‘Show the work’: Doctors skeptical of B.C.’s rapid test strategy, question Henry’s rationale

‘Show the work’: Doctors skeptical of B.C.'s rapid test strategy, question Henry's rationale
Physicians say recent remarks about rapid antigen tests from B.C.’s provincial health officer are misleading, inconsistent and completely inaccurate at times (Photo credit: Annie Spratt/Unsplash)

Physicians say recent remarks about rapid antigen tests from B.C.’s provincial health officer are misleading, inconsistent and completely inaccurate at times, with one doctor calling on her to produce scientific data that supports limiting their availability to the public.

During Tuesday’s COVID-19 media briefing, Provincial Health Officer, Dr. Bonnie Henry, said the lack of rapid test kit availability comes down to supply chain issues, poor packaging and that many of them require a medical professional or machine – even though B.C. has received millions of tests from the federal government and used less than 10 per cent of them.

However, Dr. Victor Leung, an infectious diseases physician and medical microbiologist in the Lower Mainland, believes much of the information about rapid tests was either confused, misrepresented or inaccurate, in terms of how it was presented on Tuesday.

“The response from the provincial government and the public health teams with respect to rapid antigen tests does not make a lot of sense and it also seems that the answers shift in terms of why we’re not using them. It is not very consistent,” he told CHEK News in an interview Tuesday night.

Among the comments Henry made Tuesday was that anywhere from 1.3-1.4 million of the tests B.C. currently has on hand can only be used by a medical professional or need a machine.

“About 1.3 to 1.4 million of the tests that we have … are ones that require a healthcare provider to administer. “They are ones that have a little test box and it is a nasopharyngeal test swap, and you do the swap, you do the test, it has the machine that does the test,” said Henry on Tuesday. “So, the machine is the limiting factor. You can’t send that home.”

But, that’s not exactly accurate.

According to federal government data, British Columbia has received four different rapid test products – Abbott ID Now, Abbott Panbio, BD Veritor, and Lucira – as of Dec. 3 and Dr. Leung said only one of them actually requires a specific machine.

“Abbott ID Now is a type of nucleic acid testing, more specifically called isothermal nucleic acid amplification, and it can be done in about 15 minutes, as well. That’s the test that needs a machine and it generally is placed in labs or clinics or other types of medical facilities because it does require a setup with the machine,” he explained.

RELATED: Physician urges B.C. to provide free COVID-19 rapid antigen tests

Out of the 3,200,306 tests sent to British Columbia so far, the majority of them are Abbott Panbio (2,180,850), followed by Abbott ID Now (626,976), BD Veritor (389,880), and Lucira (2,600).

“If she talking about a test that needs a machine, then the numbers don’t add up to me. Unless she’s adding BD Veritor and mixing that with the nucleic acid test,” said Leung.

Dr. Leung explained that Lucira is also a nucleic acid test amplification test, more specifically loop-mediated amplification or LAMP test.

“These types of nucleic acid tests are good for all phases of COVID infection from prior to being infectious to the time you’re very infectious,” he said.

The other test products that British Columbia has received – Abbott Panbio and BD Veritor – are known as rapid antigen tests, which detect the protein of the virus when there is enough virus for someone to likely be infectious.

“These rapid antigen tests are actually much better, much more accurate because it tells you if this person is currently infectious,” explained Leung. “In British Columbia, we have 2.1 million of those that were received. They deployed about a million and the about 230,000.”

Of those two rapid antigen test products, BD Veritor comes with a handheld device as well as a nasal swab.

“This requires a small handheld device to read the results,” said Leung. “But at the same time, you can also read it with the naked eye and in fact, when you read the result with the naked eye, you have a lower chance of a false positive.”

Although he isn’t entirely certain, Leung suggested that Henry might also be lumping in Abbott Panbio into the group of tests that need a professional to administer them. He said that could be because there are actually two different types of Abbott Panbio tests.

“One is a nasopharyngeal swab test, which is what we had from the beginning,” explained Leung. “Those tests were available back in late November of last year. At the time, at least outside of Nova Scotia, health professionals were required to administer them because it would be pretty difficult for someone to take a nasopharyngeal sample on themselves. So, I could see how that may have been a barrier.”

The other type of test is simply a nasal swab test, which can be done by anyone and can be self-performed. Leung said Abbott Panbio kits that contain the nasopharyngeal swab can simply be replaced with nasal swab tests.

“It’s replaceable, the manufacturer allows for that,” he said. “So, it’s not something that’s not doable.”

What are BTNX, Roche and lateral flow tests anyway?

Nova Scotia, New Brunswick, and Saskatchewan have been handing out free rapid test kits to residents for weeks now while Alberta and Quebec have either just begun doing so or announced plans to hand them out.

Throughout Tuesday’s media briefing, Dr. Henry suggested that another reason for not handing out rapid test kits is because B.C. was not provided with the same ones that Alberta or Nova Scotia are using, called BTNX.

“Alberta and some of the other provinces, Nova Scotia, in particular, have an at-home type of kit that we don’t have in B.C., a kit that is more amenable to distributing to people, the BTNX kits,” she said Tuesday.

According to the federal government’s website, British Columbia has not received any BTNX or Roche SD Biosensor — another test product that provincial health officials have said they’re waiting on.

Dr. Leung said the tests all pretty much work the same way, but are packaged differently.

“BTNX, those are pre-packaged into smaller quantities like quantities of five. So yeah, easier to distribute,” he said, adding that Roche SD Biosensor has “very similar performance.”

On Tuesday and in recent public comments Dr. Henry has mentioned lateral flow tests as something that would be ideal for British Columbia.

“One of the things we have been looking at for some months is the at-home tests, similar to what is used in the U.K., lateral flow tests they’re called, which come in kits of about five with the dropper,” she said during Tuesday’s briefing.

Leung said, however, that lateral flow tests are the same thing as a rapid antigen test.

“They all work in a similar way in which you collect your specimen, you place the specimen in a buffer, and you drop the fluid that has the specimen in it. The liquid that is the specimen onto a cartridge. The cartridge has a nitrocellulose strip packaged inside a plastic and the buffer migrates along this nitrocellulose strip and that’s what the lateral flow aspect refers to,” he said. “So, they’re just different names for similar things.”

Nova Scotia has ‘done the best’ when it comes to rapid testing, say experts

Dr. Bonnie Henry also explained that another reason for not handing out rapid test kits is because about 700,000 tests need to be removed and separated from the kits they came in – something she said was too time-consuming.

“It is really challenging to break those down,” she bemoaned on Tuesday. “It takes a lot of time, you have to get, it takes people power, from a lab has been running full system, from public health people that have been running full steam. So, that is the challenge that we face.”

However, Nova Scotia, which has received more than 4.6 million tests and already used 1.1 million of them, has been able to overcome a similar challenge by repackaging the tests with the help of volunteers, said Dr. Leung.

“Nova Scotia has done that by getting volunteers to do it,” he said, adding. “Being rigid and inflexible with testing approaches that are important in a pandemic means that you don’t act until you think you have something that’s perfect and reality. The systems that are deployed in Nova Scotia, for example, are much more practical and effective.”

Dr. Lyne Filiatrault, who was formally involved in British Columbia’s SARS response in 2003, agrees. She says Nova Scotia has been a leader in Canada, particularly when it comes to rapid tests.

“As far as I’m concerned, and the province in my mind that has done the best by really engaging with the community to use rapid antigen test pre-emptively, has been Nova Scotia,” she said. “They have been really clear all along that this is not the only tool, but if you want to get together safe here’s a rapid antigen test.”

Filiatrault said rapid tests shouldn’t just be used when there is an outbreak, such as the one at the University of Victoria, but used in a more proactive manner.

“The proactive way, which is like Nova Scotia is doing, is to use rapid tests when [infections] are low to keep them low,” she said, later adding. “In B.C., we should be doing everything possible to use rapid tests.”

Doctor wants B.C. to ‘show’ more data

Dr. Bonnie Henry, for her part, has said that rapid tests will be made available to the public in January, but has made no indication they will become available anytime sooner, even though Health Canada has already authorized more than 20 rapid tests and encourages their use — to a certain degree — because they “provide an extra layer of defence” against the spread of COVID-19.

Furthermore, a recently released study on rapid antigen tests conducted in the United States by researchers with Johns Hopkins University School of Medicine found the tests were able to detect the virus in 87 per cent of patients who had the virus as well as in 71 per cent of those who were asymptomatic.

Henry, however, has repeatedly stated over the past week that rapid tests aren’t useful when it comes to testing asymptomatic people, particularly those who are vaccinated.

Dr. Leung said while that’s not exactly wrong, it needs a better explanation.

“This idea that it’s not useful in asymptomatic people, or unvaccinated people, as a general statement, I think needs a lot of qualifiers,” he said.

Leung pointed out that vaccinated asymptomatic individuals can still transmit the virus and that rapid tests will still detect whether they are infectious.

“Whether you’re vaccinated or not, this virus doesn’t care and it doesn’t care if you have symptoms or not. Symptoms are not a direct correlation with where someone is at with regards to their viral load,” he said. Oftentimes, people are having high detectable viral loads with a rapid antigen test before symptoms occur and those are the people who are transmitting.”

“Why wait for someone to develop symptoms before testing?”

Dr. Filiatrault said British Columbia had a good opportunity on Tuesday to reduce transmissions by making tests more available but opted against it — something that she finds puzzling.

“There’s a complete disconnect here in B.C.,” she said. “Why is B.C. not using this technology?”

Filiatrault believes it is far better to give people the tools to make informed decisions, even if rapid tests aren’t nearly as accurate as PCR tests.

“You know, if you don’t test, you have a 100 per cent chance of missing that you’re infectious,” she said.

RELATED: B.C. has used less than 10% of its rapid antigen tests, officials say they don’t prevent transmission

Leung said the rationale for not releasing rapid tests from the provincial government has been mixed and confusing, even for many physicians.

“If you do go back from last December to now, the various responses as to why they’re not being used are not consistent and they’re not aligned with the best available evidence and the best practices that we’ve learned in the last year and a half,” he said.  “Is it a supply issue, is it a logistics issue, is it a belief that these tests don’t work or that they don’t work in what situation? Is it a false positive issue, is it a false negative issue? The answers just keep coming but none of them are backed up by work that they’ve done.”

Filiatrault said she doesn’t understand the logic either.

“After everything we’ve learned in the last year, it is better to be one step ahead of the curve, never behind it, never chasing it. Being reactive does not work. You’ve got to be ahead.”

Other doctors and medical professionals have also expressed concerns regarding B.C.’s rapid test strategy.

Dr. Dalia Hasan, an Ontario-based physician and founder of COVID Test Finders who recently launched a petition urging the Horgan government to be proactive and provide COVID-19 rapid antigen tests at no cost, recently told CHEK News that B.C.’s public health officials have “blood on their hands” because they continue to deny that rapid tests work.

“The messaging coming out of the public health leaders has quite frankly been dangerous for their residents. They have denied that COVID is airborne and their messaging is congruent as if COVID is over,” Hasan earlier this month. “They’re not welcoming the public health tools that would safeguard their residents. They’re denying that rapid tests are effective and that there’s any utility when that couldn’t be farther from the truth.”

Other medical professionals who spoke to CHEK News anonymously over concerns about what could happen to them if they spoke publicly, also expressed concerns over B.C.’s rapid testing approach, particularly now that the Omicron variant has arrived.

At the end of the day, if B.C. isn’t going to make them available in the very near future, Leung said he would really like to see Henry provide data that supports her rationale.

“If they do have a position that goes against it, then show the work, be very transparent with the data that’s used to support their position. Because the data that we have to support our position and using the test is there.”

RELATED: B.C. opts against introducing restrictions as new data suggests COVID cases will climb due to Omicron

CHEK News reached out to both the federal government and B.C. Ministry of Health for comment on this story but did not receive a statement from either. However, a Ministry of Health spokesperson said in an earlier statement provided to CHEK News in response to similar questions earlier in the week about rapid tests, that its rapid test strategy was developed based on public health guidance and current science.

“Public health’s Rapid Point of Care Testing strategy was developed based on public health guidance and information, including recommendations by the federal COVID-19 Testing and Screening Expert Advisory Panel. This strategy outlines how B.C. can best utilize Point-of-Care tests to complement its foundational testing program, which utilizes PCR tests. Early in 2021, the panel shared testing recommendations that align with B.C.’s approach, including prioritizing the gold standard lab-based PCR testing for those who exhibit symptoms or have come into contact with someone diagnosed with COVID.”

The statement also stressed that testing and detecting cases of COVID-19 are a vital part of the province’s pandemic response.

“B.C.’s testing policy and work is guided by the advice of the federal COVID-19 Testing and Screening Expert Advisory Panel and Dr. Bonnie Henry. PCR tests are considered the gold-standard for COVID-19 testing in B.C. and are foundational to B.C.’s approach to detecting COVID-19. B.C.’s approach to testing increases the likelihood that those most at risk of contracting or transmitting the virus are tested immediately. This approach allows public health to detect COVID-19 cases early, which reduces transmission our communities, and helps keep all of us safer from the virus.”

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Nicholas PescodNicholas Pescod

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