Diversified Covid Screening Approaches are Paramount

If Australia is to open up its borders, we need to follow Europe’s lead and broaden our approach to fighting the pandemic with more proactive testing and monitoring. We certainly have the expertise and capability to do so.

In September last year, we suggested that a diversified vaccination strategy should be our Plan A^[1] to allow Australia to open its borders and start our post-pandemic life. As we highlighted then, the SARS-CoV-2 virus will remain with us forever and we need to learn to live with it.

Greater Sydney, surrounding areas and other cities and states are back in lockdown and under increased restrictions due to the presence of the highly contagious Delta variant. Vaccinations are rising gradually and queues at COVID-testing stations are growing rapidly. Rest assured, Delta will not be our last viral variant and neither will this be your last COVID test.

So, how do we reach the point where we are comfortable booking holidays without worrying about yet another lockdown? Or taking that next step and opening Australia up to the rest of the world?

We don’t have a crystal ball; however, we know that vaccinations, testing and monitoring are paramount to fighting the virus, along with continued work on therapeutics and contact tracing. Neither will be one-offs. Vaccinations will include booster shots, with various countries already securing their allocations, particularly for the mRNA-based vaccines, and Australia must do likewise.  The mRNA companies are already working on predicting future variants of concern to stay ahead of the virus. Vaccinating children and adolescents, which is occurring in some parts of the world, is also a very important part of the battleplan to combat this coronavirus.
 
Testing is as important as vaccinations, and on that front, Australia has some work to do. We need to progress to screening for asymptomatic carriers, not just diagnosing symptomatic carriers. This is of paramount importance if we are to return to something that resembles our pre-COVID lives, like many have in other parts of the world.
 
Currently, we go to the nearest COVID testing station when we have mild flu-like symptoms. Within 24-48 hours we receive our results and are able to return to our normal way of our life until symptoms appear again and we repeat the process. While testing levels increase at times of outbreaks, for the general Australian population, we remain focused on diagnosing an infection as opposed to screening and monitoring for it. Therein lies a significant difference to what is happening in Europe, where efforts have shifted to screening and monitoring. It is by no means perfect, but it is about both: symptomatic and most importantly, asymptomatic testing. It is about offering choice and convenience for the “testing customer”. If you want to capture asymptomatic viral carriers and stem outbreaks you must make it as easy and accessible as possible, particularly for children.

Different tests are widely available in parts of Europe, which are funded by governments, companies or individuals out of their own pocket. These include rapid antigen tests, PCR tests and those that detect antibodies against SARS-CoV-2. There are many testing sites, including pharmacies for rapid antigen testing and PCR testing facilities within airports and shopping centres (see centogene.com for example). German schools and childcare facilities are gearing up to use child-friendly “lollipop” pooled PCR tests (provided by companies such as SYNLAB),^[2] while in certain office environments, employees perform antigen rapid tests every morning prior to coming to work. Rapid antigen tests are by no means the answer, they are transitory due to their lower sensitivity versus PCR-based tests.
 
The debate in Europe, however, is exactly where it should be: about PCR screening infrastructure and moving away from the dreaded nasal swab to sample collections that can be done at home. Vienna has been embarking on such a screening program using a “gargle“ kit. Once registered, the person receives four kits per week, completes their tests and hands them in at the supermarket or petrol station. 24 hours later they receive their results (see allesgurgelt.at/en/).
 
Holland is similarly assessing its SARS-CoV-2 screening infrastructure looking at easy-to-do saliva swabs and routine testing twice a week.
 
There is no reason why Australia cannot establish monitoring infrastructure too. Australia has highly experienced and proficient scientists and companies that are more than capable of supporting a PCR screening approach. Some of them have developed PCR tests for screening projects overseas. We need a concerted effort of connecting these companies with the ones that have automation and high throughput testing infrastructure, along with government support. We have all the pieces in this country, we just need to put them together.
 
Again, as we stipulated in September last year, diversification is key not only for vaccines but also for how we detect SARS-CoV-2 variants in circulation versus simply diagnosing an infection. To us, diagnostic companies, both large and small, are crucial partners in this pandemic.

^[1] https://www.platinum.com.au/Insights-Tools/The-Journal/A-Diversified-Vaccination-Strategy
^[2] Highlights from synlab Germany

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