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How to scale up Britain’s coronavirus testing

PHE has allowed the perfect to be the enemy of the good

After a day of scathing media coverage of the government’s handling of the coronavirus, Health Secretary Matt Hancock has committed to a “significant increase in testing” with a new five-point plan.

Not only will the Government finally reach its 10,000 tests per day target and deliver those promised antibody tests – they will also build new capacity using partnerships with universities and pharmaceutical and diagnostic companies to build up to 100,000 tests per a day by the end of the month.

Lives are on the line and this couldn’t come soon enough.

Yesterday the Adam Smith Institute released a report tracing this fiasco to early decisions by Public Health England to centralise testing – at first, insisting on a single laboratory and a single testing method. It wasn’t until mid-February that the entire PHE network was activated. It was later still when NHS labs could test.

This was in stark contrast to Germany, South Korea, and later, the United States, all which have embraced a decentralised network of laboratories and a variety of methods to rapidly ramp up testing.

Early on, lack of testing severely limited the ability to undertake contact tracing and spot the emergence of the outbreak. Precious time was lost. And we have now fallen to the bottom quarter of testing per capita in the OECD.

The UK doesn’t even have the testing capacity to get essential NHS workers back to the front lines, let alone the capacity needed to move from broad-scale social distancing to targeted interventions that involve spotting and preventing potential outbreaks in the community.

From the start, PHE’s approach has been excessively protective of their turf. They have dismissed private testing and rebuffed a multitude of offers from private, charity and university laboratories.

Worryingly, PHE has requisitioned machinery from capable independent labs for new centralised testing facilities. This process has been cumbersome and much slower than simply asking these labs, which are staffed by some of the world’s leading professional scientists, to do the tests.

PHE guidelines also mandate the precise chemicals and equipment that must be used to test for COVID-19. This rules out thousands of machines capable of doing the pretty standard PCR test process. Many of the private labs also have some stocks of the precious reagents. Central control has come at the cost of scale and speed.

Despite defensive claims by the Government, there are substantial private sector resources that can be tapped. For example, the UK does have Randox, one of the world’s leading diagnostic firms. Randox claims to have developed a test that can report 540 results in less than 5 hours, as well as identify and differentiate between strains of coronavirus. This home-grown test isn’t being used by PHE or the NHS.

The perfect has been allowed to be the enemy of the good. In normal times testing is highly standardised to ensure careful tracking, quality control and verification. This often means using a single type of machine, following a single protocol, and using the same chemicals.

But these are not normal times. We need scale, and we need it fast. This can only be achieved with lots of different methods, and activating the thousands of machines and people that are willing to help. PHE should follow a whatever works approach; the usual processes are too slow when lives are being lost every day.

Caroline Plumb of the Covid-19 Volunteer Testing Network, a civil society group coordinating labs who are capable of undertaking tests, explains that “the Government needs to take a more pragmatic approach”. She says that “while the best solution would be highly prescriptive and standardised, we have to recognise that there is a trade off that has to be made and it needs to be struck in a different place.”

Many of the labs linked to the Covid-19 Volunteer Testing Network are currently unable to undertake official testing.

While Hancock’s five-point plan is a welcome step forward, we are waiting for the specifics about approving more processes, machinery and testing types. Fast-tracking this process is essential if the Government is to reach their ambitious 100,000 tests per day target.

There is no time for usual bureaucratic delays or power grabs. PHE must stop trying to do everything themselves, we need to fast-track approval of companies, universities and charities. Importantly, we should be using every type of machine and every type of reliable test.

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