Taxpayers spend more than 580 million on COVID-19 testing in NSW

The NSW government is considering the use of rapid COVID-19 screening in workplaces to boost the state’s testing capacity, but is facing resistance from pathology companies that perform the gold standard, laboratory-based tests that have cost taxpayers more than half a billion dollars.

Laboratories have performed 2.2 million COVID-19 tests since the Sydney outbreak began six weeks ago and more than 8.6 million tests since the pandemic started last year. Private pathology companies receive a Medicare subsidy of $85 per test and public laboratories receive a benefit of $42.50.

NSW Health’s Dr Jeremy McAnulty said rapid antigen testing may be useful in workplaces.Credit:Dominic Lorrimer

NSW Health Laboratories have performed 3.4 million tests and private providers have performed 5.2 million tests up to July 25, running up a Medicare bill of $587 million.

But the NSW government is concerned the state has reached its testing capacity and approached industry experts for advice on the value of rapid antigen tests.

One private laboratory â€" Laverty Pathology â€" is shipping its swabs interstate and shopping around other companies to process them amid five day waiting times. The company was not able to be reached on Tuesday.

Rapid antigen testing costs about $10 per test and turns around results in 10 to 15 minutes, but it is less sensitive than the PCR [polymerase chain reaction] tests that are performed in laboratories.

NSW’s Chief Health Officer Kerry Chant said testing capacity was beginning to “max out” when more than 82,000 people were tested on Friday, since which time the daily rate has increased to around 100,000. On Tuesday, her deputy Dr Jeremy McAnulty said the state was actively reviewing the use of rapid antigen tests.

“The technology changes all the time and there has been a rapid surge of new technology in terms of diagnostics in the past last year,” Dr McAnulty said. “We are working closely to work out where rapid antigen tests may be most useful - for example in businesses or various industries.”

Rapid antigen testing has been used by film and television production companies and Opera Australia to screen employees for COVID-19. It is widely used in Germany, Singapore and the United Kingdom.

The Royal College of Pathologists of Australasia is opposed to its widespread use due to the higher incidence of false negatives.

Henning Liljeqvist, an epidemiologist and public health consultant, said officials had sought his advice on the value of rapid antigen tests following speculation the government had chosen not to use them as a result of lobbying by pathology companies.

Dr Liljeqvist said it had a place in surveillance testing because it picked up positive cases almost immediately so people did not go home and infect their families. It could be rolled out widely in workplaces and its speed compensated for the slight reduction in sensitivity compared to PCR.

“I’m not suggesting that we should replace PCR with rapid antigen testing,” Dr Liljeqvist said. “If we ever need a diagnostic test we need that precision that we have with the PCR test. But PCR simply can’t cope with the number of tests we need to do for the best, most effective surveillance testing.”

But pathology companies said they had not yet reached their limit and most laboratories were able to perform more tests without reducing turnaround time. Three public laboratories in NSW are each performing 4000-5000 tests per day, while private companies are doing up to 20,000.

NSW Health said in a statement that despite record testing rates, its laboratories still had the capacity to surge, and they were delivering negative results within 24 to 72 hours.

Bill Rawlinson, who runs the public laboratory at Prince of Wales Hospital in Randwick, said testing could be upscaled through pooling, whereby several samples are tested in a group and only re-tested individually if the group tests positive. This had been done in some form since February.

“We’ve not yet come to capacity, certainly in our lab and certainly not in the other public health laboratories,” Professor Rawlinson said.

“The reality is that, as a public laboratory, we have a very similar approach to [the private labs]. There’s no doubt that the PCR tests are better than rapid antigen tests at the moment.”

Greg Granger, director of strategic operations at Histopath, said there was room for growth in the amount of PCR testing performed in NSW and a switch to rapid antigen testing would compromise on quality. “That’s the trap that other countries have fallen into and the virus has got away from them,” Mr Granger said.

Scientists were developing on-the-spot PCR testing, though it would not be cheaper than PCR testing, he said.

Dr Sean Parsons, founder of at-home COVID-19 test biotech Ellume, said there was “limited utility” for rapid antigen tests while there was very low community transmission.

“But sooner or later COVID-19 will escape the elimination strategy,” Dr Parsons said.

“We cannot do hotel quarantine forever and lockdowns forever. Rapid antigen tests are useful for ubiquitous and frequent testing, catching the most at risk people for transmission, compared to PCR tests that are far more expensive and have far longer delays in results.

“The country has been slow on the vaccine rollout. And if we’re not careful, we’re going to be slow with these additional tools.”

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Harriet Alexander is a reporter for the Herald.

Lucy Carroll is a reporter covering health for The Sydney Morning Herald.

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