Coronavirus testing failures

The list of the unrealized vanity projects by Boris Johnson includes “Boris Island” airport, a “garden bridge” over the River Thames and a bridge between Northern Ireland and Scotland. Operation Moonshot is likely to join this list.
Photo from Wikimedia

Coronavirus testing has been a litany of failures, now we have the Moonshot folly

It started on 12th March when the government announced that they would discontinue testing in the community: this decision, as well as the delayed lockdown, made us one of the countries with the highest number of coronavirus deaths.

When the Westminster government finally accepted the need for a Test and Trace system, they decided not to build on the existing capabilities of NHS laboratories and local Public Health departments. Instead, they created a dysfunctional hotchpot of disparate commercial providers. 

There have been problems with testing throughout, including inadequate capacity and delayed results, whilst the failure to share results with Public Health England and local public health teams contributed to an extended lockdown in Leicester

More than 100 public figures have complained about the fact that the details of the Test and Trace contracts, given to private companies, have not been disclosed. This outsourcing has been done outside of the normal tendering processes and, says Dr Wrigley , with minimal oversight, governance and transparency. 

The UK Coronavirus testing capacity increased rapidly up to mid-June but then remained static at a capacity of around 200,000 daily tests until the end of August. It seems that we have failed to foresee an eminently predictable increase in test requirements: this has now become a major problem impacting on our ability to control the second wave. 

In the community the inability to request a test and delays in getting the result prevent an effective implementation of isolation and contact tracing. 

Matt Hancock has blamed asymptomatic individuals for clogging the system with less relevant test requests, whereas Baroness Harding (the head of Test and Trace) has stated that the number of tests requested is three times the testing capacity, though she could not be sure due to double counting. No precise figures have been provided to substantiate either claim.

Even more astonishing was Baroness Harding’s statement on 17th September, when she said that the government is now working on criteria to decide which test requests should be prioritised. We are in the seventh month of an epidemic during which demand has often outstripped capacity. Why had nobody thought that we needed carefully assessed prioritization criteria before this crisis?

NHS hospitals have been banned, again, from launching their own coronavirus testing: this is nonsensical. NHS pathology laboratories could have provided not just increased testing capacity, but also experience in building test-ordering systems that filter out inappropriate requests, experience at managing demand and a long-standing practice of auditing the appropriateness of test requests.

Recently, Matt Hancock and Boris Johnson have made announcements about a new bold project: Operation Moonshot. They are now promising 10 million tests a day, enough to test the entire population every week, so that all those testing negative could go back to a normal life. 

The cover of the British Medical Journal on 19th September 2020. Various articles in this issue argue that operation Moonshot does not have a sound foundation.
Cover of BMJ with permission

There are several problems with the Moonshot proposal. The £100bn estimated cost is enormous and the technology is still under evaluation. Thus, planning, commissioning and delivering would require much more than just a few months. 

However, there is also a more fundamental problem: even the best coronavirus tests seem to have a ‘sensitivity’ of just about 70%: this means that if 100 individuals with the infection are tested, only 70 give a positive result. Let us assume that one in a thousand has the infection. In a football stadium with a 40,000 capacity it would be safer to admit a reduced attendance without any testing: amongst 4,000 spectators there would be four with coronavirus but, with rigorous precautions, there would be limited or no infection transmission. Conversely, if 40,000 spectators were allowed, there would be 40 infectious individuals and only 28 could be identified and excluded with testing: the remaining twelve would cause much more infection transmission in a packed stadium under a false sense of security.

What we need in the next few months is a strengthening of our standard testing capabilities. Moonshot is a distraction that will be remembered alongside other promises such as the tracing app that would be delivered in May 2020 or the return to normality by November. A vaccine is our best hope for 2021.