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
Testing

Covid-19 testing in the UK

On April 2nd 2020 (not the first!) the UK Government’s web site published a press release stating that:

The UK will carry out 100,000 tests for coronavirus every day by the end of this month, Health Secretary Matt Hancock pledged today.

Increased testing for the NHS will form part of a new 5-pillar plan, bringing together government, industry, academia, the NHS and many others, to dramatically increase the number of tests being carried out each day.

Professor John Newton the Director of Health Improvement for Public Health England, has been appointed to help deliver the new plans and bring together industry, universities, NHS and government behind the ambitious testing targets.

So how is Matt’s pledge and John’s delivery plan looking at the end of April? According to the Department of Health and Social Care‘s latest daily update:

As of 9am 30 April, there have been 901,905 tests, with 81,611 tests on 29 April.

Not quite there yet then, though there is still one more April update to come! Much more recently another Government press release on April 28th announced that:

Anyone in England with symptoms of coronavirus who has to leave home to go to work, and all symptomatic members of the public aged 65 and over, will now be able to get tested, the government has announced today.

This will mean people who cannot work from home and those aged 65 and over can know for sure whether they have coronavirus and need to continue isolating.

Members of their households with symptoms – a new continuous cough or high temperature – will also be eligible for testing.

Anyone eligible can book a test using an online portal.

The government also announced that NHS staff, care home staff and care home residents will be eligible for testing whether or not they have symptoms.

How’s that coming along do you suppose? I’m over 65 and I’d very much like to know for sure whether I have had coronavirus. I even have some of the symptoms! However there is evidently a problem. The Government’s online testing portal told a familiar tale yesterday evening:

Today I discovered via Twitter that somebody else managed to get further through the process than I did, only to discover:

I myself am also forced to wonder why on Earth a United States credit checking agency such as TransUnion should be involved in the process of obtaining a long overdue test for a UK citizen suffering from the symptoms of Covid-19?

Answers on a virtual postcard in the space provided for that purpose below! Should I receive an answer to that question I’ll pose another one:

What does the UK Government make of this proposal in the British Medical Journal for “Mass periodic testing” of the citizens of this sceptred isle?

At the end of (say) 3 weeks of lock-down all households and care homes would return self-taken swabs taken on that date from all residents. All residents would test negative in most homes, so most people could resume normal life within a month of starting the lock-down.

Meanwhile on the NHS front line:

[Edit – May 1st]

Here is the BBC’s video of this evening’s Covid-19 daily briefing from Downing Street, hosted by Matt Hancock:

Fast forward to 36:40 where Channel 4’s Victoria Macdonald asks:.

There was a report in the HSJ that a sample would only be counted once it had been processed, but that testing has been changed and it’s counted once it’s been posted out. Is that the case?

Matt swiftly passed that buck to Professor John Newton, and it’s not until 38:40 that Victoria receives an answer:

There’s been no change to the way that tests are counted. As we’ve developed new ways of delivering tests we’ve taken advice from officials as to how this should be counted.

So, the tests that are within the control of the programme, which is the great majority, are counted when the tests are undertaken in our laboratories. But any test which goes outside the control of the programme, they’re counted when they leave the programme, so that is the tests that are mailed out to people at home and the tests which go out in the satellite. So that is the way they are counted, have always been counted, and the way we were advised to count them by officials.

So that’s the way they are counted, have always been counted, and the way we were advised to count them by officials.

According to Matt Hancock:

That’s all set out on gov.uk

Whilst according to the BBC:

The total testing figure includes 27,497 kits which were delivered to people’s homes and also 12,872 tests that were sent out to centres such as hospitals and NHS sites. However, these may not have been actually used or sent back to a lab.

According to my hasty mental arithmetic:

122,347 – 27,497 – 12,872 = 81,978

Those mysterious “official” bean counters have a lot to answer for!

[Edit – May 8th]

The UK Government’s Covid-19 “contact tracing” smartphone app created by NHSX is now available to residents of the Isle of Wight as part of an initial trial. Here’s an initial review of the app:

Isi’s Dad’s thoughts? Here’s a brief summary:

The app is named NHS COVID-19, and is described by the NHS as “an automated system for rapid symptom reporting, ordering of swab tests, and sending targeted alerts to app users”. It’s one of three parts of the trial which has just started here, the other two being:

  • “web-based Contact Tracing and Advisory Service (CTAS) and increased capacity to provide tailored alerts to all contacts by phone.”
  • “widespread availability of rapid swab testing kits to make sure confirmed cases remain in isolation, and support rapid detection and isolation of higher-risk contacts.”

This is quite different from what has been generally reported: the NHS sees the app primarily for rapid symptom reporting and the ordering of swab test kits.

Installing and configuring the app is simple, provided that you have an iPhone running iOS 11 or later, or a compatible Android phone, about which I will say no more…

Early indications here are that this app protects the user’s privacy, doesn’t track users at all, doesn’t flatten batteries, and is unobtrusive to the point where you can’t even tell whether it is detecting contacts. It doesn’t appear to be the contact tracing app which was expected, though: it’s not ‘track and trace’ so much as ‘diagnose and test’, and may explain where Boris Johnson intends sending his promised 200,000 test kits a day.