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COVID-19: Expert hopes province will shed its distaste for rapid tests

‘Rapid tests have been proven to be quite useful in a number of different settings,” says infectious disease expert Dr. Brian Conway

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The holiday season was a scramble between the haves and the have-nots: Those that had access to rapid antigen tests for COVID-19 and those that did not. Some got them from employers, others shelled out to order online.

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With the Omicron variant spreading and the province limiting PCR testing, demand for rapid antigen tests has skyrocketed. The more accurate PCR tests are reserved for “those who really need it,” as the provincial health officer put it, including health care workers and people in a high-risk category.

Many in B.C. wonder about why health authorities here are unwilling to use the rapid tests more widely, as some jurisdictions have. Although their reliability on detecting Omicron has not been fully determined, a study  in August found rapid antigen tests taken at home were 78.9 per cent accurate.

On Tuesday, after Dr. Bonnie Henry was accused of withholding a stockpile of rapid antigen tests, she called the suggestion that the province had millions of tests in a warehouse an “urban myth.”

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On Wednesday, the Health Ministry told CTV the province has 1.3 million tests on hand and was expecting 17 million more from the federal government. On Thursday, it said approximately 500,000 tests would be arriving in B.C. by Jan. 12.

“As our supply increases, we’ll be able to expand use of rapid tests beyond the priority health care settings. A key focus in the coming week, as we receive increased supply, will be how we provide additional rapid tests to K-12 starting the week of Jan. 17,” a statement said.

Dr. Brian Conway, the medical director of the Vancouver Infectious Diseases Centre, hopes Henry will rethink her position.

“Rapid tests have been proven to be quite useful in a number of different settings and people have made up their minds as to their usefulness,” said Conway.

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While rapid antigen tests may not be as accurate as PCR tests, Conway said they can be a helpful tool to curb spread in limited social settings.

Dr. Brian Conway with rapid test in Vancouver.
Dr. Brian Conway with rapid test in Vancouver. Photo by Arlen Redekop /PNG

“If you bring someone new into the environment, who brings in a bunch of other contacts by extension, the usefulness is to ensure they are not bringing COVID,” said Conway. “If you introduce someone new, a boyfriend, a friend from out of town, if they are positive, they can’t come in.”

Conway cautioned that a negative test doesn’t mean a person does not have COVID-19.

“You still need to be very careful.”

Certain workplaces, such as long-term care facilities, could benefit from doing “serial tests” in staff in addition to the single tests already required for visitors. The same goes for other health-care settings where concerns about preserving service capacity are paramount.

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“We might want to have some policy of repeat testing in key areas,” said Conway.

Distribution of rapid tests needs to be “planned very carefully,” said Conway, “and always understood in the red light, green light scenario. The red light is you can’t come in if you are positive, but a negative test doesn’t mean you aren’t infected. … There is no green light.”

The goal, said Conway, is not to use rapid tests to allow people to bypass restrictions, but to “strategically use rapid tests to get around some of the limitations of the testing system.”

Rapid tests have long had a place in public health, not just to detect diseases in individuals, but to track their spread in communities. “There are rapid tests for strep and the flu, HIV and hepatitis C, and we do that regularly,” said Conway, who uses them in his outreach programs on the Downtown Eastside.

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As for the accuracy of rapid COVID-19 tests, Conway said, “They pick up 70 to 75 per cent of cases, that’s not nothing.”

Shirley Seary, 69, and her husband Chris, 72, were protected over Christmas after Seary’s daughter tested positive on a rapid antigen test she had picked up at UBC — and cancelled Christmas together. “It was good the tests were available. It kept us safe,” said Seary.

Vancouver actor Ellie Harvie ordered rapid tests online in early December “before the madness,” so she and her family could test before having a small, within limits, gathering. “I had been using them for a TV project I was on, so I knew how to use them.

“We all tested negative,” said Harvie.

Conway said he is hoping for a more open discussion about the use of rapid antigen tests. He believes that the public will be able to use them effectively. “I think we are smarter than we used to be in terms of COVID-19, and that on the whole, the risks are outweighed by the benefits.”

On Thursday, Ontario announced it would be expanding access to rapid antigen tests in three sectors: testing for return-to-work after an infection, testing people without symptoms as a screening method, and for those with COVID-19 symptoms.

dryan@postmedia.com

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