Clear the confusion over coronavirus antigen testing

THE EDITOR, Madam:

The Ministry of Health and Wellness (MOHW) announced it would have had its COVID-19 antigen (rapid test) kits in August of 2020. This was not forthcoming and by September/October of 2020, independent operators were able to get kits into the Jamaican marketplace. The MOHW labelled these kits as unauthorised and illegal. They discouraged practitioners from using them. In the continued absence of kits from the MOHW, and persistent demand, use of these test kits increased island-wide.

There was then a call for practitioners to report the results from these tests to the relevant health departments. The MOHW has now announced, in January of 2021, that eight entities are authorised to do COVID-19 antigen testing, presumably with authorised kits. Of the eight listed, enquiries revealed the following: two said they were not ready, and one said they were awaiting further confirmation. Yet another said they were out of reagent. Another could not be reached by phone, but their web portal offered appointments and the promise of results in 24 to 48 hours for a rapid test.

Two entities which do PCR testing are fully booked for January, but appointments are available for February.

I am not a political animal. I support and applaud the MOHW’s efforts and successes to date as it relates to COVID-19. I, however, feel that this limited availability of testing in the community spread phase of the pandemic is decidedly off the mark.

My questions are as follows:

• What efforts have been made to evaluate/validate the tests that have found their way into the marketplace?

• If the tests are not recognised, why ask for the results? Presumably, the results are invalid, and further, it exposes the practitioner to the jeopardy of being accused of using an unverified instrument.

• What are the requirements for an institution/practitioner to conduct rapid antigen testing?

GAME CHANGER

Rapid testing has been hailed as a game changer in the COVID-19 pandemic at all levels, from the World Health Organization onwards. This test is meant to bring testing and results to the ‘point of care’ in real time. Limiting access and centralising testing defeats the entire purpose. Point-of-care tests and testing are not new. There are limitations and trade-offs which have to be made and understood for this modality of testing. A similar debate took place with the introduction of HIV test kits – an example of a point-of-care test kit. The use of HIV test kits is now standard practice.

There is an entire resource in the fight against COVID-19 which is being overlooked. This resource is the islandwide reach and expertise of private practitioners. It continues to be my pet peeve that private practitioners seem to be peripheral to the planning and organisation in this battle, and, indeed, are often cast as an hindrance, as this policy appears to reflect.

I don’t know what the MOHW’s calculus is as it relates to the use of COVID-19 antigen kits; however, I do feel very strongly that it requires a rethink.

DR ORVILLE NEMBHARD

Family Physician