COVID-19 infections – and the diagnosis and recording of infections as ‘case numbers’ – will always matter. However with the collapse in testing, test positivity rates soaring, PCR restricted to a small fraction of people and rapid antigen tests (RATs) largely unavailable and unaffordable, case numbers are no longer informative. Trends can only be reliably monitored by tracking hospitalisations, which lag case numbers. Testing and tracing are pillars of epidemic control, and the WHO has called on countries to strengthen both to deal with Omicron. Australia has done the opposite.
Without adequate case finding (which relies on testing at scale) and contact tracing, the Omicron epidemic will grow and both health and the economy will suffer. Testing allows us to find infected people and isolate them so they do not infect others.
Contact tracing is conducted because close contacts are at highest risk of becoming infected next, and if they are not identified, tested and quarantined they will go on to infect others and cause exponential epidemic growth. Contacts need to be traced and tested within 24 -48 hours to stop them infecting others. RATs become even more important as an adjunct to digital tracing with QR codes when governments cannot keep up with the scale of cases. Yet we have seen abandonment of tracing efforts. For those who can find and afford a RAT, inadequate communication has been provided on false negatives early during Omicron infection, and on possible lower sensitivity of nasal vs throat swabs.
The ongoing spread of COVID-19 continues to cause death and illness, including “long COVID”, as well as disruptions such as staffing shortages across all industries and supply chains. Governments, as the central public health decision makers and system funders, have an obligation to protect citizens from premature death, widespread disease and disability.
OzSAGE believes public healthcare must be publicly funded to ensure that vulnerable communities are not left behind. It is essential for RATs to be provided for free to the public and for adequate supply to be made available. RATs provide a practical control to limit the spread of disease and decrease the load on ambulance services and Emergency Departments. Hospitals, General Practices, Residential Aged Care Facilities and Disability Services are examples of services that can be kept safer with a RAT program.
- RATs should be made free and readily available by government to all Australians including in regional, rural and remote areas and those in disadvantaged populations. Free RAT provision should include the close contacts including the asymptomatic and not just those who are unwell. Ready access and choice of saliva RAT is important as it is easier to use for some individuals, including those with disability.
- Information regarding which RATs are approved, how best to use them and their appropriateness in different circumstances must be shared publicly, in easy-to-understand community languages.
- Enhanced educational material about how to properly undertake a RAT, with verbal, written and pictograph forms of information must be provided.
- QR code or equivalent system should be set up with RATs that link into digital result tracking to assist with case identification, case surveillance and contact tracing.
- Website/hotline be established of where RATs are available, in real time.
RAT are simply one of the Vaccines Plus tools and a component of “test and trace”. All other controls, including child vaccination, third dose vaccination, safe indoor air ventilation and N95-level respirators are also vital to cut the spread of disease.
The TGA has approved some 22 rapid antigen self-test kits (at time of writing). This means there is information available on the sensitivity, specificity and external validation of these tests. Our OzSAGE document describes considerations in better use of RAT and definitions of sensitivity and specificity.
Provision of RATs to General Practice is critical to continuing the vaccine rollout and being able to stay open to look after our patients’ healthMs Anna Davidson, General Practice Manager
RATs provided free to all, will add to other layers of control that individuals put in place in their businesses and homes and help stop the exponential spread of disease with disruption to critical and safe function of societyDr Karina Powers, Occupational and Environmental Physician