Dáil debates

Thursday, 21 October 2021

Covid-19: Reframing the Challenge, Continuing our Recovery and Reconnecting: Statements


4:45 pm

Photo of Kieran O'DonnellKieran O'Donnell (Limerick City, Fine Gael) | Oireachtas source

The number of people on trolleys in University Hospital Limerick is still very high but has decreased to 27. It is not the top Trolley Watch figure today, which is welcome news. There are 40 confirmed Covid cases in the hospital. They are putting pressure on isolation beds. Nine of these patients are in ICU. It is said that almost six in ten people ending up in hospital are unvaccinated or not fully vaccinated.

It is said that 52% are fully unvaccinated, 5% are partially vaccinated and 2% of cases are unknowns. We have to get a campaign going to persuade people to continue to be vaccinated. I welcome the booster programme that is coming on stream and I hope it will spread to all the age cohorts. It is of great importance.

I will spend my time discussing the just published interim report of the rapid testing expert advisory group, chaired by Professor Mary Horgan. The Minister will be aware that I am the Chairman of the Committee on Transport and Communications, which has been pushing for antigen testing since December last. We produced a report seeking rapid antigen testing for aviation. We held various public hearings with all of the interested parties, including the Chief Medical Officer, Dr. Tony Holohan, various aviation experts and the Minister for Transport. We very much welcomed the announcement establishing a rapid testing expert advisory group four months ago.

I welcome that there has been a programme on rapid antigen testing but I am somewhat underwhelmed by advisory group report. I accept that it is an interim report but I would have liked to have seen more progress around the terms of reference, including that it "Support Government departments". There has been some engagement with Departments, specifically the Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media and the Department of Enterprise, Trade and Employment, but there appears to be no engagement with the Department of Transport. That is very disappointing.

The terms of reference include that the advisory group support Government Departments "in the design and assessment of pilots". There have been some pilots. It was to provide "guidance to Government departments on the use of rapid tests." The report appears to be based on developing a risk assessment model to assist in supporting the use of rapid antigen testing. There is no timeframe for having that particular framework in place. I welcome a risk-based model, as I always do, but the purpose of rapid antigen testing is to assist PCR testing. It is not a stand-alone test. It is used for screening in the tourism sector, nightclubs and so on to contribute to reducing infection rates.

Rapid antigen testing detects people when they are at their most infectious. PCR testing detects people across a much wider range, whether they are infectious or not. PCR is the benchmark but rapid antigen testing has a role. We need to see the final report and we need a timeframe for putting in place the risk assessment model The report is looking at a model to be based on the background risk of SARS-CoV-2 within the population participating in an activity; the risk of SARS-CoV-2 transmission associated with the activity or setting; and the most appropriate testing approach to best mitigate the risk. We all know that PCR is the gold standard. I would like to see more pilot programmes and more engagement between advisory the group, which has been up and running for four months, and the Department of Transport, as well as other Departments. It should set out a programme.

Members of the public have started to use rapid antigen testing. The chair-designate of the Dublin Airport Authority appeared before the Joint Committee on Transport and Communications yesterday. He uses rapid antigen testing for his own purposes, as do the staff where he works. My worry is that people will escalate their use of rapid antigen testing. I would like that to be done in a co-ordinated and structured way. The basic model is in place but I would just like to see more urgency in implementing it. This is a welcome first step and I commend the Minister on that. However, I would like to know when the risk assessment model will be in place.

The conclusions of the report do not give dates in respect of when rapid antigen testing will be introduced. We have no concrete dates as to when it will become a formal part of the toolkit for detecting Covid-19. Rapid antigen testing has a place in nightclubs, restaurants and schools. It is complementary. My worry with this report is that it appears to compare antigen testing with PCR testing. They are not comparable tests. PCR is the gold standard and is very successful but we cannot use PCR tests to screen people because it costs too much and takes too long.

I will present an example to the Minister. If someone is flying in having taken a PCR test, the result will be available in 24 hours. Given that the virus escalates so quickly, someone could take a PCR test 48 hours before a flight and by the time that person gets on the aeroplane, he or she may be heavily infected with Covid-19. The rapid antigen test would detect that. I see rapid antigen testing as stand-alone.

The terms of reference of the advisory group, which I greatly welcomed, refer to supporting Departments seeking to deploy rapid tests in their respective sectors, supporting them in the design and assessment of pilots for their respective stakeholders and supporting them in developing standard operating procedures. These are all very welcome tasks. The group was also to maintain a list of currently validated tests for guidance.

The EU is beginning to do that. It was also to monitor rapid tests in development and those emerging on to the market.

I wanted the Minister, in addition to PCR testing, which is the gold standard, to bring in antigen testing along to assist in the detection of the virus. This is a low-cost model. PCR is very good in detecting at any range but I wanted to use rapid antigen testing to assist. If these tests are not 100% accurate, that is fine, but if they detect one person who is highly infectious, particularly in settings like nightclubs or live venues where we have seen pilot testing, they will be of great benefit.

I ask the Minister to ensure there is engagement with all Departments, including the Department of Transport. I would like to see the risk assessment model being expedited. The report states:

To address the first component, [This is about the population] ... HIQA and University College Dublin have developed an algorithm which can provide a time-updated estimate of the risk of someone who is ... positive attending an activity/setting.

The expert advisory group is looking at the type of risk and setting a person is going in to. In many cases, for example, in live venues or nightclubs, PCR testing will be impractical. Rapid antigen testing has a key role to play in these settings because it can be done just before people enter and highly infectious people can be detected. This is nothing new. The Joint Committee on Transport and Communications has been front and centre on this from day one. We see that the biggest mistake is that people compare PCR with antigen testing, which are two totally different tests. One complements the other or, to put it another way, the PCR test is effectively the engine and main driver. It is the mother bee and the antigen test is basically the ground worker, the bees working away assisting the queen bee. They should not be viewed as like for like.

The report notes that a rapid review evidence synthesis being conducted by researchers at SPOR will examine the evidence for each of the other two components. That needs to be expedited. I fully agree on the risk-based model but I am worried that we are putting PCR testing up against antigen testing. PCR testing will win every time on the overall spectrum.

Antigen is there to assist PCR. I would like that to be front and centre in the final report that will be provided by Professor Horgan and her colleagues. I would also like to know when the report will be published and the risk-based model put in place. We need to get practical. PCR is the Mercedes and antigen is the Mondeo, but the latter complements the former, not vice versa.


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