Covid-19: 'Not possible' to replace swabs with rapid tests, Hiqa says

Covid-19: 'Not possible' to replace swabs with rapid tests, Hiqa says

Hiqa said the swabbing system remains more accurate than rapid test alternatives. File Picture.

A rapid test for Covid-19 isn’t suitable for Ireland yet, the health watchdog has said.

This is because they are not as accurate as the swabbing system used here.

The Health Information and Quality Authority (Hiqa) looked at a variety of alternatives to the current test, including antigen-detection diagnostic tests.

These are designed to directly detect Covid-19 proteins both in a laboratory as well as a “near patient” setting and are so-called “rapid diagnostic tests” because they can produce results in less than 30 minutes.

According to the World Health Organisation (WHO), there are nearly 100 companies developing or manufacturing rapid tests for Covid-19 antigen detection. 

Hiqa has concluded, though, that alternatives like antigen-detection diagnostic tests instead need to be validated in Ireland in a clinical setting before they can be adopted here.

And it has recommended the HSE start using antigen-detection diagnostic tests - as part of a validated rapid testing system - across the health service and test centres in Ireland as soon as possible.

This would be to see how effective they are in an Irish setting.

At present, rRT-PCR - or nasopharyngeal swab - is the standard diagnostic ‘tool’ for Covid-19 in Ireland.

The National Public Health Emergency Team (Nphet) asked Hiqa to carry out a rapid health technology assessment of alternative tests and approaches to rRT-PCR.

The results of its study - which was published this morning - are based on the scientific literature, international recommendations, and input from the Covid-19 Expert Advisory Group.

And Hiqa has advised NPHET that it is “not possible to provide an across-the-board endorsement of specific technologies due to variation in performance of individual tests”.

Dr Máirín Ryan, Hiqa’s Director of Health Technology Assessment and Deputy Chief Executive, said: “The evidence shows effective testing strategies rely on a portfolio of tests, using different technologies that can be applied in different settings and situations.

“There is no single test that is suited to all contexts.

“Testing people at or near the point of care, including with the use of rapid antigen detection tests, has the potential to expand test capacity, reduce test turnaround times and improve access.

“Such tests typically show reduced diagnostic accuracy compared with the current test.

Therefore, depending on the circumstances, results from a rapid antigen detection test may need to be confirmed with the current rRT-PCR test. 

Hiqa also advised that the introduction of validated rapid testing in Ireland should now be considered to enhance Covid-19 prevention and control.

“Efficient processes with accurate and reliable rapid tests would facilitate timely clinical management and public health measures,” Dr Ryan added.

“Clinical validation studies help determine the real world performance of tests.

“Before any new test is implemented, it is crucial that these studies are undertaken in Ireland in the settings for which use of the test is planned.

“Along with the adoption of accurate and reliable rapid tests, such a system would support the reliability of the testing service.

“A cohesive national strategy is needed to ensure the right tests are undertaken in the right people at the right time for the right purpose.

“Planning now to support delivery of the strategy will facilitate rapid deployment of tests that meet the requisite standards once validated for use.” 

The findings and advice were submitted to NPHET for their consideration and to inform public health advice on October 7.

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