The Case for Rapid Antigen Testing


PHILIPSBURG, Sint Maarten—As health experts around the globe continue to confirm, COVID-19 is not going away soon, and we may have to live with it until the end of 2021, if not longer.

If the government does not lift the barriers that are constraining and delaying the economic recovery, short and long-term damage to our beloved destination will occur. In the short-term, businesses will eventually close if they have little or no revenue during this upcoming winter season, employees will be laid off, and tax revenues will decline further.

In the long-term, poverty will rise, we face increasing crime, deficits will become larger, Sint Maarten as a tourism destination will lose market share, foreign reserves will decline and the NAF/USD fixed exchange rate will be at risk, and, most importantly, public health will decline because of economic hardship.

“While the situation will gradually improve in 2021, hopefully, because of vaccines and medical treatment, Sint Maarten needs to step up its game and take advantage of every opportunity to attract guests to its shores,” said The Maho Group President & CEO Saro Spadaro.

Spadaro feels strongly that the government is lagging in its decision-making process and its adoption of on-arrival rapid antigen testing. “We are running out of time. Tourism, and the livelihood of this country, is at severe risk”, said Spadaro.

A presentation was given to the Ministry of Health and the Ministry of Tourism on Thursday, October 8, 2020, by TENTO Health, with a proposal to combine a smartphone application and a digital health solution for managing and controlling COVID-19. The application is endorsed by Apple and Google and available in their app-stores. The proposal is a collaboration between TENTO and the South Korean healthcare company, SD BIOSENSOR, which manufactures, amongst other medical supplies, rapid antigen tests.

“This is a real, actionable, and affordable plan,” said Spadaro. “To date, and to our knowledge, the government has not done anything about it. So, whether they choose to go with this company or another like it, the government must decide by November 1, to have a system implemented by December 1. These dates are consistent with the presented proposal. If the French and Dutch governments are using such technology and implementing systems by these dates, then why shouldn’t we?”

US travelers have started to travel again, but they are hesitant when it comes to taking the PCR COVID-19 test before traveling to a destination. It’s expensive, and sometimes, the results take too long.

“The current system of PCR pre-testing for arrivals prevents travelers from getting on a plane right away. First of all, it’s difficult to get tests, it can get pricey especially for families, and represents an immediate barrier to a would-be traveler. Also, it’s ineffective because passengers can become infected in the five days following the test and before they arrive in Sint Maarten. “Research with leading tour operators show that clients prefer to book destinations that have requirements that are easier to comply with, in particular, those with no pre-testing,” noted Spadaro.

To limit the importation of infection, Sint Maarten currently requires a PCR test for COVID-19 obtained from a nasopharyngeal swab and performed within five days before arrival on the island. Travelers and airlines indicate that this protocol is not practical and leads to cancellations.

Further challenges arise because of competition from destinations that have more flexible or no pre-departure testing requirements. Proof of this risk is SunWing’s recent announcement that it is resuming operations to some Caribbean destinations and Mexico, but Sint Maarten is not on that list. All the Caribbean destinations mentioned in SunWing’s announcement do not require pre-departure PCR tests.

American Airlines Vacations has advised that consumer travel to Mexico rose 40% year-over-year in June and continues to increase, but Caribbean travel shows a negative trend. The company’s travel agent bookings to Mexico are up about 700% year over year and these same agents are simply not selling the Caribbean due to a lack of on-arrival testing. American Airlines’ load factors are 90%+ for the Mexican destinations of Cancun and Los Cabos, and due to demand, American Airlines is adding new routes to Mexico for the winter season.

Travel giant Expedia has also advised that there is demand for travel in the marketplace, and customers are willing to book vacations, however restrictions and requirements implemented by individual Caribbean islands are crucial in driving demand; easier to comply with requirements result in higher demand for certain destinations.

Jet Blue Vacations—another critical partner for Sint Maarten—reported that travel to Aruba is increasing because of on-arrival testing, and the company has indicated that bookings are up for destinations that have more liberal testing requirements.

Flight Centre Travel Group said that there is currently more interest in the Dominican Republic since the restrictions were further lifted, and, in reviewing its bookings made in September, travelers are seeking Jamaica, Riviera Maya, Cancun, Punta Cana, and Aruba.

“We must act now to stop losing market share to Mexico, the Dominican Republic, Jamaica, and claim our share of the travelers willing to go on vacation this winter,” said Spadaro. “Technology and risk analysis are critical for successfully balancing the protection of public health with our limited healthcare infrastructure, and also in stimulating economic activity to ensure jobs are protected, and that poverty does not increase.”

The TENTO (or similar) app will allow Collective Preventive Services (CPS) to communicate with guests while on the island, monitor symptoms, request feedback, etc. TENTO is General Data Protection Regulation (GDPR) compliant, and in a second stage, the app can be used to store vaccination certificates for passengers. Expanded local testing with Rapid Antigen testing will allow CPS to better control the spread of COVID-19 on the island, thus saving lives and protecting the healthcare system.

Rapid Antigen Testing has been accepted all over the world as an effective testing method, and an affordable, costing approximately 75% less than a PCR test. Sint Maarten needs to develop a powerful protocol to manage the risk of infection, based on rapid antigen testing on arrival, COVID-19 insurance, and random PCR-testing to verify the accuracy of rapid testing.

The World Health Organization (WHO) issued guidance on September 11, 2020, highlighting the value of rapid antigen tests for jurisdictions where there is a high level of community transmission and where PCR testing is not available, or results are delayed.

The International Air Transport Association (IATA) has stated that governments must find alternatives to border closures and quarantines and recommends rapid testing. The use of these inexpensive, faster antigen tests can change the way a country handles the pandemic. Specifically, rapid antigen testing can be deployed to actively ‘go after the virus’ and effectively prevent transmission. This is the strategy being adopted by the United States and France. On October 16, 2020, the French State Secretary for Transport, Jean-Baptiste Djebbari announced that French airports will start using rapid antigen tests at the end of October.

On October 7, the Dutch Minister announced the approval of two rapid antigen tests.  Interestingly, the study for the tests was conducted in Utrecht and Breda, and Aruba.  In the Netherlands, the investigation into the practical application of rapid tests – in addition to the PCR tests currently deployed – has started. According to an article in the Brussels Times, The Netherlands has ordered two million rapid antigen tests.

In an article in the Daily Herald on October 15, Minister Hugo de Jonge of the Dutch Ministry of Health expressed his concern about the COVID-19 situation on Sint Maarten; not because of the number of confirmed cases, but because of the limited testing taking place on the island.

 “I support efforts that allow us to safely lower barriers that turn away tourists from visiting our shores. We must strike the right balance between the safety of our people’s health, with the health of the country’s economy. Today’s antigen tests, currently being assessed by France and the Netherlands, appear to offer that balance so that we can revive our economy by increasing the number of arrivals while mitigating risk,” said Minister of Tourism Ludmila de Weever.