Diagnosis delays lead to PCR test push

Jolyon Attwooll

24/06/2022 3:25:43 PM

Vulnerable patients with symptoms should get the more sensitive test to allow treatment to be fast-tracked, says deputy CMO.

Person receiving PCR test.
Symptomatic patients at risk of developing severe COVID are being encouraged to seek a PCR test immediately. (Image: AAP)

GPs should encourage symptomatic patients at risk of developing severe COVID to seek a PCR test immediately, even if a rapid antigen test is negative, the Deputy Chief Medical Officer Professor Michael Kidd has said.
Professor Kidd made the remarks at the most recent primary Care COVID-19 update seminar, saying the more sensitive tests could allow GPs to prescribe oral antiviral treatments to those in greater need of protection in a more timely way.
‘We are seeing some people who are getting symptoms and doing a rapid antigen test which comes back negative and then a few days later doing another test which comes back positive,’ he said.
‘We are recommending that if you have someone who’s at risk and who may benefit from the antivirals that they don’t rely on a negative rapid antigen test.
‘If they have symptoms, and they have a negative RAT, please ask for them to arrange to get a PCR test so that there is no delay in making the diagnosis and getting people onto treatment.’
The advice comes at a time when the Federal Government is stepping up efforts to raise the profile of the oral anti-viral treatments, which it says are not known about by the ‘vast majority’ of the broader population.
The two oral COVID-19 antiviral treatments available on the Pharmaceutical Benefits Scheme (PBS) – molnupiravir (sold as Lagevrio) and nirmatrelvir in combination with ritanovir (sold as Paxlovid) – are both recommended for at-risk patients within five days of symptom onset.
Treatments can only be issued following a positive COVID-19 test, but concerns have increased in recent weeks about the sensitivity of some rapid antigen tests’, particularly to the new subvariants that are beginning to dominate transmission in Australia.
The focus on PCR testing coincides with a clampdown by the Therapeutic Goods Administration (TGA) on ‘non-compliant’ sponsors of rapid antigen tests. The TGA this week reported issuing a fine of $106,560 to a company for failing to provide adequate information about the performance of the tests it supplied.
The reliance on rapid antigen tests has increased dramatically this year, with most states now reporting many more cases from the use of the self-administered home tests rather than the more-sensitive PCR assessment.
This week, Federal Minister for Health and Aged Care Mark Butler said he has been seeking advice from Department of Health officials about effective ways of amplifying the message about oral antiviral treatments.
One mooted possibility is the idea of sending text messages to vulnerable COVID-19 patients to remind them to speak to their GP about antiviral treatments.
The Government says a new $11million ‘Take on Winter’ communication campaign launched this week will seek to raise awareness of the treatments, as well as boost uptake of flu vaccines and COVID-19 booster shots.
RACGP COVID Working Group member Associate Professor Charlotte Hespe Charlotte Hespe recently told newsGP that she is pushing PCR testing to allow quick access to antivirals.
‘The key message is if you’ve got symptoms but you’ve received a negative RAT, don’t assume that you’re in the clear, go and get a PCR – particularly if you’ve had contact with other people that have either got COVID or flu,’ she said.
‘For me, it’s about being able to treat people. If I know you’ve got COVID or the flu and you qualify for antivirals then I can access it, but I can’t do that without a positive test.’
In the COVID-19 primary care webinar, Professor Kidd said there has been an increase in cases this week, coinciding with a rise in hospitalised patients and mortality, with 361 COVID-19 deaths reported in the previous seven days compared to 295 the week before.
Of the 9559 COVID deaths that had been recorded in Australia at the time of publication, 7320 have occurred this year.
Who is eligible for oral antivirals in Australia?
According to PBS criteria, the drugs can be prescribed for those with mild-to-moderate COVID-19 confirmed by a PCR or RAT within five days of symptom onset, among the following patient groups: 

  • Those aged 65 or older, with two other risk factors for severe disease
  • Those aged 75 or older with one other risk factor
  • Those aged 50 and older who are of Aboriginal or Torres Strait Islander origin with two further risk factors for severe disease
  • Those with moderate-to-severe immunocompromise
The RACGP’s COVID-19 resources includes information relevant for every state and territory.
A guide with details relevant to general practice about the COVID-19 oral antivirals has also been published by newsGP.
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Dr Ian   28/06/2022 6:06:16 AM

There is fear about estimating how many people who died from Covid 19 who could have been saved if given the antivirals on time . And in addition to Paxlovid and Molnupiravir there is intravenous Remdesivir which was given to patients hospitalised after many days of illness from early in the Covid 19 Pandemic till a group decided to trial Remdesivir early as possible in the illness with the finding of an 85 % reduction in progression to severe illness . Trial started September 18 2000 before vaccines approved NEJM Jan 27 2022 R.L Gottlieb et al . ATAGI has approved it for use in children as risk weighing 3.5 kg or more at it is being used in Pregnant Patients at risk .