British experience suggests that ‘free’ antigen testing alone is not enough
By now, most Londoners are familiar with the NHS Test and Trace Covid-19 self-test box.
This is what you take before you see your extended family. This is what you subject your high school students to on a Sunday night. This is the test we take after a âriskyâ weekend or going to the pub as we used to call it.
Between spring and September, these boxes were free at the local pharmacy or library. Since September we have to call the NHS or go online to get a code. The code allows us to go back to the pharmacy and pick up another box. Dab and repeat.
The UK government introduced the bi-weekly testing program for all school staff and secondary school students in August. If the test gave a positive result at school, the student would go home.
Now, most schools require students to test themselves twice a week at home, on Sunday and Wednesday evenings.
Above all, the tests are free. You don’t pay anything. Schoolchildren pay nothing. (Certified travel antigen testing works under a private, paid system, just like PCR testing.)
The deployment of the antigen test has not been without controversy.
As in Ireland, there were concerns that routine ad hoc testing would encourage risky behavior. Doctors here say it’s hard to provide evidence anyway.
In addition, there were questions about value for money.
In January, the British medical journal said Â£ 1 billion had been spent on testing. At the end of May, the I The newspaper reported that the Department of Health and Welfare had spent Â£ 3.14 billion on them “since February”.
In June, damning coverage of a National Audit Office report suggested that only 14% of the nearly 700 million tests could have been used.
Most importantly, the report referred to tests “that weren’t logged,” meaning that users hadn’t interacted with Test and Trace. The report’s authors recommended a public information campaign to bring users into the orbit of official contact tracing.
As the report suggests, however, there appears to have been some waste. Some communal areas have even reported stocks, although such dizzying enthusiasm seems to have given way for more reason.
âThere is a fascinating association with [the word] ‘free’, âsays Dr Dean McDonnell, a psychologist licensed by the Psychological Society of Ireland and co-author of an article on how Covid-19 has affected health behaviors.
âThe environment we associate with ‘free’ tends to be marketing. And if the public perceives marketing, they are more inclined to be wary.
McDonnell suggests that the introduction of community testing – in places such as schools, sporting or musical events – could encourage adoption, especially among those in need of persuasion.
âIt’s incredibly uncomfortable,â says Dr. McDonnell, âno one likes to put it in their face. But it is a necessary discomfort.
âSome people will need encouragement, and seeing other peers take tests in an incentive environment – like going out – keeps you from doing something you don’t enjoy. “
High viral load
Doctors say antigen tests are imperfect but still useful and certainly better than nothing.
“They are used a lot more [than PCR] in screening for asymptomatic or pre-symptomatic [cases] people who could be infectious but don’t know it, âsaid an NHS infectious disease consultant Review.
âIt requires regular testing because the tests themselves are quite insensitive. The individual might not be contagious at all on Monday, but could be on Wednesday.
âIt might not be until Friday that you develop symptoms, by which time you have had two days to infect people if you haven’t already had a test.
“It’s flawed compared to PCR, but it’s good at detecting people with a lot of viruses, but bad at detecting people with low amounts of the virus,” the consultant said.
There is some correlation between a positive antigen test and a high viral load PCR result.
It should be noted that âfreeâ antigen testing does not appear to have significantly reduced the amount of virus circulating in the UK. As of Thursday, more than 40,000 cases have been reported.
Perhaps this is not surprising, as children who are dutifully tested twice a week have to travel to school on buses or trains in which only half of their transport mates continue to wear masks.
Antigen testing, even free, is not a solution in itself.
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