I would be interested to know if anybody else is having this raised in their workplaces and if you are looking at purchasing some, and if so from where? — Steffan St Clair-Newman

Has the Govt lifted the ban on their importation yet? A trial is underway and a consortium of companies and organizations have permission to bring some in
The companies taking part in the trial include:

• Mainfreight
• Foodstuffs North Island
• Genesis
• Hynds Pipe Systems
• Mercury
• Summerset Group
• Wellington Airport
• Christchurch Airport
• Sky NZ
• Queenstown Airport
• Spark
• Vodafone
• The Warehouse Group
• ANZ Bank
• Contact Energy
• Fulton Hogan
• Countdown/Woolworths NZ
• Fletcher Building
• Carter Holt Harvey
• Meridian Energy
• DHL Express NZ
• Air NZ
• Auckland Airport

Looks like our political masters have finally made up their mind to allow Rapid Antigen Testing :wink:

From 1 December businesses that choose to use rapid antigen tests for surveillance testing will be able to directly source approved tests from the following authorised suppliers (all are nasal swabs):

Roche Diagnostics NZ Ltd
Abbott Rapid Diagnostics
Pantonic Health (Australia) or Arrotex Pharmaceuticals (NZ) Limited
EBOS Group Ltd.

Businesses need to pay for rapid antigen tests themselves.

From 15 December, if you don’t want to buy tests directly from these authorised suppliers you’ll be able to buy them from a local distributor. The Ministry of Health is currently working through the details of supply.

The Ministry of Health recommends that businesses trial different tests before committing to buying one in bulk as there are differences in processes — Business.govt.nz

.

From 1 December businesses that choose to use rapid antigen tests for surveillance testing will be able to directly source approved tests from the following authorised suppliers (all are nasal swabs): — Business.govt.nz

What was the basis for not allowing businesses to directly source RAT themselves (either from local of international distributors)?

I understand if it is in relation to some legal requirement (e.g. if they changed the vaccine order to be either vaccinated or "this specific" RAT) but if it was just a business wanting to do better the just "do you have Covid symptoms" for higher risk workers (e.g. short term labour they have sourced out of Auckland during the lockdown) then why is the Government getting in the way of this as it is essentially an employment relations matter and with good employee consultation shouldn't be an issue.

I'm just finding it hard to understand the rational of a lot of the decisions that the government is making around the management of Covid!

I'm just finding it hard to understand the rational of a lot of the decisions that the government is making around the management of Covid! — MattD2

Would be a bad thing to go down that wormhole Matt, at least they can be used now.

I received the below yesterday asking for an expression of interest. It seems they going to be a distributor.
We had two questions for them i) How do these tests reach a very high sensitivity greater than 95% and have a specificity rate of 99.6% in Australia, and ii) How do the kits perform for asymptomatic people who are infected.
I can send you the documentation they then provided. if you are interested, my email is sandradotnieuwoudtathill-labsdotcodotnz
---------- Forwarded message ---------
From: F.A.S.T. Ltd <infoatfastonlinedotcodotnz>
Date: Wed, 1 Dec 2021 at 09:50
Subject: Rapid Antigen Test - Update

Good morning
Last week the Government announced the approval for the use of Rapid Antigen Testing (RAT) for businesses. As you can appreciate there is still are rigorous process to go through with MBIE and MoH as this is rolled out but we are just about there.
The test we have aligned with is considered to have a very high sensitivity greater than 95% and has a specificity rate of 99.6% by the Therapeutic Goods Administration in Australia. I have attached the instructions for use of this test to give an indication of the requirements for administering it within your business.
If you would still like to register your expression of interest for these Rapid Antigen Testing Kits, please click below to complete the form. link link

From my queries I have made so far the Roche SARS-CoV-2 Rapid Antigen Test Nasal product is intended for professional use with testing performed by a healthcare worker or self-collection under the supervision of a healthcare worker.

On the 15th of December the MoH will be releasing a Self Test option, designed for patients to test themselves. The Ministry has indicated that these will be available from the 15th December which in my opinion is a more viable option for small to medium businesses.

Protocol (in theory):
Have area set aside for staff who choose not to be vaccinated
Conduct self test
If negative, may enter work space
If positive, must leave worksite, self isolate and follow public health guidelines

I understand your approach but do question testing only unvaccinated workers, as this may create a us and them attitude. Which is a situation you possibly want to avoid as some anti-vaxers are resolute in their beliefs. And any perceived bias would be an open door for them to attempt to make life very hard. Just some ramblings

I do understand that, as none of the protocols are implemented, as yet as they warrant more in depth consultation.

But there are many companies, customers and suppliers now drawing the line in the sand, due to government mandates, and sending out letters that they do not want unvaccinated staff on their premises. This has a knock on effect as a PCBU may not other suitable alternative duties for the worker.

Due to the current climate of having a shortage of skilled staff, this would result in a stand down for specific staff members. For small to medium business, this is not sustainable position, as many cannot afford to keep on staff that are not fulfilling their job description and doing the job they were hired for.

Due to the current climate of having a shortage of skilled staff, this would result in a stand down for specific staff members. For small to medium business, this is not sustainable position, as many cannot afford to keep on staff that are not fulfilling their job description and doing the job they were hired for. — TracyRichardson

I am also seeing situations where we are somewhat playing chicken with determining how Covid risks will be managed in the long term, especially considering what part the vaccination plays in the wider scheme - to a point where effective planning is being sidelined until someone blinks and calls for the site to be "vaccination only" (even though both sides know that going vaccinated only is not really a viable option as it will have significant impacts on the sites being able to actually be staffed and operated).

In my mind (for whatever reason) some of the industry guidelines have been coopted as just another vehicle for the drive for increased vaccination rates rather than providing good industry specific guidelines for managing risks of an infectious disease in a workplace - specifically spending too much of their effort on justifying the implementation of a "vaccination only" policy rather than management of the risk of Covid spreading through their industry member's workplaces.

Regarding daily (or similar) RA testing - at the estimate low end of $10 per test and checking every day it is going to cost more than an additional $2,500 for testing each year per unvaccinated worker. But what is the effective risk reduction?

Some back of a napkin math...
Looking to other countries for an estimate on the average number of workers we should expect to become infected on any given day it would be reasonable to estimate <0.1% (USA - 0.032%, UK - 0.065%, Aus - 0.054%, Ireland - 0.093% - calculated from the rolling 7 day new cases)).
The US CDC are reporting that >80% new infections are in unvaccinated people (here)
RA test are expected to return a false positive for every 4 tests out of 1000 (MoH guide)
From the expected daily infection rate and the skew of infections being more in unvaccinated people we expect that (roughly) 0.08% of the unvaccinated workers will become infected in any given day, and likewise 0.02% of vaccinated workers. Lets assume a workplace with 100 workers and 90% vaccination rate, so we will have 90 vaccinated workers and 10 unvaccinated.

For the case where we are only testing unvaccinated workers - on average each day we would expect that:
0.008 (10 x 0.08%) will return a positive test because they are actually infected,
but 0.040 ((10 - 0.008) x 0.4%) will luck out and return a false positive,
with the remaining 9.952 returning negative results,
(and 90 workers not tested as they have been vaccinated).
But that doesn't make much intuitive sense so lets look at it from a perspective of how often should we expect a positive test on average. Which is we should expect a positive test approximately every 21 days (so roughly one per month), except that is any positive so includes the false positives too. We would expect an actual positive result from an infected worker only every 125 days (or roughly twice a year).

But now consider if we test everyone on site each day - this ends up with:
0.026 (10 x 0.08% + 90 x 0.02%) will return a positive test because they are actually infected,
but 0.400 ((100-0.026) x 0.4%) will luck out and return a false positive,
with the remaining 99.574 returning negative results.
or positive test approximately every 2.3 days and an actual positive result from an infected worker every 38 days.

This also highlights the need to not focus on the unvaccinated, as while they may be more likely to become infectious this is outweighed by the fact that there are many more vaccinated people that still can (even though they are less likely to be on an individual level). In the case above if you only tested unvaccinated workers you would potentially miss catching 2 or 3 additional actual infections early compared with if you were testing everyone... although you would also be needed to deal with a false negative every few days which will be a significant burden on the operations (especially following the MoH guide for RA Testing linked above).

All the above is to say that some significant consideration on the actual effectiveness for how you will use RA testing is needed. One example where the benefits will likely be worth the effort/impact is for a response to a positive Covid case in the workforce - to augment the health monitoring of casual contacts who can continue to work while monitoring for Covid symptoms

All good points.

I would recommend implementation of a monthly health monitoring program that covers all staff, as the effectiveness of the covid vaccinations also needs to be taken into consideration, as they have a tendency to loose their strength within 6 months requiring boosters.

I would not be surprised if the annual covid jab becomes the norm in the future.

It is definitely an evolving conversation. And warrants much more discussion.

Tracy, what do you mean by a monthly health monitoring program?

Rapid antigen testing kits only tell you if you have an active infection today that is producing the covid spike protein.
Rapid antigen testing kits can not tell you if you are likely to have an active infection tomorrow or next month.

If you have a covid infection that is not at a high viral load, the rapid antigen testing is less likely to pick it up. The high sensitivity % quoted is usually measuring people at a high viral load and therefore people who are most infectious (and the people you are least likely to want to come in the building).

From my research, from a workplace point of view, it seems the rapid antigen testing is most useful when someone is symptomatic in the workplace, and it could be asthma, allergies, a cold, etc or covid. The test will help to rule out covid and provide reassurance. (acknowledging that sick people need to stay home of course). Or as MattD2 says, you are working with a close contact, household contact or workplace contact situation and people on the periphery of the public health advice want/need extra testing,

My thinking is that if you are doing surveillance testing then every 3-4 days is most likely to pick up an infection, providing the person has a high enough viral load (with or without symptoms) and depending on all the other covid mitigation controls you have in place and the risks of transmission in your workplace. Once you start this system it is for the long haul, and the costs add up.

A pos rapid antigen test then needs PCR testing through the public health system.

I am guessing more guidance will follow from WorkSafe/MBIE/MoH etc. The info is being updated daily at the moment.

https://www.mbie.govt.nz/about/news/lessons-learnt-from-rapid-antigen-testing-trial/
https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-health-advice-public/assessment-and-testing-covid-19/rapid-antigen-testing
https://www.nature.com/articles/s41598-021-88498-9

it seems the rapid antigen testing is most useful when someone is symptomatic in the workplace, and it could be asthma, allergies, a cold, etc or covid. The test will help to rule out covid and provide reassurance. (acknowledging that sick people need to stay home of course) — Jane

Yes this would be a good use case in my opinion - speaking from personal experience when instead of being booked in for a doctor's consult to get my yearly hay fever medication I was booked for a Covid test because I had a runny nose, sneezing and itchy eyes... you know typical hay fever symptoms which I had literally just told them! Although whilst frustrating I can't really fault them for the precaution.

I was listening to an article on RNZ last week, and some interesting facts no one talks about.

RAT done by medical professional is accurate around 85%. RAT done by the general public is accurate around 50%. A lot of public ones have turned out to be invalid due to how they are being done or they don't poke up the nose far enough or don't screw the cap tight afterwards. There is one that you wipe the

RAT can only detect when one has a high viral load. A lot of infected don't have a high viral load for a long period of time, so it is hard to catch.

A negative RAT doesn't mean they are negative for Covid19. They can be tested positive in a PCR at the same time, or get a positive RAT in the next few days. I worried about people getting a negative result and think they are Covid19 free.

If they are tested positive, they are sent to the public PCR testing station and stay home until they have received a negative test result. RAT is an additional monitoring tool, like a thermometer to check for fever.

To be effective, we need to do RAT frequently (e.g. every three days) for everyone (vaccinated or not). This brings the accuracy close to 98%. We bought two boxes of the RAT. They are $20 each and we have over 120 staff... Not a cheap exercise!

We are also stuck with paying for non vaccinated staff to do their non government funded tests ($160!) for their travel. Shame the RAT wouldn't help, as the result needs to come from a lab.

We are also stuck with paying for non vaccinated staff to do their non government funded tests ($160!) for their travel. Shame the RAT wouldn't help, as the result needs to come from a lab. — Yonny Yeung

I was under the impression that all PCR Covid testing was free of charge (link), are you paying $160 per test to a private lab to speed up the turnaround for the results or something else?

Also do you have a source for the accuracy rates that you have stated? I have seen information that the accuracy can vary widely depending on the manufacture of the test. And also how have you calcualted that the accuracy increases to 98% if you are testing all workers every 3 days?

Not a cheap exercise! — Yonny Yeung

If that's $20 per test, then that's costing over $200k per year to test all 120+ workers every 3 days! Given the concerns with the accuracy, false positives, etc. of the testing is that cost really worth it or could that money be better spent in preventative measures instead?

I was under the impression that all PCR Covid testing was free of charge (link), are you paying $160 per test to a private lab to speed up the turnaround for the results or something else? — MattD2

No, the government isn't paying for travel or monitor related tests (e.g. in and out of NZ or travel on Air NZ when they are not fully vaccinated or as a company's monitor programme). Air NZ requires this to be completed before they are allowed onboard if they are not already have My Vaccine Pass. link
Effectively it is the same PCR test, goes to the same lab. They prefer us to do them at the GP, not at a public testing place.

Breaking news from RNZ looks like you can get RAT done at a pharmacy and get the result within 15mins for travel within a day. This would save a lot of money for those non vaccinated needing a pre departure test.

Accuracy NYTimes RNZ RNZ Stuff I can't find the exact RNZ clip, but they all mentioned it. Shame they don't have a history list on my RNZ app.

I can't see we would be able to do this frequently for all staff based on the cost, and as you said, the accuracy is rather low.

It would be better if they are like the ISO accredited drug test results. It's either a positive or negative, not a maybe.

Interesting wording on when testing is not free, sounds like a nightmare to navigate - is it free for a worker with a travel exemption flying out of Auckland (Vac or not), but not if they fly out from anywhere else in NZ if they are unvaccinated? And yeah I didn't consider international travel, that seems just as nightmarish to get people in and out of NZ at the moment.

Regarding that "98%" claim in the NY Times article that looks to be based on a study looking at PCR and lab-based antigen testing, not Rapid Antigen testing so I would take the 98% claim with a grain of salt. Although the articles do highlight the importance of anyone doing the testing to be properly trained to be most effective, those I know using RA testing as part of their Covid management have trained internal staff that will oversee the resting so that they have as much confidence as possible in the results. Especially since poor administration of the test could negate any benefits of a constant monitoring program (if you can't do it right the first time, it will be more likely that you don't do it right any other time.. so your always going to be in the group that is less accurate).

And don't forget that the RA tests are screening test - just like the ISO accredited drug test, which either return a negative or a non-negative which requires lab analysis to establish if and what drugs have actually been taken. Even a home pregnancy test (which is very similar to the Covid RA test in technology) are just screening tests that require a doctor's consult to confirm pregnancy.

In a business sense given the current very low infection rate in NZ unless we are pre-screening for individuals that have a higher likelihood for being infectious with Covid (e.g. showing Covid symptoms, or close/casual contacts, or traveling from a region with much higher infection rates) before using RA testing we are likely to create more problems that the actual risk we are trying to manage:

The benefits of rapid antigen screening are relative to the amount of disease that is present in a population (prevalence), with greater benefit from settings with high prevalence. At low levels of prevalence, the risk of having a false-positive test results will exceed the public health benefit. — MoH Interim Guidance Framework for the Provision of Rapid Antigen Screening for COVID-19 in Clinical and NonClinical Settings

My main point not to rush in and implement a RA testing program on the basis that "more testing is always better" - it is critical to consider how and when the RA tests will be used, especially what the response will be for a positive test. Will you treat it like a positive Covid case (e.g. isolation for the worker and all close contacts until confirmed by a PCR test) even though it is potentially more likely to be a false positive than an actual infection? Or do you risk potential close contacts continuing to work while waiting on confirmation of the RA test? This is a real business risk that needs to be considered - especially with the MoH advice that on average 4 out every 1000 tests is a false positive, since the more you test the more likely you will get a false positive. And assuming the MoH false positive rate is true and testing 120 workers every 3 days you should be expecting to deal with a positive test ever 1-2 weeks (that is much more likely to be a false positive than an actual case).

Correct. Auckland border testing is free link but not free when you fly anywhere on Air NZ unvaccinated on or after 15 Dec.

At $2000+/year per employee, I don't think we can afford to do that every 3 days.
When we start using it, if someone tested positive on RAT, all close contact will be sent to do the PCR test. They get to come back to work after they get the official result on txt. Then they do another PCR test on Day 5, but they don't get stand down on Day 5 unless they are symptomatic.

I guess the 0.4% false positive rate is an acceptable margin of error, just wish it causes less disruption to the business when one is tested positive.

Steffan, Ryman mentioned in a communication that they were looking at introducing RATs for visitors but no further mention to date or anything on funding.

Any latest user experiences - good, bad or indifferent - with regard to RAT here in NZ?

Thanks all

Andy Bunyan just had email to our query about RAT availability from from one of NZ's approved suppliers Roche Diagnostics NZ Ltd. They are out of Self Test RAT (a global problem) and stock that requires a medical professional to conduct the test is not due into the country until at least March.

At a minimum quantity order of 2500 kits (5 tests a Self test kit) and a 1 year shelf life

Our experience has been quite good.

We are currently undertaking a trial with a key part of our business where people are self-testing three times a week. There's good compliance, the team see the importance of the testing, and they understand how it fits into our overall Covid response.

As @robyn moses has mentioned I think supply will be the biggest issue going forward. Suppliers are already mentioning delays until late-Feb/ March.

do you have any insight into the frequency of false-positives for your use of RAT? Or for those that participated in the pilot for RAT in the construction industry last year?

MoH guidance indicates the likelihood of false positives as 4 in every 1000 tests, which is pretty high and could potentially cause not insignificant logistic issues where untargeted (wide/frequent) RAT for general surveillance is used. Most studies I have read have results with specificities in the 99.X% vicinity which is in line with the 4 in a 1000 advice from MoH.

I'm very interested to hear of any data from real world RAT programs to see if the lab results match up with reality or not.

Our trial is too small to have encountered false positives yet (it's only got eight people in it).

https://www.health.govt.nz/system/files/documents/pages/moh0011_rat_info_guide_decision_tree.pdf

I deleted this post as it was in reply to part of @Chris Anderson's post that was revised and removed... but to save it being just a blank post I thought I post this relevant video regarding RAT
Why LESS Sensitive Tests Might Be Better
Really important are the caveats at the end - that RAT is only one part of the puzzle, and that it shouldn't be considered as an straight alternative to PCR testing or even vaccinations and basic hygiene practices (cleaning, sanitising, mask wearing, etc.).

I edited my comment, it seems that advice had changed. For a while it was a bit confusing as different MOH advice seemed to contradict itself.

For a while it was a bit confusing as different MOH advice seemed to contradict itself. — Chris Anderson

For a while... to me there still is a a lot of confusion within the MoH! Just look at the various (changing) definitions of a Casual Plus Contact!
All good - deleted my post (as best I could) to avoid any confusion in the thread.
Cheers @Chris Anderson!

We've administered just over 6000 RATs now within our business. It's part of the puzzle as others have said but is really useful for giving reassurance to people who are in the "monitor for symptoms" groups after casual contact.

Excellent Jo, that's a good number of tests done.

Our trouble is still about accessing the RATs.
We are hoping the community transmission is still low while the RAT are not widely accessible.

Interesting to note the MoH guide might not be correct for all testing kits on the "read your result" timing. Access Bio CareStart is read result within 10-15mins (same as MoH guide). Roche (SD Biosenser) is read result within 15-30mins. Abbott Panbio and Siemens (Healgen) Clinitest are read within 15-20mins. After those prescribed timing, the results tend to show false positive.
These are the four currently approved RAT authorised by MoH.

The Australia Therapeutic Goods Administration under Department of Health published a list of approved RAT. Looks like Access Bio CareStart and Roche have a lower clinical sensitivity, while Abbott Panbio and Siemens Clinitest have higher clinical sensitivity. Worth noting when you are picking a brand for your testing.

Updated gazette for businesses to be able to purchase RATs: https://gazette.govt.nz/notice/id/2022-go201?stageDraft

That's brilliant Jo - thanks for the insight. Am dealing with some handwringing over accuracy of tests and perceived risk to those performing the tests. If they are being used in that casual contact space then it is easy to see where reassurance can be had.