The 7SEF: Stage 4 - Test

This is Stage 4 of ICAN's 7 Stage Elimination Framework. You can read the Introduction here.

Goal: To find every case of the virus as quickly as possible.

Timeframe: Mass testing starts in the first week of the stay-at-home period and continues until Stage 7 – Reopen.

With the county seal in place and the stay-at-home order established, the virus will be fixed in place and the mass rapid testing program can find it quickly. This approach tests households on multiple occasions over a period of a week to 14 days, and a series of negative results provides very strong evidence that the virus is not present.

While an individual rapid test has a lower sensitivity than a PCR test, repeating the rapid test over multiple days will increase the overall sensitivity of the testing regimen. A single rapid test with a sensitivity of 50% becomes 75% accurate on the second day, and 87.5% accurate on the third day. By taking advantage of this multiplicative effect, the repeated rapid testing regimen is cheaper, quicker, and more flexible than PCR testing, and in the context of an elimination framework, is significantly more effective.

The addition of a mass testing program is the biggest difference between this elimination protocol, and the first lockdown that took place from March to June 2020. The repeated testing of the population speeds the process of elimination and shifts the burden of adjustment from the people onto the policymakers, who would be responsible for its implementation.

The successful execution of a mass testing program presents a logistical challenge; firstly, to acquire and mobilise the necessary resources, and then to ensure that the testing regimen is implemented consistently and effectively. However, there is extensive international experience from which we can develop principles of best-practice, and many international experts would be happy to offer their advice. Ireland is limited only by the ambition of its leaders.

Implementation | Logistics

Tests are administered via mobile testing units, in testing centres, at drive-through testing facilities, and with home test kits. Offering multiple testing options will increase the number of tests performed and reduce the risk that the testing method leads to accidental infection. High-risk households (large, shared accommodation) and high-risk individuals (essential workers) are tested early and often with both rapid tests and PCR.

Individuals in large households (not families) could be invited to choose voluntary quarantine in order to reduce the risk to themselves and to their housemates. Low-risk confirmed cases (young / healthy) go to safe and comfortable isolation facilities and their contacts and housemates are moved into quarantine. High-risk confirmed cases (older / comorbidities) go by ambulance to local hospitals and medical facilities as required.

Implementation | Respect for Civil Liberties

While this testing protocol relies on high levels of public participation to be effective, some citizens will choose not to be tested. In a liberal society, such a personal decision can only be made by the individual and their choice must be respected. Rather than vilifying those who refuse to be tested, we should give them every opportunity to reconsider their decision, while recognising that the protocol does not need 100% participation to be successful. It should also be recognised that had this crisis been handled effectively in the first few months of 2020, few – if any – of the extreme infringements on our civil liberties that have been experienced over the last year would have been necessary, and the nation would not have found itself in a position where mass testing was required.