Finn McRedmond: Ireland has lessons to learn from UK on antigen tests

Government must hold the population’s risk-management capacity in low regard

Dr Tony Holohan, chief medical officer at the Department of Health: encouraged those with suspected Covid to eschew antigen tests in favour of a PCR. Photograph:   Colin Keegan, Collins Dublin

Dr Tony Holohan, chief medical officer at the Department of Health: encouraged those with suspected Covid to eschew antigen tests in favour of a PCR. Photograph: Colin Keegan, Collins Dublin

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After nearly two years of the pandemic, the most impressive thing about Ireland’s response is its sustained ability to never learn from its mistakes. The most recent failure – of Nphet or the Government or both (it can be hard to know who is in charge) – lies with the frustratingly slow uptake of antigen testing.

This summer in England anyone could walk into a pharmacy and pick up a box of tests for free, no hassle. Several big events required proof of a negative result upon entry. They quickly embedded themselves in the architecture of daily life in London. Amid a peak in infections last summer antigen tests were not a silver bullet, but they were a helpful mechanism for virus-management.

The British government was not gripped by months of delay and flip-flopping, there was no confused and conflicting public messaging about their efficacy, no suggestion that they were too difficult for people to use correctly, and not a hint of psychological torment overtook the process. Number 10 does not always exhibit a greater grip on sanity and clear headed policy making than Dublin, but it can and does happen.

In Ireland, antigen tests were first dismissed as snake oil. Nphet chief Tony Holohan encouraged those with suspected Covid to eschew them in favour of a PCR. Only now – over seven months since they were recommended to the Government – are there proper discussions in place for how to deploy them. They won’t be free, they’ll be subsidised, they won’t be subsidised. Schools must apply to receive them, rather than simply be sent them.

The mess is laughable. And for an administration so keen on lockdowns, and so hyper-cautious when it comes to relieving restrictions, its non-committal anxious vacillation on the question of rapid testing beggars belief.

And the driving concern – expressed by Holohan – is a flimsy one. Antigen tests are not 100 per cent reliable: if they return a false-negative they might lull us into an equally false sense of security, giving us the mistaken confidence to mix with others in so-called high-risk environments. I think we ought to be spared such paternalism. If this is the reason for prevarication, then the Government must hold the population and its risk-management capacity in very low regard.

The calculation Holohan has made is called risk compensation. And it has been one of the most consistent problems in pandemic management world-over. The argument goes like this: anything that might increase our safety – antigen tests, masks, vaccines – in turn causes our behaviour to be more risky. Imbued with misplaced confidence, gains made by these measures will be counteracted by our newfound lack of caution.

It’s the sort of five-steps-ahead style thinking that must make people feel terribly clever. And it is a mode of reasoning employed by those who argue seat belts and bike helmets have the counterproductive effect of making us less safe: they only cause us to drive or cycle dangerously. Unfortunately when risk compensation is placed under empirical analysis the results are at best ambiguous and at worst wildly off the mark. As Atlantic writer Zeynep Tufekci explains: “Even if safety improvements cause a few people to behave recklessly, the benefits overwhelm the ill effects.”

Masks

Nevertheless we have seen this type of thinking all over. When Covid became a mainstream concern in early 2020 we were urged not to wear masks. There were several reasons: experts underestimated the extent of airborne spread of the disease, we needed to protect supplies for hospital staff and key workers, masks would give us that feared confidence to behave in otherwise risky ways.

Of course by July 2020 in Ireland masks were mandatory in several circumstances, and the measure has just been reintroduced in England too. It does not seem unreasonable to suggest any risk compensation considerations were misfounded. As Tefecki pointed out, empirical research confirmed that wearing masks actually increased adherence to other precautionary measures in the States. If that is the case then Nphet ought to have seen itself making the same mistake with antigen tests.

In trying to justify their aversion to rapid testing – or the slowness of their uptake – it seems the authorities in Ireland missed out on a very simple calculation about human behaviour: most people are inherently wary of catching a sometimes-lethal airborne virus. Just as most people are inherently wary of driving recklessly on the side of a cliff, seatbelt or no seatbelt.

Antigen tests are not 100 per cent reliable. But nor are PCR tests. Vaccines are not 100 per cent effective. Nor is social distancing or lockdown. And we know that Covid is primarily airborne yet we are still asked to sanitise our hands before walking into most buildings. Dithering on rapid testing is not just disorganised and foolish but it’s inconsistent with other measures happily adopted by the Government.

But there is a more foundational problem. Even if antigen tests increase risky behaviour in a few, their opponents are still missing out on the bigger picture. It has been abundantly clear for quite some time now that we cannot eradicate the Covid risk to absolute zero – certainly not with the means available to us currently.

What we can do is mitigate and balance risks: how can we pursue a life as normal as possible – including going to weddings and pubs and restaurants – in as safe a way as possible? Antigen tests will not see an end to Covid, but they are another means to help us live imperfectly with it.

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