An expert group convened by the Government has split on the role of rapid antigen testing in suppressing Covid-19 and reopening society.
While the final report of the expert group, chaired by Government's chief scientific adviser Prof Mark Ferguson, recommends widespread use of the tests, including the potential for mass rollout in schools by September of this year, it was not supported by all members of the group.
A note on an unpublished copy of the report, seen by The Irish Times, says it is a "majority report" supported by four members of the six-person group, but not by two senior doctors in the Department of Health and the Health Service Executive.
The Irish Times reported last week that there was division among members of the group over the report, which was submitted to Minister for Health Stephen Donnelly recently.
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Notwithstanding the split in the group, the majority report finds that rapid antigen tests should be deployed across a range of different settings in Ireland, with widespread use in schools possible by September this year.
Unlike PCR, which looks for the RNA of the virus, antigen tests look for specific proteins made by Covid-19. The tests, which take 15-30 minutes to produce a result are much cheaper but most are less sensitive.
The report recommends an ambitious rollout of the technology across a wide range of settings, including in schools, to facilitate sport, and in universities and workplaces around the country. It calls for the HSE and the Department of Education to “immediately establish at scale” a series of pilots and feasibility studies in primary and secondary schools.
It argues that there is a growing evidence base for the use of the tests amongst asymptomatic people alongside the growth of commercially available rapid tests, stating that “it is important that Ireland is positioned to take advantage of these developments”.
It says that if the pilot results are positive, “widespread rapid testing could be deployed in all schools by September 2021”, and that a strategy of rapid testing could be deployed before major State exams.
The report was supported by Prof Ferguson, Prof Kingston Mills of Trinity College Dublin, Prof Paddy Mallon, a consultant in infectious disease, and Prof Mary Horgan, also a consultant in infectious diseases and president of the Royal College of Physicians in Ireland. However, Dr Lorraine Doherty, National Clinical Director of Health Protection with the HSE and Dr Darina O'Flanagan, a special adviser to the National Public Health Emergency Team at the Department of Health did not support it.
The report calls for an immediate start to implementing its recommendations and says rapid testing should be a “shared community action and responsibility” across community groups and State agencies, and that consideration should be given to naming the programme.
Those who test positive should obtain confirmation via a PCR test through the existing HSE system, it says, while the Covid-19 app could be adapted to allow people their tests and upload them.
Tests which meet certain standards and have been validated by the European Commission Joint Research Centre can be rolled out on a self-administration basis, "allowing people to take control over their health", the report found. However, the State should also consider using tests that have been validated alongside published results in other non-EU countries.
While governance of testing programmes executed by the HSE would fall within its governance structures, the report notes that “careful consideration needs to be given for appropriate governance structures” for programmes that will be executed by a range of actors and involve a high degree of self-sampling, testing and reporting.
It argues that tests which are easier to perform, generate rapid results and do not need specialised infrastructure or equipment could be used to supplement current PCR testing, including the establishment of mobile testing facilities which could be rapidly deployed to outbreaks, clusters or high-risk areas.
It recommends that a number of major pilot programmes be established quickly to collect data on the use of the rapid tests, including in employers, Government agencies and departments, community groups, schools, colleges, sporting organisations and among the public.
“Particular focus should be paid to young people who will be the last to be vaccinated, who are more likely to be asymptomatic, have been identified as key early drivers of [Covid] infection, have the lowest risk of severe disease and the greatest desire to socialise responsibly,” the report states. A group should be established to co-ordinate sharing of information on tests, sampling and training which will allow organisations establish their own testing programmes.
It calls on the HSE to assist in the establishment of rapid testing in schools, healthcare settings and other parts of the public sector. The health service should also establish programmes in nursing homes and other residential care facilities where most residents have been vaccinated, allowing visitors to undertake face-to-face visits if they do not test positive on arrival.
The tests should also be used by the HSE in combination with PCR testing to “rapidly identify and isolate infectious cases” when an “index”, or first, case is identified. The tests could also be used to screen workers or contractors visiting settings where there are vulnerable people, or other healthcare settings, in prisons, homeless shelters, direct provision and other settings.
The Department of Enterprise and employers should establish rapid testing programmes and pilots in workplaces, especially where significant face-to-face interactions or attendance at workplaces is required from employees. The Department of Further and Higher Education should establish rapid testing in third-level institutions aiming for voluntary serial testing of students and all staff at least twice a week, with a particular focus on students in halls of residence.
“Such testing would facilitate the safe return to campus-based activities,” the report finds, and it argues that as infection rates drop and higher vaccination achieved, it “should be possible to safely pilot whether [rapid tests] would allow the relaxation of social distancing in lecture theatres and laboratory-based teaching venues”.
Government departments should be asked to deploy regimes alongside sporting organisations such as the GAA, IRFU and FAI for the rapid testing of participants initially “and then spectators, to enable a more widespread safe return to both outdoor and indoor sport”.
