The UK has a comparatively high test capacity but is failing to use it efficiently in tackling Covid-19, researchers say, raising concerns including a lack of follow-up and adequate financial support of those isolating.
Now researchers have compared it with systems in five other countries – Germany, Ireland, South Africa, Spain and South Korea – finding that while the UK has the highest proven test capacity, its system has serious flaws.
“It is no use having, as we have, a very high relative number of tests if that doesn’t lead to people being isolated and supported so that we break chains of infection,” said Prof Michael Hopkins of the University of Sussex business school, a co-author of the work.
The study, which has yet to be peer-reviewed, compared the test and trace systems of the six countries with the five principles of an optimal programme, as set out by the UK’s Independent Sage committee, such as the need for quick and accessible testing and isolation of infectious individuals. The team also looked at recommendations from the World Health Organization.
While a lack of data meant the performance of the systems could not be compared, the team was able to look at the gaps in the approaches. The results, based on programmes up to the end of August, showed all the countries’ systems had problems, for example the South Korean approach raised privacy concerns, while Spain lacked contact tracers.
Despite the UK having the highest proven testing capacity of the six countries, the team found flaws in its test and trace system, including access to tests and individuals taking their own swabs. The researchers said people wanting a test should be triaged by GPs and, if a test were required, it should be carried out by a healthcare professional to avoid poor sample collection.
“Any other scarce resource in the NHS, you have primary care as gatekeepers,” said Hopkins.
The team also expressed worries about where the tests were processed. “Notably in the UK, the commissioning of new, private, large-scale testing in the Lighthouse laboratories has bypassed accreditation and raises quality concerns,” the researchers said.
What the UK government said on Covid testing
1 September 2020
“Not only are we getting the pandemic under control, with deaths down and hospital admissions way, way down, but we will continue to tackle it, with local lockdowns and with our superlative test-and-trace system.”
9 September 2020
“NHS Test and Trace is doing a heroic job, and today most people get an in-person test result within 24 hours, and the median journey is under 10 miles if someone has to take a journey to get one … [To Keir Starmer] We make the tough calls – all he does is sit on the sidelines and carp.”
9 September 2020
[On the ‘moonshot’ proposal for mass, near-instant testing:] “We are hopeful this approach will be widespread by the spring and, if everything comes together, it may be possible even for challenging sectors like theatres to have life much closer to normal before Christmas.”
16 September 2020
“We don’t have enough testing capacity now because, in an ideal world, I would like to test absolutely everybody that wants a test immediately … Yes, there’s a long way to go, and we will work night and day to ensure that we get there.”
17 September 2020
“Of course there is a challenge in testing … We have sent tests to all schools to make sure that they have tests available. But of course I also recognise the challenges in getting hold of tests … Tests are available, even though it is a challenge to get hold of them.”
They flagged concerns over the low effectiveness of the UK’s contact-tracing system, saying it lacked measures for those self-isolating, with not enough checks on adherence and their health and wellbeing. What is more, while full guidance about self-isolation was available, it was only online and not in all required languages. The team added that the financial support available to those isolating might not be enough. “You mustn’t have a choice between paying the bills and going to work and infecting people,” said Hopkins.
Prof Chris Bonell, of the London School of Hygiene and Tropical Medicine, said there was an urgent need to improve the reach of testing provision and tracing in the UK. “We also need to provide much more generous financial support to those being asked to isolate. This will encourage those testing positive to report all their contacts. It will also enable those asked to isolate to do so,” he said. “Unless we make these changes we are clearly heading for major trouble.”
However, he had reservations about the proposal that GPs should triage people, saying test access needed to be as quick and easy as possible. “Given the current undercapacity, there needs to be some prioritisation,” he said. “However, expecting GPs to manage this alongside their other works seems a poor way to manage this.”