeist. The service was established to enable and coordinate Covid-19 testing. It is crisis management with a capital C. “We are usually in the office, at a distance of 1.5 meters and with the necessary adjustments, of course. Although we have grown so fast in recent months that we also work from home according to a schedule. The organization started in the spring of 2020 as the National Coordination Diagnostic Chain (LCDK), with 4 people. It is now called the Testing Service and it employs around 80 people”. Niels has been working there as a consultant since November 2020 and is noticeably proud of what is being achieved.
“We have just celebrated our 1 year anniversary. Although there is little to be celebrated given the circumstances, obviously. When I look at the whole of the test chain, with everything that is in place, including the work that we do together with the Municipal Health Services (GGD), it’s a big achievement. For example, the software that we now use to process all data was used by a limited number of GGDs before Covid for their day-to-day work. So, with significantly less traffic and users. In the meantime, use has increased incredibly, and there are also many more parties that need to do something with those data. Consider, for example, all GGD test locations, laboratories (about 60), general practitioners, National Institute for Public Health and the Environment (RIVM), healthcare institutions, Testing Service, and so on."
Image: Timeline of the Testing Service
But this IT system, CoronIT, has often received negative press recently, hasn’t it?
“That's right, but from a technical point of view it is very admirable that within a short time an existing system meant for other activities has been expanded to a size of several hundred thousand users and changes per day. The system is indeed down now and then, but that is because they are still developing. The government is also constantly demanding new applications. Something as extensive as the vaccination program, for example, had to be given a place. That’s asking quite a bit of course. And all that is happening while it is used very intensively in the meantime. We can't just say: sorry, under construction.”
First, a practical question: what exactly does the Testing Service do?
“We are responsible for the diagnostic chain. When you register for a corona test, you do so with the GGD. The administration of the test is provided by the GGD. The cotton swab with the sample is then transferred to a laboratory for analysis. After analysis, the lab passes the test results to the GGD. If it is negative, you will receive an email and you can find the result in your DigiD. If it is positive, the Source and Contact Investigation will start. The GGD calls citizens who have tested positive to inform them. The Testing Department is responsible for the purchase of sufficient testing material, the allocation of laboratories to test lanes for Covid-19 and is also contractually responsible for all this. The entire coordination of the diagnostic chain lies with the Testing Service. We monitor the performance of the laboratories on the basis of Service Level Agreements (SLAs), we ensure good logistics between the test lines and the labs, and ensure that the test results in the Netherlands are passed on to the citizens and GGD within the agreed time. And perhaps more importantly, the Testing Service ensures that there is sufficient capacity to process all the tests taken. If, for example, a source and contact investigation by the GGD shows that there is a local outbreak, then we, in cooperation with the GGD and sometimes also the Ministry of Defense, make it possible for large-scale testing to be carried out at that location on short notice.”
“There are three possible outcomes: positive, negative and "indeterminate". If a certain lab has a lot of "indeterminate" results, then one of my tasks is to find out what is going wrong there. Indeterminate means that the person in question has to get retested. We want to prevent that as much as possible. We also keep an eye on the amount of time it takes to get results back. We promise a result within 48 hours, but we aim for much faster. That is very important for people's willingness to get tested. We have made agreements like this with laboratories, and we manage them accordingly.”
17 million national coaches
It comes with challenges to work here, Niels has found out: “There are so many opinions and theories about corona and the appropriate approach. I noticed that I have become more and more reluctant to say where I currently work, because you are approached with out-of-context news, so-called facts and self-fabricated theories. Few people really have the complete picture, and there is no arguing against that. It is an emotional topic, of course. It has so much impact on everyone's daily life, so people automatically form their own opinion. I sometimes compare it to a World Cup of football, when The Netherlands suddenly also have 17 million national coaches”.
And despite that negative reporting, you sound proud to work here, tell us more
“There has been a very steep learning curve for all the organizations involved over the past eighteen months. The GGDs, for example, are municipal authorities, which have been financially cut back a lot in recent years. However, they have set up all those test streets in a very short time and filled them with thousands of employees. They have partly done this in collaboration with the Ministry of Defense, because soldiers of course know better than anyone how to work in crisis situations. We also worked with specialized soldiers at the Testing Service. They have helped us enormously in setting up the operational organization”.
Niels is positive about the cooperation between all government agencies. “The GGDs fall under a municipality and actually report to the mayor of a GGD region. But in times of a pandemic, the Minister of Health, Welfare and Sport (VWS) may act nationally in coordination. In addition to Defense, there are also other Ministries involved to address the tensions in society and possible solutions. Think of the Ministry of Economic Affairs to get society ‘up and running’ again. But the RIVM, the OMT, National Patient Distribution and some Covid-specific consultation bodies and organizations are of course also important players. What actually happens is that there are a lot of organizations now doing activities that were originally not "standard" within their range of duties, and for which they were not equipped. No one was adequately prepared for this pandemic. But despite this, that collaboration is going quite well overall. I think that's good to see, and to be part of it is very special. And no, not everything is perfect, but on the whole, and in the current context, we are doing a good job. People who work in the Covid chain, especially in healthcare and the GGD who have a lot of contact with citizens, are faced with so much negativity, threats even. While many of us work 7 days a week. It should be known that many of us have been going the extra mile for more than a year now.”
What is the biggest challenge in your work?
“Finding the right balance for the testing capacity. Not too much, because that costs society money, but certainly not too little. The GGDs have been working with regional laboratories for a long time for their normal activities, such as the testing for other types of infectious diseases. At the beginning of the pandemic, these laboratories were called upon, but their capacity turned out to be too limited. Then we started working with large international laboratories to meet the demand. At one point the Minister gave the order to be able to process 200,000 tests per day, so we had to expand considerably. That is why contracts have been concluded with several laboratories to achieve those 200,000 tests per day, whilst keeping a high standard. Fortunately, we never had to use this number in one day. Of course, we have no influence on the amount of people who sign up for a test every day. And regional spread is of course also a factor in this. But the diagnostic chain is prepared for this amount. Compare it with the Fire Department. It is ready day and night for a fire or other calamity, but does not always have to respond. This also applies to the number of tests that can be processed during this pandemic. It does require that we constantly look for that balance. "
How do you determine that balance?
“We are data driven. For example, we have a so-called cockpit on which we can see exactly how things are going for the entire country, per laboratory and test street. This means that we can actively manage various SLAs and intervene when necessary. We can now also predict some peaks. Think of the Easter days. Prior to this, massive amounts of tests were requested because people wanted to go to their families. Shortly thereafter, very little traffic enters those test streets for a while, but then it goes up again because people have spent too much time together. We see this reflected in the number of positive test results. I am curious what the effect of King's Day will be. But the citizens' willingness to test makes or breaks the system."
“I am involved in major implementations and transitions in the test landscape, among other things. Part of this is contract management with some of the large laboratories. I am also a general troubleshooter. If something goes wrong, I am one of the employees who talks to laboratories and GGD regions. I enjoy coming out of that conversation to mutual satisfaction after a difficult or tough conversation. Hard on the content, soft on the relationship where possible. We do need each other after all”.
“In the coming months my main goal is to keep thing calm and structured in the Dutch test chain where possible, in view of new contracts. Continuity and preservation of quality is incredibly important, but if in the meantime the costs for The Netherlands Inc. can be limited as much as possible, then I will be even more satisfied.”
Niels Aerts (20176134), consultant