Blog posts

Rational use of lateral flow tests for Covid-19

In recent days, it has become very clear that there are nowhere nearly enough lateral flow tests for Covid-19 in England to allow the government’s policy of their indiscriminate use. Even if funding could be found to buy more tests, it is unlikely to government could source enough tests to meet current and future demand because of the many other countries that are also trying to obtain the tests as they struggle to control the wave of infections from the Omicron variant of SARS-CoV-2.

The government is in part to blame for the current problems with the increased demand tests. It has encouraged members of the public to test regularly; for example before social events such as parties; and before meeting friends and family from outside their immediate household. The very high level of Covid-19 cases in the UK (with around 183,00 cases reported on 29 December) also means that many more people will have been advised to test regularly in line with guidance from Test and Trace. This will include guidance for close contacts of cases who are asked to carry out daily tests for 10 days if they are fully vaccinated to avoid isolating. People with a Covid-19 infection can also test themselves on day 6 and day 7 of their illness, and end their period of isolation if they are asymptomatic and the two tests are both negative.

What can we do to improve how well lateral flow tests are used? The first step is for the government to publish data on the daily supply of tests. We then need clear guidance from the government on what groups should be prioritised for testing and how frequently they should test. Carrying out several tests in one day is not a good use of these tests. And nor is carrying out daily lateral flow tests after a positive PCR test (other than on day 6 & 7 as discussed above). Even daily tests are inappropriate in asymptomatic people when there is currently such a large gap between the supply and demand for tests. NHS guidance is for staff to test twice per week with a lateral flow test but many asymptomatic people are testing more frequently than this. NHS Trusts and general practices need to review their testing polices and give clear guidance to staff to protect the supply of tests.

Once we have information on the daily supply of tests, we can then prioritise who will have access to the tests. This kind of prioritisation is quite normal in healthcare and was done, for example, with Covid-19 vaccination to ensure access was given based on clinical and occupational priority. Groups for priority access to tests should include:

– NHS staff in patient-facing roles

– People working in social care

– Teachers and other people working in schools

– Workers in essential parts of the economy such as public transport

– Groups such as HGV drivers to ensure that deliveries of essential items continues

– Patients who are clinically vulnerable

– People following guidance from Test & Trace

There is also now a lack of PCR for tests to diagnose Covid-19. An important question for the government is should we use lateral flow tests to give better access to testing for people with symptoms and reduce testing for people who are asymptomatic? If this does happen, we will still need to decide and which groups would have access to lateral flow tests in place of PCR tests. Successful implementation of this policy could allow many more people to receive a test. Although lateral flow tests are not as sensitive as PCR tests, they will still identify many people with Covid-19.

We also need to look at the costs of supplying these tests and determine what we can afford to spend. Although the tests are supplied at no cost to the public, they are not free and will come at a considerable cost to the taxpayer. Access to diagnostic services and other health services always has to be limited; and based on factors such as clinical need, health outcomes, and cost-effectiveness.

With the UK facing record numbers of people with Covid-19, we need the government to act quickly, decisively and rationally to ensure we maximise the benefits of England’s Covid-19 testing capacity.

A version of this article was first published in the Guardian Newspaper.

Questions and Answers about Lateral Flow Tests for Covid-19

Lateral flow tests are now being used by many members of the public. In this blog, I answer some of the common questions that people ask about these tests, which I was asked to comment on for articles for the Guardian Newspaper and VICE UK.

How do lateral flow tests work and how reliable are they?

Lateral flow test (LFTs) work by detecting the proteins on the surface of the SARS-CoV-2 virus that is the cause of Covid-19. They can be carried out at home and don’t require a laboratory to process the test, unlike PCR tests. They also give a result very quickly, typically within 30 minutes. They are less accurate than PCR tests, which is why PCR tests are recommended for people with symptoms.

Studies show widely varying estimates of the accuracy of LFTs, typically detecting between 40%-90% of people who have Covid-19 in different studies. We can’t just take an average of these studies to determine the accuracy of the tests as this will depend on a range of factors – such as the type of people in the study, what stage of illness they were at, what specific test was used, and how well the test was carried out.

We do know that carrying out the test correctly is very important. It’s essential therefore to read the instruction leaflet that comes with the test and to watch one of the NHS videos that explain how to carry out a lateral flow test to learn the correct technique.

How do I carry out a lateral flow test?

Before you start, read the instructions that came with the test. If your test needs a throat swab, open your mouth wide and rub the swab over your tonsils (or where they would have been if you have had a tonsillectomy). Put the same swab inside your nose (about 2.5 cm / one inch up or until you feel resistance). If your test requires only a nose swab, put the swab inside your nose (about 2.5 cm / one inch).

After you have done this, put the end of the swab into the tube so it’s in the liquid, then squeeze the liquid from the tube onto the test strip and read the test result once the waiting time advised in the instruction leaflet has passed. Once you have the result, record this via the reporting website. This is important as it allows the government and the NHS to monitor Covid-19 infections in the UK.

Full instructions on how to carry out the test are available on the NHS Website. There are also several NHS videos available online that show people how to use the tests properly.

People online have had negative lateral flows but positive PCRs – why is this? Should I get a PCR instead?

Lateral flow tests and PCR tests work in different ways. Lateral flow tests detect some of the proteins in the virus, can be carried out at home and give a result quickly. PCR tests detect the genetic material (RNA) in the virus and require a laboratory to do this. The result of a PCR test takes longer to come back but it will pick up more infections than a lateral flow test because the test has a higher sensitivity than a lateral flow test.

Because lateral flow tests are not as accurate as PCR tests, they can sometimes be negative in people with symptoms when the subsequent PCR test is positive. If you have symptoms of a possible Covid-19 infection, you should always get a PCR test and not rely on a lateral flow test. If you don’t have symptoms, a lateral flow test is sufficient. PCR tests should be reserved for people with symptoms of a possible Covid-19 infection to avoid overloading government laboratories with unnecessary test requests. (UPDATE: From 11 January, most people with a positive lateral flow test do not need to take a confirmatory PCR test to confirm they have Covid-19).

What are the symptoms of a Covid-19 infection?

When Covid-19 first arrived in the UK in early 2020, the main symptoms people were asked to look out for were a high temperature, a new continuous cough, or a loss or change to their sense of smell or taste. Now that so many people in the UK have some immunity because of vaccination or a previous Covid-19 infection, they may get other symptoms when infected – such as a headache, runny nose, sore throat, or sneezing. So even if you think you might just have a cold, you should still get a PCR test.

How long before meeting family/friends should you take one, and does taking multiple LFTs increase their accuracy?

The test should be done on the day of the meeting. One test is sufficient. Although you can carry out more than one test a day, there is a shortage of tests in many parts of England. If the tests are over-used, this will lead to further supply problems – including for key workers such as NHS staff who are required to test regularly for employment purposes.

Does the thickness of the ‘test’ line on an LFT give any indication of how infectious you are? (if it’s a weak line, does that mean you are hardly shedding any virus? Does a thick one mean you are really infectious?)

The test is designed to tell you if you may be infected and is not designed to estimate how infectious you may be. You shouldn’t therefore use the thickness of the line to try to estimate your infectivity. At a time when the prevalence of Covid-19 in the UK is so high, a positive test means that you are very likely to be infected and you should isolate until you get the result of a PCR test; and then isolate further if this is positive.

If you are still testing positive on an LFT after 10 days’ isolation, are you still infectious and do you still need to isolate? (MIT medical journal says: “But what if someone still tests positive after 10 days? This is very common. People who have tested positive for COVID-19 are very likely to continue to test positive after 10 days. But they are not contagious.”)

There is no need to keep on testing repeatedly if you have had a positive LFT result and this is then confirmed by a PCR test. You should complete your period of isolation and, if in England, carry out any required LFTs as advised by NHS Test and Trace. In England, people who are fully vaccinated can now carry out LFTs on day 6 and day 7 of their isolation period and come out of isolation if both these tests negative. Unvaccinated people will need to continue to isolate for 10 days. Test results can sometimes remain positive for a period after day 10 of isolation ends but this not necessarily mean you are still infectious. (UPDATE: From 17 January 2022, the isolation period in England was reduced to five days if the lateral flow tests are negative on day 5 and day 6).

If you’ve tested positive, including for Omicron, does that mean you won’t get it again?

Reinfections can occur after a previous Covid-19 infection. These are more common with Omicron which a recent study from Imperial College London showed was over 5-times more likely to cause a reinfection than the Delta variant. These reinfections will have been in people who have had an infection with a variant such as Delta, Alpha or the original version of SARS-CoV-2. Because Omicron infections have only occurred recently in the UK, we don’t yet know how prone people who have had an Omicron infection will be to a repeat infection.

Should You Even Be Travelling Home for Christmas?

In an article for VICE UK, I answer questions from Darcey Edkins about staying safe this Christmas in the midst of a wave of Covid-19 infections driven by the Omicron SARS-CoV-2 variant. We cover topics such as the Three C Approach to personal safety, why you should wear a well-fitting FFP2 mask, and testing for Covid-19.

Given the scientific data out there, is it safe to travel home for Christmas right now?

There is currently a high level of Covid-19 in the UK so you need to take appropriate precautions when travelling such as adopting the “Three C Approach” to reduce the risk of infection to you. This means: Avoid closed spaces; Avoid crowded spaces; Avoid getting too close to other people when outside your household. When you travel home, you should use a good quality FFP2 face mask to protect yourself better if you are on public transport or enter places such as bus, train and service stations. You can test yourself before you travel with a lateral flow test. If you have symptoms, you should not travel until you hear that your PCR test is negative.

I have seen people saying that lateral flows are not reliable – how much can I rely on them to make a call on whether I am COVID-negative?

Lateral flow tests will detect the majority of people with Covid-19 but they are not as accurate as PCR tests (which are processed in a laboratory). The accuracy of a lateral flow test can improved if it is carried out correctly. Lateral flow tests will detect infections from the Omicron variant.

Before you start, read the instructions that came with the test. If your test needs a throat swab, open your mouth wide and rub the swab over your tonsils (or where they would have been if you have had a tonsillectomy). Put the same swab inside your nose (about 2.5 cm up or until you feel resistance). If your test requires only a nose swab, put the swab inside your nose (about 2.5 cm).

After you have done this, put the end of the swab into the tube so it’s in the liquid, then squeeze the liquid from the tube onto the test strip and read the test result once the waiting time advised in the instruction leaflet has passed. Once you have the result, report this via the website. This is important as it allows the government and the NHS to monitor Covid-19 infections in the UK.

Full instructions on how to carry out the test are available on the NHS Website. There are also several NHS videos available online that show people how to use the tests properly.

People online have had negative lateral flows but positive PCRs – why is this? Should I get a PCR ahead of travelling home?

Lateral flow tests and PCR tests work in different ways. Lateral flow tests detect some of the proteins in the virus, can be carried out at home and give a result quickly. PCR tests detect the genetic material (RNA) in the virus and require a laboratory to do this. The result of a PCR test takes longer to come back but it will pick up more infections than a lateral flow test because the test has a higher sensitivity than a lateral flow test.

Because lateral flow tests are not as accurate as PCR tests, they can sometimes be negative in people with symptoms when the subsequent PCR test is positive. If you have symptoms of a possible Covid-19 infection, you should always get a PCR test and not rely on a lateral flow test. If you don’t have symptoms, a lateral flow test is sufficient. PCR tests should be reserved for people with symptoms of a possible Covid-19 infection to avoid overloading government laboratories with unnecessary test requests.

When Covid-19 first arrived in the UK in early 2020, the main symptoms people were asked to look out for were a high temperature, a new continuous cough, or a loss or change to their sense of smell or taste. Now that so many people in the UK have some immunity because of vaccination or a previous Covid-19 infection, they may get other symptoms when infected – such as a headache, runny nose, sore throat, or sneezing. So even if you think you might just have a cold, you should still get a PCR test.

Is there any other precautionary stuff I can do to ensure I don’t give COVID to my loved ones this Christmas?

People who are unvaccinated are more likely to become infected with Covid-19 and transmit infection to others. To protect yourself and others, ensure you are vaccinated – including with a booster. Your friends and family members should also ensure they are fully vaccinated. Another step you can take to reduce the risk of infection is to test for Covid-19 before you all meet up and then once or twice each week.

Good ventilation will also reduce the risk of infection as will limiting the size of the gathering. For ventilation to work best, you need a good flow of air in and out of the room you are in. This would mean opening at least one window and the door to the room. The more air that flows through the room, the quicker any virus that is in the air will disperse, thereby reducing the risk of infection. If you want to measure the quality of air in a room, you can use a carbon dioxide monitor. Higher levels of carbon dioxide indicate poorer air quality and are a sign that you need to open more windows to improve ventilation.

Regarding the number of people you have in a room, there is no “right” number. The more people who are in a room, the more likely it is that one will have a Covid-19 infection. But other factors also important – such as the size of the room and its ventilation, whether all the people are fully vaccinated, and whether they have all carried out a recent lateral flow test to check their infection status.

When you are outside in places such as public transport and shops, you should wear a good-fitting mask. Higher specification FFP2 masks provide better protection from infection than the cloth masks and surgical masks you see many people wearing. Good hygiene is also important.

Should I be testing every day I’m home for Christmas, just to be sure? Should I be testing multiple times a day?

Testing every day is not a good use of lateral flow tests. Some people do carry out more than one test per day but this will lead to tests running out very quickly as the supply of tests in the UK  is limited and there are not enough tests available for everyone to do this. You should test before you meet up and then once or twice weekly. There is no need to carry out multiple tests on the same day. There is currently a shortage of lateral flow tests in many parts of England and they should be used sensibly. We also need to ensure that key workers such as NHS staff have sufficient tests for their own use. If you have symptoms, you should get a PCR test and wait for the result rather than carrying out multiple lateral flow tests.

Why was London hit first by Omicron?

One question I have been asked is why the London-region has been the area of the UK most affected by the Omicron variant of SARS-CoV-2? Over 80% of Covid-19 cases in London are thought to be due to Omicron compared to a national average in England (as of 19 November) of 67%.

There are several factors that have driven the rapid increase in Omicron cases in London.

London is the UK’s main international travel hub with the UK’s busiest airports located nearby. Hence, travellers from overseas who are infected with a new variant of SARS-CoV-2 are more likely to arrive in the London region than in other parts of the UK. London also has a very large number of international visitors – for activities such as work, study, tourism, leisure, and sports events.

London is the also UK’s largest city and is very densely populated, with many overcrowded households, often with people from three generations living together (multi-generation households), which makes infections more likely to spread.

London has a lower vaccination uptake than other parts of the UK. Around 20% of adults in London currently remain unvaccinated. Although vaccines provide less protection from infection with Omicron than from the Delta variant, they do still provide some protection; more so in people who have had their first two primary vaccinations followed by a booster vaccination. The lower vaccination rate will lead to infections from Omicron spreading more quickly; as well as increasing the likelihood of severe disease. This would in turn increase hospital admissions and pressures across the NHS in London.

We will see Omicron spread across the rest of the UK in the next few weeks. However, it may be the case that the higher levels of vaccination elsewhere in the UK will blunt the symptoms from an Omicron infection; with fewer people developing a more serious illness than in London. This remains to be determined and new data in the next few weeks should answer this question.

Detecting Covid-19 infections from Omicron using lateral flow devices

Several patients have asked me if lateral flow devices (LFDs) will detect Omicron infections. These are the rapid tests that people can use to check for Covid-19 infection while they are asymptotic. NHS staff are required to use these tests regularly if they are in patient-facing roles.

Short Answer: Yes. The UK HSA has confirmed this in an initial laboratory evaluation of the LFDs currently used in the UK. The data from the initial samples in the HSA study show a similar sensitivity for the detection of Covid-19 from Omicron to that seen for previous strains of SARS-CoV-2 including Delta, which has been the predominant strain in the UK from May to December 2021.

All LFDs approved for use within the UK specifically detect the nucleocapsid protein of SARS-CoV-2 using a combination of 2 or more different antibodies, each targeting a distinct epitope. Full details of the study are available on pages 14-16 of the HAS study. Finally, remember that LFDs are not 100% sensitive and won’t detect some infections. Full details of the study are available on pages 14-16 of the HSA report.

If you have symptoms of a possible Covid-19 infection, get a PCR test. Irrespective of your test result, continue to practise good infection control measures such as wearing a face mask and avoiding higher risk venues such s very crowded indoor spaces with poor ventilation.

The NHS needs urgent support as we enter the most challenging period of the pandemic yet

On Friday 17 December, a record number of Covid-19 cases (93,045) was reported in the UK.  Unfortunately, the recently identified Omicron variant has proven to be considerably more infectious than previous variants. Vaccines are also less effective against Omicron, with two doses of the vaccine providing only limited protection from symptomatic Covid-19 infection. A booster (third) dose increases protection but not to the level seen against other variants.

Although the clinical severity of Omicron-linked cases is still to be fully determined, the sheer volume of cases will lead to greater pressures on all sectors of England’s NHS. This comes at a time when the NHS in England is already struggling to cope with existing demands, whilst also trying to manage the enormous backlog that has built up since the start of the pandemic in early 2020.

With the NHS now tasked with substantially increasing the number of Covid-19 vaccines available, we are entering a very challenging period, juggling; the increased rollout of Covid-19 vaccinations, a surge in Covid-19 cases, usual winter pressures, such as seasonal respiratory infections and other urgent medical problems, and maintaining rapid access to care for people with suspected cancer.

Other important areas of work also need to continue. This includes childhood vaccinations, mental health services, and community care for vulnerable patients. Inevitably, much of the elective work that the NHS does will have to be deferred, leading to yet further increases in NHS waiting lists for specialist care. There will be less capacity to defer elective NHS care in general practices, leading to further frustrations from patients, if access to primary care services is curtailed.

Unfortunately, due to these challenges a deterioration in health outcomes will occur. It is not always easy to separate out urgent from non-urgent medical problems. If people are asked to defer seeking care, some patients will inevitably suffer delays to their diagnosis.

It is essential that access to primary care services is maintained during this challenging time. Unfortunately, many community healthcare providers are already suffering from long-standing workforce shortages that cannot be easily addressed. Ideally, expanding Covid-19 vaccination capacity would be in addition to, rather than in place of, these services. But this requires rapid planning at national and local level, and a willingness to give local clinicians the autonomy to develop their own solutions without the bureaucratic hurdles that are often the hallmark of the NHS.

The continued waves of infection the NHS has faced since the start of the pandemic have taken a considerable toll on the physical and mental health of NHS staff. The largest wave of infection yet, from Omicron, will add further to this toll. As well as the direct risks from Covid-19, an infection that has disproportionately affected healthcare workers, the mental health of NHS staff has also been adversely affected; with high levels of problems such as stress, burnout and post-traumatic stress disorder. This in turn has led to high levels of absence due to illness, which further compounds the pre-existing shortages of staff. Recognising the impact of working during the pandemic on healthcare professionals is essential, as are initiatives to improve the well-being of staff.

The NHS is entering one of its most challenging phases – probably more challenging than the previous two large Covid-19 waves in March 2020 and January 2021. The public need to understand that the NHS urgently need support. In the worst-case scenario, this could mean the NHS being placed on an emergency footing for several months if there are very high numbers of Omicron cases and the reduced effectiveness of vaccines lead to a prolonged increase the number of severely ill patients in need of NHS care.

A version of this article was first published in The House Magazine.

Boosting the nation against covid-19: are the vaccination targets feasible?

With the number of covid-19 cases from the Omicron SARS-CoV-2 variant rising exponentially in the UK, Boris Johnson, the prime minister addressed the nation on 12 December 2021, announcing a target to deliver a booster covid-19 vaccine to all eligible adults in England by the end of December. The devolved governments in Wales, Scotland, and Northern Ireland are expected to set similar targets. This extremely ambitious target will involve delivering over one million covid-19 vaccines per day in England over the next couple of weeks. So far, 81.3% of adults have received two vaccine doses in England, but despite this the covid-19 alert system in England moved from 3 to 4 as a result of the large increase in daily case rates and the concerns that the latest variant is overwhelming the NHS.12 In response, the Joint Committee on Vaccination and Immunisation has recommended reducing the time between second doses and boosters from six months to three months, rendering 14 million more individuals eligible for boosters.34 Across the NHS, staff are once again having to rapidly mobilise to ensure that as many people are vaccinated as quickly and as safely as possible, while not compromising other important areas of healthcare.

The UK’s initial vaccination programme was world leading, but then faltered mid-2021, before picking up speed again more recently.5 The covid-19 vaccination programme is delivered in multiple venues, including mass vaccine centres, schools, and workplaces, but the majority of vaccines are still administered in primary care, placing additional pressure on already overstretched GP and community pharmacy teams. There is a well documented GP crisis: falling numbers of GPs are failing to keep up with population growth and the increase in primary care workload, leading to fewer physicians caring for more patients in a chronically underfunded primary care system.6 7 This has led to increased waiting times and access issues, with a knock-on effect on hospitals at a time when there are also shortages of other key NHS professionals in secondary care.8 With a rising number of Omicron cases requiring further medical care, more resources are urgently required to safely manage this ambitious booster campaign, along with ongoing core NHS work and the usual winter demands. NHS England and the British Medical Association have agreed some pragmatic changes to focus on essential work and deprioritise some of the bureaucracy that has limited patient benefit.9

Despite the proposed acceleration of the booster rollout, frontline NHS staff were not given advance notice and GPs are yet to be informed about key details, including when they should expect deliveries of vaccines. To ensure efficient ramping up of the vaccination programme, the UK’s chief medical officers have agreed to temporarily waive the 15 minute wait policy as the majority of adverse reactions occur in the first two minutes following vaccinations, with case rates of 4.7 per million vaccinations reported for anaphylaxis.10 11

The success of the covid-19 vaccination programme has required essential healthcare services to be compromised. The pandemic has exacerbated already existing challenges in the NHS, further compounding a severe backlog for specialist care, which has now reached six million, and will take many years to resolve.12 While the public health benefits of covid-19 vaccinations are clear, specific groups remain disadvantaged by mass vaccination. Some have argued that the suspension of services, including urgent and elective surgical services, may require more equitable decision-making processes as they may not be in line with the four pillars of medical ethics: beneficence, non-maleficence, autonomy, and justice.13 With the booster rollout now escalated, primary care teams are having to increase vaccination uptake without recommendations set out to address patient’s concerns, and alleviate the impact this may have on other healthcare services.

The UK is well placed to deliver large scale vaccination programmes, with all four devolved nations achieving some of Europe’s highest vaccination rates pre-pandemic.11 Appropriate and timely government planning and preparation are still needed to mitigate the risks, including economic decline and additional lockdowns, and to prevent exacerbating the impact observed across non-covid-19 healthcare services. For several months, the government ignored warnings from experts requesting an urgent move to “Plan B,” and requests to mandate standard public health measures, including mask wearing, ventilation measures (i.e. installing air filtration devices in schools), working from home, lateral flow testing before social events, and physical distancing. These have become the norm in the other three UK nations and in many European countries. The government also ignored calls to establish a sustainable, cost-effective system for covid-19 vaccination that could respond rapidly to any new demands, including the requirement for booster vaccinations.5 At this critical time, it is essential that the government invests in the systems that it relies on so heavily and that it adapts its covid-19 roadmap accordingly.

We have seen an “unimaginable” £37 billion squandered on test-and-trace—much of it on private consultants—and highly criticised by the government’s own watchdog.14 The booster rollout can showcase the power and flexibility of UK’s primary care system—but not immediately; it must be planned effectively by local NHS teams and the government. The number of booster doses will increase gradually albeit not at the rate the government hopes, and boosters take two weeks to be fully effective. We must hope that what we can achieve with boosters in the coming weeks will be sufficient to limit the impact of Omicron on public health, attenuate NHS pressures, and prevent the introduction of more severe measures.

Tasnime Osama, honorary clinical research fellow,  Simon Hodes, NHS GP partner,  Mohammad S Razai, NIHR in-practice fellow in primary care,  Azeem Majeed, professor of primary care and public health

A version of this article was first published in the British Medical Journal.

 

The Three C Approach to Personal Safety During the Covid-19 Pandemic

The UK is facing a surge in Covid-19 infections from the Omicron variant of SARS-CoV-2 coronavirus with a record number of Covid-19 cases (78,610) reported in the UK today. Cases of Covid-19 due to Omicron will soon account for most infections in the UK. Omicron has proved to be highly infectious – more so than other variants of SARS-CoV-2 – and is also able to evade vaccines better than other variants. To protect yourself, and reduce the risk of infection to you and others remember the three C approach to personal safety:

– Avoid closed spaces

– Avoid crowded spaces

– Avoid getting too close to other people when outside your household

These are simple and effective messages that need to be disseminated and adopted widely.

Remember also to get vaccinated – including with a booster as well as your first two doses – and to wear a good quality FFP2 mask when in indoor spaces outside your home. Three doses of vaccines provide much better protection against symptomatic Covid-19 infection than one or two doses. Test regularly with lateral flow devices. These don’t pick up all infections but can help identify the people who may be most infectious.

Finally, remember to improve ventilation whenever you are indoors, particularly with people from outside your household. The virus that causes Covid-19 (SARS-CoV-2) is airborne. Good ventilation can help  disperse the virus and reduce the concentration in the air, thereby lowering the risk of infection.

When vaccination, testing and ventilation are combined with wearing a higher quality face mask and adopting the 3C approach, you are reducing the risks of infection for you and the people close to you when you follow this guidance.

Covid-19 booster vaccination questions answered

When am I allowed to have my booster?

You can have your booster Covid-19 vaccine once you are three months past your second vaccine dose. The gap was previously six months but has now been reduced.

Who is eligible for a booster?

Anyone aged 18 and over is now eligible for a booster. People aged 16-17 with underlying health conditions that put them at higher risk of severe Covid-19 are also eligible for a booster. The NHS will aim to vaccinate people in order of clinical priority.

Can I have a booster if I’ve never been vaccinated?

You can’t have a booster until you are three months past your second Covid-19 vaccination. If you have not been vaccinated, you will need to have your first two vaccine doses eight week apart and then get your booster three months after your second dose People who are not vaccinated are at much greater risk of a serious Covid-19 illness, hospitalisation and death. So please do come forwards for vaccination if you are currently unvaccinated.

Does anything stop me from receiving a booster? (e.g., you need to wait if you’ve have Covid recently or received a flu jab)

If you have recently had another vaccine (e.g., flu) and your Covid-19 vaccine booster is due, you should still go ahead with this rather than delay your booster. Getting your booster promptly means that there is then not a delay in getting further protection from the booster. The only exception to this is the shingles vaccine, where a seven day interval should be observed between the vaccines.

Are booster jabs safe for everyone?

Research has shown that Covid-19 vaccines, including boosters, are very safe with only a very small risk of serious side-effects. The risks from a Covid-19 infection are far higher than from vaccination.

Why are boosters all of a sudden more urgent?

The immunity provided by Covid-19 vaccines begins to weaken after a few months. A booster vaccine substantially increase people’s protection from serious illness. Another reason why boosters have become more important is that the UK is now facing a wave of infection from a new Coronavirus variant, Omicron, which is more infectious than the previous Delta variant. Two doses of vaccines work less well against Omicron than Delta. A booster dose will provide a lot more protection against Omicron than provided by two doses. Ensuring that people receive a booster dose will reduce the number of people who are seriously from Covid-19, and keep down deaths and pressures on the NHS.

Can pregnant women have boosters?

Pregnant women are eligible for boosters and should get one when this is due. The vaccines being used for boosters have been shown to be safe during pregnancy for both the mother and baby.

Where can I get my Covid booster?

Boosters are available from a range of sites. This includes NHS vaccine centres, GP surgeries and pharmacies. You will need to check where the sites are in your local area as not all hospitals, pharmacies and GP surgeries are offering boosters.

Do I need to book or can I go to walk-in centre?

In the past, it was possible to go to a walk-in centre for a Covid-19 vaccination. However, because of the very high demand that there will now be for boosters, you may find that there is a very long queue or that you are turned away if you attend without an appointment.

What advice would you give to someone who is hesitant about the booster?

Covid-19 is a very serious illness. Vaccines are a safe way to protect yourself from these risks. By getting vaccinated, you are also helping to protect others – such as older family members or family members who are clinically vulnerable because of their medical problems. Vaccines have been fully tested and were shown to be safe and effective in clinical trials before they went into general use. We have now given many billions of vaccine doses globally, so we have excellent data in their safety and effectiveness from countries across the world.

A version of this article was first published in the Daily Mirror.

Staying safe this Christmas in the midst of an Omicron Covid-19 wave

The number of Covid-19 cases in the UK has increased in recent weeks to an average of around 50,000 per day. The number of cases caused by the Omicron variant, although currently small, is doubling about every three days. If this increase continues, Omicron will replace Delta as the most common variant of the Coronavirus in the UK within a few weeks. This is concerning because it looks like our current vaccines may be less effective against the Omicron variant than against the Delta variant. The good news though is that three doses of a vaccine (the first two doses followed by a booster dose) should continue to provide good protection from serious illness, even if current Covid-19 vaccines are a little less effective against Omicron. To help counter the threat from Omicron and limit the pressures on the NHS, the government is introducing new measures in England to reduce the risk of infection. As well as following the new rules, you should also ensure you are fully vaccinated – including receiving a booster vaccine – and use lateral flow test before attending events or meeting others from outside your household. Some people with weak immune systems will need four vaccinations before they are fully vaccinated. And remember that if at any point you develop symptoms of a possible Covid-19 infection, get a PCR test and isolate until you get the result of the test.

I’m having my family over for Christmas dinner, but some of them are unvaccinated. What should I do?

People who are unvaccinated are more likely to become infected with Covid-19 and transmit infection to others. If you have vulnerable family members – such as elderly relatives – joining you for your Christmas dinner, my advice would be for your unvaccinated relatives not to attend. If they do attend, you should aim to reduce the risk of infection by asking them to carry out a lateral flow test before they visit. You should also improve the ventilation in your house as this will also reduce the risk of infection.

My elderly mother missed Christmas last year. Can she come round this year?

People from different households can mix indoors this year, so your mother can come round. Ideally, everyone eligible for a vaccine who is present should be fully vaccinated (including boosters) and take a lateral flow event before your mother arrives. Children under 12 are not currently eligible for a vaccine. They should also take a lateral flow test as there is currently a high Covid-19 infection rate in children.

I’ve booked to go with my family of four to a West End musical over Christmas. Can we still go?

Theatres remain open. You will be required to wear a mask whilst in the theatre. Currently, a COVID pass is not needed for entry to a theatre but it is a good idea for everyone to carry out a lateral flow test before leaving home for the theatre.

My work is throwing a big Christmas party for all 50 employees. Will it still go ahead, and if so, will it be safe to go?

Christmas parties can still go ahead but many employers are cancelling them because of the risk of infection in crowded, indoor settings; particularly where ventilation is poor. A COVID pass is not required for entry to the party but if the event does go ahead, ideally, everyone attending should ideally be fully vaccinated and take a lateral flow test before the event. If you are clinically vulnerable through age or a medical condition, or live with someone who is clinically vulnerable, my advice would be not to attend the event even if fully vaccinated because of the risks from a breakthrough infection.

My department is planning a Christmas lunch with around 15 people. Is that still allowed? What precautions should we take?

Christmas lunches organised by employers can go ahead. Everyone attending should aim to be fully vaccinated and take a lateral flow test before the event. People who are clinically vulnerable – or live with someone who is clinically vulnerable – should consider missing the event.

Will my kids’ school Christmas play still be allowed to happen, and if so, what extra restrictions might there be?

School Christmas plays can go ahead. However, many schools are limiting the number of people who can join the event, meaning that parents may not be able to attend. If you are allowed to attend, you should wear a face mask and take lateral flow test before attending. Ensure that you are also fully vaccinated.

What precautions should I take when I go Christmas shopping?

Wear a face mask whilst indoors and on public transport. An FFP2 mask provides greater protection and many public health specialists advise the use of these rather than standard surgical masks. Wash your hands or use had sanitiser before and after leaving shops.

Is it safe for my children to have friends around to play over the Christmas holidays?

Children can have their friends round. A lateral flow test for everyone can help in reducing the risk of infection. Ventilation can also help reduce infection risk. Younger children (under 12) are not currently eligible for a Covid-19 vaccination.

What will happen to the Christmas Eve midnight mass we all normally go to?

Religious events can still go ahead and are exempt from the from requirements to use the NHS COVID Pass. A face mask will be required whilst indoors in the church. To reduce the risk of infection further, everyone attending should be fully vaccinated and take a lateral flow test before attending.

Will me and my mates still be able to have our traditional festive drinks evening at the pub?

You can still have your festive drinks with your friends. As the venue is likely to have less than 500 people, the NHS Covid Pass in not needed to enter. A face mask is not required either. You should remember however that indoor events like this carry a risk of infection because the venue may be crowded and social distancing will not be possible. Ensure you are fully vaccinated and use a lateral flow test before the drinks event.

A version of this article was first published in the Daily Mirror.