WHY COVID TESTING NEEDS A RESET

31 Mar

Cases and hospitalisations are rising across the world, yet ironically, many countries are stopping free tests. Why have tests been singled out? Other pandemic strategies are arguably ineffective or at a cost that far outweighs the benefit, yet those strategies remain.

We didn’t arrive at this place of distrust and COVID fatigue suddenly, rather it was a general undercurrent fuelled by politics, media hype and human nature. The moment tests became a trade, your price of entry for freedom, the public lost trust. The moment test results became unreliable, the public health system lost control. Before we argue the benefits of testing and explain the reset the world needs, it’s worth reviewing the three core pandemic strategies: lockdowns, vaccinations and testing.

LOCKDOWNS

The idea behind lockdowns was simple: Limit interaction to contain the spread of COVID and prevent deaths. The verdict on the success or failure of this measure remains unsettled and has been the source of heated debate since the first lockdown in China in January 2020. On one side, scientists claim that millions of lives were saved and the public health system protected because of ‘non-pharmaceutical interventions’ (NPIs). On the other side, scientists claim the negative impacts on the economy, society, education and mental health far outweigh any benefits of lockdown.

Numbers tell a compelling story, albeit not the full story. For the UK, one year of lockdowns cost £251 billion—approximately the cost to build 16,000 schools or 1,400 hospitals. In Australia, recent lockdowns cost approximately $140 million per day in lost economic activity. Lockdowns in China cost at least $46 billion per month. The full lockdown of India in 2020 cost approximately $26 billion. The US government has spent more than $3.5 trillion in relief packages, with $4.5 trillion pledged, including health care, disaster relief and education.

Given that more than 6 million people have died, if you look at the value of statistical life (VSL), the mortality cost is more than $38 trillion or 40% of global GDP. The Economist believes the true VSL is closer to $114 trillion or 120% of GDP. Did lockdowns help keep these figures down?

The economic costs of lockdown are clear. The world plunged into the deepest recession seen in more than a generation, with little chance of recovery in the next generation. Was it worth it?

The harms to society of lockdowns must not be overlooked. One in five adults experienced depression during lockdown. According to a recent study published by the European Commission, “before the pandemic we had about 10-20% of children suffering from mental illness problems... Now, from the last two years, it looks like it’ll go up to 20-25%.”

“For the UK, one year of lockdowns cost £251 billion—approximately the cost to build 16,000 schools or 1,400 hospitals.”

Drug and alcohol abuse are at the highest level in three decades. According to the CDC, more than 100,000 people in the US died from overdoses in the first 12 months of the pandemic. Also in the US, child abuse victims aged five and older, tripled during the first four months of the pandemic. Domestic violence referrals rose 12% while calls to helplines rose 65%.

We also must factor the non-COVID costs and the thousands of cancers left undiagnosed and untreated during lockdown. In the UK alone, 350,000 patients were not referred to hospital, representing a 16% decline compared to the same period before the pandemic. Macmillan suggests women being diagnosed with stage four breast cancer has increased by 48% over the last few months, which the charity says is due to COVID disruption to NHS care. The NHS still has not caught up from the backlog caused by lockdown. How many cancers were missed? How many life-saving surgeries were missed?

The benefit side of the argument is difficult to quantify, especially as we don’t fully understand why some countries without restrictive measures experienced similar mortality rates as those with severe restrictions. Sweden is the most cited example and experienced fewer deaths and fewer cases than most European countries. Similar examples are seen in Africa and North America.

Was forcing healthy people to stay at home worth the societal, mental and economic costs?

VACCINES

The public were led to believe that the COVID vaccine was the holy grail, the return to normal and the end of COVID. Because these messages circulated at a time of heightened anxiety and fear, they became a mantra of sorts. The vaccination meant freedom. The drive was impressive and community support was strong. In the UK, volunteers by the thousands gave their time to help get jabs in arms. A little piece of paper with a date was flashed like a lottery card.

As vaccines were rolled out across the globe, studies were published citing cases of extreme reactions to the vaccines. Concerns grew and leading scientists questioned if the vaccines were rushed. Afterall, never before had a vaccine been developed and tested this quickly. That these concerns were dismissed by many media outlets, and along political party lines, eroded trust.

As vaccine hesitancy grew, governments tried different schemes to encourage people. Celebrities leant their faces and voices to create trust. Companies offered incentives. Doctors tried to educate. When these measures proved ineffective, many governments and private companies resorted to vaccine mandates. The mood changed. Instead of freedom, to many, vaccines began to feel like punishment as mandates weaponised health.

Further fuelling this distrust was news about efficacy. Israel was in the lead for vaccines and the world watched and learned. Soon we were told that boosters were needed, then a third jab for those most vulnerable. Then the studies once hidden revealed the truth: efficacy wanes. It is a widely accepted fact that the more you try to artificially boost antibodies, the less effective those antibodies become. Health authorities already knew that from experience with the MERS vaccine. Ninety days was as long as it lasted (in COVID context, that time period coincidentally matches each new wave). As this news spread, trust took another hit. Two camps (pro-vaxxers and anti-vaxxers) became more strident and science was ignored while emotion led.

We wonder, if we were given the full story without politics, just science, would vaccination rates be higher in communities with a long history of distrusting vaccines? If governments did not tie jobs to vaccines would the trucker convoy in Canada and then America have happened?

Based on the science we have today, resulting from hundreds of studies across the world, there is strong evidence that vaccines prevent serious illness and limit hospitalisations. For those most vulnerable, the small risk of side-effects from the vaccine is much less than the serious risks of COVID. It is important to talk to your doctor and make an informed decision.

One of the most destructive disinformation claims is that vaccines make you immune. No one can pinpoint the source of this lie but it persists, even in highly educated, professional circles. Vaccines do not make you immune! Fully vaccinated people can become infectious and can spread COVID, even if they are asymptomatic. And even if you have been fully vaccinated and have contracted COVID before, that does not mean you cannot catch it again.

Relying on vaccinations alone does not end COVID. Relying on boosters every three to four months, is not only expensive, but may have unintended health consequences.

“Covid booster vaccines every four months cannot continue.”

— Sir Patrick Vallance

TESTING

Before we criticise current testing methods and their failures today, a brief lookback is deserved. It wasn’t all bad, it was just slow to change.

PCR is the hero of the pandemic, at least in the early days. People were desperate to know if they had a cold or COVID. Scientists were desperate to learn and track cases, hoping to identify hotspots, measure the impact of easing restrictions and enforce new restrictions to curb the spread. Mass testing accomplished both goals and the public was happy to help because there was a sense of patriotic pride and purpose in protecting those most vulnerable that also helped to mask the growing fear.

As much as the world loves the ‘gold standard’ PCR, public health officials acknowledged in the early days of the pandemic that PCR was not enough for mass screening due to cost and slow results. Appointments were often difficult to book and results during peak times took up to one week.

Rapid antigen (aka lateral flow) tests received regulatory approval in late summer 2020, and FDA approval in the United States in December. Also in December, the NHS began offering free at-home antigen tests. The announcement was celebrated because it provided convenience and control.

By this time in the pandemic story, especially in the UK after a second lockdown, public trust was at an all-time low. The introduction of travel testing was met with mixed reviews when it was first introduced in the UK in January 2021. By then, many countries still had closed borders or allowed entry, but only after 14 days of quarantine. In the UK, the idea of taking a PCR test 72 hours before departure, and skipping the dreaded quarantine, was greeted as a sign of normality. At first.

Fit-to-fly was positioned as a benefit as if some earned reward, but it signalled another blow to the already beleaguered travel industry and to people hoping to travel. Public sentiment shifted as tests became an expensive trade. Your price of entry to freedom.

Horror stories of lost tests and lost holidays circled along with growing doubt surrounding testing accuracy. How many people had recovered from COVID but tested positive months later? The rich vs poor divide fuelled resentment as a family of four could not afford the expense of testing.

When the FDA issued a class 1 recall (the most serious type of recall) of Innova lateral flow tests in June 2021, the UK government ignored the warning and continued giving the tests to the public for free. There were serious doubts in the accuracy of the results. The FDA continued removing approval from other lateral flow brands for the next six months, including the second brand of free lateral flow tests the NHS purchased. Once again, the public felt lied to and wondered where billions of pounds went. The VIP fast-lane resurfaced in headlines.

“Real-world performance for rapid antigen tests is “50% or lower than clinical…and 50% as sensitive as PCR.”

— American Society for Microbiology

Omicron changed everything. This new, more contagious, more vaccine-resistant variant broke COVID testing, but the reasons have been hushed up under the banner of ‘living with COVID’. The first blow was the spike in demand as Omicron spread from South Africa to Europe in late November 2021, then Asia and America in December. At the same time, supply chains were crippled with massive staff shortages and suddenly, swabs were unavailable, reagents stuck in China. Testing halted at a critical time.

Shortages in tests concealed what scientists already knew: Both PCR and antigen tests were struggling to detect Omicron.

Accurate results for the Omicron variant on PCR require 35-40 cycles (50 is optimal) and at least 36-48 hours. Pre-Omicron, cycles were closer to five and labs could rush results in four hours. In a study published in the National Library of Medicine, 5 December 2021, researchers found up to 58% of false-negative PCR results and the College of American Pathologists stated PCR tests are only 80% accurate and that’s the ‘best case scenario’. That’s alarming, especially when PCR was celebrated as the most accurate and millions relied on those results to travel, visit sick relatives and work.

The expense and slow results of PCR gave antigen an advantage (on the surface). In reality, and According to the American Society for Microbiology, real-world performance for rapid antigen tests is “50% or lower than clinical…and 50% as sensitive as PCR.” The other issue with lateral flow tests is the inability to detect COVID in the early infectious stage when people are contagious. For an accurate positive result using antigen, the viral load must be so high that most positive cases won’t be detected. Omicron is much faster than other variants, averaging three to four days from infection to symptoms. Vaccines shorten that window, but do not eliminate it. Scientists predict that millions of false-negative results occurred in the United States and the United Kingdom during the winter months.

Relying on results from either PCR or antigen is risky because by the time the viral load is high enough to detect, someone is already infectious and has already spread the virus to countless others. For omicron especially, current tests do not work!

“Researchers found up to 58% of false-negative PCR results and the College of American Pathologists stated PCR tests are only 80% accurate and that’s the ‘best case scenario’. ”

— National Library of Medicine

THE WAY FORWARD

People are disillusioned with testing because it is not working. They are tired of thinking about COVID and want to return to normal. Unfortunately, the pandemic is not over. People are still being hospitalised and dying. Experts predict that long-COVID will become the next biggest public health threat as up to 30% of people with COVID will go on to experience crippling fatigue, fertility problems, cognitive decline, lung scarring or heart attacks. The common cold doesn’t cause these diseases. The flu doesn’t cause hallucinations, delusions, talking incoherently and agitation, but COVID psychosis does.

There is a better way forward…