Special report: Airlines may have to wait for quick tests go-ahead

Carriers want rapid Covid assessments, but they may not come soon. Ian Taylor reports

Rapid Covid tests for travellers appear the best way to reduce quarantine times and relax travel restrictions.

But aviation leaders’ demands that the government move to rapid testing risk falling on deaf ears unless tests on travellers are sufficiently accurate. The government’s Global Travel Taskforce was assessing the capacity of private testing providers this week ahead of making recommendations.

Rapid point-of-care tests (POCTs) would obviously be preferable to the RT-PCR tests used by the NHS which are considered ‘gold standard’ but require lab analysis which can take 24‑48 hours and is therefore costly.

Iata argues for a global system of pre-departure antigen testing because tests for antigens – molecules which stimulate an immune response to the virus – are faster and cheaper.

Airlines for Europe managing director Thomas Reynaert told a Global Business Travel Association (GBTA) online meeting last week: “We need to come up with the scientific evidence that antigen tests are better than other tests [and] convince health authorities to get rid of quarantine.”

A4E represents BA owner IAG, easyJet, Ryanair, Tui, Lufthansa, Air France-KLM and other leading carriers.

At the same time, an airline-commissioned review of Public Health England (PHE) modelling, which informs government policy on quarantine, concluded the work is “flawed” and “significantly underestimates” the effectiveness of testing air passengers.

It criticised government claims that testing on arrival might pick up only 7% of passengers with asymptomatic Covid infections, instead arguing testing might pick up 33% to 63% of all infected passengers – although this would still leave two in five or more undetected.

Virgin Atlantic chief executive Shai Weiss claimed the review, by economic consultancy Oxera and health data-analytics company Edge Health, “identifies flawed and outdated assumptions” and “reveals testing will capture a vast majority of cases”.

However, the PHE modelling only considered the likelihood of a test on arrival picking up asymptomatic passengers not all those infected. It assumed those with symptoms would not travel.

Transport secretary Grant Shapps made this thinking clear when he told the Airlines 2050 summit last week: “Symptomatic passengers should not be travelling. This is about asymptomatic passengers.”

To compound the difficulties, studies suggest the existing antigen tests airline bodies are demanding be adopted are less sensitive to detecting Covid-19, in particular in asymptomatic cases.

The European Centre for Disease Prevention and Control noted last month that even “when rapid antigen tests are well-validated . . . these tests tend to have lower sensitivity [and] a negative rapid test may not rule out infection”.

The World Health Organization, in guidance on faster diagnostic tests on September 11, noted: “The trade-off for simplicity . . . is a decrease in sensitivity.”

It warns: “Do not use antigen rapid diagnostic tests for airport or border screening.”

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