THE GOVERNMENT’S EXPERT Advisory Group on Rapid Testing (RTEAG) suggested over two months ago that antigen tests should be used twice a week.

Government advised the public last week that people attending bars, restaurants and other indoor environments should consider using antigen tests multiple times a week to limit the spread of Covid-19. 

The recommendation was contained in the most recent letter from Chief Medical Officer Dr Tony Holohan to Health Minister Stephen Donnelly about NPHET’s latest recommendations, sent on 9 November.

In his letter, the CMO noted that the RTEAG recommended the use of antigen testing by individuals who regularly engage in higher-risk activities “such that they should consider self-testing on a serial basis, at a minimum of twice weekly”.

It is understood that this is the first time the minister heard about the recommendation to self-test twice a week.

But minutes from a meeting of the RTEAG, held via Zoom and attended by the minister, show that the group discussed the proposal about how often self-testing should occur on 1 September.

The minutes note that the group agreed to “recommended frequency for self-testing should be twice a week and self-administered”. 

While Health Minister was in attendance for most of the meeting with his adviser, notes state that Donnelly left the meeting before the frequency of self-testing was discussed. 

However, sources who spoke to The Journal said it would be inaccurate to claim that the minster was sitting on the recommendation for over two months. 

The Journal also asked the Department of Health about the RTEAG discussion on regular self-testing that took place on 1 September, and why it took over two months for NPHET to approve the group’s recommendation.

In response, a spokesperson said that the RTEAG “may discuss particular issues at more than one meeting before making a recommendation to the minister”.

“The RTEAG, on an ongoing basis, discusses and reviews the use of rapid testing in a wide variety of settings,” a statement read.

“As you will note from the minutes, these discussions are informed by ongoing research and evidence synthesis.

“The group makes recommendations to Minister Donnelly for consideration on an ongoing basis, informed by these ongoing bodies of research, evidence and data gathering.”

Cost-benefit analysis

At the same 1 September meeting, the RTEAG also discussed how a cost-benefit analysis of antigen tests wider use “would be important”.

The minister asked for the group’s advice on whether to make antigen testing “free to the public or charge a nominal fee”.

He told the group at the meeting that antigen testing would be an additional tool in the fight against Covid-19, saying that it would play an “important role… when society fully opens up”.

And he further asked whether the group would issue advice to him about the best method to rollout the use of rapid tests by means of GPs and pharmacies, and for use in schools. 

He requested that a report would be sent to him regarding the mass deployment of antigen tests in conjunction with the Covid App, or whether it should be done geographically or by sector.

A source told The Journal that over the past three months, there has been a “massive undertaking” of evidence-gather and the development of a framework and modelling system for antigen testing. 

The RTEAG has linked up with Canadian researchers to correlate how rapid testing works over a six-month period to ensure ongoing monitoring of its use.

Logistics 

Speaking on RTE’s News at One today, the head of the RTEAG Professor Mary Horgan said NPHET had recommended that people engaging in high-risk activities should take two antigen tests three days apart.

She also said that antigen tests are “really good at picking up people that are infectious”, but acknowledged that a lot of logistical work is needed to widen their use.

The group previously looked at a range of issues to achieve this, including: the type of tests that should be used; how individuals would use tests; where and when tests should be used; and whether to link antigen test results to the test-and-trace system through a new online portal.

Horgan also explained that while survey results initially showed that the general public had limited understanding of how antigen tests work, she believed this was now changing as more people use them. 

She said this could “change faster” if educational materials were provided, and highlighted how people “should be brought to educational material” like YouTube videos and frequently asked questions when they search for antigen test tutorials online. 

“That is a key component,” she said. 

The HSE’s video on antigen testing (which can be viewed here) is currently unlisted on YouTube and is not searchable on the platform.

Ferguson report

Senior sources have said the RTEAG have worked tirelessly to get antigen tests on the agenda, and noted that it was seven months since a report to government recommended their use in certain settings.

The Ferguson report said that antigen tests “should complement” existing PCR testing programmes and that there was “growing evidence” for asymptomatic antigen testing due the increased commercial availability of the tests. 

The group suggested at the time that if studies were successful, widespread rapid testing “could be in all schools by September 2021″.

This week’s recommendation follows questions by Opposition TDs as to the pace of the formal rollout of antigen testing by the Government.

Speaking in the Dáil this week, Labour leader Alan Kelly said: “It is a year since I raised the issue of antigen tests. I have been taking them for a year because I have elderly parents. They are not a panacea, but they help.”

He asked the Taoiseach whether a subsidy would be put in place for antigen tests, and called on the government to consider giving them away for free until 1 January.

However, Stephen Donnelly said that the tests will not be free, although they will be subsidised.

This decision has been criticised, even by those within the government parties, including Fine Gael Senator Regina Doherty, who suggested that it showed that people are not being trusted.

Not Giving #Antigen tests for free is nothing to do with money - listening to Dr Tony Holohan on @RTENewsAtOne it’s all about not trusting Irish people to use them ‘properly’

— Regina Doherty (@ReginaDo) November 17, 2021

But Taoiseach Micheál Martin defended the move in the Dáil today, saying that Ireland “can learn from the UK experience where the wider deployment of antigen testing did not all go to plan”.  

Despite the move towards the wider use of antigen testing, there are no indications from Government that the system will be used for hospitality, which continues to rely on the Covid Pass. 

Previously the Taoiseach said the Government would adopt a three-phase approach in reopening hospitality, firstly with the use of vaccination certificates, and “in the second phase to do an assessment of the potential use of PCR testing and; in the third phase to look at antigen testing”.