The warehouses across New Zealand full of millions of RATs

By the numbers (as of June 15)

• Money spent on RATs: $1.1 billion
• RATs imported: 135 million
• RATs on order: 47.9 million
• Total RATs: 182.9 million
• RATs held by the Ministry of Health: About 50 million (stocktake ongoing)
• RATs distributed: 79.7 million

The Government has spent more than $1 billion on 180 million Covid rapid antigen tests. But after a mad rush, very few people now seem to want them. Blair Ensor reports.

In a massive warehouse, at an undisclosed location on the outskirts of Christchurch, sits the South Island’s stockpile of rapid antigen tests (RATs) – all 5 million of them.

By now, nearly every Kiwi should have used one of the tests, which are the main tool for determining whether someone has Covid-19.

The RATs are packed inside large boxes, stacked on about 500 pallets at the warehouse. They’re waiting to be shipped to various collection points, like Ngā Hau E Whā Marae in Pages Rd, Christchurch, where they’re distributed for free to people who are either household contacts of confirmed Covid-19 cases, or who have symptoms.

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When the tests were first made available for free to the public in February this year, hundreds of pallet loads of them were coming and going from the warehouse each day. In recent weeks, that has slowed to less than a handful.

At places like the marae, there are no longer kilometres-long queues of people in their cars waiting several hours to get their hands on RATs. They arrive sporadically, one or two vehicles every 15 minutes. That’s despite Covid-19 and Influenza spreading freely in the community, and the health system being under immense pressure.

Those working on the front line of the Covid-19 response believe that after an initial mad rush for RATs in late February and March, nearly everyone now has some stashed at home.

“I think we’ve hit saturation,” says Rebecca Ihaka, who’s the site leader at the marae collection point.

Either that, or people’s desire to use them is waning.

Whatever the case, one thing’s certain – they’re not in short supply.

Jet boats, stock trucks and RATs

Since October last year, the Government has spent $1.1 billion on about 180 million RATs.

When it placed its first order, testing for Covid-19 was almost exclusively carried out using polymerase chain reaction (PCR) tests, which could detect very small viral loads and were almost 100% accurate – something that was important when pursuing an elimination strategy.

But with a growing number of cases in the community, and a shift towards living with Covid-19, rather than “no Covid”, there was a need for a test that was easier to access, could be self-administered, gave quick results and was cheaper.

RATs, which are mainly produced in the United States and China, ticked all those boxes. One downside was that they worked better with a high viral load, usually in the middle of an infection. That meant some positive cases would go undetected, particularly when used by regular punters.

In mid-February, as the highly transmissible Omicron variant of Covid-19 spread rapidly through New Zealand, RATs were rolled out in stages. Asymptomatic critical workers who were close contacts of a case and needed to continue to work were among the first to be able to access them.

Within days, the country’s PCR testing capability was overwhelmed and RATs became the main device used for detecting the virus in the community.

The roll-out wasn’t without controversy, though. With the explosion of Omicron across the world, supply of RATs was constrained, and the Government was criticised for not securing more, sooner.

There were huge queues of cars as people waited to get their hands on RATs at collections sites. Those who didn’t have the patience to do that, and could afford to do so, were able to buy them from pharmacies and supermarkets who’d acquired them privately. The price of an individual test ranged from $6.50 to $15.

But in the months since then, pressure on supply has eased. And with millions of RATs arriving in the country by air and sea regularly, the Ministry of Health has pumped huge numbers of them into a distribution network it says was designed to ensure tests are reaching those living in the most vulnerable communities. Central to that network are marae, such as Ngā Hau E Whā.

According to the ministry, 95% of New Zealanders live within 20 minutes’ drive of a place where they can get RATs for free. Jet boats and stock trucks have been used to get tests to people living in remote rural areas.

As of June 15, the ministry had distributed 79.7 million RATs. A further 50 million* were sitting in various warehouses, like the one on the outskirts of Christchurch, and another 47.9 million were on order.

Neither the ministry nor Customs has a record of how many of the tests have been imported privately.

Ministry testing and supply senior manager Jo Pugh says the 50 million RATs currently in reserve are estimated to last about 33 weeks, based on the country’s current rate of consumption.

“We’re expecting a bit of a surge or a new peak over winter (between July and September) so that will dramatically increase how many are being used.”

The number of positive cases reported daily in New Zealand has fallen to about 5000 (Director-General of Health Dr Ashley Bloomfield earlier this month said reported cases represented about two-thirds of those circulating in the community).

Pugh says modelling suggests that number could rise to 7000 to 10,000 in a second wave of infection. That is why there are tens of millions of RATs still on order.

Predicting the rate at which we’re consuming RATs is far from an exact science.

Pugh is unable to say how many of the 79.7 million tests the ministry has distributed have been used. That’s because once the tests leave warehouses, officials are reliant on the public’s reporting of results online through My Covid Record.

However, many people, particularly those who test negative, aren’t logging their results. And there’s no way of differentiating between results obtained using ministry tests and those imported privately.

“We will probably never know how many RATs have been used,” Pugh says.

Using back of the envelope modelling, Covid-19 Modelling Aotearoa programme co-lead Dion O’Neill estimates positive cases, household contacts and people who have Covid-like symptoms should comfortably be consuming between 750,000 and 1 million tests in total each week.

His modelling relies on many assumptions, not least that everyone who should be testing is doing so twice on average.

Pugh says the drop-off in people collecting RATs from places like Ngā Hau E Whā isn’t unexpected.

“It’s difficult to understand what people are doing out there but … it’s really normal to see a big rush on something that’s new and effective and seems to be a really important part of that fight against Covid. I think people who need the RATs have got the RATs – there are so many out there.”

If the Government has over-ordered, it has the ability to cancel shipments, she says.

“The important thing is we have enough.”

Should more RATs have been ordered sooner?

“I think the way Omicron kind of hit the world, it took a lot of countries by surprise. We were fortunate in that we had a bit of time and … we could actually put some pretty robust plans together. We increased our orders when we needed, and we’ve had enough – we’ve never run out – and we have enough to serve us well for the rest of the year.”

RATs will continue to be available for free to those who are symptomatic or household contacts, while there is a public health need, Pugh says.

She is unable to say how long that need might exist. The ministry’s current testing plan extends through to December.

“We’re always reviewing our testing guidelines and adapting that to emerging evidence. As we get closer to that time we’ll have more of an idea of what else is ahead.”

Experts say there will be a need to distinguish between Covid-19 and other illnesses for the foreseeable future, which is realistically years rather than months.

The Government needs to be careful not to throw itself “head long into one [testing] strategy” so it has the ability to adapt to new technology, says Dr Joshua Freeman, Canterbury District Health Board’s clinical director of infection, prevention and control.

However, in terms of a testing option that is “accessible on a massive scale”, RATs are unlikely to be surpassed in the short term, Freeman says.

O’Neill says he’d like to see their use become normalised.

While the current public health response only allows for free RATs for those who are symptomatic or household contacts, he routinely tests himself before attending social events where he’s going to be mixing with people in close proximity.

In the future, he hopes there are different RATs the public can use to detect the top three or four illnesses circulating at any one time.

“It would be a very good way to have lower disease prevalence in the community,” he says.

And with the current rates of sickness doing the rounds, it’s hard to argue with him.

*Subject to ongoing stocktake.