Boris Johnson’s drive to use mass so-called moonshot testing to control the spread of Covid-19 will fail unless stringent quarantine rules are relaxed, senior government advisers have warned.
Oliver Wright, Chris Smyth www.thetimes.co.uk
Ministers have been told that plans to use millions of 15-minute tests to screen large parts of the population for asymptomatic Covid-19 risks being undermined by the existing test and trace system.
In particular they have been told that the “ridiculous” policy requiring the contacts of people known to have infections to self-isolate for two weeks or face a £10,000 fine risks undermining public acceptance of the mass testing initiative.
Instead ministers should use the new capacity to relax the quarantine rules and allow those who have come into contact with a known Covid-19 case to carry on with their daily life while being tested every two days.
“It’s a massive problem,” one senior figure advising the government, said. “The threat of self-isolation has killed the test and trace programme. People just say screw you — I’m not doing it. Compliance is really low.”
They added: “With the new tests they need to say we’ll still do contact tracing but we will ask people to pop in every two days and get another test, and provided they remain negative, then they can go about their business rather than being confined. You test them on day two, day four, day six and then they’re in the clear.
“I really don’t understand why they aren’t changing course.”
Robert West, professor of health psychology at University College London and a member of the government’s SPI-B behavioural advisory group, said that using rapid tests to free contacts from the need to isolate would be “very useful”.
He said: “It is potentially a massive step forward if people could get a test quickly and be confident of getting the result the same day. It would just give everyone so much more confidence that you’re not going to put someone in a really difficult position by naming them as a contact.”
He said that poor compliance on self-isolation was “primarily a matter of financial and practical support”.
“If you look at the demography of people who haven’t isolated they are struggling financially, in insecure jobs and have caring responsibilities. That is really pretty crucial.”
He said fixing test and trace was crucial to avoiding restrictions. “We have to find a way to identify and quarantine people who are infectious and support them to isolate. If we can do that we don’t need mass lockdowns.”
Sir John Bell, regius professor of medicine at Oxford University, said the new mass testing initiative that will begin trials in Liverpool this week must reduce the number of people needing to self-isolate.
“These need to be seen as tests that promote enablement rather than restrictions,” Sir John told the Today programme on Radio 4. “Although people with a positive test will still need to confine themselves for a period of time.
“What we hope ultimately you’ll be able to do is to avoid the quarantine of contacts that has caused so much trouble.
“People get pretty irritated when they get told they passed someone in the shops and they now need to quarantine for ten or 14 days. With these tests it should be possible to test these people every two days and they can go about their business provided they remain negative.”
Flavio Toxvaerd, a lecturer in the economics of infectious diseases at the University of Cambridge, said: “The incentives to get tested are complicated and may vary from person to person. A civic-minded individual who is asymptomatic but tests positive for Covid-19 may choose to self-isolate. This would be a desirable outcome. But others may take a positive test result as a cue to be less cautious, as they are no longer at risk of infection. They thereby put others at risk and in such cases, testing may backfire.
“For some, not knowing their infection status may be preferable to testing positive as a positive test may bring forced self-isolation and loss of income. Unless the government puts in place the right incentives, plausible deniability may look attractive to some who suspect they are infected but who stand to lose a lot from self-isolation. So a sensible testing policy must go hand in hand with proper support and incentives for those who test positive.”
Ministers have been burnt by over-hyped pledges on testing in the past. But this time there is a belief — among politicians and their scientific advisers — that the UK is on the verge of a game-changing increase in capacity that could allow the country to live with Covid-19 without the need for lockdowns (Oliver Wright and Chris Smyth write).
Sir Patrick Vallance, the chief scientific adviser, said that increased testing may come ahead of a vaccine in advances that could help normal life to resume.
The cause for optimism is the validation of four types of new tests that do not require lab processing and can be done at home with results returned in as little as 15 minutes.
While Liverpool will be used in the first instance to test how best to run such a mass screening programme, it is likely to be rolled out nationally at the end of the upcoming lockdown period.
One senior figure involved in the programme said there should be enough of the new devices to potentially test the whole of the UK before Christmas and that this was something ministers were “definitely” thinking about.
But even with the new tests, deploying them at such a scale will be a tall order with a population of about 66 million.
One negative test does not mean you will not become infected, so it is not necessarily a passport for a normal Christmas. People also have to agree to be tested in the first place, and many may be reluctant to risk the prospect of a positive test.
In Liverpool the plan is to offer a test every week. There will also be targeted interventions such as in schools, colleges and healthcare settings. There could also be door-to-door testing in areas with high rates. The idea is to see what is effective, what uptake looks like, and the effect in reducing transmission.
Testing everyone in a one-off programme is not a strategy. But it could be a reset moment on the path towards a more targeted programme of regular testing and allow the end of social distancing.
Ministers are determined that it does not become another eye-catching target that they miss while distracting from the need to find a coherent screening plan.
Jeremy Hunt, the chairman of the health select committee, warned that hospitals could experience similar levels of transmission as during the first coronavirus wave without a rigorous testing regime for health workers.
Calling for more routine testing of NHS staff, he told the Today programme: “My biggest worry, frankly, is that we still have not introduced weekly testing of NHS staff.
“We know that up to 11 per cent of coronavirus patients in hospital died last time, having caught the virus in a hospital, and I think it would be quite unforgivable if we made the same mistake twice and didn’t take that terrible weight off the minds of NHS staff of worrying that they might be giving the infection to their own patients.”
Four types of test
The original test that is used in NHS laboratories and Test and Trace “lighthouse labs”. It involves amplifying a small sample of the coronavirus’s genetic material through repeated heating and cooling to stimulate key reactions.
The test is extremely reliable but takes several hours to process in a specialist lab. This means that it is hard to turn around tests in under 24 hours. There have been concerns that because it is so sensitive it picks up cases where people have fractions of the virus’s genetic material, or RNA, in them but are not actually infectious.
This technique allows test machines to pick up genetic material without the need for the series of temperature changes. This means results come back much quicker — sometimes in 20 minutes.
The equipment needed is much smaller than for PCR tests — about the size of a laptop computer — which means they can be used for localised community checks rather than having to send samples away. The government intends to use these tests for screening in places such as hospitals to ensure that asymptomatic patients and staff do not spread the disease.
These tests use the same RT-Lamp technology but with a sample of saliva rather than a full throat and nasal swab. The advantage of this is that it is much easier to administer and makes it potentially more reliable. Most of the problems with PCR tests have been connected to samples rather than a failure of the testing itself. These tests are also likely to be used in community settings.
This is pregnancy test-style technology that requires only a sample to be run along the surface of an absorbent pad. Such tests are cheap and can be mass-produced.
They are quicker than other tests — giving results in 15 minutes — and do not require specialist equipment or technicians to administer. This means they can be scaled up very rapidly. They are less accurate than other tests; however, because they detect coronavirus protein rather than RNA, they are better at identifying those most likely to be infectious.