JANUARY 11 — We await with bated breath this week for the possibility the worst-case scenario — a full-scale lockdown like that of March last year. Another lockdown will kill more than the virus — much more. Globally, we are seeing that lockdowns are bluntest of the tools that we have on hand and we need to view as the very last “nuclear option”.
On January 7, 2021, 46 of Malaysia’s medical thought leaders sent an open letter to our Honorable Prime Minister proposing 10 urgent and critical actions which the Malay Mail chose to reproduce.
The first two proposals truly gladdened my heart:
1. To ramp up testing with triaged, mass and frequent testing regimen, utilizing inexpensive rapid testing kits (RTK-Ag), instead of PCR, to help to slow the transmission of Covid-19.
2. Early RTK-Ag diagnosis of cases within 24 hours would enable rapid isolation of cases and facilitate prompt contact tracing.
For the last few months, I have been screaming, begging and pleading to all I am in contact that all out mass testing needs to be initiated now.
So far, most governments have put all efforts in the “vaccine shotgun”. We are still a long way from a vaccine that is safe, effective and mostly importantly, available to all.
Director-General of Health has warned, the worse is yet to come. We cannot wait. We must act now.
To win the war on Covid-19, we need a multi-pronged public health strategy that includes a national testing plan with widespread frequent rapid antigen tests to stop the virus. We need to think strategically. More important, we must now allow the “perfect to be the enemy of the good” as public health systems tend to favour an antibody PCR testing that takes days to return results and is far more expensive.
Antigen testing tests “contagiousness”. They are extremely effective — more than 95 per cent sensitive compared to the typically used PCR test) in detecting Covid-19 when individuals are most contagious — in the days way before the symptoms emerge.
Paper-strip antigen tests are inexpensive. More important, results come in minutes. They can be used without cumbersome and expensive machines and reagents. There is no need to trained staff. Newer tests are saliva based and completely eliminate the stab into the nose that the current testing mandates.
Central to the kit is a small paper strip with a substance embedded on it that detects SARS-CoV-2 and changes colour when the virus is present in the sample. To use the test, the person gently swabs the front of their nose or a take a saliva sample. This allows testing to be done a mobile make shift facility, at a pharmacy or even the privacy of your home.
Widespread and frequent rapid antigen testing is the best possible tool we have at our disposal today — and we are not using it enough. It would significantly reduce the spread of the virus without having to shut down the country again.
Accordingly to Professor Michael Mina of the Harvard Medical School, whom I am in contact and work with, If only 50 per cent of the population tested themselves in this way every four days, we can achieve vaccine-like “herd immunity effects”. Mina has convincing data that the cost of implementing a programme like this would be less that 0.5 per cent the cost that the virus inflicts on the economy.
Unlike vaccines which stop transmissions through immunity, testing can do this by giving us the tools, in real-time, to know if they are contagious before they have symptoms. This will stop them from unknowingly spreading the virus.
Testing is that proverbial “ounce of prevention”. The return on investment would be massive in many obvious ways. The cost is so low. I estimate that it will be less than RM100 million if implemented fully in Malaysia). Not implementing it would be truly a national tragedy. A programme like this could turn the tables on the virus in weeks. The Lancet, on October 31, 2020, reported the success in Slovakia — where massive screening broke the vengeance of the virus in weeks.
It is lot simpler than the other tools that we have in the arsenal. We would have to ship the tests to participating facilities and make them available in schools or workplaces. Better still, this programme does not need the entire population to participate. Even if half of the community disregards their results or chooses to not participate altogether, outbreaks would still be turned around in weeks.
The point is to use these tests frequently so people are likely to know their status early, before they transmit to others. It is frequency and speed to get results, and not the absolute sensitivity that should take precedence in a public health screening program.
With antigen testing, specificity (or potential for false positives) are important to consider and can be easily solved by including a second confirmation test to confirm original positive test results. The sensitivity and specificity of these tests have been issues — but that debate is settled. We now have the data. It is not true that these tests aren’t sensitive enough compared to PCR. These tests are incredibly sensitive in catching nearly all who are currently transmitting virus.
For widespread adoption, testing must be convenient. Reporting should be voluntary — with the “click” on a smartphone screen. To stop Covid-19 we need to put the “public” back in public health. We need to empower the people.
Believe me, there will be mass cooperation. Malaysians are exhausted. The last lockdown literally broke us. Folks I know will give it their all to prevent more mayhem.
I have a personal story to share. Last Thursday, one of my managers called me late at night. His wife was Covid-19 positive. The whole office came back the next day except him. We had the rapid antigen test done. The results came back in an hour. All 34 of us tested “negative” and went on our work and lives without anxiety and stress. My manager too tested “negative” with the antibody tests two days later. This can be a real cost and time effective solution.
Let us have discussion and action. The global network to help is available.
* Datuk Dr Rajen Manicka is the CEO of Holista Biotech. He is a pharmacist with a doctorate in Holistic Medicine. He has been actively involved in many ministerial level committees over the years.
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
