PCR tests within 15 minutes walk for everyone means discovering and isolating cases before widespread transmission. Many cities already have test requirements for everyday activities. How much is it all going to cost, and who will pay?
By FAN Xu, MAO Dun
China will make PCR Covid tests available within 15 minutes walk for everyone, the State Council said on May 9. The measure is a cornerstone of the dynamic zero-Covid policy, which means discovering cases early and isolating them before widespread transmissions.
Many big cities already have test requirements for everyday activities. In Beijing, a negative test is needed a maximum of 48 hours before entering any public venue including malls, offices and schools. In Wuhan, it’s 72 hours. Shenzhen and Hangzhou have similar requirements.
It is common to see people queuing up at testing sites - usually a booth with a few healthcare workers. Tests within a 15-minute walk for everyone in a vast and geographically challenging place like China means a lot of booths.
A testing site requires at least 1,000 people to be viable and can serve up to 3,000. Shanghai has one for every 2,500 residents. Hangzhou for every 1,200. Each site costs about 25,000 yuan (US$4,000) to install. One test site for every 2,000 of China’s 1.4 billion people would mean 700,000 booths – set up costs of around 18 billion yuan. Other estimates of costs range from around a third amount to close to double. If the 15-minute policy only applies to big cities, only 200,000 testing sites will be needed.
Each test costs 4.5 yuan for pooled testing and 23.5 yuan if the infection rate is high and pooled testing is unavailable. If half the people in big cities take tests every 2 days, costs run to more than 350 billion yuan a year. As with setup costs, estimates vary wildly from 60 billion yuan to 750 billion yuan.
Since the Shanghai outbreak began, doctors and nurses around the country have put aside their regular work to focus on mass testing. The arrangement is temporary but has caused staff problems. It is not viable to rely on doctors and nurses in the long term. If mass testing becomes regular, at least three workers will be required per site, sending costs spiraling.
To put these numbers into perspective, 350 billion yuan is 0.3 percent of China’s GDP and 20 percent of its healthcare spending, rising to as much as 40 percent in the most pessimistic projections.
Each province will be different, given its urban population and fiscal condition. Guangdong will incur the highest costs (90 billion yuan) requiring around 7 percent of its fiscal revenue. Guangxi, in contrast, will spend a fifth of its revenue, even though the average cost per test will cost less than half that of its rich neighbor.
In June 2020, 100 billion yuan of government bonds were issued to fund pandemic control. Some have suggested doing the same again. Another concern is the extent and quality of general health care and of medical insurance coverage.
Community health centers, primary care clinics and even private businesses such as pharmacies will have to participate. Even a small slice of it will be a big win for whoever is awarded testing contracts, though the potential for conflict of interest is painfully obvious.
“If for-profit institutions get into the testing game, will we ever stop testing? Will the pandemic ever end?” said a healthcare worker who prefers to remain anonymous. He said public medical institutions and community healthcare facilities should take more responsibility, and if a third-party for-profit institution is to run testing sites, more regulatory moves from the authorities are needed.