British experience suggests ‘free’ antigen tests alone are not enough

By now, most Londoners are familiar with the NHS Test and Trace Covid-19 self-test box.

t’s what you take before you see your extended family. It’s what you subject your secondary school children to on a Sunday evening. It’s the test you take after a weekend’s “risky behaviour”, or going to the pub as it used to be called.

Between spring and September, these boxes were free from the local chemist or library. Since September, we have had to call the NHS or go online to get a code. The code allows us to go back to the chemist and take another box. Swab and repeat.

The British government introduced the programme for twice-weekly testing of all school staff and secondary school students in August. If the test returned a positive result at school, the student went home.

Now, most schools require students to test themselves twice a week at home — on Sunday and Wednesday evenings.

Crucially, the tests are free. You pay nothing. Schoolchildren pay nothing. (Certified antigen testing for travel operates under a private, paid-for system, as does PCR testing.)

The antigen test rollout has not been without controversy.

As in Ireland, there were fears that routine ad hoc testing would encourage risky behaviour. Doctors here say it is difficult to provide evidence either way.

In addition, there have been questions about value for money.

In January, the British Medical Journal said £1bn had been spent on the tests. By late May, the i newspaper reported the Department of Health and Social Care had spent £3.14bn on them “since February”.

In June, damning coverage of a National Audit Office report suggested that only 14pc of almost 700 million tests may have been used.

Crucially, however, the report referred to tests “which had not been registered”, meaning users had not 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 would suggest, though, there appears to have been some waste. Some council areas even reported stockpiling, although such giddy enthusiasm seems to have given way to more reason.

“There’s a fascinating association with [the word] ‘free’,” says Dr Dean McDonnell, chartered psychologist with the Psychological Society of Ireland and co-author of a paper on how Covid-19 has affected health behaviour.

“The environment we associate with ‘free’ tends to be marketing. And if the public perceives marketing, they are more tempted to be suspicious.”

McDonnell suggests that introducing communal testing — in locations such as schools, sporting or music events — could encourage uptake, particularly among those needing persuasion.

“It is incredibly uncomfortable,” says Dr McDonnell, “nobody likes putting things up their nose. But it’s a necessary discomfort.

“Some people will need encouragement, and seeing other peers taking tests in an environment that is incentivised — like going out — takes the sting out of doing something you don’t enjoy.”

High viral load

Doctors say that antigen tests are imperfect but still useful and certainly better than nothing.

“They are used much more [than PCR] in screening of asymptomatic, or pre-symptomatic [cases] people who might be infectious, but not know,” one NHS infectious diseases consultant tells Review.

“That requires regular testing because the tests themselves are quite insensitive. The individual might not be infectious at all on Monday but then might be on Wednesday.

“It might only be on Friday that you develop symptoms, by which time you’ve had two days to infect people if you haven’t already taken a test.

“It’s imperfect compared to PCR, but it is good at picking up people with lots of viruses, but bad at picking up people with low amounts of virus,” the consultant said.

There is some correlation between a positive antigen test and a high viral load result in PCR.

It’s worth noting that ‘free’ antigen tests don’t appear to have made much of a dent in the amount of virus circulating in the UK. As of Thursday, more than 40,000 cases were reported.

Perhaps unsurprising, as those children who are dutifully tested twice-weekly must travel to school on buses or trains in which only half of their fellow commuters continue to wear masks.

Antigen testing, however free, is not a solution on its own.

Visit our Covid-19 vaccine dashboard for updates on the roll out of the vaccination program and the rate of Coronavirus cases Ireland

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