One year ago, Tony Blair called on the government to introduce nationwide mass testing. At the time, it was highly controversial and the premise disputed. Roll forward 12 months and many countries are now basing a core component of their response to the virus on mass testing.
What is the state of play on testing in the UK?
The UK is now conducting lab-based PCR tests for those with symptoms of Covid-19. Alongside this, mass rapid antigen testing is being rolled out to detect asymptomatic carriers of the virus, which can account for around a third of cases.
Rapid tests have been subject to significant criticism over the past year but we have been consistent and clear that they form a critical element of the overall testing picture. In fact, they are now the backbone of the UK’s testing regime.
As we recently reiterated, rapid tests are well suited to detecting asymptomatic contagious carriers of Covid-19. As they are less sensitive than PCR tests, they pick up Covid-19 carriers with a higher viral load, meaning they are contagious. This is ideal for surveillance testing.
As society slowly reopens from the third national lockdown the frontline of testing is currently in schools. We argued in January that the government should accelerate vaccination of key workers like teachers. This plan was not adopted, which leaves testing in schools the core defence against rising transmission of the virus.
How is testing in schools done?
Students and staff now test regularly with rapid tests. Secondary and college students are testing twice a week with a lateral flow test. Primary school pupils are tested less often due to lower levels of transmission between younger children.
The same process applies in independent schools. Private schools, however, have for some time been using testing. Eton College, for example, tested all staff and students before term in autumn 2020. Highgate School did the same before the return of pupils this March, testing all 1,200 students – a process they have repeated since and plan to repeat after the Easter break. A private school in Kent even purchased a £35,000 rapid-testing machine, overseen by the school nurse.
Coupled to this the government has put in place twice-weekly testing with rapid tests for the families of primary, secondary and college children. This testing process has now been widely rolled out.
The latest weekly data on schools testing (4-10 March 2021) shows the following:
7 million tests were conducted in secondary schools, with 2000 positives.
800,000 tests in primary schools with 500 positive results.
At present all schools are using Innova rapid tests. According to Public Health England, this test has a false positive rate of 0.1 per cent, however this will be higher both in practice and when prevalence of the virus is lower, as it is now.
So, how is the process going?
In the spirit of the academic setting in which testing is being done, we give the government a B minus for schools testing.
It is to their credit that they have rolled out rapid testing in the way we have been arguing for a year. Rapid antigen testing will be critical in identifying asymptomatic contagious carriers of the virus and limiting transmission in schools. When the government set up the schools-testing regime, they did the best with the tools available but there is room for improvement.
How can we get from B minus to an A?
Confirmatory PCR tests. We have no clear picture of how many of the positive results identified with antigen testing are false. This is because follow-up PCR testing is not being conducted systematically. With case numbers so low at present, we believe follow-up PCR tests are important, not just to ensure people are isolating when they really need to, but so we have a true overall picture of how rapid tests are doing.
Test to release. When someone is sent home to isolate after a positive rapid test, they should be able to access further tests during the isolation period and leave once they are negative. The same should apply to those identified as a close contact of someone positive and therefore asked to isolate. They should also have access to testing and, if clear, be allowed out of isolation. A trial is currently planned for daily testing of contacts in 200 schools after the Easter holidays. This should be copied and rolled out across the school system.
Expand tests. Innova was the only test available when rapid testing was rolled out in schools. It is a solid choice but there are several other tests and technologies available that can improve the quality of testing. We urge the government to roll these out in schools.
Best practice. Ensure best practice in testing methods across schools. This will require a mixture of better training of those conducting the tests and introducing cutting-edge AI and machine-learning tools to better identify correct/incorrect results.
Roadmap.The government should give urgent thought to and publish a roadmap for this testing. What is the intention for how long it will continue to be carried out? What prevalence rate of the virus in schools would mean this widespread testing is no longer required or indeed viable.
In the spirit of a good school report, we congratulate the government on getting mass rapid testing moving at speed in schools but also offer suggestions for improvement to get to best-in-class practice.