Rapid mass Covid testing comes with caveats that cannot be ignored

No solution is perfect, but the government has the means to improve and strengthen the UK’s new testing programme, writes Samuel Lovett

A pedestrian wearing a face covering walks past a sign directing people to a rapid lateral flow Covid-19 testing centre at London Bridge train station (AFP via Getty Images)

The government’s latest universal testing programme, confirmed by Boris Johnson on Monday night, shares similar scales of ambition to Operation Moonshot – which sought to carry out 10 million Covid tests a day by early 2021, at a cost of £100bn.

However, unlike its predecessor, this latest initiative is set for take off. Under new plans outlined by Downing Street, everyone in England will now be able to take a free rapid test twice a week, regardless of whether or not they have symptoms. 

There are no eligibility restrictions to the programme. Anyone can request a test, enabling them to check from the comfort of their home whether they are carrying the infection. All schools, workplaces and other community settings will offer these services on a weekly basis.

The initiative has been lauded by some experts as a “powerful tool” in helping to detect asymptomatic cases, which account for one-third of infections, and the government insists it will “stop outbreaks in their tracks” as the vaccine rollout continues.

Others have warned that the failure to offer sufficient financial support means people with insecure jobs and wages will be discouraged from requesting the tests out of fear of returning a positive result, thereby rendering the programme irrelevant to certain portions of society. 

Read more:

• Everyone in England to be offered two rapid Covid tests a week in bid to stop new outbreaks
• Boris Johnson gives green light for shops and pubs to open from Monday
• North at risk of ‘being left behind’ again as Covid cases rise and experts warn of new variant threat

Concern has also been raised over the accuracy of the tests, known as Lateral Flow Devices (LFD), which deliver a far higher proportion of false negatives than the superior PCR testing.

One of the main shortfalls of the government’s approach is the failure to provide more financial support to those struggling to self-isolate. Currently, people on low incomes who test positive are entitled to £500 per week – less than the minimum wage – yet very few are deemed eligible for this scheme.

Those who cannot afford to spend two weeks at home are either continuing to work when infected or simply avoiding getting tested. It’s unsurprising, then, that nearly half of people in the UK are still failing to self-isolate when displaying symptoms of Covid-19, according to research.

Susan Michie, a behavioural psychologist who advises the government, told The Independent that  unless rapid testing is followed by adequate financial and practical support for self-isolation, then the programme is “likely to be a waste of resources and even make matters worse”.

Fears around the accuracy of the LFDs also cannot be ignored. Following a trial of mass rapid testing in Liverpool last year, academics claimed the devices missed 60 per cent of positive cases and as many as 30 per cent of those with high viral loads. 

Others have said there is not enough evidence or data to pin a nationwide screening programme on the LFDs, while a recent review conducted by a group of international experts said the test’s brand played a key role in determining accuracy. The UK has spent close to £1bn on devices manufactured by the US firm Innova, which appear to pick up 58 per cent of positive cases.

Underpinning this is the fear that the LFDs could be misinterpreted by the public. “If they are used as a confirmatory test then they could be counterproductive as people may be less careful with their behaviour than if they had not taken the test at all,” said Prof Michie. Because of this, she added, the tests should not be incorporated into any certification process adopted for the UK.

There are positives to the new testing programme. Irene Petersen, professor of epidemiology at University College London, called the scheme a “powerful tool” that will help to “keep the epidemic under control”.

“There’s no intervention that’s going to be perfect,” said Prof Petersen, but mass testing still offers a means for “many of us to do our little bit to reduce transmission”. 

They will also be of particular benefit in those environments where people are at greater risk of catching coronavirus, such as in food factories and other closely contained work settings.

Time is naturally short during a pandemic, with authorities forced to adopt policies that would otherwise require years of deliberation and inspection. But while there are clear strengths and shortcomings to mass testing, it’s not obvious the wider public knows this – the government has a responsibility to communicate this message and ensure it strengthens the system.