Coronavirus: Why Italy's trailblazing rapid tests failed to stop the second wave
AFP - [email protected]
Published: 11 Nov, 2020 CET.
Updated: Mon 16 Nov 2020 09:20 CET
Italy was the first country in Europe to bet big on rapid "antigen" coronavirus tests, and its apparent success encouraged Britain, the United States, Slovakia and others to follow suit.
However the tests, which are roughly 80 to 90 percent accurate, have not stopped an outbreak that has rocketed from around 500 cases a day in August, when they were first rolled out, to more than 35,000 now - with the total number infections set to top one million on Wednesday.
IN GRAPHS: Track the spread of coronavirus in every region of Italy
"I believe these tests are not used properly at the moment, they are just distributed randomly to everybody," Professor Andrea Crisanti of the University of Padua told AFP, saying the government has no overall plan.
He said their use as a measure to protect vulnerable people in care homes, for example, was "absolutely criminal" because positive cases could slip through the net.
'No alternative'
A vaccine may well be on its way, but not in time to battle the current wave of infections in Europe and elsewhere.
Instead, policymakers are left scrambling for solutions that avoid a repeat of the economically devastating lockdown earlier this year.
Italy last week shut bars, restaurants and shops in the worst-affected areas and introduced a nationwide night curfew, but has so far stopped short of another nationwide shutdown.
The antigen tests have become a crucial part of the italian authorities' efforts to avoid a second lockdown.
They take just minutes to produce a result and they are cheap, unlike the "gold standard" molecular PCR tests that are close to 100 percent accurate.
Photo: Alberto Pizzoli/AFP
"Having such an instrument is fundamental, you have a method to immediately understand if a patient has the virus. It is a good starting point," says family doctor Francesco Stevanato, who has carried out roughly 50 tests from his clinic in Venice.
Rolling them out in airports, it was thought, could help protect the travel industry. With wider availability, schools and businesses could safely stay open.
Professor Sergio Abrignani of the University of Milan, who co-authored a letter with some of Italy's leading scientists in September calling for their widespread use, conceded that they were not an overall solution.
"But there are practical situations where the antigen test has no alternative," he told AFP.
"For example, when I am boarding a train or a ship and want to reduce the risk. The molecular test takes too long to give me an answer."
Anyone who tests positive with an antigen test in Italy is supposed to get a PCR test to confirm the result.
But the real danger is false negatives - if the rapid tests have an accuracy level of 80 or 90 percent, infected people will return negative
results.
'No specific strategy'
"If your objective is to screen a community to know if transmission is there, fine," said Crisanti.
However, he said that to halt transmission, rapid tests must be complemented by the accuracy of PCR tests, along with surveillance tools and
stay-at-home orders.
The Italian health ministry told AFP there was no specific strategy in place for testing beyond boosting capacity.
And the National Institute of Health, in charge of monitoring the epidemic for the ministry, could not provide any data related to the uptake of rapid tests.
An integrated approach is frustrated by the fact health policy in Italy is largely controlled by regional officials - creating wide variations.
But Crisanti said the government should have built a broader plan to capitalise on the lower number of cases after the lockdown.
"If they had built a network for molecular (PCR) tests, if they had integrated this capability with an information tool... and if they had built
infrastructure to make the beds available where they are needed, I'm sure we would be in a completely different situation."
By AFP's Joseph Boyle and Giuliana Ricozzi
Comments
See Also
However the tests, which are roughly 80 to 90 percent accurate, have not stopped an outbreak that has rocketed from around 500 cases a day in August, when they were first rolled out, to more than 35,000 now - with the total number infections set to top one million on Wednesday.
IN GRAPHS: Track the spread of coronavirus in every region of Italy
"I believe these tests are not used properly at the moment, they are just distributed randomly to everybody," Professor Andrea Crisanti of the University of Padua told AFP, saying the government has no overall plan.
He said their use as a measure to protect vulnerable people in care homes, for example, was "absolutely criminal" because positive cases could slip through the net.
'No alternative'
A vaccine may well be on its way, but not in time to battle the current wave of infections in Europe and elsewhere.
Instead, policymakers are left scrambling for solutions that avoid a repeat of the economically devastating lockdown earlier this year.
Italy last week shut bars, restaurants and shops in the worst-affected areas and introduced a nationwide night curfew, but has so far stopped short of another nationwide shutdown.
The antigen tests have become a crucial part of the italian authorities' efforts to avoid a second lockdown.
They take just minutes to produce a result and they are cheap, unlike the "gold standard" molecular PCR tests that are close to 100 percent accurate.
Photo: Alberto Pizzoli/AFP
"Having such an instrument is fundamental, you have a method to immediately understand if a patient has the virus. It is a good starting point," says family doctor Francesco Stevanato, who has carried out roughly 50 tests from his clinic in Venice.
Rolling them out in airports, it was thought, could help protect the travel industry. With wider availability, schools and businesses could safely stay open.
Professor Sergio Abrignani of the University of Milan, who co-authored a letter with some of Italy's leading scientists in September calling for their widespread use, conceded that they were not an overall solution.
"But there are practical situations where the antigen test has no alternative," he told AFP.
"For example, when I am boarding a train or a ship and want to reduce the risk. The molecular test takes too long to give me an answer."
Anyone who tests positive with an antigen test in Italy is supposed to get a PCR test to confirm the result.
But the real danger is false negatives - if the rapid tests have an accuracy level of 80 or 90 percent, infected people will return negative
results.
'No specific strategy'
"If your objective is to screen a community to know if transmission is there, fine," said Crisanti.
However, he said that to halt transmission, rapid tests must be complemented by the accuracy of PCR tests, along with surveillance tools and
stay-at-home orders.
The Italian health ministry told AFP there was no specific strategy in place for testing beyond boosting capacity.
And the National Institute of Health, in charge of monitoring the epidemic for the ministry, could not provide any data related to the uptake of rapid tests.
An integrated approach is frustrated by the fact health policy in Italy is largely controlled by regional officials - creating wide variations.
But Crisanti said the government should have built a broader plan to capitalise on the lower number of cases after the lockdown.
"If they had built a network for molecular (PCR) tests, if they had integrated this capability with an information tool... and if they had built
infrastructure to make the beds available where they are needed, I'm sure we would be in a completely different situation."
By AFP's Joseph Boyle and Giuliana Ricozzi
Join the conversation in our comments section below. Share your own views and experience and if you have a question or suggestion for our journalists then email us at [email protected].
Please keep comments civil, constructive and on topic – and make sure to read our terms of use before getting involved.
Please log in here to leave a comment.