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WHY ANTIGEN TESTING, and why now?
It’s been a long, querulous debate throughout Ireland’s pandemic with health experts regularly clashing with politicians and with each other over the use of antigen testing versus PCR testing.
The Government announced yesterday that it is to increase the use of antigen tests, advising that they be used by fully vaccinated people who are deemed to be close contacts of a confirmed Covid-19 case, but who have no symptoms.
Taoiseach Micheál Martin confirmed that antigen tests will have an “enhanced role” as part of a series of new Covid-19 measures, and that tests will be sent to symptomless fully vaccinated close contacts of confirmed cases.
“A more wider use of antigen tests is certainly on the cards,” the Taoiseach said in response to a question from The Journal.
Tánaiste Leo Varadkar said that there would be more information on how exactly this would work “very soon”.
What is an antigen test?
Antigen tests – or ‘lateral flow’ tests – give a result quicker than a PCR test, usually within 10-15 minutes, but are not as accurate – particularly for those without symptoms.
PCR tests, seen as the gold standard in testing, are the type of test used to confirm that someone has Covid-19 – this type of testing is done in a laboratory, and can take up to 48 hours to give a result.
Taoiseach Micheál Martin has said previously he would like to see more widespread use of antigen testing as Ireland reopens, but NPHET have shied away from recommending that so far, arguing that the tests are not as good as PCR tests.
“It’s not a skepticism of antigen testing, it’s the absence of evidence to show that they work well enough to recommend their use,” Chief Medical Officer Dr Tony Holohan said at a NPHET briefing in July.
NPHET on Monday, however, recommended to Government that the HSE should implement a programme of Covid-19 antigen testing, and get a PCR confirmation in the event of a positive result.
It also recommended that the Rapid Testing Expert Advisory Group be requested to provide a view on voluntary self-testing by asymptomatic individuals who plan to engage in high-risk activities, such as going to nightclubs; and that the Group be requested to examine rapid testing as a part of the Covid-19 pass for those for whom, on medical grounds, it is not been possible to get fully vaccinated.
But wasn’t it only recently that antigen tests were dismissed by NPHET?
That’s true.
As well as Dr Holohan’s remarks from July, his NPHET colleague Professor Philip Nolan made headlines in May when he dismissed the use of Lidl antigen tests out of hand.
Responding to a tweet by the supermarket chain, which was advertising the sale of its new antigen tests alongside barbecue goods such as sausages, Nolan said:
“Can I get some snake oil with that? It makes for a great salad dressing with a pinch of salt and something acerbic. Stay safe when socialising outdoors over the next few weeks. Small numbers, distance, masks. These antigen tests will not keep you safe.”
Nolan’s comments were described as unhelpful by Minister for Health Stephen Donnelly who said antigen testing is a part of Government policy when it comes to reopening society.
“I don’t think it was a helpful comment, if I’m honest. It is Government policy.
“I have great respect for Professor Nolan and I have no doubt that his concern was around people using them in the wrong way,” Donnelly said today.
“I think it is entirely possible that anybody just going into a supermarket and picking up a pack without maybe having had a conversation about the fact that if you get a negative result it really doesn’t necessarily mean you’re negative at all that it could create a certain risk.
“But I think they are one part of the tool kit we have and I think as the technology gets better and better and the specificity and sensitivity of the tests gets better and better and the usability of them as well gets better and better, I think there is a good chance that as the year progresses and probably through next year they will have a more important role to play,” said the minister.
There was a nuance behind Nolan’s tweet that wasn’t put across, however, as outlined by Donnelly – antigen tests could give people a false sense of security, and it’s worth remembering that only 40% of adults in Ireland had received a first vaccine dose by that point.
(We looked at the issue in detail in an episode of The Explainer podcast which you can listen to here.)
Donnelly in April set up an expert group tasked with assessing the use of antigen testing. It recommended that the self-administered Covid-19 tests should be rolled out across a number of settings.
This expert group was chaired by Professor Mark Ferguson, Director General of Science Foundation Ireland and Chief Scientific Adviser to the government.
In July, Professor Mary Horgan, president of the Royal College of Physicians of Ireland, who was a member of this group was asked by the Health Minister to lead a group to progress the use of rapid antigen testing.
A spokesperson for Donnelly at the time said: “Minister Donnelly has made it clear that he supports the wider use of these tests and so does the government.
“They are not a replacement for PCR but an additional tool. This group will provide expert advice to facilitate the rollout of tests in various sectors.”
Said Horgan: “There’s no debate about PCR tests being more sensitive, but antigen tests pick up infectious people so people who are shedding high amounts of the virus at that point in time that the test is done.”
“They’re the people that we need to detect, and really it is case detection, so that they’re identified before they leave home and go to the workplace or go to college so that they can stay at home and go into our very successful testing strategy that we have at the moment.”
So where are we now?
Currently, antigen testing is being piloted in seven college campuses this autumn: students test themselves twice a week at home, and can upload their results online using the HSE Report Antigen Result website.
Antigen testing has also been used at high-risk sites, such as meat processing plants.
In England, each household can order one pack of antigen tests a day, and each pack contains seven antigen tests.
In recent weeks, there have been increased calls for antigen testing to be used more widely to help suppress the current increase in Covid-19 cases, including by teachers’ unions to help reduce the number of Covid-19 cases in schools.
With more detail set to come from Government over the coming days on this new policy, NPHET in its letter said that a planned transition away from mass scale PCR testing could not happen at the moment due to the prevalence of the virus.
It did not explain, however, if its position on antigen testing had changed but simply recommended a new approach.
This chimes with what the State’s health watchdog HIQA said last month when it recommended against antigen testing being used on a more widespread basis as a replacement for current Covid-19 mitigation measures.
In new advice to NPHET , HIQA has said there is “uncertainty regarding the effectiveness of rapid antigen testing for screening of asymptomatic individuals” due to a “relatively low number of studies”.
HIQA also raised “ethical concerns” around their use, such as the implications for false negative and false positive test results, and said that rolling out antigen tests at scale would “incur a significant total cost”.
“A negative antigen test in an asymptomatic person should not be viewed as a ‘green light’ to engage in activities that would be otherwise considered as high risk for transmission,” HIQA’s chief scientist Dr Conor Teljeur said in September.
For now, the use of antigen testing remains limited when it comes to official public health policy, and even NPHET’s recommendation applies to only a very specific cohort.
NPHET on Monday said that given the high incidence of Covid-19 in the community, the HSE should implement a programme of antigen testing, followed by PCR confirmation of positive cases, for fully vaccinated people who are deemed to be close contacts of a confirmed Covid-19 case, but who have no symptoms.
Results are released in September! Norma Foley needs to resign, between this and the school bus fiasco she is abysmal at her job!
@John Long: it’s the junior cert , it really doesn’t matter
@Ciaran: The kids put the effort in. Should that be dismissed?
@Ciaran: except to the kids who did the exams
@John Long: Get over yourself, it’s the junior cert, an exam of no importance of any description.
@Ciaran: you seem to have the same attitude as the rest of the government. It really doesn’t matter!
@Justin Gillespie: No.
@Justin Gillespie: it is important as it’s basic requirement for apprenticeships.
@Justin Gillespie: I think it’s you that needs to get over yourself not every wants to go on to leaving cert so junior cert is very important to those that want to go for an apprenticeship instead.
@Bernard Mc Grath: you might be going over his head here. I doubt he even knows what apprenticeships are let alone their relation to the JC
@John Long: This is the SEC, not the DES. So, no matter what you think of Norma, this isn’t her fault.
@sean o’dhubhghaill: Her position is minister of education!
We keep forgetting that exam fees are paid for a product that has not been delivered in time. Maybe the State Exam commission should refund for being in default of an undertaking.
@Irish big fellow: There has been no exam fees for the last three years nearly because of Covid
Clearly gave this zero priority. Money on offer vs hours and expertise expected not attracting numbers needed, payment for those that do the job takes months to come through. Corrections completed long ago and yet results delayed and delayed and delayed. Ball dropped.
Junior cert provides valuable experience for future state exams, it important the results are released in a prompt manner as people who decided to drop out and take up an apprenticeship need them as it is a requirement for apprenticeships.
I don’t think it can be overstated how completely worthless it is as a learning aid to receive exam results 5 and a half months after the exam.
Students will already be neck deep in a new curriculum by then and preparing for christmas tests on that. They won’t even remember what the questions were in an exam so long and will have already made subject choice or higher level decisions already.
The whole thing is just an insult to students. Forced to sit a state exam the state has seemingly little interest in correcting. It should be a resigning matter for the Education minister but it’s Ireland and we’re used to tolerating less.
Correct me if I’m wrong; Teachers are paid 12 months of the year, yet are paid extra for correcting papers. How is it not a mandatory part of the job??
@El Grogan: Do you want LC exams to be marked by people who don’t want to mark it and who don’t care? What do you do with those, who make a pig’s ear if it? Do you take them off the job and pay them less? So the people who remain marking thw state exams get paid more? Oh, wait…………………..
@El Grogan: I had a similar conversation regarding the leaving cert results. From my understanding of what I got in reply, normal teachers don’t mark state exams, professional exam markers do. My point at the time was that I found this strange as teachers are paid over the marking period yet this is not part of their job. In France, for example, it is. Not all teachers are needed but each teacher chosen, gets a mail detailing what marking centre they are required to attend to mark papers. Exams end in early July and results are published near the end of July, despite the student population being much larger.
@David Stapleton: You can efficiently and accurately mark 25 exams per day. At 5 days a week over 3 weeks that is about 350+ exams per corrector.
Best of luck to all
The results are typically released mid September
I think the junior cert is pointless unless the person wants to leave school afterwards and get an apprenticeship. It’s alot of unnecessary pressure to put on a teenager if they go to do their leaving certificate because when you get that then the junior cert is nothing
@Anthony Hilton: look up the reason
I remember my first day in 4th year. “The junior cert meant sod all lads….the leaving cert will be 10 times as hard and you’ll have less time to learn it all as this is a doss year”
Where did all the examiners go?! 1 in 3 disappeared?
Was it down to the post-covid travel bottleneck or something else?
@Rachel Ray: the problem at the moment comes from two sources: dumbing down of educational standards, accompanied by students’ sense of entitlement. Who would want to involve themselves in a situation where everybody demands that they do well and if they don’t, go for rechecks. A neighbour of mine is a teacher and according to her the economic imperative to get as many people through education right up to college standard has created chaos since she is caught between retaining her own integrity re marking and giving in to economics that insist everybody must do well and then pay for the next stage of their education
@Rachel Ray: They made the perfectly rational decision that time with their families was more important than money, maybe?
have your say