Thursday, 25 February 2021
Topical Issue Debate
I thank the Minister of State for attending to address this important issue. I am glad that this has been selected as a Topical Issue matter and thank the Minister of State for taking the time to respond. I have been raising this issue for a number of months and am keen to hear about the Government's plans or intentions for the roll-out of rapid antigen testing.
The WHO and the European Commission recommend rapid antigen testing that meets the minimum performance requirements of greater than 80% sensitivity and 97% specificity. A number of rapid antigen testing products currently in use in this country far exceed these requirements, including the Roche and Abbott tests. Rapid antigen testing should be administered by trained professionals. Indeed, the nasopharyngeal sampling requires it. The rapid tests could be conducted on-site, in pharmacies or in local health centres. Results can be uploaded to the Health Passport Europe platform, which can be used for receiving and displaying Covid-19 status and certification. This technology exists and is being used in the corporate sector by many pharmaceutical companies and multinationals as well as in the food processing sector and the construction industry. This rapid testing technology is being used at the national children's hospital construction site, for example. I have been informed that the screening taking place in some of the businesses and building sites I have mentioned has detected Covid positive cases before they entered the workplace. I have been told that four Covid positive workers were detected recently at the site of the national children's hospital. Rapid antigen testing was key to identifying these cases early and subsequently isolating those affected. This meant there were no knock-on consequences for that site.
Rapid antigen testing can complement the PCR testing in use. It is not intended to replace PCR testing but can play a pivotal role in screening and detecting Covid positive cases. It can also give hope to certain sectors that business can reopen and hope to individuals that they can attend necessary appointments and spend time with their loved ones. Rapid testing can also provide protection for people in the workplace. It can help to protect our front-line staff as they deal with the wider public in the context of appointments, surgery and medical emergencies. I reiterate that this is not a panacea for all of our Covid-related problems but it will complement the PCR testing we are already doing. I urge the Minister of State to relay my arguments to the Minister for Health and the Government. Health screening can give our country greater confidence and some reassurance that there is a way out of our current situation. The investment required to do this could be minimal. Many companies are doing this screening themselves anyway and are leading on it. It is time for the Government to consider it as a tool to strengthen the measures being undertaken, including vaccinations and quarantining.
I thank the Deputy for raising this important issue. I am responding on behalf of the Minister for Health, Deputy Donnelly. Testing and contact tracing continues to be fundamental to our response to the pandemic. It is critical to ensuring that we can identify and contain the spread of the virus.
The HSE has adopted RT-PCR as the gold standard test for diagnosing Covid-19 cases. This is the most reliable test that we have available for this purpose. In addition, appropriately validated antigen diagnostic tests are now being deployed by the HSE as a supplement to PCR testing, just as suggested by the Deputy. These tests are being used for specific indications in acute hospital settings and as part of the response to outbreaks in the community setting, particularly in symptomatic vulnerable populations and for their close contacts. Antigen detection tests, ADTs, are described as rapid and simple to perform. The validation work that has been done by the HSE and across Europe to date indicates that ADTs are most effective in detection of symptomatic cases, when symptom onset is within the past five days and when the likelihood of test positivity is greater than 10% among the target population. The validation studies available show significant disparities in test performance as against some manufacturer's claims. Many of the tests available do not meet the minimum performance requirements set by the WHO and the European Centre for Disease Prevention and Control, although that is a general finding and does not relate to the specific tests referred to by the Deputy. This means that the tests currently available are of limited use in most circumstances when testing asymptomatic populations. It is also clear that new tests and new technologies are becoming available every day.
Considerable work has been undertaken to date to evaluate the use of ADTs in an Irish context. While antigen testing will not replace the requirement for large scale RT-PCR testing for public health purposes, validation of tests is continuing in the HSE due to the potential role that ADTs have in our national testing strategy. Consideration is also being given to the use of antigen tests in asymptomatic community populations. Professor Mark Ferguson, the Government's chief scientific adviser, has been asked by the Minster for Health to set up a group to examine the use of antigen tests in the community and more expert advice is expected shortly to inform us further on the potential of these testing technologies. While we now have more tools at our disposal, it is clear that we need to deploy existing tests appropriately and be guided by scientific evidence in doing so, particularly since we are aware of the limitations of many of the tests available.
I reassure the House that the national testing policy is kept under review and we will use whatever tools are appropriate to fight Covid-19. I hope that addresses some of the Deputy's queries.
I welcome the fact that Professor Mark Ferguson has been asked to keep this under review. However, we need to have a bit of ambition. The two tests I mentioned from Roche and Abbott meet the minimum standards set by the WHO. If we are to give people hope of the prospect of work post Covid or even as the vaccination programme is carried out, this is pivotal. In addition, if people have medical or dental appointments, an antigen test half an hour before they arrive could provide a lot of reassurance, not just for the patient but also for the staff at medical and dental clinics. I welcome the fact that Professor Ferguson is keeping it under review but believe that we need to do more, especially in the context of the vaccine roll-out. It is a fluid situation and there might be more speed bumps down the line with the roll-out of the programme. This would give people light at the end of the tunnel and some hope regarding the prospect of returning to some semblance of normality. I emphasise again that I am not talking about replacing PCR testing but complementing it. The more people we test, whether it is through PCR or rapid antigen testing, the better.
I draw the Minister of State's attention to the example of Liverpool, where daily rapid antigen testing was carried out in the city recently.
More than 200,000 people in the city were tested out of a population of 500,000. Of those 200,000 rapid tests conducted, some 4,000 people were found to be asymptomatic and carrying the virus unbeknownst to themselves. The rapid tests rolled out in Liverpool daily enabled those people to be identified and to isolate themselves.
I reiterate that the intention is not to use antigen testing to replace the system we have. As the Minister of State said, PCR testing is the gold standard. I believe there is a place for rapid testing as well, however. The HSE could publish guidelines for this type of rapid testing and then allow companies to provide this type of test to people, because there is a demand for them. This type of testing is already being undertaken all around us, such as in major pharmaceutical companies and other multinationals, for example, and it is about time that we moved with this trend.
I thank the Deputy for raising this matter. It is interesting that we are having this conversation today, because only last week I met Paul Reid and Dr. Colm Henry regarding this matter. The week before, the Minister of Health and I also had a long conversation on this issue. Rapid antigen testing is a complementary tool, and as the vaccination programme is being rolled out it is imperative that we have backup alternatives available as we reopen society. It would give people the hope that Deputy Pádraig O'Sullivan spoke about.
When reopening society, we must also consider locations such as student campuses. We must have an option we can use in those contexts and that is where rapid antigen testing can have a role. I compliment the Minister on the appointment of Professor Mark Ferguson, who has been tasked with reviewing this matter. One aspect of the roll-out of the vaccination programme is relevant to this context, namely, how the national immunisation advisory committee, NIAC, has responded with its re-examination of those groupings assigned priority. Such a reassessment is exactly what is happening with rapid antigen testing.
The question now is how we can best use the tools available to us to ensure we can continue to function as a society when the vaccination process starts. We should not only give hope when we start to open up, but also an assurance that we will be able to respond to any situation which might develop, do the required tests and lockdown affected sectors. One sector that comes to mind where that could be done is in meat plants. The same kind of rapid antigen testing could be done in small communities where one or two cases might pop up. A review of the roll-out of rapid antigen testing is therefore at the forefront of the Minister's ambition in this context as well.