‛Contacts’ definition borders on unethical and cruel
My family and I moved here from the United States on the Work from Bermuda Residency Certificate programme last autumn to access excellent, safe education for our children during the global pandemic. We have personally been very happy with the science-based efforts by the Government to emphasise vaccination, testing at the border and mask wearing in public. However, the new focus by private schools and businesses on twice-weekly lateral flow testing will backfire. It will result in unnecessary surveillance by the government and more excessive quarantines, not less. It will interfere more with education and business, not less.
The real issue is the Government's unreasonable insistence on treating entire classrooms and families of students as “close contacts”, when they are in fact “casual contacts”, and on the Government’s refusal to step in line with most major countries —United States, Britain and Europe — that do not require vaccinated adults to quarantine after Covid exposure. The more the schools test, the more positive cases they will find, which will result in more students at home and more classroom/school-wide quarantine.
As I’m sure many readers have heard, antigen tests, while rapid, are not as accurate as PCR tests. As the FDA clearly states: “positive predictive value varies with disease prevalence when interpreting results from diagnostic tests. PPV is the per cent of positive test results that are true positives”. Even with 98 per cent specificity, you will end up with high numbers of false positives (20 out of 100 false positive results) when disease prevalence is low (under 10 per cent) and even more (as high as 70 out of 100 false positives) when disease prevalence is very low (about 1 per cent to 2 per cent, which is where we are at right now in Bermuda).
Antigen diagnostic tests are designed to be used by doctors and trained personnel in a supervised setting when patients present with symptoms (ie, illness, infection). This is what happens when your child goes to the doctor and gets swabbed for strep, or RSV, or flu. The rapid tests are quite accurate when used in this way. Still, doctors often send the culture in for more enhanced analysis (ie, PCR) when the result is negative but the child is still sick. This is because antigen tests have a higher rate of false negatives than PCR tests. Ultimately, it is not the test result but the presentation of real symptoms and signs that guides the doctor’s decision to administer and interpret the test.
Excessive, at-home, asymptomatic testing of children will only add more disruption, confusion, and anxiety to our already stressed-to-the-breaking point situation. If the tests work, they will detect true positives, which will necessitate a follow-up PCR test and result in more classroom-wide quarantine under the present law. When the tests don’t work, or parents are motivated to be dishonest (which is understandable given how much disruption there has been to income, childcare, education and housing security), we will end up with a false sense of safety that could easily replace common sense (such as limiting your social engagements and keeping your child home when they are sick). Our existing problem, while tragic, is not for lack of testing; it is for lack of sufficient healthcare resources for unvaccinated adults.
I urge the heads of schools, business leaders, the Minister of Education and the Minister of Health to reconsider this misguided, though well-intentioned lateral flow testing protocol. Although some families, such as ours, have the ability and privilege to opt out of the schooling system here, most do not. And what starts with a “pilot programme” in the private schools will almost certainly become law for the public schools. It is unethical and cruel to force parents to choose between educating their children and submitting to excessive, unnecessary medical procedures when their children are not even sick.
KATHERINE MacLEAN, PhD
Former research scientist, Johns Hopkins School of Medicine