One Destination, different paths: screening for Covid-19
Over the course of the current Covid-19 crisis, the importance of reliable, accessible testing to screen for the disease has become increasingly apparent.
Lateral flow tests (or rapid tests), offering accurate results in as little as 10minutes, are increasingly becoming pivotal to the UK government’s strategy to reduce the spread of the coronavirus by identifying asymptomatic patients, and for re opening the UK economy.
According to the British Medical Journal, over 384 million kits have been ordered by the UK government at a cost of over £1.3bn (€1.5bn; $1.8bn) [1], but there are still concerns over the accuracy of some of these tests, which has led to the UK Government becoming reliant on PCR testing, which is a laboratory based polymerase chain reaction (PCR) tests which is often seen as the “gold standard”.
However, PCR testing, has to date, generally been seen as unsuitable for mass screening of the population given, the time taken to test, are relatively expensive per sample, and are not very portable, because of the need for laboratory processing.
With the new government drive to increase workplace testing in sectors open during lockdown, to detect coronavirus (COVID-19) in people who are not showing symptoms, and Cabinet ministers being tasked to encourage their sectors to take up the offer of rapid workplace testing, marking efforts to normalise testing in the workplace across both public and private sectors, we are entering the new dawn of testing.
Is your business ready for what’s coming?
With the UK vaccination programme progressing at a pace, the UK Government departments are now being tasked with ensuring targeted, rapid testing is set up in all key workplaces to ensure vital public and economic services can continue
According to the Department for Health and Social Care (https://www.gov.uk/government/news/government-boost-to-rapid-workplace-testing) the Government is now looking to drive workplace testing, with the criteria for workplace testing programmes targeted at businesses with more than 50 employees.
The PMs “Build Back Better” has already led to many employers already taking up the offer of rapid, regular workforce testing, with 112 UK organisations across almost 500 sites joining government backed rapid testing.
Health Secretary Matt Hancock said:
“To save lives and protect the NHS, we have again asked for everyone to work from home. But we know that for some this is not possible, which is why the workplace rapid testing programme is so important.
“Employers should regularly test their staff, and this drive across government to raise awareness and encourage more businesses to introduce rapid testing for employees is incredibly important. When you consider that around one in three people have the virus without symptoms and could potentially infect people without even knowing it, it becomes clear why focusing testing on those without symptoms is so essential.
“We are already working with many employers to scale up workforce testing, spanning the food industry, retail sector, transport network, and across the public sector too. I strongly urge businesses and employees across the country to take up this offer of rapid testing to help stop this virus spreading further.”
An online portal has been already been launched to make it even easier for business in the private sector to get involved and find out more about offering rapid testing in the workplace.
https://www.gov.uk/get-workplace-coronavirus-tests
https://www.bbc.co.uk/news/uk-55967069
See our link to the Employers Guide to Workplace Testing here: https://www.peoplemanagement.co.uk/experts/advice/employers-guide-to-workplace-covid-testing#gref
However, according to FTI Consulting plans for a speedy expansion of the UK’s rapid testing capability have been revealed, aiming to deliver 400,000 rapid lateral flow tests to homes and workplaces daily, creating the biggest ever British Sovereign test and a new global diagnostic industry. https://www.fticonsulting-emea.com/insights/featured-perspectives/covid-19-weekly-uk-public-affairs-roundup
However, with UK capacity limited, and the creating of the new UK Rapid Test Consortium – UK-RTC involving the biggest UK manufacturing providers such as BBI Solutions, Abingdon Health and Omega Diagnostics likely to be working at full capacity to achieve the currents target from April 2021, supply to the private sector could be severely limited.
Unlocking the Economy: PCR v Lateral Flow – Debunked
If you have recently been tested for Covid19 it is likely you will have taken a PCR test.
The Polymerase Chain Reaction (also known as PCR) test is administered by a fully trained and qualified healthcare professional in a medical or laboratory setting, rather than by the person being tested. The need for results to be interpreted by a trained and qualified healthcare professional is also key.
PCR tests give you a fairly accurate indication of whether or not you are infected with coronavirus.
Whilst PCR testing has been, and remains the corner stone to controlling Covid 19, it is generally deemed unsuitable for unlocking the UK economy, and the reopening of business and leisure.
Pros
Minimally invasive – performed using nasal swabs, throat swabs and tests of saliva or other bodily fluids
Allows for social distancing – while some molecular tests, including RT-PCR, are sometimes conducted at a hospital or clinic, swabs can also be taken from the patient’s car or at home
Fewer false negatives in some instances – deep nasal swabs will have fewer false negatives compared with other tests, such as throat swabs or saliva tests
Cons
Long turnaround times – in some instances, RT-PCR tests can yield results in the same day or within one to two days, but test results taking up to one to two weeks have been reported during the pandemic
False negatives – molecular tests have been shown to produce results that say the patient doesn’t have the virus when they actually do; the rates of false-positives have ranged from 2% to 37%
Uncomfortable for some people – deep nasal swabs can be uncomfortable for some people, especially small children
Furthermore The Journal of Clinical Microbiology https://jcm.asm.org/content/58/6/e00512-20 recently compiled a paper highlighting many challenges we face with PCR, further identifying its unsuitability for mass testing and unlocking global economies, given the fact that after collection, swabs should be placed in viral (universal) transport medium for rapid transportation to the clinical microbiology laboratory, ideally under refrigerated conditions, and many adults find it difficult to take the test given the swab must be inserted deeply into the nasal cavity.
So how do Lateral Flow (Rapid) tests compare?
Simple, accurate and cheap mass screening is increasingly becoming the focus of the UK Government, with the likes of the British Medical Journal stating that “lateral flow tests are pivotal to the UK government’s strategy to reduce the spread of the coronavirus by identifying asymptomatic patients” https://www.bmj.com/content/372/bmj.n287 and The Times recently reporting a “Mass testing blitz as Boris Johnson plans easing of lockdown” (https://www.thetimes.co.uk/article/hz-splash-17-hsc-xz3dpdnvx) with the NHS Test and Trace preparing for nationwide “surge” testing under which more than 400,000 rapid lateral flow tests will be sent by post to homes and workplaces every day, with the aim of getting the country to “a new normal”.
The lateral flow antigen test (also known as LFD) on the other hand is a much different test.
These lateral flow tests (or commonly called Antigen Tests) involve taking a swab sample from your nose and/or throat. The sample is then analysed for specific spike proteins. If these proteins are found, it means you are infected with coronavirus now.
However, lateral flow tests have not been without their criticism.
Operation Moonshot, a mass testing scheme championed by the prime minister’s former chief adviser, prompted the government to buy huge numbers of so-called lateral flow tests from Innova Medical Group, spending close to £1 billion on these tests
However, as the UK diagnostic industry evolves, the accuracy of tests improves, with the likes of Avacta Plc currently validating the worlds most accurate lateral flow test at Public Health England Porton Down facility (https://avacta.com/results-of-initial-evaluation-of-sars-cov-2-lateral-flow-antigen-test-with-clinical-samples/) , showing a clinical specificity of 100% which forms part of possibly one of the most transformational tests globally, with the controversial Test and Trace service’s £22bn budget now going on testing rather than contact tracing, with nearly 90% of its £7bn extra from the Treasury going on lateral flow tests alone.
Lateral flow assay (LFA) based diagnostic tests are widely used for point of care (POC) and consumer/self-testing, due to the combination of rapid results with cost-effective testing, achievable by non-specialists. The most well-known application are pregnancy tests. The Clearblue test was the first commercial application of lateral flow technology, in 1988
The WHO has issued specific advice around the current status of Point of Care testing for Covid 19 (https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19)
See how Lateral flow tests work: https://youtu.be/MDGI82cLLTw
PCR v Lateral Flow : Unlocking the Economy
The UK Parliament posted in January 2021 “A test for mass screening would need to be sensitive enough to detect infected people; but very high specificity becomes much more important if tests are used to screen lots of healthy people.” https://post.parliament.uk/mass-testing-for-covid-19-january-update-on-lateral-flow-tests/
This has led to the likes of The World Health Organisation recently launching, the WHO R&D Blueprint which was activated with the aim of accelerate diagnostics, vaccines and therapeutics for this novel coronavirus (https://www.who.int/teams/blueprint/covid-19), along with global Governments partners working collaboratively in order to expand on our testing capabilities.
With the advancement in global diagnostic developments “Oxford University and PHE confirm lateral flow tests show high specificity and are effective at identifying most individuals who are infectious” https://www.ox.ac.uk/news/2020-11-11-oxford-university-and-phe-confirm-lateral-flow-tests-show-high-specificity-and-are and John Bell, Regius Professor of Medicine at Oxford University (https://www.medsci.ox.ac.uk/divisional-services/staff/regius) recently stating in regards to the Preliminary report from the Joint PHE Porton Down & University of Oxford SARS-CoV-2 test Rapid evaluation of Lateral Flow Viral Antigen detection devices development and validation cell: (LFDs) for mass community testing , that he believes ‘The data in this validation report demonstrates that these inexpensive, easy to use tests can play a major role in our fight against COVID 19”. It appears we are on the right path for community and business mass screening.
Link to report: https://www.ox.ac.uk/sites/files/oxford/media_wysiwyg/UK%20evaluation_PHE%20Porton%20Down%20%20University%20of%20Oxford_final.pdf
Whilst PCR testing is seen as the “Gold Standard” of testing due to its accuracy, it will always been unsuitable for mass screening, and reopening the economy.
Lateral Flow tests, are seen as cheap, accurate and easily accessible
The Coronavirus glossary: Every COVID-19 related term you need to know
Steve to insert some key laymen terms
https://www.immunology.org/coronavirus/connect-coronavirus-public-engagement-resources/covid-19-testing-infographics
Keep up to date with the latest Covid Statistics here https://coronavirus.data.gov.uk/
[1] https://www.bmj.com/content/372/bmj.n287