Canada has been reluctant to embrace rapid tests. This Harvard epidemiologist says we can’t afford to wait

Canada is poised to be the next country to deploy mass rapid testing for COVID-19 in a gambit that Harvard epidemiologist Michael Mina says could immediately stem the spread of the virus.

As an epidemiologist and assistant professor at Harvard T.H. Chan School of Public Health, Mina has been leading research around COVID-19 testing throughout the pandemic.

Rapid at-home testing could be a COVID-19 game changer, he said.

Mina argues that government regulations should be changed to encourage manufacturers to develop the tests and public funding rolled out to assist companies with building them.

Other countries have had success with or are moving to use rapid testing to control the spread of COVID-19. In Canada, some rapid-testing systems, which provide results in minutes, are approved and being widely used. But the tests aren’t approved for household use and top public health officials remain skeptical since, generally speaking, a faster test yields less accurate results. However, when it comes to an effective testing strategy, Mina says accuracy isn’t everything.

Even as the world is preparing for the rollout of COVID-19 vaccines, with Canada expecting to begin inoculating people come January, Mina is warning that a rapid-test plan is urgently needed since the spread of the virus will continue to spread for months into 2021 and the dangers will remain real.

Rapid testing is a misunderstood strategy and one that other countries have used effectively in slowing the pandemic, he said. As Canada’s case numbers soar, Mina said this country should do it too.

“For Canada, if you could build 1 to 2 million tests per day, you could actually accomplish this, and one start-up company could produce that,” he said.

The pandemic calls for complete mobilization and a paradigm shift, argued Mina. “We’re literally in a war with a virus.”

At the start of the pandemic, Mina set out to study one question: how accurate does a test need to be to curb the spread of a virus at the community level?

Over months of research, Mina has found that developing a testing program which can identify infectious people and pull them out of the community is what’s crucial. The best way to do that? It’s not about using the most accurate tests, argues Mina. It’s using tests that deliver results quickly across the broadest possible population and using those tests often.

“In every single scenario, the test that can be scaled more widely, can be used with frequency… is incredibly more powerful than a good (gold standard, lab-based) PCR test that is not able to be scaled,” he said.

However, provincial health authorities about using rapid tests at all, noting that many of the rapid antigen tests aren’t as accurate as lab-based tests, and experts have levelled criticism about this kind of mass “at-home” plan saying it could limit data collection and create a false sense of security.

Mina contends that they’re thinking about it all wrong.

His plan calls for millions of people to test themselves at home multiple times a week using rapid antigen tests.

Mina said PCR tests, while good at diagnosing someone, are actually less effective than rapid antigen tests when looking at the pandemic through a public health lens. That means testing as many people as possible as fast as possible.

And that in turn is useful because quickly understanding who is infectious and urging them to self-isolate helps control the spread, Mina said.

If 50 per cent of people tested themselves twice a week, and those who tested positive self-isolated, the spread of the coronavirus would slow significantly, said Mina. “You don’t need to get perfect; you just need to stop most spread.”

Mina pointed to countries in Europe for examples of successful mass rapid testing programs and said Canada should follow their lead.

In October, when Slovakia was seeing exponential growth in infections, it acquired 13 million rapid antigen tests and went on to test two thirds of its population over one weekend. Mina said it’s a “shining example” of how a rapid testing plan could work since “they’ve seen incidents go from exponentially increasing to seeing the epidemic and the outbreak come crashing down.”

“Within a week and a half, they saw 50 per cent reduction in cases,” he said.

In November, Liverpool, England, was announced as the site of that country’s first mass rapid testing program. Prime Minister Boris Johnson has indicated he’d expand rapid testing across the country and for those who tested every day with negative results, life could go on as normal, according to the BBC.

Mina has also been working with the Austrian government which recently announced a mass rapid testing plan and was also in talks with a team from the Ontario government in late November. A spokesperson for the province said the government was interested in Mina’s research findings around rapid testing but didn’t go into detail about any plans it was considering for rapid tests.

While Ontario Premier Doug Ford dubbed rapid tests “a game changer” last month, the Star that Public Health Ontario’s head of microbiology outlined how they don’t perform as well as lab-based tests. Dr. Bonnie Henry, British Columbia’s provincial health officer, said in November that rapid testing was “not a panacea,” especially for long-term-care homes.

Katherine Fierlbeck, a health policy expert and political science professor at Dalhousie University, said there are several issues that arise with rapid at-home testing on a widespread scale.

First, the tests must be designed so people can use them correctly to get a reliable result, she said. Secondly, people may have a false sense of security when they test negative raising the odds they will infect others if the test result is wrong. Finally, Fierlbeck said that with mass at-home testing, there’s no requirement to record a positive test result and so governments lose the ability to track data.

“This whole thing about rapid screening, I see the logic, but the lower the threshold, the more complications arise on a number of different angles,” she said.

Mina said he hears those critiques often and disagrees they would pose a problem. The tests can be designed to be very simple to use: a person would swab their nose, drop it into a tube, and add a piece of paper, he said. A nation-wide education strategy combined with a simple-to-use test “can do wonders,” he added.

The false sense of security argument, meanwhile, is one Mina says is “an age-old concern” that is often overblown. Critics said putting seatbelts in a car would mean people would drive more recklessly or that having an HIV test would mean people would have sex more often, said Mina. “Of course, we know that that’s false now — it’s much better to know your status.”

“This argument always comes up the moment you try to take a public health tool and give it directly to the individual,” he said.

Data collection would be voluntary if the country were under a mass rapid test program, he added, because the goal of rapid test screening isn’t surveillance. Additionally, Mina said he believes that by getting people to voluntarily input their status using their smart phone after the country provided access to millions of at-home tests, “you’ll have more data, not less, flowing to the public health agencies.”

While Canada has shipped more than 5.5 million rapid tests to all the provinces and territories, with millions more expected in the months to come, they’ve received a frosty reception with some jurisdictions saying they wouldn’t use them at all and others planning to only use them on a limited basis.

These tests, which deliver results in minutes rather than days and have to be administered by health-care professionals (they aren’t for at-home use and no at-home tests have received Health Canada approval), are widely considered to be less effective at accurately identifying the virus. Provinces are also reconfirming the results of the rapid antigen tests by submitting them for additional testing using the gold standard PCR system in a lab.

But Mina said the situation across the globe calls for mass mobilization efforts. He worries that promising news of vaccine developments might move the need to fund a massive rapid-testing program off a government’s radar.

“I think that has really blinded everyone’s ability or willingness to really take bold initiative, to tackle the virus now with the tools we have today,” he said. “In World War Two we built B-24 bombers — every 63 minutes they rolled off the Ford assembly line. That’s how we should be thinking about this.

“This is a virus that’s crippling our economies, it’s crippling our social structure, and it’s killing hundreds of thousands of people on our soils, as bad as any war that we’ve fought in decades and decades.”

With files from The Canadian Press and the Associated Press

Kieran Leavitt is an Edmonton-based reporter covering provincial affairs for the Star. Follow him on Twitter: