Governments must rapidly test a very large percentage of their populations to fight coronavirus. This note – part of our series on using technology to fight Covid-19 and cushion the impact of the crisis it has caused – sets out the technologies that governments must focus on and the steps they must take to roll out testing on a large scale.
Developed-country governments should immediately redirect all relevant technology, engineering and manufacturing capacity towards mass production of rapid-testing capabilities.
Governments should develop digital tools to support community testing, help prioritise when testing capacity is limited and enable people to prove immunity.
Governments should leverage private-sector logistics capabilities to get tests out to households.
The World Health Organisation director-general Tedros Adhanom has rightly stated that countries fighting the coronavirus should “test, test, test”. As we have argued in our primer on Covid-19 Testing in the UK, moving towards mass testing is essential for both getting people the treatment they need now and for eventually easing lockdown measures and enabling people to get back to work. Weekly testing of whole populations would allow immediate quarantine of those infected and allow lockdowns to be gradually released. There are several challenges to achieving this goal, but many can be overcome by applying technology in the right way.
Our findings are primarily relevant to developed countries, which already have the basic equipment, supplies and human resources in their health systems to respond with robust surveillance, isolation and treatment of Covid-19. The Institute is also working with governments across Africa to advise on how they can tackle this unprecedented crisis with the limited resources at their disposal. These governments must also build a pipeline of testing capacity and seek innovative local solutions where possible, but inevitably immediate efforts in these contexts on the technology and manufacturing front must also be on manufacturing PPE and ventilators and using technology to accelerate contact tracing and surveillance. The Institute has published tailored advice to African governments on how to prioritise their efforts.
There are two main types of tests – a PCR test and an antibody test.
The PCR test tells you if you currently have the virus by locating a coronavirus gene sequence and creating multiple copies that can be easily detected. It is typically carried out by a nose or throat swab.
The second type of test – an antibody test – can tell whether you have had the virus by looking for the Covid-19 igG antibody in the blood. It is carried out via a finger-prick blood test. Although scientists are confident that we can develop some level of immunity to Covid-19, it is still unclear how long this immunity lasts. It is also still unclear whether antibody tests are sophisticated enough to detect the extent of a person’s immunity. Countries such as China and Singapore have used these tests to see how the virus has spread.
Worldwide testing has been inconsistent. South Korea and China have tested hundreds of thousands of cases, whereas the US, UK and other European countries have conducted relatively low levels of testing. Countries who have conducted widespread testing have typically been able to contain the virus more easily.
1. Developed-country governments should redirect all relevant technology, engineering and manufacturing capacity towards mass production of rapid-testing capabilities.
To truly tackle Covid-19, an extremely large number of people will need to be tested, which will require a huge number of tests. However, countries like the UK and US still lack necessary testing capabilities. Governments have reported that a lack of chemical reagents that extract viral RNA from nose or throat swab samples is a major constraint to producing tests on a large scale. Yet governments that started planning testing capabilities early have managed to secure more of these essential resources.
As an urgent priority, governments need to work with partners from a variety of industries to mass produce rapid-testing capabilities. Governments should first leverage any existing tech available, for example on hospital campuses. Mobilising the private sector will also be key. There are multiple scientists and biotechnology companies around the world who are working to develop new tests that can produce results more quickly. For example, BioMedomics claims it has a “quick and easy” finger-prick test that can detect Covid-19 antibodies. Scientists at Oxford have developed a test which can produce accurate results in half an hour. Given the significant economic impact of Covid-19, and the potential of widespread testing to ease this impact by allowing people to return to work, governments should provide significant financial support to the private sector to encourage innovation and ultimately increase testing capabilities. Governments should also offer regulatory support and consider granting fast-track approvals for testing kits, although it remains essential to ensure that testing kits are still highly accurate.
In addition to developing and manufacturing tests, governments will need to explore and invest in innovative ways of conducting tests. South Korea has used phone booths, where a medical professional on the opposite side of a glass wall uses a handset to communicate with the patient, to increase its testing capacity. Spain has said that it has designed a plan to automate tests through robots. Policymakers should explore similar innovations and work with the private sector to achieve them.
2. Governments should develop digital tools to support community testing, and to help prioritise/triage when testing capacity is limited.
Once effective tests are developed and manufactured, governments face a logistical challenge: how to deploy testing kits widely to test potentially millions of people. To carry out mass testing at scale requires a great deal of coordination, which is best achieved by harnessing technological solutions. Some countries are already using technology to coordinate testing capabilities. South Korea, which has been named the gold standard for testing, has deployed a smartphone app to provide details of the virus’s spread. This data is used to inform medics, who pitch tents on roadsides and provide free drive-through testing to residents. In the US, a division of Alphabet has set up a trial website to direct people to testing facilities in the Bay Area, however the website is currently limited in scope.
Hospitals cannot afford to be overwhelmed by people asking for tests. Therefore, to coordinate community testing on a large scale, governments should support the development of digital tools. This might include an app or user interface to coordinate the roll out of tests. Volunteers or public-sector staff should be able to register their availability, and citizens should be able to book tests and be directed to relevant testing facilities. Digital tools should also enable people to receive test results and appropriate advice on subsequent self-isolation measures. Governments should work with private-sector organisations to develop these tools and promote them for use by health-care professionals and the public.
Prioritisation of Tests
In the absence of enough tests for the whole population, testing will have to be prioritised. Many governments already have a sense of who should be given priority. Testing health-care professionals, for example, is essential to prevent workforce shortages. Governments should support the creation of a user-friendly digital service so priority groups such as health-care workers can easily register for testing. They will also need to design an appropriate testing system for the entire population. Digital tools such as apps or user interfaces could be designed so individuals can register a range of factors such as job title, location and symptoms, to inform how testing should be appropriately prioritised. Graduate students from the Asian Institute of Management have created an app to identify people who need testing by enabling citizens to answer a survey that follows an algorithm that medical practitioners use for triage of people with possible infection. This will help the Department of Health and hospitals maximise their resources by prioritising patients. Of course, the feasibility of this solution depends on mobile penetration, meaning it is best suited to developed countries.
Digital Methods to Prove Immunity
For lockdown measures to be lifted, it will be necessary for people to prove that they have had the virus and have consequently become immune. Germany is researching the possibility of issuing immunity certificates to people to prove they have previously had the virus and can go back to work. For convenience, governments should consider providing people with digital cards, potentially via an app, on phones (similar to a digital rail card). Alongside this measure, public-information campaigns would be essential to prevent people trying to contract the virus with the aim of getting back to work.
3. Governments should leverage private-sector logistics capabilities to get tests out to households.
To achieve the goal of testing on a mass scale – perhaps on a weekly basis for large populations – it’s essential to make testing as easy and convenient as possible for citizens. Home testing is therefore key to a successful testing strategy. The most effective method of home testing is to leverage the logistics capabilities of private-sector organisations to get tests to households as quickly and efficiently as possible. For example, governments could work with Amazon fulfilment centres and its distribution network to deliver and pick up tests. The UK government has recently reported that it is in talks with Amazon and other companies to use their services to deliver tests to frontline health and social-care workers. Other countries should follow suit and form similar partnerships. Home-delivery should be rolled out for entire populations.