Anthony Costello, former WHO director and professor of global health and sustainable development at University College London
On virus tests, it is good that they solve swab and reagent problems. It’s good that they are galvanizing the scientific community to help and it’s good that they are setting a target of 25,000 tests [antigen tests that show if people have the virus] per day at the end of April [Hancock aspires to reach 100,000 a day in England for all types of tests, including antibody tests] I hope this will help cover health workers and patients.
If blood immunity tests go online, it will be a very useful tool for examining the extent of immunity in the population, as will their surveillance plan for Porton Down, to examine infection rates and propagate in a sample survey. The question of whether the immunity blood tests will be specific enough for Covid-19 is a big problem, because if they give false positives, it will be dangerous for people who believe they are immune to come back to the front line and infect the patients.
None of these strategies, however, solve the fundamental problem of stopping the spread of the virus.
Eleanor Riley, Professor of Immunology and Infectious Diseases at the University of Edinburgh
Under normal circumstances, Public Health England (PHE) (and Health Protection Scotland) have extremely strict test protocols, all validated according to the highest certification standards. This has many advantages: providing solid results in which clinicians have complete confidence, aligning with standard criteria that allow national and international comparison, and regularly revalidating individual laboratories. On a normal day, it works. It is clinically robust and allows the NHS to benefit from bulk ordering of reagents from a single supplier at a competitive price.
But these are not normal times. There is an urgent need to step up testing. This may require that we adapt the protocols to use the available reagents and equipment. Research laboratories, which tend to operate in a less regulated manner, have sufficient skills, equipment and (most likely) reagents to contribute to this effort. It will not be exactly the same elements as those used by PHE, but they will work just as well.
Above all, almost all academic research unrelated to Covid-19 has been suspended; the laboratories have been put on hold and the staff sent home. This represents a great resource available for outsourcing and extending testing. The university community has the skills, the resources, and the willingness to contribute if only someone made the reasonable and pragmatic decision to give up some control. There is a glimmer of hope in Matt Hancock’s “5 pillar program” presented at today’s press conference, but one small but precious detail remains.
Dr. Michael Head, Senior Researcher in Global Health, University of Southampton
Finally, it’s good to hear the Minister of Health’s explanation about the difficulties in scaling up testing. This is due to a lack of preparation before a pandemic, which then has an impact on the ability to dramatically and rapidly increase a national response, as we have seen in Germany. These problems are also encountered in other countries – for example, France has performed fewer tests than the United Kingdom.
The minister promised 100,000 tests a day by the end of April. We will see if this level is reached. But over the next few weeks, we need to remember the lessons learned and realize that the unused capacity of a health service or public health infrastructure is not “a waste of money.” This is vital in case of urgent need, and there will be a “next time”.
Mark Harris, professor of virology at the University of Leeds
[Hancock’s five pillars] seems to be the right approach. I’m a little concerned about the schedule, which we will have to wait for at the end of April [for high levels of testing]. We hope that over the next few weeks we start to see some of the effects of social distancing and locking out, so it would be nicer to test faster than that. But I understand what [Hancock] said that we don’t have a big diagnostic industry, unlike some other countries, so we have to build from scratch – I think that’s pretty honest and open about it.
[Population sampling] is a great way to go. The challenge will be: which population do you sample? In addition, what statistical analysis will you apply to the data you draw from it? If you went to London, you will probably find a much higher proportion [of infection] than other parts of the country – this may be information we need to know.
I think we can still criticize what has happened in the past, but I don’t think it’s appropriate at this point. It is a crisis and we are where we are. We have to try to make sure that in the future we do the right things; the time for recrimination and looking back and learning the lessons will be in the future. For the moment I think [Hancock] does everything he can. Hopefully these words spoken today will materialize in actions over the next few days.
Charlie Swanton, chief clinician at Cancer Research UK, setting up a test laboratory at the Francis Crick Institute
It all makes a lot of sense. Testing is absolutely essential to bring healthcare workers to the front line, when they are safe for those around them and for patients. With a significant proportion of the workforce currently on leave for suspected coronavirus infection, testing will be vital for frontline services already in demand due to the crisis.
It would make sense to provide the coronavirus units with doctors and nurses who have been exposed to the coronavirus, and that is why antibody testing is so important.
We are obviously delighted to play a role. We hope to make a modest but significant contribution, hopefully. This will require collaboration at the national level. We will share our operating procedures, our analyzes [investigative procedures] and developing these tests with other very happy on-demand labs and providing training to get people up and running quickly enough.
By building a new British diagnostic industry, this pandemic has revealed the extreme vulnerability of each country. We are so dependent on a global diagnostic and clinical network. When the barriers come down and our supply lines go down, it’s clear very quickly how vulnerable we are. We need a way to secure our pipelines to access vital reagents and diagnostic kits, and if we can’t, we need a way to make them ourselves from scratch very quickly.
All this is possible because the technology is not complex. Finding approaches to quickly validate and qualify a diagnostic test for clinical use is difficult, but resolvable with the right networks of collaborators and established diagnostic laboratories.