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Antigen testing to be significantly ramped up in schools, colleges and workplaces, says Tánaiste

Leo Varadkar was speaking on Prime Time last night.

ANTIGEN TESTING IN schools, colleges and workplaces is going to be ramped up “significantly”, according to Tánaiste Leo Varadkar.

Speaking on RTÉ’s Prime Time programme last night, he said the government plans to  “expand antigen testing quite significantly” in these areas.

A report on whether antigen tests could be used in schools and other workplaces is due to be published this week. Professor Mark Ferguson of Science Foundation Ireland carried out the report which is understood to recommend individual departments take the lead in their specific areas.

To date, the only test system being widely rolled out has used the lab-reliant PCR tests, which detect the RNA of Covid-19 and are believed to be the most accurate. Antigen tests are rapid on-site tests to detect current infections of Covid-19 but experts have been split on their accuracy. Other rapid tests, antibody tests, indicate a previous Covid infection but are not widely used in public health settings.

Varadkar told yesterday’s press conference at Government Buildings that he will take the lead on rolling out antigen testing in workplaces in the private sector, while Higher Education Minister Simon Harris will take the lead in rolling it out in universities and third-level institutions.

Education Minister Norma Foley is tasked with antigen testing in schools, with pilot schemes ready to be rolled out. Government sources state a wider antigen testing system in schools could be ready for September.

It is understood there isn’t full agreement between members of the National Public Health Emergency Team (NPHET) or within the HSE in relation to antigen testing and its use.

While the final report from the expert group, which was chaired by Professor Ferguson, recommends widespread use of the tests, including in schools, it is believed it was not supported by all members of the group.

The independent antigen report was commissioned by Health Minister Stephen Donnelly and returned directly to him, in a bid to finally move on the issue that has been discussed for many months now.

While there seem to be differing viewpoints at all levels on the use of antigen testing, the government is pressing on with their use in other settings. 

Speaking recently about antigen testing in the Dail, Varadkar said he believes it has a role to play, but acknowledged that NPHET and some public health experts are “cautious” about such testing and its effectiveness.

Professor Luke O’Neill previously told Newstalk’s Pat Kenny that now is the time for the Irish Government to “bite the bullet” and introduce widespread antigen testing.

As society reopens, he said antigen tests would be a useful weapon, adding that the evidence for antigen testing is getting stronger and stronger.

In terms of schools, the UK Government sets out in its plan for secondary school and college students that they should be be tested twice a week.

But as they return to school this month they will receive three initial tests at school or college before transitioning to twice weekly home testing.

The UK Government also wants twice-weekly testing for all families and households with primary, secondary school and college-aged children and young people.

Previously, Education Minister Norma Foley said the department would “utilise antigen testing if NPHET recommends it”. 

Teachers’ unions have called for regular antigen testing to be introduced in schools as part of plans to re-open educational settings on a phased basis from next week.

NPHET has endorsed the use of antigen tests as a supplement to PCR testing in certain situations, and particularly when the availability of PCR tests may be limited.

The European Commission recently signed a contract for the supply of up to 20 million rapid antigen tests for donation to member states.

Antigen tests from the EU

The HSE confirmed to The Journal that Ireland received its first allocation of these antigen tests in the first quarter of this year.

“Proposal for their use in symptomatic patients within defined contexts has been made and decisions regarding deployment are being finalised with NPHET.

“We have already used antigen tests in hospitals, food sector and outbreak settings as part of the validation project,” said the HSE.

While a HIQA report found that antigen tests to date show reduced diagnostic accuracy as compared with the PCR test, the WHO suggests that these rapid tests should only be used when PCR testing is unavailable, or where prolonged turnaround times preclude clinical utility.

The HSE said their intended use is in symptomatic patients in the early stages of infection, where samples are taken and tests conducted by trained by health professionals.

“There is limited performance data currently available for the use of antigen tests in asymptomatic populations. The ECDC and WHO recommend that any country considering implementing antigen testing should conduct appropriate clinical validation of the tests for use in that setting.

“As a result the HSE established a working group who are verifying and validating a range of tests available in the marketplace, together with the options and impacts arising from the deployment of those tests,” said the HSE.

HSE boss Paul Reid confirmed that a working group is validating a range of antigen assays, including in acute hospitals, the meat processing sector, community testing sites and outbreak settings.

Antigen testing is already available to all acute hospitals and is being used by three National Ambulance Service mobile teams on a pilot basis, said Reid.

The health minister told the Dáil recently that validation studies, both here in Ireland and in Europe, are showing significant disparities in test performance (particularly in relation to sensitivity) versus some manufacturer claims, with some tests not meeting minimum performance requirements set by the World Health Organization and the European Centre for Disease Prevention and Control.

There is limited performance data currently available for the use of antigen tests in asymptomatic populations, he added.

Antigen testing will not, however, replace the requirement for large scale PCR testing which remains the gold standard for community testing, said the health minister.

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