Categories
Testing

UK “Rapid Turnaround” Covid-19 Tests

Here’s another extract from Boris Johnson’s Covid-19 “lockdown 2” briefing on October 31st:

I am optimistic that this will feel very different and better by the spring

It is not just that we have ever better medicine and therapies, and the realistic hope of a vaccine in the first quarter of next year

We now have the immediate prospect of using many millions of cheap, reliable and above all rapid turnaround tests

Tests that you can use yourself to tell whether or not you are infectious and get the result within ten to 15 minutes

And we know from trial across the country in schools and hospitals that we can use these tests not just to locate infectious people but to drive down the disease

And so over the next few days and weeks, we plan a steady but massive expansion in the deployment of these quick turnaround tests

Applying them in an ever-growing number of situations

From helping women to have their partners with them in labour wards when they’re giving birth to testing whole towns and even whole cities

The army has been brought in to work on the logistics and the programme will begin in a matter of days

Working with local communities, local government, public health directors and organisations of all kinds to help people discover whether or not they are infectious, and then immediately to get them to self-isolate and to stop the spread

The precise nature of all these “cheap, reliable and above all rapid turnaround tests” is rather vague though. Presumably Boris has his “Operation Moonshot” in mind?

Shortly after the initial Moonshot revelations in September the BMJ had this to say:

The documents talk about “buying large scale capabilities” from partners such as the drug company GSK to “build a large scale testing organisation.” However, under “potential partners for increasing laboratory capacity” the documents list only the company AstraZeneca. Under logistics and warehousing, the documents list potential partners as Boots, Sainsbury’s, DHL, Kuehne+Nagel, G4S, and Serco. Under workforce are listed universities, the Society of Microbiologists, and the British Society of Immunology.

Alongside mainly commercial partnerships, the documents also state that a number of new tests and technologies would need to be used, including some that do not yet exist.

“Delivering testing at the scale and level of ambition set by the prime minister is likely to mean developing, validating, procuring, and operationalising testing technology that currently does not exist,” the plans state. Lower sensitivity testing for “screening/enabling purposes” could also be used, with polymerase chain reaction (PCR) testing then used to “confirm positive results or in situations where accuracy is needed for highest risk individuals.”

Testing technology listed in the documents includes qrt-PCR, Endpoint PCR, LAMP, LamPORE, lateral flow antigen test, and whole genome sequencing. Two of these tests—lateral flow antigen tests and LAMP—are listed as having a “lower sensitivity” of between 80% and 100%.

I cannot help but wonder how development of those “tests that do not yet exist” is coming along? According to the Financial Times today:

As England prepares to enter its second national lockdown on Thursday, the government’s Operation Moonshot plan to deliver a mass population testing programme is back under the spotlight. According to documents reviewed by the Financial Times, the Department of Health has awarded contracts worth at least £1bn to companies providing rapid testing. Many of the technologies relating to these contracts will feed into the Liverpool trial, in which everyone living or working in the city will be eligible for a test from Friday. The strategy will hinge on new lateral flow tests, which give results in 20 minutes and can be performed on a throat or a saliva sample, as well as conventional swab tests and loop-mediated isothermal amplification (LAMP) technology.

The pilot is expected to last about two weeks, with tests being deployed by the army, and could allow teachers, pupils and hospital staff to be tested weekly. But scientists have raised concerns over the accuracy of some of the lateral flow tests being used, which are prone to missing cases of active infection. Meanwhile, delays in assessing technologies produced in the UK have led to frustration over government contracts being awarded to overseas companies.

The government has signed at least 10 contracts with companies based in the UK, US and China, totalling more than £1bn, for rapid testing technology and logistics, according to publicly available contracts on the EU public procurement site, Ted, and information shared with the non-profit legal firm the Good Law Project.

Categories
News

Why are so many English workers dying from Covid-19?

This surprising news from John Burn-Murdoch of the Financial Times greeted me on my Twitter feed this morning:

The article by Janine Aron and John Muellbauer that John linked to points out that:

Excess mortality is a count of deaths from all causes relative to what would normally have been expected. In a pandemic, deaths rise sharply, but causes are often inaccurately recorded. The death count attributed to Covid-19 may thus be significantly undercounted. Excess mortality data overcome two problems in reporting Covid-19-related deaths: miscounting from misdiagnosis or under-reporting of Covid-19-related deaths is avoided. Excess mortality data include ‘collateral damage’ from other health conditions, left untreated if the health system is overwhelmed by Covid-19 cases.

To obtain cross-European comparisons requires data collation from individual national agencies – unless the Z-scores compiled by EuroMOMO for 24 states are used. EuroMOMO’s timely measures of weekly excess mortality in Europe allow comparisons of the mortality patterns between different time periods and countries, and by age groups.

Analysing excess mortality using EuroMOMO Z-scores rather than just deaths attributed to Covid-19 Aron and Muellbauer discovered that:

Most disturbing is the comparative story for the 15-64 age group, where England’s relative record in excess mortality in the Covid-19 era is strikingly higher than in the European countries. The 15-64 age group includes the mass of the working age population. At its peak in week 15, it is 2.8 times worse than the weekly peak in next worst country, Spain, around 4 times worse than France and Belgium, and more than 5 times worse than in Italy. Within the UK, excess deaths for this age group are also strikingly worse for England than for the other nations. Puzzling too, is that Z-scores in the 65-74 age group for England, see Table 2, are similar to the 15-64 age group. By contrast, in the five European countries, excess deaths in the 65-74 age group are about twice as high as for the 15-64 age group, though still below the 65+ age group.

England is the only country in Europe, for which Z-scores for the 15-64 group had not decreased below about 2 by week 18, ending 3 May.

What is the reason for this strange English anomaly? Watch this space!