Test. Test. Test.
On Friday, Matt Hancock addressed the nation to deliver the results of the “100,000 test a day by the end of the month” target set on the 2nd April.[1] On Friday’s live Daily Press Briefing, Matt Hancock announced that the number of tests carried out on the 30th April was 122,347.[2] While it is commendable that the government has managed to bridge an almost impossible gap from the start of the month, the figures reported are deceiving still.
The World Health Organisation (WHO) stressed many times the importance of testing to control the pandemic.[3] Dr Tedros Adhanom Ghebreyesus, Director General at WHO famously said to world leaders on the 16th March “We have a simple message for all countries: test, test, test”.[3, 4] This was reinforced with a message that “testing, isolation and contact tracing — is the backbone of the response.”[3, 4] But somehow, the way world leaders interpreted this message differed vastly between countries.
South Korea was lucky to have previous experience with MERS in 2015, to prepare the country for the threat of COVID-19.[5, 6] As WHO stressed the importance of “test, test, test”, South Korea was already testing up to 20,000 people a day. Not only did South Korea’s history with MERS teach their government to upscale swab testing capacity early; but there was also a key focus to deliver results quickly within 24hrs.[5, 6] South Korea was also aware of the importance of contact tracing from their experience with MERS.[5, 7] Thus, establishing quick control of their first outbreak after ‘case 31’ attended a religious ceremony. The imperial structure of South Korean government easily allowed for emergency legislation to be arranged.[5, 7–8] Such legislation included invasive contact tracing measures and national broadcasts of infected individuals’ information.[5–8]
Germany used South Korea’s model for “widespread” and “intense” testing to ensure the curve of their outbreak was flat and short.[9, 10] Germany’s ‘case 31’ moment occurred after an annual carnival took place in West Germany, early-February. Thankfully for the Germans, their decentralised health system set in place allowed for rapid contact tracing for all who attended the carnival. Organised locally within the state of North-Rhine Westphalia.[9, 11] Their decentralised health system is also thought to be the reason why Germany states were able to rapidly upscale swab testing capacity; involving local universities and private laboratories. This was beneficial for Germany as they were quickly able to test 50,000 people a day at the start of April.[9, 12] Nonetheless, the German government has set a new target to achieve 200,000 tests per day as they now begin to end the lockdown.[12]
South Korea and Germany were not the only countries to implement an early, intensive testing system to curb their COVID-19 outbreak. Most countries that focused on providing easily accessible testing to their public, had much better experiences of dealing with COVID-19 than those that did not. Iceland established a system where individuals who showed symptoms after returning to the country were swab tested.[13] Alongside thorough testing of those who entered the country, efficient contact tracing of all individuals that may have been in contact with confirmed infected patients was introduced. The Icelandic government found that implementing a high test per thousand allowed for easier management of the outbreak.[14] Thus, allowing for social distancing restrictions to be eased going into May.[15]
Matt Hancock commended the “national achievement” of 100,000 tests a day, as the increase to testing capacity over the last month was “crucial to […] remove the worry, keep people safe, and help us unlock the lockdown”.[2] However, many have thrown caution to the Health Secretary’s optimism as 100,000 tests per day is still not enough tests for health and social care workers to control COVID-19.[16]
Further breakdown of figures published on gov.uk show that of the 122,347 tests carried out on the 30th April, only 73,191 people were tested.[17] The disparity between the number of tests conducted and the number of people tested per day is due to the need for retests on hospital wards. It is common practice for doctors to believe an individual who shows clinical signs of infection, have test results that come back negative.[18] However, the ambiguity created by measuring tests per day as the ‘standard’ has allowed the government to be unclear with the public when reporting its’ progress to limit the COVID-19 outbreak. It is also worth mentioning that of the 73,191 people tested for COVID-19, around 60% were healthcare workers or families of healthcare workers.[17] This is a cause for concern as it shows that vulnerable individuals who do not have the convenience of working near a testing facility are further disadvantaged to receive tests.
Earlier this week, in a bid to increase the number of people being tested for COVID-19, the government updated the list of people who would be eligible for testing.[19] On Tuesday, the UK government allowed anyone over the age of 65 showing symptoms of COVID-19 to be tested; alongside all NHS and social care staff and care home residents regardless if they show symptoms; as well as symptomatic key workers unable to work from home.[19–21] This update to who has priority to COVID-19 swab tests was welcomed by many; as it allows scientists to build a clearer understanding of which vulnerable individuals, and their communities, require the most attention.
Despite the increased number of people eligible for testing, this has not translated to increased access to tests for identified vulnerable individuals. The UK government expect that by increasing the number of army pop-up mobile testing units from 17 to 70 over the coming week, accessibility for individuals unable to travel to one of the 41 drive-through testing centres will rapidly improve.[22–23]
It is hoped that by increasing the testing capacity within the UK further to around 250,000 tests per day, the country can begin to control COVID-19’s spread.[24] By swelling tests per day to these numbers, the UK would have sufficient capacity for contact tracing in a worst-case scenario. [24, 25] Thorough testing of all individuals who have been infected, whether they show symptoms or not is vital to remove the chance of a second outbreak from occurring. Therefore, far more than the current 10 people per 1,000 UK citizens must be tested if we are to stand any chance to “unlock the lockdown” and end COVID-19.[14]
The UK government may try to claim a victory for performing over 100,000 tests a day, but we are still behind many countries who managed to get control of COVID-19 early. While it is encouraging that the government was able to rapidly increase the number of COVID-19 tests over the last month, we’re not near the finish line yet. The government must continue to devote resources to ramping up test capacity even further to implement a safe and effective contact tracing strategy.
References
[1] Syal, Rajeev. “Matt Hancock Sets Target Of 100,000 Coronavirus Tests A Day”. The Guardian, 2020, https://www.theguardian.com/world/2020/apr/02/matt-hancock-sets-target-of-100000-coronavirus-tests-a-day. Accessed 30 Apr 2020.
[2] UK Government. Coronavirus Daily Update. 2020, https://www.bbc.co.uk/iplayer/episode/m000j3sb/bbc-news-special-coronavirus-daily-update-01052020. Accessed 1 May 2020.
[3] The World Health Organisation (WHO). Daily Press Briefing On COVID-19. 2020, https://www.youtube.com/watch?v=2RMl8yqo6Uk&t=35s. Accessed 2 May 2020.
[4] Adhanom Ghebreyesus, Tedros. “WHO Director-General’s Opening Remarks At The Media Briefing On COVID-19–16 March 2020”. Who.Int, 2020, https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---16-march-2020. Accessed 16 Mar 2020.
[5] BBC Sounds. “Coronavirus: What Can The World Learn From South Korea?”. The Inquiry, 2020, https://www.bbc.co.uk/sounds/play/w3csythk. Accessed 30 Apr 2020.
[6] McCurry, Justin. “Test, Trace, Contain: How South Korea Flattened Its Coronavirus Curve”. The Guardian, 2020, https://www.theguardian.com/world/2020/apr/23/test-trace-contain-how-south-korea-flattened-its-coronavirus-curve. Accessed 30 Apr 2020.
[7] Kim, Myoung-hee. “How South Korea Stopped COVID-19 Early | By Myoung-Hee Kim — Project Syndicate”. Project Syndicate, 2020, https://www.project-syndicate.org/commentary/how-south-korea-stopped-covid19-early-by-myoung-hee-kim-2020-04. Accessed 30 Apr 2020.
[8] Normile, Dennis. “Coronavirus Cases Have Dropped Sharply In South Korea. What’S The Secret To Its Success?”. Science | AAAS, 2020, https://www.sciencemag.org/news/2020/03/coronavirus-cases-have-dropped-sharply-south-korea-whats-secret-its-success#. Accessed 30 Mar 2020.
[9] “Why Have The UK And Germany Taken Different Approaches To Covid”. Today In Focus, 2020, https://www.theguardian.com/news/audio/2020/apr/14/why-have-the-uk-and-germany-taken-different-approaches-to-covid-19-testing. Accessed 30 Apr 2020.
[10] Eckner, Constantin. “How Germany Has Managed To Perform So Many Covid- 19 Tests”. Spectator.Co.Uk, 2020, https://www.spectator.co.uk/article/how-germany-has-managed-to-perform-so-many-covid-19-tests. Accessed 30 Mar 2020.
[11] Bateman, Jessica. “How ‘Germany’S Wuhan’ Created The Blueprint For Fighting Coronavirus”. The Independent, 2020, https://www.independent.co.uk/news/world/europe/germany-coronavirus-lockdown-heinsberg-cases-deaths-latest-a9481686.html. Accessed 30 Mar 2020.
[12] Loh, Tim, and Naomi Kresge. “Bloomberg — Are You A Robot?”. Bloomberg.Com, 2020, https://www.bloomberg.com/news/articles/2020-04-02/private-labs-helped-germany-test-1-million-for-covid-19-virus. Accessed 30 Mar 2020.
[13] LeMieux, Julianna. “Iceland’S Aggressive COVID-19 Testing Helped Curb Outbreak”. GEN — Genetic Engineering And Biotechnology News, 2020, https://www.genengnews.com/news/icelands-aggressive-covid-19-testing-helped-curb-outbreak/. Accessed 30 Mar 2020.
[14] “To Understand The Global Pandemic, We Need Global Testing — The Our World In Data COVID-19 Testing Dataset”. Our World In Data, 2020, https://ourworldindata.org/covid-testing. Accessed 1 May 2020.
[15] “Time For A Haircut? Iceland To Begin Lifting Lockdown In May”. Reuters U.S., 2020, https://www.reuters.com/article/us-health-coronavirus-iceland/time-for-a-haircut-iceland-to-begin-lifting-lockdown-in-may-idUSKCN21W2Q8. Accessed 30 Apr 2020.
[16] Devlin, Hannah. “Impossible For UK To Meet Covid-19 Testing Targets, Scientists Say”. The Guardian, 2020, https://www.theguardian.com/politics/2020/apr/19/impossible-for-uk-to-meet-covid-19-testing-targets-say-scientists. Accessed 30 Apr 2020.
[17] “Number Of Coronavirus (COVID-19) Cases And Risk In The UK”. GOV.UK, 2020, https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public. Accessed 1 May 2020.
[18] Boseley, Sarah, and Pamela Duncan. “Hospital Chiefs ‘Increasingly Frustrated’ With UK Testing Failures”. The Guardian, 2020, https://www.theguardian.com/world/2020/apr/30/hospital-chiefs-increasingly-frustrated-with-uk-testing-failures. Accessed 30 Apr 2020.
[19] “Further Expansion Of Access To Coronavirus Testing Helps Protect The Most Vulnerable”. GOV.UK, 2020, https://www.gov.uk/government/news/further-expansion-of-access-to-coronavirus-testing-helps-protect-the-most-vulnerable. Accessed 30 Apr 2020.
[20] “Coronavirus (COVID-19): Getting Tested”. GOV.UK, 2020, https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested. Accessed 30 Apr 2020.
[21] “Coronavirus Testing: Who Can Be Tested As Millions More Covid-19 Tests Become Available”. LBC, 2020, https://www.lbc.co.uk/hot-topics/coronavirus/coronavirus-testing-who-can-be-tested-covid-19/. Accessed 30 Apr 2020.
[22] Grimmer, Dan. “Who Can Get Tested For Coronavirus And How Can They Do It?”. Eastern Daily Press, 2020, https://www.edp24.co.uk/news/politics/who-can-get-tested-for-coronavirus-and-how-can-they-do-it-1-6628711. Accessed 30 Apr 2020.
[23] Milan, Aidan. “Coronavirus UK: Where Are The Covid-19 Testing Sites In The UK? | Metro News”. Metro.Co.Uk, 2020, https://metro.co.uk/2020/04/29/covid-19-testing-sites-uk-12628946/. Accessed 30 Apr 2020.
[24] Hinch, Robert et al. Effective Configurations Of A Digital Contact Tracing App: A Report To NHSX. Oxford University, Oxford, 2020, https://github.com/BDI-pathogens/covid-19_instant_tracing/blob/master/Report%20-%20Effective%20Configurations%20of%20a%20Digital%20Contact%20Tracing%20App.pdf. Accessed 23 Apr 2020.
[25] Nicholas C Grassly, Marga Pons-Salort, Edward PK Parker, Peter J White et al. Role of testing in COIVD-19 control. Imperial College London (23–04–2020), https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-04-23-COVID19-Report-16.pdf. Accessed 30 Apr 2020.
