Are covid-19 tests still working?
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2070 (Published 17 October 2024) Cite this as: BMJ 2024;387:q2070
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Dear Editor,
Seriously? I can see the point of testing acutely ill individuals presenting to the NHS, but who on Earth is still routinely testing themselves otherwise? We now have 5 coronaviruses which cause the syndrome known as the common cold (along with numerous others), all of which have the potential to harm the old and vulnerable. The Covid vaccines are of dubious value, and certainly have little effect on transmission. Last year’s booster rollout to frontline, patient-facing NHS staff only had a 31% uptake - hardly a ringing endorsement.
The last time I tested myself for Covid-19 was in 2022, when I was actively trying to catch it (I’ll spare you the details) off my partner, a triply-vaccinated doctor at the time who was quite ill with it. My unvaccinated self entirely failed in that endeavour, both symptomatically and according to the lateral flow tests. Ah well, a healthy immune system is a wonder to behold.
The medical profession was partly responsible for the mass hysteria we witnessed during the pandemic. A pandemic whose worst year (2020) only returned the England & Wales age-standardised mortality rate to that we enjoyed in 2009. 2008’s was higher, as was every previous year with data. Don’t believe me? Ask the ONS:
https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinform...
We need to move on, and reflect on the fact that we massively overreacted, while the consequences of that reaction (especially lockdowns) continue to harm our society.
The lesson? As Corporal Jones wisely said: Don’t Panic!
Competing interests: No competing interests
Re: Are covid-19 tests still working?- Further uncertainty on the shifting sands of COVID-19
Dear Editor
We note a recent article was able to provide reassurance on the uncertainty around whether antigenic testing is still effective for COVID-19 [1]. To our mind the evolving picture of COVID-19 still raises questions in other areas, particularly, how to manage those with severe COVID-19. Changing circulating variants and increased immunity globally through exposure and vaccination [2] has dramatically shifted the manifestations and consequences of COVID-19 infections. Fewer people now progress to severe illness. Those who do become unwell differ significantly to those who became ill early in the pandemic. We therefore wonder if treatments remain as effective as previously seen in our current population.
We noted this change ourselves when conducting a recent audit. Our patients with COVID-19 and hypoxia were older (median 78 years), had more co-morbidities (such as pulmonary diseases and immunosuppression) and a higher mortality (25%) than the populations in the evidence base on which national recommendations are based [3,4].
We believe that severe COVID-19 is now predominantly a disease of the clinically vulnerable, or that COVID-19 is more commonly identified in those who are unwell already attending clinical services. In this context it is unlikely the same therapeutic efficacy would be demonstrated if studies were repeated in the present environment.
When causing hypoxia, COVID-19 is treated with steroids and other immunomodulators [3], whose mechanism of action is to reduce dysregulated immune responses [5]. These medications can have side effects and their value in patients currently becoming unwell with COVID-19 is unclear.
Those with co-morbidities and advancing age are recognised to have altered immune responses. Steroids combined with natural elderly immunosenescence are linked to inhibited immunity and increased susceptibility to infection [6]. Whilst in chronic obstructive pulmonary diseases the value of steroid use is balanced against well recognised adverse effects with alternative therapies actively sought [7]. Particularly vulnerable are the immunocompromised [8], in these patients evidence for the use of immunomodulation is questioned and not definitive [9], with ongoing assessment of novel strategies such as combination antiviral therapy to facilitate viral clearance as the disease is recognised to persist [10].
As you discussed the circumstances raising concern on the continued effectiveness of antigen testing also raise questions on the ongoing value of the current therapeutic approaches. These therapies were highly effective and saved many lives as the pandemic began. However, there is now a pressing need to account for current circumstances by re-appraisal of existing evidence and new trials to determine how to best manage our patients with severe COVID-19 infections currently.
References
1. Guenot M. Are covid-19 tests still working? BMJ. 2024;387:q2070. doi:10.1136/bmj.q2070
2. Wei J, Stoesser N, Matthews PC, et al. Risk of SARS-CoV-2 reinfection during multiple Omicron variant waves in the UK general population. Nat Commun. 2024;15(1):1-14. doi:10.1038/s41467-024-44973-1
3. NICE guidlines. COVID-19 rapid guideline: managing COVID-19. COVID-19 rapid guideline: managing COVID-19.
4. IDSA. IDSA Guidelines on the Treatment and Management of Patients with COVID-19. 5/27/2021.
5. Marik PE, Meduri GU, Rocco PRM, Annane D. Glucocorticoid Treatment in Acute Lung Injury and Acute Respiratory Distress Syndrome. Crit Care Clin. 2011;27(3):589-607. doi:10.1016/j.ccc.2011.05.007
6. Aw D, Silva AB, Palmer DB. Immunosenescence: Emerging challenges for an ageing population. Immunology. 2007;120(4):435-446. doi:10.1111/j.1365-2567.2007.02555.x
7. Ramakrishnan S, Russell RE, Mahmood HR, et al. ABRA : Treating eosinophilic exacerbations of asthma and COPD with benralizumab. Jama (Under Rev. 2024;2600(24):1-10. doi:10.1016/S2213-2600(24)00299-6
8. DeWolf S, Laracy JC, Perales M-A, Kamboj M, van den Brink MRM, Vardhana S. SARS-CoV-2 in immunocompromised individuals. Immunity. 2022;55(10):1779-1798. doi:10.1016/j.immuni.2022.09.006
9. Siempos II, Kalil AC, Belhadi D, et al. Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials. eClinicalMedicine. 2024;69(February):1-10. doi:10.1016/j.eclinm.2024.102472
10. Meijer SE, Paran Y, Belkin A, et al. Persistent COVID-19 in immunocompromised patients—Israeli society of infectious diseases consensus statement on diagnosis and management. Clin Microbiol Infect. 2024;30(8):1012-1017. doi:10.1016/j.cmi.2024.04.009
Competing interests: TJW is a member of the ESCMID/ EAN writing panel for guidance on Infective encephalitis. WKN was sponsored by Viiv to attend a conference several years ago. SKZ has nothing to declare.