Reflections on Covid testing during the Covid pandemic (1)

Reflections on Covid testing during the Covid pandemic (1)

These posts reflect the personal view of Adrian Walsh

Now that the official Covid 19 Inquiry has been launched by the UK government it seems appropriate to revisit how things developed from the perspective of the UK diagnostics industry.

Initially, it became clear that as a country we were not prepared and couldn’t cope with the demand for mass PCR testing. PCR was too slow and expensive and we had insufficient resources to manage the number of tests required on a daily basis. We had to endure the daily “theatre of numbers” as it became known as the TV bulletins gave us the latest figures of tests delivered and goals not reached. However, many scientists responded to the call to arms and pivoted towards helping with testing or developing new methods and techniques in diagnostics.

It became clear that rapid testing was required for mass screening of the public to keep ahead of the virus. Lateral flow assays had been around for years, mainly used as testing for pregnancy, malaria, and AIDS. Unfortunately, the UK diagnostic industry didn’t have the capacity to develop specific COVID antigen tests on the scale required in the timescale needed. Although many UK companies took on this task, some with government funding, a solution was needed immediately. Fortunately, many companies in Asia had such capacity to produce such kits and the government procured huge amounts of kits from China.

So it was in September 2020 that Prime Minister Johnson launched his “Moonshot” project live on TV announcing there would be mass testing for the public with newly purchased lateral flow assays costing 100 billion pounds. At the time there was much scepticism about the proposition including the BMJ quoting scientists who thought it was put together by business consultants rather than scientists and more like a “business plan” than a pandemic solution. In a previous blog at the time, I wrote the science behind it was doable but the logistics and infrastructure required to fulfill the amount of testing were not there. These tests were initially developed to be used and analysed by trained staff.  In the end, the only realistic solution was self-administered tests. 

 Trials were conducted in Liverpool to see how effective these tests would be. Views on how they performed were mixed. The sensitivity of these assays was lower than the PCR tests but was much cheaper (£2 per test for the government but free to the user). Tests were self-administered and results were obtained in 15 minutes.  Despite lower sensitivity, they were essential and excellent screening devices to monitor and control the spread of the virus until vaccines became available in 2021. Routine testing every 2 or 3 days was required, especially if one had been in contact with an infected person.

Most people are now familiar with and comfortable with lateral flow testing and I think this is a positive to come out of the pandemic.  It opens up the possibility of wider use of self-testing for a variety of conditions that will reduce the load on front-line services in clinics and hospitals. We just need the government to invest in the diagnostics industry to develop an infrastructure to cope with future pandemics. Let’s hope the current Covid Inquiry exposes how we were not prepared and stimulates the need for future investment in infrastructure.

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