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Learning to Live with COVID-19
I read a lot about COVID-19. I am optimistic that we will see significant improvement in 2021 with the potential of one or more vaccines, improving treatments for those who are stricken with the virus and hopefully enhanced testing and improved contact tracing.
Barring a miracle, it is unlikely that COVID-19 will go away. As such, it has been encouraging to see some shift in messaging from some public health authorities from a fairly steady stream of fear laden messaging to the reality that we have to learn how to live with COVID-19.
Rapid COVID-19 testing is an important part of living with the virus. I recently had the pleasure of presenting at CMC Canada’s national conference. As part of my presentation, I asked attendees if they felt that they had enough information about rapid COVID-19 tests to have confidence in them. 58% of respondents said no. With that, there seems to be a need for more information. This is my effort to help.
There are three main categories of tests:
- Molecular or polymerise chain reaction (PCR) tests determine if a person has an active infection.
- Antigen tests determine if a person has an active infection, by looking for pieces of proteins that make up the SARSCoV-2 virus. Most rapid tests fall into this category.
- Antibody (serology) tests determine if a person has had a past infection by looking for antibodies against SARS-CoV-2 in the blood.
PCR tests are the most prevalent tests at present. PCR tests look for pieces of SARS-CoV-2, the virus that causes COVID-19, in the nose, throat or other respiratory tract areas. UC Davis has recently announced a new rapid molecular test to identify both COVID-19 and the flu.
Rapid COVID-19 Tests – Important for Living with COVID-19
Rapid COVID testing has an important role to play in helping us to live with COVID, opening society faster, and keeping it open. However, a recent report indicates that rapid COVID-19 tests are slow to be used in Canada because health officials are unsure of reliability and best use.
There is concern that most rapid COVID-19 tests might not be as reliable as PCR tests, referred to as a gold standard, for detecting a person infected with COVID.
Health Affairs is a leading peer reviewed journal of health policy, thought and research. David Paltiel, MBA, PhD is a professor at the Yale School of Public Health. Rochelle P. Walensky, MD, MPH, is the chief of infectious diseases at Massachusetts General Hospital and professor of medicine at Harvard Medical School. In September, Health Affairs contained an article from Paltiel and Walensky that provided excellent insight about rapid COVID testing. The following is a summary of key points:
- Not everyone who has detectable levels of SARS-CoV-2 virus in their airways (an infected person) represents a risk to transmit the virus to others. To control the spread of COVID-19, infectious people need to be detected and isolated.
- The PCR test is better to determine if you are infected with COVID. A rapid saliva-based test, even with a risk that it could miss up to 30 of 100 infections (a 30 percent false negative rate) is likely the better tool for judging infectiousness.
- Paltiel and Walensky state that rapid, saliva-based antigen testing is an essential weapon in the fight to resume many of the activities and reopen many venues that comprise what we used to call “normal life.”
- Caution is necessary. Because the period of infectiousness only lasts about 5 days, antigen tests need to be conducted again and again. A negative antigen result received 10 days ago tells you virtually nothing about your infectiousness today. Paltiel and Walensky suggest that rapid tests should be re-run at 2-3 day intervals.
A recent article in the MIT Technology Review about rapid COVID-19 tests contained comments from Dr. Donald Thea, a public health expert at Boston University School of Public Health. His perspective on COVID-19 rapid tests align with those of Paltiel and Walensky. Thea commented that COVID-19 rapid tests allow you to find infectious cases – particularly very infections cases, like superspreaders – early, and allow them to self-quarantine to break the chain of transmission. Thea also commented that even though the lower accuracy of rapid tests means there will be some false positives and false negatives, you are still catching individuals who are highly infected and shedding a lot of virus.
I am not a scientist nor an expert in public health. I am a management consultant with a focus on risk management and a former auditor, so my perspective on rapid COVID-19 testing is seen through that lens. Based on the insights from Paltiel, Walensky, and Thea who are experts in the fields of public health and infectious diseases, it seems reasonable that rapid COVID-19 testing could help us to resume many of the activities and reopen many venues that comprise what we used to call “normal life”, with the caveat that no test provides 100% certainty. It is also important to keep in mind that it is likely not possible, or at least not easy, to reduce the risk of spreading COVID-19 to zero.
Unfortunately, there are no national guidelines in Canada on how rapid COVID-19 tests could be deployed to help us get back to “normal life”. As such there are risks that deployment may be inconsistent and slow across Canada which diminish the benefits that rapid testing could provide.