More than vaccines are required to control the COVID-19 pandemic

Australian Academy report highlights the importance of other tools, including testing

As vaccinations for COVID-19 start in the United States and the UK, there is increasing attention on when and how vaccinations will begin here in Australia. While it is expected that any approved vaccine will be effective at preventing people from getting sick due to COVID-19, it remains unclear whether any vaccine will actually stop the spread of the infection. This is a critical issue, as the vaccine may not lead to herd immunity, which protects unimmunised members of the community by breaking the transmission chain. An important report released this week from the Australian Academy of Health and Medical Sciences (AAHMS) addresses this matter: Maintaining strong foundations and building resilience: planning Australia’s path through the COVID-19 pandemic.

The AAHMS is "the impartial, authoritative, cross-sector voice of health and medical science in Australia – an independent, interdisciplinary body of Australia’s leading minds in the health and medical sciences". The key message of their report is that in order to control the impact of the pandemic, initiatives need to continue in five major areas:
  • Comprehensive public health measures including swab testing for COVID-19 linked to contact tracing, isolation and quarantine together with social distancing, use of face masks and controls of international borders.
  • A programme of vaccination, treatments and other interventions such as improved antigen based tests to enable more rapid case detection.  
  • Management of the long-term health issues such as mental health
  • Support for fighting the pandemic in our neighbouring countries in the region.
  • Maintaining research and innovation even when there are low case numbers
Australia’s success so far at containing the pandemic has relied on the use of laboratory-based testing for COVID-19 in nasal swabs but while these are the most accurate of tests, there is a time delay of at least 24hrs before results are available. And as the AAHMS report argues, there is a need for more rapid testing to improve the efficiency of contact tracing systems. The availability of quicker results would also remove the disincentive for people to isolate while they await test results.

More rapid testing is likely to be virus detection or detection of proteins (antigens) that are part of the virus or specific antibodies produced by individuals in response to infection with results available in 15-30 minutes. Such tests are available now but are not recommended to be widely used because their sensitivity or ability to detect the virus antigen is not as good as laboratory-based swab testing.

However, it is likely that innovation and development of rapid antigen tests will continue. Only this week a Brisbane-based company announced that they had developed a home-based COVID-19 test used in conjunction with a mobile phone app which has been approved for use in the United States. The AAHMS says that despite their lower sensitivity and the risk of false negative tests leading to missed cases and potential outbreaks, there may still be situations where the tests are useful because rapid tests are better than no tests.

Thus the AAHMS report states that: “the most important factors driving the effectiveness of testing and surveillance systems appear to be the frequency of testing and the speed of reporting, rather than high test sensitivity, meaning that tracing systems should be designed to maximise access, frequency and speed”.

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