COVID – 2022, the year of earlier, better, faster, more affordable, and accessible tests and treatments
If 2021 is the year of vaccination, 2022 needs to be the year of earlier, better, faster, more affordable, and accessible tests and treatments to break the back of this pandemic.
While vaccination remains a cornerstone prevention countermeasure, it is not enough on its own. Breakthrough infection requires earlier, better, and faster tests and treatments, especially with new, more transmissible variants.
Tests
The latest (by no means the last) variant of concern, Omicron, with its high transmissibility, has stretched the gold standard RT-PCR test capacity.
The long queues and wait time for results have reached a tipping point. Frustrations, anger, and disappointment of ordinary people, testers, and laboratory staff can potentially derail the whole pandemic response.
The current antigen rapid test (ART) has yet to make a real impact, especially in countries where ART has to be performed by health professionals. Even in countries where self-administered ART is allowed, supply and affordable access are significant constraints.
Too many governments still require ARTs to be done by or in the presence of health professionals. This overly cautious approach does two things. First, it puts more demands and pressure on an exhausted health workforce. Second, as some countries like Singapore1 have demonstrated, ordinary people with some education and support are more than capable of doing these tests themselves.
ART approved for self-administered at home, workplaces, educational institutions, pre-major events, and significant international transport hubs can provide a much-needed layer of early warning of potential positive infections.
In 2022, we are likely to see more "over the counter" (OTC) and "point of care"(POC) tests. Developing these two fronts is necessary to complement the under- pressure gold standard laboratory-based RT-PCR test2,3 if we are to break the back of this pandemic.
Treatments
Thus far, treatments (antiviral, antibodies, and anti-inflammatory) for Covid -19 patients have been mainly hospital-based.
The latest Omicron wave has implications for existing treatments. Most antibodies therapy has lost effectiveness at this stage of the Omicron wave (except for Sotrovimab), anti-inflammatory medicines remain effective, and antiviral drugs have mixed results (lower efficacy for Molnupiravir, while Paxlovid still has a high level of efficacy).
Towards the end of 2021, the approval for emergency use of oral antiviral drugs, Molnupiravir and Paxlovid, was much welcome news. This current generation of oral antiviral medicine can prevent infected cases from developing severe illness and hospitalization. However, they have to be taken within three to five days of symptoms to be effective. Like all drugs, there are side effects. Molnupiravir is inappropriate for children and pregnant women, and Paxlovid has contraindications for those on certain medications for treating liver and kidney diseases.
The current lack of post-exposure prophylaxis drugs has meant longer isolation for those exposed to positive cases. While such isolation is necessary, it has caused significant disruption to every level of society. Perhaps where such disruption is fast becoming a gridlocked issue is in the health system. An increasing number of health professionals who have to isolate themselves after being exposed to infected patients will get to the point where there is insufficient staff to provide care4.
In 2022, we will hopefully see more post- exposure antiviral drugs, including oral antivirals, approved for emergency use. We might even hope to see the early development of pre-exposure oral antiviral medications sometime in 2022. Both pre and post-exposure oral antiviral medications require a responsive and robust testing infrastructure and capabilities5 to be effective. The challenge will be clarifying who will benefit and making them affordable for equitable access.
Final word
Advances in vaccines against Covid-19 are nothing short of being spectacular. However, it is insufficient to break the back of this pandemic on its own. It will need better companions such as better, faster, more affordable, and accessible tests and treatments.
2022 will need to be the year of faster, better, more accessible, and affordable tests and treatments. However, it will still require decision-makers to be shift mindsets, listen to other voices and come up with better policies and process. Otherwise, we may still find ourselves in an unimaginable gridlock this time next year.
CHUAH Jin Chai 蔡 仁材 Wellington, NEW ZEALAND 31st December 2021
Notes: 1. https://www.covid.gov.sg/exposed/no-hrw