By Rosie Collins*
New Zealand is swiftly moving to a suppression strategy. That means Covid is in the community, but we are still using some safety measures to slow the spread. This is to buy time for vaccination and mostly to avoid overwhelming our overstretched health system.
To suppress the virus effectively we need to quickly roll out rapid antigen testing (RAT), an easy and quick self-administered test. The alternative, the PCR brain-scrape currently in use, is time consuming, only available at a testing centre, and perhaps worst of all, requires talking to other people – all reasons why someone might avoid being tested if they’ve only briefly been at a location of interest or are experiencing just a mild sniffle.
Making at-home testing easy to access is the kind of “nudge” policy we need – it reduces the “sludge” of a test taken in the company of strangers, where results take more than a day to come back.
What is RAT & why use it?
Rapid antigen tests are nasal swabs taken at home which return results in about 15 minutes. They cost about $10-15 each, compared to $130 for a PCR test that goes to a laboratory.
They are less sensitive than PCR tests, which made them less useful during our elimination phase when every case needed to be picked up.
Now that Covid is circulating more widely, we need to make it easier for people to get tested more frequently. The chance of being exposed has ballooned. No longer does the risk of exposure happen just a couple of times a year, like when that guy from Sydney had his holiday in Wellington in June. Vigilance is needed daily.
Singapore, Australia and the UK have already rolled out RATs. A culture of regular testing means far more cases are being picked up. Sure, the less-sensitive RAT might not pick up that you have Covid on Tuesday, but if you test again on Saturday, or someone else from your home does, odds are good that you’ll find out soon enough.
Hidden cases
Because of our high vaccination rates, cases are now more likely to be asymptomatic while still going on to infect others. In the UK, 1 in 3 people with Covid reportedly are asymptomatic but infectious.
In Singapore, where 85% of people are fully vaccinated, 98% of cases show no or mild symptoms. Still, a third of their ICU beds are being used by Covid patients.
Our narrow ICU capacity means we’re going to be dancing this tightrope too.
Learn from others
The challenge we face is making it easier to pick up more cases quickly to slow the spread of the disease. No one wants to make their kids, parents, or flatmates sick.
Here we can learn from others. In Singapore, every household received six free RAT kits in September, in preparation for the arrival of the delta variant. Additional tests can be picked up from vending machines around the city for those notified of potential exposure.
In Australia, rapid tests are available at supermarkets, 5 for $50. In the UK home testing kits are free. They’re encouraging people to test twice a week, as part of their usual routine.
Lean into convenience
“Nudge” theory tells us we need to make it easy for people to do the right thing, in this case to get tested.
If the process is a bit of a hassle, in contrast, then it is “sludge” design. When there are barriers to people getting tested, it is easier to accept on some level why people don’t, and it can lead to a lax testing culture.
When it comes to testing, we want as little “sludge” as possible to set good social norms.
RATs in every home
Last month I couldn’t get tested at either of the two doctors on my road, so the only choice was to walk 40 minutes each way to a testing centre. I don’t have a car, and Uber is not an option for people who suspect they may have Covid. After a PCR test you must isolate, sometimes for multiple days, while awaiting results.
It’s a lot of hassle and it’s time consuming, so much so that most people won’t be tested regularly on the off-chance they are positive but asymptomatic (and in fact usually can’t be tested under current rules).
It also doesn’t work if you live out of town, don’t trust public institutions, or aren’t able to drive to a testing centre.
When I was feeling under the weather it would have all been so much easier if there were home kits available. Free tests in the mailbox, in supermarkets, and in vending machines would all make a real difference as we head into the summer, when more of us will be moving around.
With free, and freely available, rapid testing it’s easy to test yourself simply as a precaution. I would love to check that I don’t have Covid before visiting my 80-year-old nana. Instead I have to gamble that I’m not positive but asymptomatic.
Get going
Fighting the pandemic without all the tools in our toolbox doesn’t make much sense. Human behaviour means that if we want testing to be a part of our suppression strategy it needs to be as easy and painless as possible in every way.
If we don’t succeed in suppressing the spread, our hospitals are going to become overwhelmed and we will be looking at new restrictions and a stop-start summer.
The UK hasn’t got much right on Covid, but its antigen testing policy is gold. Free, widespread, and regular rapid testing is the way to go. Suppression will be a bust without it.
The sooner the RATs hit our streets the better.
*Rosie Collins is an economist at Sense Partners. This article first appeared on The Spinoff and is used here with permission.
22 Comments
Absolutely. A vital tool as evidenced overseas and that inexcusably has been refused to be used in NZ. Surely complete commonsense! If you at home can identify that you sore throat or whatever symptom is just that and not covid then firstly that sets your mind at rest, secondly ditto for your family and thirdly prevents you joining the crowd at testing or your GP. Having this facility and ability as early as possible was stressed by the government’s own paid advisors, Roche & Simpson and inexplicably & incompetently ignored. NZ & NZr’s have suffered the consequences accordingly.
RATs testing is in a recent journal of Infectious Diseases had a sensitivity of 69% compared to PCR testing which was 97%. Sensitivity measures the ability to correctly signal a positive result. This means that if 100 Covid +ve patients were tested only 69 out of the 100 would return a positive test. It's not quite the magic bullet that people might imagine.
This is an important adjunct to vaccines and PCR but for high risk enclosed environments such as hospitals, and aeroplanes it isn't a good enough tool in my opinion.
We need to accept risk reduction now, not keep trying to take risk to zero. In a highly vaccinated environment, that's just overkill.
Let's summarise what we have in our arsenal:
- 70% effective but immediate Rapid Antigen Test (worst case effectiveness)
- 90% effective vaccine
- 70-90% effective at-home treatment (Moderna and Pfizer pills available next early-mid next year)
Those are your risk management tools before you even hit the base risk of severe Covid itself, which for most people is <5%.
Multiply all those together - how many more layers of protection do you demand before it all starts to get a bit silly?
[Pfizer] Vaccine effectiveness against hospital admissions for infections with the delta variant for all ages was high overall (93% [95% CI 84–96]) up to 6 months.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)0218…
I think valneva is better (traditional live attenuated virus). Novavax is still just spike protein + adjuvant. The problem with spike protein alone is that you're not developing T-cell immunity to all the other virus proteins. Also spike protein is thought to be toxic and nasty in itself.
“A good plan, violently executed now, is better than a perfect plan next week” — George Patton
Wish I had saved the link (and can't be bothered trawling my history) but I read last week a good report from a group of German health experts - their view was that mass testing is one of the most important tools in the arsenal, because once you start letting people run amok under the auspices of a vaccine passport system, people will generally behave as if there is zero risk of catching or transmitting Covid.
Widespread testing is the only way to counter this, e.g. testing before entering events or other "super spreader" scenarios.
You won't pick up everything because the accuracy isn't so strong, but you will catch the bulk of it and then be able to minimise spread further.
The MOH and government are showing their arrogance in not wanting to admit they should have had RAT up and running last year.
I was listening to a woman who had come back from working on this in a university the states, where it was developed, on Radio NZ last year.
She very exited about it and at the time she thought it was almost there, and she said within weeks it should be up and running.
This was in about September last year, it's appalling it's taken so long to make this widely available, and still hasn't been.
RAT in asymptomatic (i.e. vaccinated) individuals is pretty much a coin toss, with a sensitivity of around 50%. That is, you may as well just guess whether the person has it or not.
It will be interesting to see what the intended purpose of these is, and how the results are meant to be useful, but in the meantime I'm sure there's a lot of money to be made by selling them.
They don't want to talk about it, because they think it will discourage vaccinations if people know there's an incredibly effective treatment coming.
Vaccination has become an ideology in itself. Just look at the data used to justify 5-11 year old Pfizer vaccination. It probably won't do harm, but the reward/risk ratio is about as close to zero as you can get for individuals in that age group.
Well Molnupiravir is mutagenic so good luck with that one, but then again the vaccine itself could be carcinogenic / mutagenic. Paxlovid has one clinical trial so we'll see how that pans out. In the meantime we're just pretending that highly effective prophylactics like vitamin D, and zinc, or treatments like ivermectin don’t exist. Ivermectin has clinical trials involving almost fifty thousand people, 31 of the clinical trials are RCTs with most showing strong efficacy.
Cannot see the point in testing myself. If you get sick, stay home until you recover. Let someone know your sick if your living alone because really that's a dangerous situation to be in as we have already seen with a couple of deaths. You don't want to get to the point you so sick you should have been in hospital but can no longer make the phone call.
Since the idea has not come from the Ministry of Health under the 'leadership' of the sainted Dr Bloomfield, they will try their utmost to block it for as long as possible.
Anything that appears to take control away from 'the centre' is looked on with grave suspicion by this government.
Anything that is not a vaccine is officially discouraged by the Govt. Otherwise, people might start believing that vaccinated people can get Covid. Currently the Govt is pushing the line that only unvaccinated people can get covid and transmit it to other unvaccinated people, who will all end up in hospital, thus preventing vaccinated people from getting hip surgery and cancer treatments. Banishing the unvaccinated from society will make the world 100% safe for vaccinated people. Now if you start requiring vaccinated people to take regular tests then you destroy the vaccine illusion the Govt has so carefully cultivated.
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