As the number of Covid-19 hospital deaths in Britain increased by 563 in a single day Wednesday, Boris Johnson faces mounting criticism of the government’s failure to set up a test regime adequate to manage the crisis.
The tests have been used aggressively in countries like South Korea and Singapore to stem the spread of the coronavirus, and are also essential in determining whether health workers have been infected and are able to work.
But, according to the latest daily data, only 7,511 people have been tested in England. In contrast, Germany performs around 50,000 tests per day. Downing Street admitted on Wednesday that only 2,000 of the 1.2 million NHS members have so far been tested.
Jeremy Hunt, former health secretary, argues that mass community testing is necessary as a strategy for breaking out of the catastrophic British economic foreclosure. But is it too late?
How did we get to this situation?
Comprehensive coronavirus testing – including contact identification – was part of Britain’s initial efforts to contain the epidemic, but was abandoned on March 12 when NHS leaders decided to stop testing people with mild symptoms of the virus.
The policy change came despite Patrick Vallance, the UK’s chief science advisor, who said that barely 5,000 people in Britain – 0.00008% of the population – could be infected at this stage.
The official opinion was that mass infection was inevitable with projections of 40 million people contracting the disease; Britain, therefore, gave little priority to building mass testing capacity at the start of the epidemic, unlike other countries, including South Korea and Germany.
Sir Patrick said on March 12: “It is not possible to prevent everyone from obtaining it and it is not desirable either because you want some public immunity to protect us against it. ‘future,’ he said.
But on March 16, the government abruptly changed course when it was warned by scientists at Imperial College that its “mitigation” strategy could cause 250,000 deaths and see the NHS overwhelmed.
But this sudden change in approach meant that the UK did not have sufficient testing capabilities to aggressively suppress the disease, nor tests close enough to check the health of front line NHS staff. And the rest of the world was now engaged in the same race for source testing.
What are the barriers to expanding testing in the UK?
The NHS and Public Health England have implemented a centralized testing system with limited capacity.
Now that the British government is pushing for huge expansion – by recruiting academic and private labs as well as a new public test center in Milton Keynes – there is a global race to get the necessary equipment and chemicals as well as trained staff.
Greg Clark, Conservative Chairman of the Commons Scientific Committee, said: “It is unclear why PHE chose to centralize testing when countries like Germany and South Korea have instead mobilized large numbers of laboratories. So far, the centralized approach has not worked. “
It is difficult to unravel the causes of shortages and bottlenecks, as many materials are required to perform the PCR – polymerase chain reaction – tests which are the cornerstone of the identification of Covid-19.
Some are truly in short supply and some are subject to distribution bottlenecks. Some can be reconstituted quickly, others require a complex and long synthesis.
Many hospital, university and private laboratories are now turning to help with the diagnosis of Covid-19, as doctors complain that they can sometimes wait seven days for the results to come back. “It’s a borderline farce,” said a Hertfordshire doctor.
But expanding laboratory capacity is far from straightforward, said Stephen Baker, a professor of molecular microbiology at Cambridge University, whose own laboratory is being converted to help nearby Addenbrookes Hospital.
“There are several problems with the establishment of new diagnostic testing capability outside of regular diagnostic laboratories,” he said. “Research laboratories have different approaches, equipment and personnel.
“There is nothing more dangerous at this time than reporting incorrect negative or positive results to staff or patients.”
How serious is the shortage of chemical reagents?
PCR tests require reagents to extract the viral genes from the swab patient sample and then amplify them so that they can be more easily detected. The test involves primers and biochemical probes (synthetic fragments of genetic material) and two enzymes called reverse transcriptase and DNA polymerase.
“It’s true that manufacturers are struggling to keep up with demand,” said Doris-Ann Williams, chief executive of the British organization In Vitro Diagnostics Association. “It is not true that there is a shortage of reagents per se. “
She said the UK government is talking to manufacturers and is also considering alternative supply routes, as small businesses can potentially fill the void with their products and reagents that could be used on stand-alone PCR machines. Roche, Abbott and Thermo Fisher Scientific are three of the world’s leading test players.
But Al Edwards of the University of Reading school of pharmacy said replacing the equipment was not easy. “To make this test accurate, you have to keep the ingredients fixed,” he said. “While other versions may work, it’s not easy to just switch to another type. There may be tiny changes that cause the test to fail. “
Why can some people be tested privately?
Anyone wondering why footballers and celebrities can get tested for coronavirus but not health care professionals will find the answer in the burgeoning private market for home testing.
Tests cost between £ 225 and £ 375 and can be ordered online. Michelle Tempest, an analyst at Candesic, a healthcare consultancy, said, “There are clearly tests available if you have the money. Providers include the Harley Street Private Clinic, CityDoc and Randox Health.
Leander de Laporte, founder of Medbelle, a London-based start-up that typically provides cosmetic surgery, said his company had started offering World Health Organization-approved home test kits at cost Monday .
“We use the same tests as the NHS, which check if you have the virus,” said de Laporte. “We don’t know why the government is having so much trouble; we assume that this is due to the shortage of laboratory capacity or the slow process of setting up physical test stations. “
Can mass tests end the UK lockdown?
Jeremy Hunt says it is “vital” that the government adopt mass testing as an exit strategy from the current lockdown, so that any new cases after the restrictions are lifted can be quickly isolated, with contacts quarantined.
But Britain will need to step up testing from its current level of less than 10,000 people a day to reach this type of scale and without mass testing, the only other exit strategies are a vaccine – still not in sight – or the prospect or repeated blockages if the disease resurfaces.
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Boris Johnson ultimately wants to run 250,000 tests a day, but Downing Street says it would include a mix of PCR and antibody tests, which establish if someone has ever been infected. Millions of these tests are on order, but their use has so far not been approved.
“I don’t think it’s too late,” said Devi Sridhar, professor of global public health at the University of Edinburgh. “But I think we have to go back and start building this backup, otherwise I don’t see a way out of the lock. “
Reporting team: George Parker, Laura Hughes, Clive Cookson, Gill Plimmer, Donato Paolo Mancini and Peter Foster