Agency: Rapid tests suitable for home use

Covid-19 rapid test. Photo: Madis Veltman

An Estonian company with around ten people has its employees test themselves for the coronavirus using rapid antigen tests before coming into contact with colleagues every Monday. An employee tested positive 15 weeks after the system was introduced. The person went straight home and was not in contact with colleagues. They felt under the weather the next day and turned to their family doctor. The person tested positive two days later. Without the company’s testing routine, that person would have kept coming in for several more days.

The incident prompted the employer to have employees take the rapid tests home with them and test themselves before coming in.

Businessman Raul Rohtla finds that rapid tests could be the new normality. Rohtla said that in the above example, the company managed to avoid having to send the entire staff into isolation that would have paralyzed its business activity. “There are dozens of other examples that I know of,” he said. His company also uses rapid antigen tests. “The antigen tests used in this case work with samples taken from nostrils (as opposed to deep in the nasopharyngeal duct – ed.),” Rohtla explained. He added that his company uses tests that have been adopted by the Austrian education system.

Rapid testing is included in Germany’s strategy for exiting the crisis. Home use of rapid tests was legalized in March. Germany has been buying rapid tests since March 8 and is giving residents at least one free test every week. The country has told media outlets that the aim is to slow down the spread of COVID-19. France and Austria have also allowed use of home tests for a few months. In Denmark, people have to use rapid tests in airports.

Rapid testing in Estonia

Head of communication for the Health Board Imre Kaas said that rapid tests meant for professional use have been available in Estonia since last spring.

“The board has asked traders to add a warning label that these products are meant for professional use only. The need for the warning arises from the Advertising Act and the agency is simply asking traders to comply with the law,” Kaas said. This means that rapid tests can be sold in Estonia and suggesting the Health Board is hindering or trying to stop it is mistaken. “We require distributors to sell their goods honestly and in compliance with the law,” Kaas said, adding that several shops have unfortunately decided to advertise the products as meant for home use.

He explained that while people are free to buy products meant for professional use only, traders are obligated to present the correct information. “If such a label exists, the user knows the product is meant for professional use only and can decide whether they want to take the risk and buy it,” Kaas said. He said that a person who has COVID-19-like symptoms but tests negative might be fooled into thinking they are healthy even though false negatives happen. Doctors can rely on their experience to draw additional conclusions. “This creates the danger that the virus is inadvertently transmitted to new people; for example, when someone who has gotten a false negative test result goes shopping,” Kaas explained.

Estonian-German medical equipment manufacturer Selfdiagnostics has asked the board to greenlight rapid tests for home use also in Estonia. Member of the board Marko Lehes said rapid tests are becoming a part of everyday life. Germany, France, Austria and the UK have plotted a course for the future,” he said.

“You can test yourself before going out to meet people and it takes just 15 minutes to get the result,” he explained. Rapid tests are more convenient than their laboratory counterparts as they do not require the sample to be taken from the nasopharyngeal duct and are at least five times cheaper, costing an average of €10. While rapid tests are meant for on the fly decisions and getting a quick overview of prevalence, nasopharyngeal duct PCR tests that are analyzed in laboratories are used to treat patients and make medical decisions.

Asked how accurate an antigen test is, Lehes said that rapid tests are 98 percent accurate when it comes to determining whether the person is infectious. “There might be a few false negatives out of 100 tests, while even they will not be super infectious,” he added. Lehes knows of several cases where the PCR test has come back positive while the antigen test is negative. “This has happened when the person has already recovered from the virus,” Lehes said. “A PCR test will show a person is Covid-positive for a long time, while they are no longer infectious and should not be in quarantine,” he said.

Even though rapid antigen tests are more accurate at determining whether someone is infectious, PCR tests are conclusive when it comes to whether the person is carrying the virus. “Carrying a dead virus does not mean you are infectious,” Lehes said. That is why rapid tests are good for checking whether one is infectious before going to the theater, movies, shopping, school or work.

Need to trust people

Lehes said that major industrial countries have come around because they have a lot more data and greater administrative capacity. “It is still relatively new in Estonia and people wonder whether it really works,” he said, adding that the state needs to have resources for considering alternatives.

The businessman said that while Germany has now made room in its legislation for rapid testing, relevant efforts began in August of last year.

“Private and public sector cooperation is also important,” Lehes added. Because manufacturers have a lot of data on tests, countries should look at alternatives offered by the private sector. “The state is not capable of containing the pandemic by itself – it needs to trust people and entrepreneurs,” Lehes said. He remarked that trusting people with rapid tests and greenlighting them for home use would deliver a breakthrough in the fight against the coronavirus.