Liverpool mass coronavirus testing pilot: the possibilities and pitfalls ahead

Everything you need to know about programme advocates hope will offer road map back to normality - but which, on day one, is already under fire

Hundreds of people in Liverpool have been tested for coronavirus as part of a new city-wide pilot scheme, a trial being heralded as a potential game-changer.  

Six new test centres have been built in the city and residents will be offered a regular Covid-19 test, regardless if they have symptoms or not.  

The centres opened midday yesterday and will be open for at least two weeks. Nearly an hour before they were open, queues began forming outside as people waited to receive a test.  

Hundreds of soldiers have also been arriving in Liverpool to help with the launch.  

But as the troops, health officials and city leaders prepare to roll out the ambitious pilot, growing concerns continue to emerge about the accuracy of the tests themselves.

Here’s everything you need to know about the programme – and its potential pitfalls…

What’s the point of mass testing?

Advocates – and that’s pretty much the entire scientific community – say mass testing is the currently the best way to control Covid-19 and, without a vaccine, the only route back to some kind of normality.

By regularly screening an entire population, authorities can identify whether someone is infected even before they start showing symptoms. This means that those who are found to be positive can be asked to self-isolate, while those who are negative can continue with their everyday lives.

“In principle I don’t think there’s any doubt it’s a good idea,” Jon Deeks, professor of biostatistics at Birmingham University’s Institute of Applied Health Research, told The Independent. “If we’re to bring virus levels down, then wide-spread testing in one form or another is certainly going to have to play a part.”

Why has Liverpool been chosen for a pilot?

The northwest city has the highest rate of coronavirus deaths in England and was the first place to be put in tier 3 of the government’s virus alert system.

Crucially, there had been fears – now receding slightly – that its hospitals could be overwhelmed if virus rates continued going north. As of this week, a third of all in-patients had Covid-19.

"We're very close to the limits of what Liverpool hospitals can cope with,” said Dr Tristan Cope, medical director at Liverpool University Hospitals Trust.

Who can get tested? And how will it work in practice?

Basically, everybody who lives or works in the city: about half a million people in total.

To be clear, it is not mandatory but officials say that those who do come forward will be helping bring infection rates down, returning life to some kind of normality and saving lives.

“This is an incredible opportunity to turbocharge our efforts to reduce coronavirus in the city,” said Mayor Joe Anderson. “Let’s all get tested, for our families, our mates, our Liverpool and set an example to the country and the world.”

How exactly this will all work remains, even on Friday, a little sketchy.

Mobile test centres are being set up at places considered especially vulnerable to coronavirus spread, including health centres, care homes and university sites. But, additionally, there are also specific community test centres being created.

Six of the latter have so far been announced to open across the city at midday on Friday, with a full list of locations on the council’s website.

Specifically, these sites are for people not suffering symptoms. People can arrive for walk-in appointments but are encouraged to book online in advance.

Anyone who does already have symptoms is asked to book online first with a testing site and time then allocated to them.

In total, it is hoped some 64,000 tests can be carried out every day.

How long will the results take? And what then?

The wait for a verdict depends on the type of test being taken with three types set to deployed.

The so-called gold standard for accuracy is the PCR test which will provide results within two to three days, officials say.

But more commonly used – about 50,000 a day – will be lateral flow and Lamp (loop-mediated isothermal amplification) tests. Both these are far quicker, offering results back within 20 minutes at the quickest and about four hours at the longest.

The only problem is their accuracy – or lack of. More of which below.

For now, people found to be negative can go about their normal day (albeit under national lockdown conditions), while those who are positive will be instructed to self-isolate.

In the latter case, said Liverpool’s director of public health Matthew Ashton, people will be offered instant support, including guidance on “how to access food, access shopping, if they earn a certain level how to access payment".

So, what are the concerns?

Accuracy, mainly.

Self-evidently, a programme such as this is only as good as the tests being carried out. The problem is that there are real and growing doubts about how good they actually are.

In smaller trials in Salford last month, the Lamp tests identified only 46.7 per cent of infections according to a letter from Greater Manchester's mass testing group. If those rates were replicated in Liverpool, it would mean thousands of positive cases being missed and, as such, allowed to remain and spread out in the community.

It would, essentially, mean we were back in whack-a-mole territory and unarmed without any reliable data.

The rapid lateral flow tests, meanwhile, are so unproven they come with manufacturer’s warning: “Negative results do not rule out infection.”

For these, there have been no population trials at all and the results of trials done by government scientists at Porton Down have not been published.

“It is crucial we try and understand the accuracy rates of these tests before we pin hopes on it,” said Professor Deeks.

The other potential pitfall may be uptake.

Initial unscientific feedback suggests many residents in Liverpool would be happy to get tested on the regular if it means a chance of returning to normality,

Yet whether such willingness in theory translates to action in practice is something that is to be seen.

“Going to get a test when you feel well and healthy is an imposition for people,” says Deeks.

To encourage greater uptake, he says, there must be a greater publicity, more test centres created in convenient locations, and full financial and social support for anyone told to quarantine as a result.

Could it be rolled out to the rest of us?

That’s the aspiration.

The Liverpool pilot is scheduled to last at least 10 days but officials have suggested that, if it appears to be working, it will roll on much longer.

Pertinently, the government has already said it is aiming to get to a point where 10 million tests could be carried out every single day in the UK.

"We will aim to distribute millions of these new rapid tests between now and Christmas, and empower local communities to use them to drive down transmission in their areas,” Boris Johnson said previously, although, as ever with this prime minister, the lines between optimism and reality appear to be somewhat blurred.

Could it offer a glimpse of all our futures? “Wait and see” appears to be the only real answer.