Dr Tony Holohan says antigen testing cannot be considered a ‘green light’ and excludes their use for international travel

Chief Medical Officer Dr Tony Holohan reiterated his reservations about what he sees as the limitations of antigen testing, including their use in international travel.

r Holohan, who is appearing before the Oireachtas transport committee, will say that in some contexts they present risks to those involved in activities and cannot be used as a “green light”.

In his address, Dr Holohan said: “As the evidence evolves – and assuming that this evidence supports rapid antigenic testing – we are more than willing to support their further use when appropriately evaluated worldwide. real indicates that it can provide an additional benefit. in the response to the pandemic.

“Ultimately, however, based on the knowledge to date, the surest way to reopen the company, including to international travel, will be to continue to control the incidence of the disease through a series of measures. health issues that are continually reviewed, while advancing the national immunization program. to ensure that as many people as possible in the population are protected by vaccination.

He states that the epidemiological situation of Covid-19 in Ireland remains stable and currently gives rise to a largely positive outlook, despite a persistent level of uncertainty due to the threat of variants and while a significant proportion of the adult population does not. is not yet fully protected by vaccination.

He stresses that breaking the chains of transmission cannot be achieved by testing alone.

Ultimately, it depends on the extent to which appropriate individual and public health follow-up actions are implemented and supported by a broader and comprehensive public health response.

“That said, access to accurate and timely COVID-19 testing is an essential part of a multi-faceted response strategy that supports case identification and contact tracing, clinical management of cases, infection prevention and control, and disease surveillance, including emerging diseases. variants.

He adds that in this country to date, testing for the SARS-CoV-2 virus has been primarily based on a robust and agile PCR testing capability that has been built to around 175,000 tests per week.

PCR remains the most accurate and internationally recognized gold standard diagnostic test for SARS-CoV-2, he adds.

He will tell the committee that international evidence to date, including two recent major international publications from the Infectious Disease Society of America (IDSA) and the Royal Statistical Society (RSS) in the UK, the recent synthesis report on validation of the Covid-19 test published by the HSE and existing guidelines from the World Health Organization (WHO) and the European Center for Disease Prevention and Control (ECDC) all indicate that rapid antigenic tests are generally helpful better outcomes in symptomatic people and in settings of high disease prevalence, and worse in asymptomatic people in low prevalence settings.

“Based on existing evObviously, the use of rapid antigenic tests may be considered in high prevalence settings such as epidemics where the likelihood of individuals before testing for infection is high and where more rapidly available results can support PCR testing due to the ” early identification of cases and implementation of appropriate measures. follow-up public health actions.

“The HSE has already made rapid antigenic tests available for deployment in such scenarios, when deemed appropriate by local public health physicians.

“Rapid testing may also be considered in environments with a higher risk of COVID-19 transmission, such as may exist in meat processing plants. Substantial work has been carried out to evaluate the use of rapid antigenic tests in asymptomatic workers in this setting within the framework of strictly controlled processes and the HSE and the Ministry of Health have supported the piloting of rapid antigenic tests in factories of meat processing led by the Ministry of Agriculture, and the Navy.

“The HSE has also made available rapid antigenic tests for use in acute hospital settings.

“In addition, the Ministry of Health has supported the development of a collaborative pilot project by the Ministry of Higher and Higher Education, Research, Innovation and Science, SFI, HSE, HIQA and a number of third-level institutions to examine the potential applicability of different rapid testing approaches in third-level institutions and we look forward to reviewing the results of this study.

“Separately, the HSE is also implementing plans to pilot the use of rapid antigen testing in child care settings as well as a number of third level institutions.”

However, he states that “while there may be potential utility to be gained from using rapid tests in controlled environments and this may evolve over time, we still have a lot to learn about these tests and their use. reality – as opposed to hypothetical – advantages and limitations.

As the authors of the Royal Statistical Society in the UK report pointed out, the proper assessment of the adequacy of Covid-19 testing has been overlooked to date, with many tests coming to the market without proper assessment. real world and well-designed studies evaluating tests in the real world where they are used should become standard practice.

In particular, although pilots can be seen as ‘red light’ rapid testing activities, picking up additional cases in a timely manner and appropriately integrated into the larger framework of the public health response, great caution is advised. with regard to any development towards the use of rapid antigens. tests for “green light” or “enabling” testing activities, in particular without taking into account the current epidemiological situation. “

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