Business and Media pimp for dodgy covid test. Govt caves. Questions Remain.

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Recent vociferous demands by business interests and the National Party have pressured the government into allowing Rapid Antigen Testing (RAT) to be used throughout the country. The pressure has grown as freight-trucking companies and others have demanded the ability to move between Auckland and the rest of the country. Again, vociferous calls amplified by MSM  (mainstream media) eager for click-generating headlines.

Over the last few months, the MSM  have amplified calls to introduce RAT – often uncritically.

On 27 August, RNZ’s ‘Checkpoint‘ aired a story promoting RAT. ‘Checkpoint‘ reporter, Nita Blake-Persen, wrote effusively on RAT:

‘‘Delta’s reach is like nothing New Zealand has seen before – with Covid-19 cases from the Auckland outbreak today reaching 277 and contacts passing 24,000.

That reach has put a massive strain on New Zealand’s PCR testing capacity – the only recognised testing used here – with thousands of people waiting up to eight hours to get the test, and then up to five days to get results.

But there’s hope that rapid antigen tests – which are widely used overseas – could help alleviate some of that pressure.’’

New Zealand Aged Care Association (ACA) Nursing Leadership Group chair, Dr Frances Hughes, was hugely supportive of RAT, with six thousand nursing staff working in the ACA and many waiting for all-clear results from the currently used nasal (nasopharyngeal) swabbing:

‘‘If we could do this for our frontline health workers and get those tests back and have a system that gets them back quicker and gets them back to work earlier? Absolutely, it would be a great initiative.’’

Dr Hughes’ concerns that her priority was to get employees “back quicker and gets them back to work earlier” was obvious.

‘Checkpoint‘ also interviewed president and CEO of Innova Medical group, Daniel Elliott.  Innova is a major supplier of RAT and unsurprisingly sang the virtues of his company’s product:

They use the test to help keep schools open, to keep workplaces going, to be able to keep people that are working in closed environments that are critical infrastructure – police and fire – [going].

Now they’ve gained enough confidence with it and they’re starting to use it to open up pubs and sporting events, concerts, things like that.

While somebody may have a positive PCR test, it could be 20 to 30 days that they have an infection, but they may not be contagious to others.

What this type of test actually does is, is it’s really screening for people who have a viral load that is contagious or infectious to other people.

In what could pass as a free advertisement for his product, Mr Elliott stated:

‘‘They’re inexpensive, highly accurate tests that can be widely deployed in New Zealand and other places, that will certainly help open up the economy.’’

The statements were not challenged.

More to the point, someone at RNZ, putting together the ‘Checkpoint’ story quoting Innova’s CEO failed to noiced that eleven weeks earlier – the US Food and Drug Administration (FDA) had warned the public not to use their RAT:

The U.S. Food and Drug Administration (FDA) is warning the public to stop using the Innova Medical Group SARS-CoV-2 Antigen Rapid Qualitative Test for diagnostic use. The FDA has significant concerns that the performance of the test has not been adequately established, presenting a risk to health. In addition, labeling distributed with certain configurations of the test includes performance claims that did not accurately reflect the performance estimates observed during the clinical studies of the tests. Finally, the test has not been authorized, cleared, or approved by the FDA for commercial distribution or use in the United States, as required by law.

[…]

On April 23, 2021, Innova Medical Group recalled their Innova Medical Group SARS-CoV-2 Antigen Rapid Qualitative Test. The FDA has identified this recall as a Class I recall, the most serious type of recall.

As at 20 August, the United Kingdom has continued using the Innova testing kit. That, despite the FDA recomending that purchasers  “destroy the tests by placing them in the trash or return the tests to Innova“.

RNZ had effectively pimped a product that the FDA had recalled, citing “a risk to health“.

On 6 October, twenty five of Aotearoa New Zealand’s largest companies added further pressure on the government to allow RATs to be imported and used:

• Mainfreight
• Foodstuffs North Island
• Genesis
• Hynds Pipe Systems
• Mercury
• Summerset Group
• Wellington Airport
• Christchurch Airport
• Sky NZ
• Queenstown Airport
• Spark, Vodafone
• The Warehouse Group
• ANZ Bank
• Contact Energy
• Fulton Hogan
• Woolworths NZ
• Fletcher Building
• Chorus
• Carter Holt Harvey
• Meridian Energy
• DHL Express NZ
• Air NZ
• Auckland Airport

Mainfreight’s managing director, Don Braid, was clear in his priorities:

‘‘This is business wanting to take care of their people from a health and safety perspective and to keep their sites operational.’’

Genesis CEO, Marc England, said it clearly:

‘‘Huntly is a critical part of New Zealand’s energy network – it simply has to keep running, and the only people who can operate Huntly are those who work there.’’

Once again, the RNZ story offered no counter-balance to business demands. Their statements were presented uncritically.

Queenstown Airport CEO, Glen Sowry – though not medically or epidemiologically trained –  described RAT as  ‘‘a very efficient, less invasive and reliable way’’ of testing for covid19:

‘‘Alongside vaccination, efficient and accessible testing is key to ensuring we get our economy moving and reconnect with the world, while keeping people safe.’’

There was no critical analysis of Mr Sowry’s assertions.

It was left to TV3/Newshub to offer a note of caution to using RATs. University of Otago clinical microbiologist, James Ussher, warned:

‘‘Rapid antigen tests are less sensitive than the PCR tests that have been used in New Zealand to date. We have been pursuing an elimination strategy and that has required the most sensitive tests so we don’t miss cases… As such, rapid antigen testing hasn’t formed a part of our response.

There are hundreds of these tests out there and they have very variable performance. The best ones can be about 80 percent sensitive compared to PCR, but many of them perform a lot worse.’’

Mr Ussher was candid as he further pointed out the unsuitability of RATs:

‘‘I can understand the desire of businesses to ensure continuity of business through regular screening of employees, however we need to make sure we’ve got appropriate processes in place before using these. An important thing to remember… a positive test needs to be appropriately followed up, because it would be more likely at this present time that it would be a false positive.

There is the risk of missing true infections and that’s particularly relevant in patients admitted to hospitals who have symptoms, in which case you really do need the most sensitive test – a PCR test. But there’s also the issue of when you’re doing screening in a population with a very low chance of having it, that any positive is more likely to be a false positive.’’

This was one of the few instances where MSM aired words of caution from an actual expert. Someone who knew the limitations of Rapid Antigen Testing and had no profit-motive to frame their narrative.

So the vocal demands from business were well canvassed by a (mostly) compliant media. Even our political servants added pressure on the government to introduce RATs:

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When, nearly two weeks later,  RNZ finally got around to asessing the worthiness of RATs, it was left to ‘The Detail’ – a programme aired at 5AM. Hardly the same high-participation coverage as ‘Checkpoint’s‘ 5PM to 6.60PM “drive  time” slot. The dawn programme also pointed out:

Rapid antigen tests, on the other hand, are nimble: they still involve a throat or nasal swab, but they deliver a result in as little as 15 minutes, and can be used by just about anyone, any time, anywhere.

On the other hand, they aren’t as reliable as PCR tests: when administered by a trained medical professional, their reliability is around 75-90 percent; but when used by an untrained person, that accuracy can drop as low as 50 percent.

Microbiologist, James Ussher, however, is 100% correct in his cautioning over the use of RATs.

In July this year, ‘Science Direct‘ reported a study on RAT, concluding:

The positive rate of RAD test using saliva samples was low throughout the clinical course. Poor concordance was observed between nasopharyngeal swab specimens and saliva samples (75.9%, kappa coefficient 0.310). However, a substantially high concordance between the RAD test and viral culture was observed in both nasopharyngeal swab specimens (86.8%, kappa coefficient 0.680) and saliva samples (95.1%, kappa coefficient 0.643).

[…]

The sensitivity of the SARS-CoV-2 RAD test was insufficient, particularly for saliva samples. However, a substantially high concordance with viral culture suggests its potential utility as an auxiliary test for estimating SARS-CoV-2 viability.

The US Centre for Disease Control (CDC) was clear on RATs in that it was:

Less sensitive (more false negative results) compared to NAATs, especially among asymptomatic people

The fact that this test is not as sensitive and accurate as current processes is an ongoing concern. RAT does not detect asymptomatic carriers of Delta – the most infectious strain of covid19 yet known (to be confirmed).

Which means infected workers such as truck drivers can return a false negative at the Auckland border and then drive on to their destinations throughout the country. The consequences would be costly in terms of extending lockdowns; closed or reduced-operating businesses; and hundreds of millions spent on wage and business subsidies. Not to mention hospitalisations; ICU wards full, and a mounting death toll.

Infected truckies from Auckland have already been detected in Tauranga and Palmerston North.

If we are going to continue elimination, then RATs are utterly ineffective for this task, as Dr Joshua Freeman, a clinical microbiologist and the clinical director of infection prevention and control at Canterbury District Health Board pointed out:

‘‘When elimination is the overarching strategy and the proposal is to, in any way, relax precautions based on a negative result, the relatively high rates of false-negative results with rapid antigen testing is a major drawback.’’

It is abundantly clear that businesses demanding the use of RAT to facilitate commercial activities.

Just as the doomed Trans-Tasman bubble was vigorously hyped by business interests and the National Party, and which resulted in a Returnee from Sydney transmitting Delta to another Aucklander, the wide implementation of Rapid Antigen Testing will also have dire consequences.

The comments from Dr Frances Hughes, Daniel Elliott, Don Braid, Marc England, and Glen Sowry above all had one salient point in common: they were advocating for business interests to take priority over peoples’ safety and wellbeing.

The RAT offers a quick, albeit inaccurate, test-result – something that businesses desperately desire to operate smoothly. That these tests are inherently unreliable and unsafe is of little concern. The priority of a commercial enterprise is to it’s shareholders. Public safety is for government and its myriad official bodies.

If businesses can succesfully implement RAT, it will have paid lip-service to containing covid19 with minimal hurdles to their money-making pursuits.

To paraphrase an old tv commercial from the 1970s/80s, the RAT is a “Clayton’s” test: the covid test you’re having when you can’t be bothered with a real covid test.

The Rapid Antigen Test is a short-cut we can ill afford. But Delta will love it.

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UPDATE

On 14 October, the government acceded to demands from the business sector. Citing the “coalition of around 25 businesses across a range of sectors”,  an “exemption was granted by the Director-General of Health, to import and use approved rapid antigen tests”.

Let’s hope this turns out better than the ill-fated Trans Tasman Bubble. If it is successful, National will take credit for it’s implementation.

If it fails, and Delta spreads throughout the country, they will point blame at the government.

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References  

RNZ: ‘We need clarity’ for Covid-19 test to cross Auckland border – business owner

RNZ: Checkpoint – Call for government to consider cheaper, quicker testing for Covid-19

FDA: Stop Using Innova Medical Group SARS-CoV-2 Antigen Rapid Qualitative Test: FDA Safety Communication

Dark Daily: UK Continues to Use Innova’s SARS-CoV-2 Antigen Rapid Test Despite Recall and FDA Warning Letter

RNZ: Coalition of 25 companies want to import 370,000 rapid antigen tests – but need permission

Otago Daily Times: Call to allow rapid antigen tests

Newshub: COVID-19 – Expert warns business coalition calling for rapid antigen tests to proceed with caution due to unreliability

Twitter: Chris Bishop – rapid antigen testing – 1.18 PM,  September 16 2021

RNZ: Judith Collins reiterates call for use of rapid antigen testing

RNZ: The Detail – The lowdown on rapid antigen tests

Science Direct: Accuracy of rapid antigen detection test for nasopharyngeal swab specimens and saliva samples in comparison with RT-PCR and viral culture for SARS-CoV-2 detection

Towards Data Science: Cohen’s Kappa

US Centre for Disease Control: Interim Guidance for Antigen Testing for SARS-CoV-2

TVNZ: Small number of locations of interest expected from Covid-positive truckie

TVNZ: Auckland truck driver who travelled to Palmerston North positive for Covid-19

Stuff media: Covid19 – Nasopharyngeal swabs, PCR tests still the ‘gold standard’

Newsroom: Sydney returnee likely source of Covid outbreak

Youtube: Claytons Commercial Australia 1980s

Beehive: Government green lights rapid antigen testing

Scoop: National Party – Time to introduce rapid antigen testing

Reference Sources

MIQ: History and origins of MIQ

Covid19: History of the COVID-19 Alert System

MBIE: Managed isolation and quarantine data

RNZ: Timeline – The year of Covid-19 in New Zealand

Stuff media: Covid-19 – A timeline of the Delta outbreak

Recommended Reading

The Bad News Letter: The Fifth Columnists

Knightly Reading: Media lessons from a pandemic

Previous related blogposts  

Free Speech, done Newshub-style

The Microbiologist, the Caretaker Leader, and some Nasty Germs

One thousand dead New Zealanders per year?

The Virus, the Media, and John Key

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Acknowledgement: Guy Body

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