Tag: Testing

It’s time for more targeted use of lateral flow tests for Covid-19

Lateral flow tests for Covid-19 that give a result quickly are a key part of the government’s plans to manage the covid-19 pandemic in England.[1] They are required for key workers such as NHS staff; and for people following guidance from Test and Trace, either because they have a covid-19 infection or have been a close contact of a covid-19 case.  The government also announced recently that other groups of workers in essential industries would be required to carry out regular lateral flow tests.[2] This would be in addition to the tests required by other groups, such as school children.

And yet, despite their potential value, the government has been distributing the tests in a very haphazard fashion; with the outcome that many groups – such as NHS staff – are complaining that they are unable to obtain tests.[3] Meanwhile, other groups of people have been using the tests excessively – including families carrying out daily tests on each family member and in some cases, carrying out multiple tests each day. People have also been using the tests to “monitor” themselves daily after a positive PCR result for covid-19; something that is not currently required except for tests on day 6 and day 7 of the isolation period in fully vaccinated people.

As with any area of healthcare, the NHS in England has a limit on the number of lateral flow tests it can offer. Earlier this month, the government stated it was delivering 300 million tests per month.[4] However, even 300 million tests each month (around 10 million tests per day) is nowhere near enough to offer everyone in England a daily lateral flow test. Hence, an appropriate system is needed for prioritising who should have access to the tests; and how the tests are supplied to these groups. The current system whereby most people obtain their tests from the government’s online ordering system means that the tests may not always be  used appropriately or by the people who have the highest priority for testing.

The NHS already has well-established systems for prioritising access to health services. We saw this, for example, with the Covid-19 vaccination programme when early access to vaccination was based on clinical need and for occupational protection.[5] This meant that the elderly, the clinically vulnerable and those working in healthcare had the earliest access to vaccination. The same process has not happened in prioritising access to lateral flow tests. Given the high cost of supplying tests to England’s population and their limited global availability, as more countries aim to increase their own use of the test in the face of the wave of infection from the SARS-CoV-2 Omicron variant, it’s essential for the government to reconsider its policies on community covid-19 testing.

The government is in part responsible for the increased demand for testing from the public that has led to the current shortage of 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. However, it has not offered clear guidance on how frequently to test. NHS staff, for example, are only advised to test twice weekly; far less than some members of the public are currently doing even though they have no medical or occupational reason to test more frequently.

How can we improve how well lateral flow tests are used? As a first step, the government needs to decide what groups should be prioritised for testing and how frequently they should test. Once the size of these groups and their frequency of testing are known, the government can allocate a large enough sample of tests to meet their needs. Priority groups for access to lateral flow tests will include NHS staff in patient-facing roles; other key workers such as the police and fire service; workers in essential parts of the economy such as public transport; carers of vulnerable people and people working in social care; and people following guidance from Test & Trace. Tests are also needed by schools where testing of pupils is taking place.

We also need to look at the costs of supplying these tests and determine what we can afford to spend on them. 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. The same rules should apply to lateral flow tests so that the maximum benefit is obtained from spending on covid-19 tests.[6]

With the UK now 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. Lateral flow tests can play an important in England’s pandemic response but the same principles of prioritisation should apply in their use as in any other area of healthcare provision.

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

References

  1. Majeed A. Questions and Answers about Lateral Flow Tests for Covid-19.https://blogs.imperial.ac.uk/medical-centre/2021/12/23/questions-and-answers-about-lateral-flow-tests-for-covid-19/
  2. Walker P.100,000 key workers in England told to take Covid test every working day. https://www.theguardian.com/world/2022/jan/04/100000-key-workers-in-england-told-to-take-covid-test-every-working-day
  3. Majeed A. Of course England is running out of Covid tests – the strategy is a flawed one.https://www.theguardian.com/commentisfree/2021/dec/30/running-out-covid-tests-strategy-flawed
  4. Johnson B. PM statement to the House of Commons on COVID-19: 5 January 2022.https://www.gov.uk/government/speeches/pm-statement-to-the-house-of-commons-on-covid-19-5-january-2022
  5. Majeed A, Molokhia M. Vaccinating the UK against covid-19 BMJ 2020; 371 :m4654 doi:10.1136/bmj.m4654
  6. Raffle A E, Gill M. Mass screening for asymptomatic SARS-CoV-2 infection BMJ 2021; 373 :n1058 doi:10.1136/bmj.n1058.

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.

Be aware of the overlap in symptoms between colds and Covid-19

During the previous winter (2020-21), rates of colds, flu and other respiratory infections were very low across the UK because of social distancing and other infection control measures. Now that these measures have largely stopped, we are seeing an increase in respiratory infections.

The symptoms of a cold can typically include a blocked or runny nose, sore throat, headache, cough , loss of smell, sneezing and muscle aches. Many of these symptoms can also occur in people with a Covid-19 infection. Now that most adults in the UK have been fully vaccinated with two doses of a Covid-19 vaccine, when people do contract Covid-19, it is often with milder symptoms that can overlap those from a cold. This means that for many people with these kinds of symptoms, a Covid-19 test will be needed to separate the two conditions.

There will be a lot of scope to confuse the symptoms of colds and Covid-19 during the winter. The message for the public should be to always be cautious if you have symptoms of a cold, get a test when appropriate, and limit interactions with people outside your household until you are better.

You can read more about this issue in this Daily Mirror article.