Covid 19 Delta outbreak: Dr John Dunn – Saliva testing is the solution


Our most recent disastrous lockdown is due to two avoidable errors: allowing the virus to board in Sydney and then dumping it in Auckland’s CBD. The result is killing the economies of New Zealand and the Cook Islands.

I support Sir Ian Taylor’s call for the Government to get help “off the bench”. There is huge ability and goodwill in the business sector.

Dedicated remote MIQ has been described as too hard and too expensive. It costs Auckland $1 billion a week at level 4, mostly borne by businesses. What could you build for a billion? Trouble finding workers? Perhaps double border staff salaries and add perks and generous leave for another billion? We would still be way ahead.

This pandemic will last years. And there will be another. Proper MIQ seems like a good investment and could be used selectively alongside appropriate geo-fenced home isolation for low risk, double-vaccinated, virus-negative travellers.

More importantly, move efforts upstream and instigate saliva PCR testing immediately pre departure for any traveller to New Zealand. The technology is proven and equivalent to nasopharyngeal swab testing.

Saliva PCR is quick, non-invasive, accurate, repeatable, scalable, inexpensive and, inexplicably, unused.

Many are confused about terminology and techniques. The gold standard is Reverse Transcription- Polymerase Chain Reaction (RT-PCR) which takes the virus out of the cells, amplifies it and identifies it. It is incredibly accurate, whether the sample is obtained from a nose swab or saliva.

Saliva antigen Lateral Flow Testing (LFT) is quite different. It is widely used overseas, including in the UK, but is criticised as it lacks sensitivity. LFT has been the subject of a comprehensive and prestigious Cochrane Review which rates accuracy at only about 58 per cent. It results in a lot of missed cases (false negatives) especially in the early asymptomatic but infectious stage. Therefore it is not appropriate where high quality screening is required.

There are several saliva PCR options in New Zealand. The Government controversially awarded its $60 million saliva contract to a large company, owned by the NZ Super Fund and Canadian interests. They have been slow to act, and use a test initially only validated against “spiked” saliva and not real world virus.

Sir Ian has been offered the MicroGEM Spitfire 6830 system for his travel trial. It awaits FDA approval.

Two other companies use fully validated protocols from the University of Illinois and Yale University respectively. The latter group, Ubiquitome, locally produces a miniaturised, benchtop, point-of-care, FDA and Medsafe approved PCR analyser. Kiwi ingenuity at its best. A result is obtained in 90 mins appearing in real time through an app.

We are employing this for all staff twice weekly, and all patients pre admission, at our private hospital. It works excellently.

We also mandate staff vaccination, as for all healthcare workers in NSW. In NZ, the Medical Council, the Medical Association and Colleges of GPs, Surgeons and Anaesthetists all call for this. Why mandatory vaccination is not in place in our hospitals, and indeed many industries, remains a mystery.

Covid-19 has become a disease of the unvaccinated. This is more than an issue of individual rights as this group threatens to overwhelm our health system when they get sick.

While handwringing prevarication paralyses Cabinet, business needs to take the lead on vaccination and screening. Air New Zealand has just mandated vaccination for international travellers, but could also establish airport-based PCR testing. Initially start in Auckland to allow safe reopening of the Cook Islands bubble, and then in Australia for NZ bound passengers.

The key question is “Does this person have the virus right here, right now?”. Saliva PCR answers that reliably, on the spot, within two hours. Then they can safely get on the plane or enter the hospital.

To borrow Sir Ian’s analogy, I am sick of warming the bench and, unless red-carded, would gladly join his rapid and thoughtful initiative. We can bring our expertise and experience to support his trial.

Our government is doing many things well, but too slowly, including vaccine ordering and delivery, pre-departure saliva PCR, travel to Covid-free countries and intelligent isolation. The Cook Islands government meanwhile has been exemplary in achieving literally 99.9 per cent vaccination.

Finally, the team of 1.5 million has taken enough hits for the other team of 3.5 million, and the expat team of 1 million. Let’s take the MIQ, and not the mickey, out of Auckland.

– Dr John Dunn is CEO of Endoscopy Auckland and honorary medical advisor to the Cook Islands Prime Minister.

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