During the past week, the UK has seen an alarming rise in COVID-19 cases. With a second wave of infections approaching, there is a need to adequately respond with a robust test and trace system. However, neither the testing nor the tracing system currently in place is prepared for the substantial increase in demand for tests. As autumn begins, we face the co-occurrence of schools and universities reopening, people returning to work, and the approach of the influenza season.
Children have now returned to school, where the risk of becoming ill increases. As soon as a child shows any symptoms that could indicate COVID-19, they are sent home from school. They are not allowed to return unless they have had a negative test or have isolated at home for 10 days, which also affects other members of their household. If they test positive, some schools send home so-called bubbles of children, which can include as many as 250 children.
As many illnesses have symptoms that overlap with those of COVID-19, it is hard to distinguish the underlying cause. For example, symptoms indicative of influenza infection could be mistaken for COVID-19
. With the influenza season approaching, it is likely that anyone displaying these symptoms will require a test to rule out COVID-19. Additional guidance is needed from health officials to help educate the public on when it is appropriate
to get a test.
With such uncertainty, it is understandable that there has been a huge surge in demand for tests. But the response by the UK Government is concerning. Many people have reported having to travel hundreds of miles to test centres because no tests or appointments have been offered locally. UK Health Secretary, Matt Hancock, has admitted that tests will be rationed
, with some groups being granted priority access. It is difficult to believe that the Government did not predict the possibility of this increase in demand when children returned to schools and people went back to work. Dido Harding, head of NHS Test and Trace, claimed that the modelling used to advise the Government had not predicted such a steep increase in demand, and blamed SAGE for getting its predictions wrong. Nevertheless, demand for testing is up to 3 times
higher than capacity—how has this scenario occurred?
There does not seem to be a physical shortage of testing kits, more that they are not being distributed properly and it is difficult for people to get an appointment at one of the test centres. Also, laboratories processing the tests are limited in the number of tests they can do each day (375 000 tests per day) due to staffing and resources available. Although this number is much higher than back in March, Operation Moonshot, a Government pledge to reach 500 000 tests per day by the end of October, and 4 million by February next year, seems ambitious.
Community testing is where the Government is falling short. According to a BBC report
, nearly all community testing is processed in one of seven so-called Lighthouse Labs, which were close to capacity in August. Only one third of test results
in community testing centres are returned within 24 h. If tests are not completed in a timely manner, results might not accurately reflect whether someone is infected.
The situation can evolve rapidly, but it is not too late to prevent a repeat of earlier this year. Independent SAGE
have released a 10-point emergency plan to avoid another national lockdown, to be implemented in this 2–3-week grace period before the situation worsens. They recommend a strategy to build a functional testing system: rebuild the testing system based on trusted local NHS and public health structures; recruit local contact tracers; provide clear, consistent, and culturally appropriate messaging about testing and effective measures; establish a clear strategy and set priorities for symptomatic and asymptomatic testing; and provide wrap around support, enabling people to self-isolate.
Perhaps it is time to consider alternative methods of mass testing. Suggestions include using pooled saliva samples
, which could allow for community testing at a lower financial cost. The COVID-19 symptom-tracker app from King’s College London could also help track the spread of infection across the country. Testing should also be integrated through primary care to help triage patients in whom testing is necessary.
Keeping the R number low is crucial to manage a second wave. But this number will be difficult to calculate, and inaccurate, without data on infection rates because of an inadequate testing system. Measures proposed by SAGE and Independent SAGE, if feasible, should be implemented as a matter of urgency. Otherwise the country could be forced into a lockdown by default.
Published: September 22, 2020
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