• The first 34 trusts should receive kit for asymptomatic testing by the end of this week, “benefitting 250,000 staff”
  • England-wide rollout should follow by the end of next week
  • Asymptomatic testing will use less sensitive or specific lateral flow testing
  • More accurate LAMP test to be rolled out by NHS Test and Trace in November and December

The NHS will rollout twice-weekly asymptomatic testing for all patient-facing staff by the end of next week, according to a letter from NHS medical director Stephen Powis.

Government said only last week that universal asymptomatic staff testing would start in December, but government has now agreed it will bring this forward to this week for a first tranche of 34 trusts; and all others next week.

HSJ  has asked if primary care is covered.

The tests at 34 trusts this week will cover “over 250,000 staff,” Professor Powis said. He set out plans for the new testing regime in a letter to Commons health and social care committee chair Jeremy Hunt who has been pressing the government for routine staff testing since the summer.

“Staff will be asked to test themselves at home twice a week with results available before coming into work,” Professor Powis said. The new testing regime can start following “further scientific validation of the lateral flow testing modality last week, and confirmation over the weekend from Test and Trace that they can now supply the NHS with sufficient test kits”.

As of last week, the government and NHS England’s plan was to use a different method — Loop-Mediated Isothermal Amplification or LAMP saliva tests — for staff routine testing; but this will not be on stream until December. The lateral flow tests will be used, in staff’s homes, in the meantime. Lateral flow tests are less accurate than the PCR swab tests, having lower specificity and lower sensitivity.

A test’s specificity relates to the proportion of samples it can correctly identify as negative for the coronavirus. Its sensitivity relates to the proportion of samples it can correctly identify as positive for the virus.

Professor Powis said: “Testing twice weekly helps mitigate the sensitivity considerations, and to mitigate the lower specificity, all positive results will be retested via PCR.”

The LAMP saliva test will be made available to sufficient trusts by Test and Trace in November and December, the letter added.

This move by the centre “builds on the extensive asymptomatic staff testing already occurring in parts of the country with outbreaks – over 70,000 NHS staff have been tested asymptomatically in those areas in recent days,” Professor Powis added. 

The letter came in response to one from Mr Hunt on 5 November in which he urged Professor Powis and Chris Whitty, England’s chief medical officer, who is responsible for deciding testing priorities, “to bring forward these plans and start weekly testing of all staff – or as a minimum all staff who have contact with patients – utilising PCR testing capacity until the LAMP test are ready for full deployment as necessary”.

He said he was “profoundly disappointed that you are only planning to roll this testing out to staff at some point in December given the urgency of the situation we now face”.

Failing to test asymptomatic patients in the first wave led to a significant proportion of cases that were transmitted in hospital, Mr Hunt said. These nosocomial infections were “a leading driver of overall infection rates”.

“I am gravely concerned that we may be about to make the same mistake regarding nosocomial infections and let the virus spread through our healthcare system,” he said.

The Labour party has also been pressing for regular staff testing. 

The proportion of total new patients with covid in hospital, who are likely to have caught it in hospital, has risen to 15-20 per cent in recent weeks; after falling substantially over the summer as overall cases and hospitalisations fell.

Corrected at 8.50am on 10 November to remove the reference to hospital staff, as NHS England has so far specified all patient-facing NHS staff.

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