An Open Letter: A New Perspective on the Continuing COVID-19 Crisis

In early September, we all began to take notice of the COVID-19 infection numbers going back up, and with another lockdown as the least attractive option, the solution today needs to be different.

Widespread testing had proven itself the first and most important line of defense against the virus, and while flattening the curve was the first important challenge in our global fight against the pandemic, but with economies and businesses weakened and on the brink today.

The world needs a new philosophy and scalable solution, focused on smarter and more targeted testing.

In the past few weeks, coupled with the new challenges faced by rising infection rates around the world, we have witnessed the advent of Rapid Antigen Tests. While clinical testing performance and usage of antigen tests has to be further evaluated, they may provide an excellent opportunity to relieve some of the pressure on healthcare systems and provide faster and cheaper testing for more people.

Before racing to adopt new testing methods and strategies, it’s important to understand the strengths and weaknesses of different testing methods to then better plan how they can be best combined to deliver the most efficient and effective testing approach. To show what we mean, we can take a look at two popular tests that are currently most prominent in the limelight, RT-PCR and Rapid Antigen Testing, though this by no means an exhaustive list of comparisons between all different tests available on the market today.

In general, the benefits and limitations of any test are based on five main factors:

• Accuracy: of the test result (sensitivity and specificity)
• Speed: the time between the sample collection and the availability of the rest result
• Cost: how expensive the test is
• Availability: how many people can get tested in a specific timeframe and the manufacturer’s ability to produce reliably and at a high speed the tests needed to meet the demands
• Sampling procedure: not shown in this in the chart below since both RT-PCR and Rapid Antigen Testing use nasopharyngeal swabs

So rather than wondering ‘which test is better’, what we should really be asking at every opportunity is ‘what are the benefits and limitations of each test’ to help us determine how they can best be used, and who is best placed to accurately and efficiently carry them out.

For example, RT-PCR testing at a mass scale is cost-prohibitive, takes longer for the results to come out and needs to be analyzed in a lab, and this can only take place if the RT-PCR test is available at all, which has been an ever-present and mounting concern due to global shortages. The real power in rapid antigen testing is in its availability, cost-effectiveness and speed. The tests are easy to handle and can be used outside a laboratory setting. However RT-PCR tests remain absolutely necessary in confirming and identifying positive infections.

Rapid antigen tests are a relatively new tool in our arsenal and their final intended use is yet to be determined. For example, the German national test strategy recommends to evaluate rapid antigen tests in the setting of critical infrastructures like hospitals and nursing homes. Visitors can, immediately before visiting the facility, get a rapid antigen test if they come from a region with an increased 7-day incidence, such as more than 50 people per 100,000. In case a visitor is positive, they would still require a RT-PCR test to confirm the results ensuring that the use of RT-PCR tests is better targeted, focusing on those who are more likely to be positive and freeing up capacity for RT-PCR tests where they are needed most urgently.

In summary, every new weapon in our arsenal provides us with the distinct opportunity to avoid hard lockdowns and curfews, allowing for fewer restrictions and a closer resemblance of pre-covid normalcy. Combined, Rapid Antigen Testing, RT-PCR, and other tests play an important role in a holistic testing strategy that can successfully manage the pandemic. As a digital health company, we are providing the tools at our disposal for publicly sponsored studies that aim to provide decision-makers with the pilot projects and outcome data they need to form their expert opinions. We’re currently engaged with one study and three pilots and we’re hoping to see more take place across the world.

We cannot do this alone, and we call upon governments, their ministries, private companies, and diagnostic lab partners, to join us in fighting our biggest battle of the decade, if not the century.

In a series of upcoming updates which we will make available publicly, my team and I look forward to sharing the findings from the studies and pilots we’re involved in and a deep-dive on focused topics that we believe will make the difference we need as we continue the battle against COVID-19.

If you want to learn more about Medicus solutions that support Rapid Antigen Testing and RT-PCR, reach out to me: baher@medicus.ai.