15 September 2020

COVID-19: SOLVING THE TESTING ISSUES

Today (15 September) the Health Secretary Matt Hancock faced questions in the Commons about the problems with availability of COVID-19 swab tests to see if someone has 'Got it'.

Children are being sent home from school and not allowed back until they have been tested and proven negative.  That's parents off work to look after them.  People in general are struggling to get tests, all over the country, with tests eventually available tens of miles away from home.

Then the tests themselves are prone to 'false negatives' of around 30%, so people with negative results are being told to self-isolate in any case. As I found when I was tested a couple of weeks ago.

People are saying that the 'Test and Trace' system has got to be fixed.  Some say it should have been working before schools went back this month.  "More tests" is the shout.

Hancock is having to say that there is unprecedented demand, now infection rates are rising, and that healthcare and care home settings will need to be (rightly) prioritised.


WHAT'S THE PROBLEM?

Hancock has said that people who are not eligible, who do not have symptoms, are asking for tests. This might be a contributory factor.

But the main problem is the sheer complexity and cost of the RT-PCR tests currently being used.

A kit of parts has to be used by each person being tested, including a swab, a test tube for the sample, and various other pieces.  If any one of these parts is unavailable, the kit is incomplete and unusable.

When the sample gets to the testing laboratory, the complex RT-PCR process requires equipment, reagents and staff.  If any one of these elements are missing, the samples cannot be processed.

It appears that the lack of lab capacity is the key problem.  Presumably when people are finding tests available a long distance away, it is because that location is being served by a different lab.

The cost of RT-PCR is also horrendous.  I dread to think of the CapEx and OpEx costs of the new lab near Loughborough that will be able to process 50,000 tests a day.  This is due to come on stream in a couple of weeks

As I said two months ago, "There’s no point just asking for more tests, the testing strategy must be more focused."

"That’s using RT-PCR more selectively, and preferably with better types of tests. Any alternative ‘Got it’ tests must be;

  • Simpler
  • Quicker
  • Cheaper
  • Preferably more reliable, by not being based on swabbing
  • Yet clearly identify all variants of SARS-COV-2 without counting other coronaviruses"

OPERATION MOONSHOT

The objectives of "Operation Moonshot", that PM Johnson announced last week, are fundamentally those.  (Who in Government is reading my blogs?) 

The LamPORE test equipment
The trials in Hampshire and Salford will be using different "LamPORE" technology that has already passed small-scale trials.

This uses saliva samples rather than swabbing, and processes samples using the LamPORE technology from Oxford Nanapore.  Test results in 90 minutes.

This is only a stepping stone, as the objective is to have tests giving results in 20 minutes or less.  This is especially important in testing people on arrival in airports, seaports and Chunnel trains.


WHAT DO WE DO IN THE MEANTIME?

As the Loughborough lab facility shows, you can't just wave a wand and new lab capacity magically appears.

If the LamPORE trials work, that would potentially provide some relief with extra capacity.  But this will take time to prove and then scale up.  I'm highly sceptical about saliva samples, though I understand LamPORE can revert to swabs.

The only way to live with reasonable RT-PCR capacity is to have a low infection rate.  It was obvious that schools would likely increase the community infection rates, not so much the children but due to the adults mingling.  Staff in the staff room, and parents of younger chidren at the school gate.

Likewise university students returning.  There is already a problem at Oxford Brookes Uni, and term only started yesterday.

It was therefore necessary to get down to very low infection rates over the summer, by whatever means necessary.  What I call #NearZero..

The "Eat Out to Help Out" scheme no doubt had the opposite effect, not only to bring people together in eateries early in the week, but give the green light to doing so later in the week when the subsidy wasn't available. The opposite of social distancing.


WHAT TO DO NOW?

The answer to the question "How do we get enough tests?" is to get infection rates down to very low levels.  It's the answer to a whole host of other questions too.

To take just a few:

"How do we keep schools open without sending children home?" A very low infection rate

"How do you let university students back without infections rates rising rapidly?" A very low infection rate.  

"How can you use public transport safely?" A very low infection rate.

"How can I ensure there is a very low risk of meeting some out and about infectious, who doesn't know it?" A very low infection rate.

"How can people who have been shielding get out and about safely?" A very low infection rate.

"How can employers open places of work whilst looking after their staff, where their staff can feel safe?"  A very low infection rate.

And as a result "How can we grow our economy quickly?" A very low infection rate.


The "Rule of Six" will have some impact in reducing the climbing infection rates.  But I doubt it is enough to reverse them across the country.  A second lockdown is probably the only answer.  The first lockdown got infection rates down to a sixth of the peak level in only three weeks.


An investment of three weeks in a proper second lockdown would be worth it.  The Government shirked the option over the summer, when it would have been easiest.  And PM Johnson made it clear at the recent press briefing he is still trying to avoid it.  But sometimes you just have to bite the bullet.  Now infection rates are higher, and once we're over this unusually warm weather, people will be more indoors, where infection of others is more likely. 

Any delay risks an even bigger second wave.

Indeed if we want enough tests, schools open, businesses open, and the economy thriving, we need #NearZero.  And get there fast.



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