Since then in daily press conferences, senior government ministers and their scientific advisers have refused to answer repeated questions about whether this change in strategy was a deliberate choice or the result of a lack of test resources .
“If it’s because we don’t have capacity, then say so. And describe the plans to build it, “said Devi Sridhar, professor and president of global public health at the University of Edinburgh. “Be honest with the public because there is confusion as to whether testing is even part of the UK strategy. “
In the latest in a series of communication mishaps that hit the government, Health Secretary Matt Hancock inadvertently revealed last weekend that the UK was not even using its full capacity to tests.
After Hancock tweeted on March 29 that the country had reached 10,000 tests per day, Public Health England followed the next day stating that if the capacity had increased to 10,949 per day, the actual number of tests carried out on March 28 was 9,114.
While the gap was not large, it was creepy for critics who questioned the government’s ability and ambition to increase testing, especially after it became clear that Germany would test about 70,000 a day.
When the epidemic hit the UK for the first time in late February, the country quickly carved out a place for itself as a test leader, implementing robust testing and contact tracing, while complementing these tactics with a Wider surveillance focused on intensive care units and primary care sites.
But as the number of cases continued to grow, the strategy changed. On 12 March, England’s chief medical officer Chris Whitty said it was “no longer necessary to identify all cases” and said the country would move mainly to testing hospital patients with symptoms.
Experts and the public have pointed out that the tactic appears to contradict repeated calls from the World Health Organization (WHO) for large-scale testing and contact tracing.
While Singapore and South Korea have become countries where in-depth testing and contact tracing seem to work, Whitty defended the UK’s “targeted approach” while promising that testing would actually increase.
It was not until March 17 that the government’s chief scientific advisor, Patrick Vallance, admitted that the United Kingdom [does] no mass tests available to the public now. ”
In an email sent until March 22 and viewed by the London Playbook, a senior official from Downing Street asked UK research institutes if the government could borrow the machines needed to perform the COVID-19 tests.
“We urgently need to step up testing,” the email said. “As the supply of these machines is limited, the Prime Minister is making an urgent appeal for you to lend us your machine (s) for the duration of the crisis. “
Shortly thereafter, promises of dramatically increased testing emerged. Prime Minister Boris Johnson has said that the UK will increase testing from 5,000 to 10,000 per day to 25,000 per day, and possibly 250,000. The promise of 25,000 euros is scheduled for mid-April at the end of April, but it is still unclear when the target of 250,000 per day will be reached.
While the government promised tens of thousands of tests a day, it also touted antibody tests, a potential game changer, of which 3.5 million had already been ordered.
These tests look for antibodies to the virus and can tell if someone has already been infected. In contrast, tests used so far in the UK look for the virus itself and only indicate if a person is currently infected.
The main caveat about the 3.5 million antibody tests in the UK was that they had not yet been evaluated. Public Health England (PHE) was still trying to find out if these tests would work as promised.
Then, in what seemed like a historic moment, Sharon Peacock, director of the National Infection Service at PHE, told members of the House on March 25 that the rollout of home antibody tests would be imminent, perhaps in the days following the test evaluation. being completed.
These tests would be available for purchase through Amazon, Boots or other pharmacy retailers, she said.
But a few hours later, Whitty had to come back to these remarks.
“I don’t think it’s something that we’re going to suddenly order online the next week,” he said.
On the contrary, the government has said its message is that as soon as capacity increases, healthcare workers will be on the front line for all new testing capacity, including antibody testing.
In a capacity building effort, the government announced on March 27 that it is setting up three new “hub laboratories” with universities, research institutes and companies lending their test equipment.
Thermo Fischer Scientific and Randox, who produce the equipment, would provide technical support, while Amazon and the Royal Mail would provide logistical support.
As part of the test campaign for NHS staff, driving test centers were opened with the help of companies such as Boots and Ikea. Drug maker Roche is also working with PHE to be able to use Roche’s high-throughput machines, which can deliver results in as little as a few hours.
However, full scaling up of this investment is not expected to be completed in the coming weeks.
The problems go beyond the test itself. Laboratory capacity must measure up, with the Guardian pointing out that the UK simply does not have as much national laboratory capacity as a country like Germany. Although the capacity has increased from a single laboratory carrying out the tests to 12, some fear that this number is still not enough.
Anthony Costello, former director of WHO, thinks there is a simple solution using the 44 molecular virology laboratories in the UK, which are used to test for infections such as HIV and hepatitis B.
He told the BBC’s “Today” program on March 31 that it would bring the country to Germany’s test levels and that it was “perfectly doable.”
In all these scenarios, the tests themselves are carried out in the laboratory, in one or two days to turn around. But there is also another option on the horizon, said Ashley Woodcock, clinical director for respiratory medicine at the University Hospital of South Manchester.
It’s a quick point-of-care test, which Woodcock says is “starting to happen.” These tests are performed at the bedside of a patient, the results being provided on site or shortly thereafter.
In addition to the standard laboratory tests, Woodcock said he hoped these tests could be launched “within two to four weeks” so that inpatients can be diagnosed “at the first point of care within 15 minutes of each great site ”.
Jeremy Hunt, former secretary of health and now chair of the House of Commons health and social services committee, is leading the calls for mass tests.
In one video on March 31, Hunt said it was “internationally proven” that community testing was “the most effective way to break down transmission.” He considered it “essential” that mass testing be part of the national strategy.
The government has taken a very different approach. On 27 March, England’s deputy medical director, Jenny Harries, said that strong containment and contact tracing measures were “not appropriate at this stage in the UK epidemic”.
“The proper thing to do if you have symptoms is to isolate yourself,” she said.
According to the WHO, testing should be at the heart of governments’ responses to the pandemic.
The tests are about more than just one person who knows their status, said WHO director-general Tedros Adhanom Ghebreyesus on March 30. Instead, if it is known where and how a person acquired the virus, this information allows the authorities to implement much broader public health measures.
“Without testing, it’s like moving blindfolded,” he said.
Annabelle Dickson, Charlie Cooper and Cristina Gallardo contributed to the report.
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