COVID-19 has disrupted our daily lives for nearly 21 months. Initially the “finish line” was vaccination, but with the rise of this latest variant and pending fifth wave, that finish line keeps moving.
We’ve been asked to use all of the tools in our tool box, and yet there is one tool that remains elusive in B.C.: widespread adoption of rapid antigen testing.
In B.C. (and most of Canada), we’ve been painstakingly slow to embrace rapid antigen testing. As a society we have adopted many tools that previously would have been unthinkable: masks, physical and social distancing, and (multiple) vaccines. However, few British Columbians have access to these simple — yet essential — screening tests.
Rapid antigen testing is a quick and easy tool to detect if someone has a high SARS-CoV-2 viral load which means they are more likely to transmit the virus to someone else. This type of screening test is intended to identify infected individuals not currently showing symptoms but who may be contagious—so that measures can be taken to prevent forward transmission.
Public health experts have poignantly stated that transmission of the virus through asymptomatic individuals is the “Achilles’ heel of current strategies to control COVID-19”.
This is because, unlike SARS-CoV-1 (the cause of the original SARS epidemic in 2003), SARS-CoV-2 sheds at high concentrations from the nasal cavity even in individuals who harbour the virus without any symptoms. Even with masking and social distancing, such individuals could be at a high risk of spreading the virus.
While a COVID-19 vaccine is the most effective way to protect ourselves from the devastating effects of the virus, the vaccine is not currently available to everyone as those under 5 years old are not yet eligible to receive it. It is also still unclear how long immunity lasts with the vaccine. The slow rollout of the third dose in Canada and the rise of the new variant Omicron mean we need to use every tool we can.
Moreover, the current diagnostic approach which relies on polymerase chain reaction, or PCR test, is expensive, has long wait times, and must be processed by a lab. In addition, many PCR testing facilities have been decommissioned making testing less accessible.
In contrast, rapid antigen tests are low-cost and easy to use, so screening twice or three times a week can be both cheap and easy. We have ample evidence of their usefulness internationally, from places such as the United Kingdom and France and within Canada, such as in Nova Scotia and Greater Toronto.
Rapid antigen tests can be used in a workplace to test employees, or in schools to test students, faculty, and staff following a recent exposure. In both examples, the intent is to use the screening testing results to determine who may continue to participate in activities and who will need to take protective measures, including self-isolation.
At UBC, we have been studying rapid testing, and more recently self-testing as one tool against COVID-19 since January 2020. Our ongoing research and clinical experience demonstrates great uptake and acceptability by testers, ease of use, and high sensitivity and specificity, or accuracy of the tests.
Yet sadly for British Columbians, rapid antigen tests remain largely inaccessible due to an unspoken (but palpable) aversion to the value and usefulness of rapid antigen tests.
As we move forward in this never-ending pandemic, rapid antigen tests are an important aspect of change management. They can also be seen as a harm reduction strategy.
That is, by protecting oneself and others from spreading a potentially fatal infectious disease. Now is the time to democratize and promote widespread use of rapid antigen tests.
We can do this by urging our politicians and public health leaders to use the expiring stockpile to protect people who can’t be vaccinated and the immunocompromised. We can also make noise and lobby members of parliament and legislative assemblies to ensure that rapid tests are made freely available to purchase at neighbourhood shops.
The pandemic isn’t over but rapid tests might help us hang on to some sense of normalcy.
Sabrina Wong is a registered nurse and professor at UBC specializing in health services and policy research with a focus on equitable health care; Kristen Haase is a registered nurse and assistant professor at UBC.
