Not before time the covid testing programme finds proper purpose

The UK started off from a poor position. It, like many western countries, had not learned the lessons of SARS and lacked an appropriate pandemic contingency plan. The UK, unlike most of its counterparts, also had a poorly funded and fragmented public health function. It also had – when compared to Germany, for example – a weak public and private diagnostics sector. The failure to deliver on the aims of the Carter reforms have cost the country dear.

Against this background, the rapid scaling of testing capacity is a testament to the hard – and largely unrecognised — work of civil and public servants, particularly those in the Office of Life Sciences. Insiders readily admit in hindsight that the “100,000 tests” target was “ridiculous” but say that without a goal of some sort it would have been hard to create the environment in which both NHS and other actors “achieved more than they thought was possible”.

But creating a system larger than Marks and Spencer’s delivery network with a myriad of players, including the army, in a few weeks on top of such ill-prepared infrastructure has inevitably produced a clunky programme. It still, for example, lacks effective data management and it is often hard to determine who is responsible for what.

It also took too long for the penny to drop with government that the programme needed a specific purpose beyond simply testing as many people as possible.

The establishment of NHS Test and Trace creates the opportunity to accurately determine to a clear purpose – for example, to break the chain of infection – and deliver on it.

One of the silver linings of the pandemic is that the UK will now join many Asian countries in having a dedicated agency or department responsible for combating pandemic threats – which are only likely to increase in coming years. The forthcoming NHS Test and Trace strategy and business plan will set out the scale of the operation’s ambitions. Do not be surprised, for example, if the suggestion is made that the Lighthouse Labs network should become a long-term part of the NHS’ pathology capacity.

Critics have focused on the testing programme’s ability to contact those who have become infected and then track down anyone they have come into contact with. This depends on individuals requesting a test when they develop symptoms – and on those people being able to get to a testing centre.

Those close to the programme believe this workstream is developing satisfactorily, given that testing has only been available to most for a few weeks.

It helps that the vast majority of outbreaks are in health and social care settings and stem from interactions in similar environments – notably canteens and smoking sheds. In short, NHS T&T know where to look for outbreaks.

Test and Trace insiders are less relaxed about “back” or “business” tracing. This is the process of working out how the person who contacts NHS T&T became infected in the first place and whether others may have also been infected in the similar way. This will become increasingly important as the lockdown is eased.

This involves much more forensic work on behalf of the NHS T&T – with tracers having to work methodically through the movements of an individual over a two-week period. It also requires businesses and other operations to keep an accurate log of who has visited their premises.

In Germany people are asked to sign visitors books; in New Zealand there is a voluntary smartphone route of recording where you have been – and in South Korea, a compulsory one.

The government has already signalled that it will require the former – and the development of a voluntary digital option can be expected soon.

Another concern is using spare testing capacity in the most effective way. There are growing calls for all health and social care staff to be tested on a regular basis. There is some logic to this, as it is already known that asymptomatic staff are behind many outbreaks.

However, as prevalence falls, the relative impact of false negative and false positive tests increases. As a positive test could lead to entire departments having to self-isolate – as happened in Morecambe Bay – false positives could be disastrous. False negatives, for the obvious reason, could also cause chaos.

Better, say those close to NHS T&T, to take a much more targeted approach and focus efforts where other indicators – such as a cluster of absences – suggest an outbreak.

Better too to have whatever spare capacity there remains within the NHS used to quickly test the residents of care homes where an outbreak is suspected.