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Quick and (Uneasy) Easy: Rapid Testing Challenges

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Jim Kellner, a Calgary pediatrician, is a member of the Federal COVID-19 Immunity Task Force, which has helped inform government policies on infection and immune issues.Todd Color / Globe and Mail

Rapid COVID-19 testing is widely seen as an important tool for controlling outbreaks, especially among children as winter approaches, and the highly infectious delta mutant remains the predominant strain in Canada.

Still, how best to use a rapid test that can produce results in 15 minutes continues to be debated, even among experts, due to its limitations.

Canada has a local patchwork of approaches to school settings. Many places have been set up in the last few weeks. This is partially supported by the federal government, which purchases and distributes millions of tests, despite the rapid tests that are currently widely used in the workplace.

“these days, [rapid tests] Jim Kellner, a Calgary pediatrician specializing in infectious diseases at the Alberta Children’s Hospital and a member of the Federal COVID-19 Immune Task Force, who helped inform government policies on infections, is an immune problem.

Dr. Kellner points out that there is little debate about the usefulness of these tests, including Abbott’s Pambio, which is used to screen unvaccinated workers and travelers. However, their effectiveness in screening large unvaccinated groups, such as children aged 5 to 11 years, is less clear.

“The discussion of these tests has been going on for over a year, not just in Canada, but around the world and always has the same dimension,” adds David Naylor, Co-Chair of the COVID-19 Immune Task Force. We contrasted Canada and the United States. The United States has made it free to use rapid tests with non-uniform results.

Understand the test

The advantage of rapid testing, often referred to as antigen testing, is that, for example, a gentle nasal swab can be used by parents to administer to their children while providing rapid results in the field.

In contrast, the widely used PCR (polymerase chain reaction) test usually uses an unpleasant deep nasal swab, often given by a nurse. The sample will be sent to the laboratory and the results will take at least a few hours.

“That quick turnaround and relative ease” makes quick testing attractive during the “snuff season,” says Dr. Naylor. He says some parents united to buy a large number of tests without government policy.

Although almost accurate when symptoms are present, rapid testing is not very effective in identifying viruses in asymptomatic populations with low incidence, Dr. Naylor adds.

This tends to produce false positives (results that indicate disease in the absence) and, to a lesser extent, false negatives (results that the virus is absent when present) compared to PCR tests. Because there is.

PCR tests that can detect the genetic material of COVID-19 are significantly less likely to cause false positives and false negatives, and as a result, are often needed to confirm rapid positive test results.

Rapid diagnostic techniques differ in that they detect unique proteins on the surface of the virus called antigens. Not all asymptomatic cases can be detected if the virus is abundant. In addition, rapid testing is considered to have less specificity (a scientific term for the ability to identify disease-free samples) than PCR testing. As a result, rapid testing results in more false positives.

“How (rapid testing) is performed in the real world depends on the prevalence of the population,” said Program Director of Public Health and Preventive Medicine at the Dallalana School of Public Health at the University of Toronto. Barry Pakes says.

For example, Pakes is likely to have some false negatives and hundreds of false positives for every 10,000 rapid tests in a population with a 0.1% prevalence of the virus (or 10 actual cases). The doctor says. “Therefore, how it is deployed as a program is very important.”

As such, Dr. Pakes states that rapid testing is more effective in controlling outbreaks in schools and tracking viruses that spread to areas of high prevalence and low vaccination. He explains that the higher the incidence, the more true positives there are compared to false positives.

How the states differ in the debate

Despite the agreement in this regard, the state has not followed a similar path using rapid testing. For example, in Quebec, it is offered in staff-managed schools for symptomatic, unvaccinated children. In Alberta, rapid tests are available for parents to test symptomatic children in areas of outbreak at home, but in Ontario, tests are currently outbreaks or asymptomatic vaccines not available. Used in high school incidence communities for inoculated children.

In contrast, as of mid-November, BC had not yet provided rapid testing of children in the school environment, but Manitoba only required testing of unvaccinated staff. Meanwhile, Saskatchewan and Nova Scotia provide rapid testing to parents for children under the age of 12.

“Despite our efforts to provide the federal government with a broader framework, it didn’t look like there was national coherence in how this should be done,” says Dr. Naylor.

School situation

He states that he is “more hawks” about using rapid diagnostics more widely than some colleagues for unvaccinated children.

Despite its limitations, Dr. Kellner of Calgary points out new evidence suggesting that rapid testing may be effective in controlling outbreaks. He points out a British study published at The Lancet in September. In this study, some schools used a 7-day rapid test for close contact during outbreaks, while others quarantined close contact at home.

“Rapid testing worked like quarantine in controlling outbreaks, sending more children to school,” he wrote of a study of students aged 11 to 18 years.

False negatives are less common, but they are important because they can lead to more spread. Again, antigen testing may miss more asymptomatic cases than PCR testing, but studies show that these individuals usually carry “non-infectious levels of virus,” Dr. Nayler said. increase.

A systematic regimen, such as that used in the workplace, which requires two to three weekly tests, is more likely to find the most infectious cases, Dr. Kellner said.

The vaccine approach between the ages of 5 and 11 is likely to reduce the use of rapid testing, he says, and PCR remains the primary diagnosis in the symptomatic case. Still, prompt testing remains important as children under the age of 4 remain unvaccinated.

“At the very least, parents need to be able to test their symptomatic children at home and provide the school to test their symptomatic children if they develop symptoms at school,” he says.

Aside from the debate, Dr. Kellner and other experts have been used for a long time, for example in pregnancy, as the next pandemic is not a problem, as accuracy increases and consumer awareness and demand increase. If you agree that rapid inspection technology will be more widely available, but when.

“Because this is the Fitbit generation, it’s no wonder that this kind of testing is more common.”

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