Many healthcare workers will have breathed a sigh of relief on hearing that rapid diagnostic tests (RDTs) for covid-19 will soon be available.
To date, nearly 100,000 people have been tested with nose and throat swabs, of which approximately 10% were positive. Generally, the tests have been restricted to those sick enough to be admitted to hospital. The government has defended this approach, saying that “testing is not needed if you’re staying at home.” With limited capacity, this strategy makes sense, but many healthcare workers have questioned why they must also self-isolate rather than being tested, when their symptoms of cough or fever might be due to other causes, and they could return to work sooner.
One reason for taking this approach to healthcare workers might relate to the accuracy of the methods of testing at present, with some preliminary studies and many anecdotal accounts (some reported here) querying high levels of false negatives. A falsely negative test could result in a reassured healthcare worker returning to work while still shedding the virus, potentially infecting very vulnerable people.
This is why antibody testing could be a game-changer for the workforce. The accuracy of these tests still needs determining. But if they are able to sensitively detect IgG antibodies to covid-19, healthcare workers can reasonably assume they have immunity of some duration, allowing them to return to work safely.
The announcement on Monday during Public Health England’s evidence to parliament that the 3.5 million RDTs the Government has recently purchased will be available “within days” is therefore welcome.
However, the announcement was also worrying, with PHE suggesting that the testing could before long be made available online and in chemists. The Chief Medical Officer clarified that the tests are not something we will “suddenly be ordering on the internet next week”—but any availability of the tests to purchase over the counter, given their scarcity, warrants scrutiny.
It must not transpire that young, well-off, able-bodied people are able to panic buy the tests at the expense of others. With an increasing number of cases of severe illness and death from covid-19, the inverse care law needs to be at the top of the minds of doctors and decision makers. Testing for covid-19 must not be more readily available for those who have the easiest access to it. The roll-out must be progressive.
The epidemic has exposed more brutally than ever that, in a free market, opportunities to access certain goods are dangerously unequal. 1.5 million people are supposed to be in “shielding” mode, leaving many unsure of how they will get food and medicine without leaving the house. Many more—elderly people, disabled people, and others with chronic illnesses—have struggled to meet their basic needs while others have been stockpiling. Meanwhile, a doctor in London has been accused of making £1.7 million in profit from allegedly selling tests at £375 each. Across even the right-wing press this has been denounced.
Doctors and the general public have also queried how Idris Elba and the Duke and Duchess of Cornwall have been tested for covid-19 when they have all been described as having mild symptoms or none.
NHS workers—including cleaners, caterers, porters, nurses, doctors, managers, physiotherapists and many, many more who hold the health service afloat—need prioritisation for testing. Only this way can the workforce challenges be overcome and those most vulnerable to severe disease from covid-19 be assessed and treated in adequately staffed hospitals and surgeries.
Alongside testing these workers, the various testing approaches available—antigen and antibody—should be used in a way which detects infection efficiently and protects the most vulnerable. It is concerning that it appears that some testing might not be co-ordinated centrally, or perhaps not even by the health service at all. The equitable distribution of healthcare resources is what the NHS was built for, and the new commissioning role of NHS England hints at how testing might be done in a way that avoids a postcode lottery. Low risk, asymptomatic people should be carefully assessed, but not initially prioritised for testing. Of course, when tests become more widely available, the response can adapt and more aggressive testing strategies can take over.
The World Health Organization director general, Tedros Adhanom Ghebreyesus, last week called for countries to “test, test, test,” and it seems that the resources are beginning to meet this call in the UK. It is worth holding on to hope that the first wave of RDTs in the coming weeks will have a significant impact, but that impact must be felt across society.
Joseph Freer is an NIHR Academic Clinical Fellow, Institute of Population Health Sciences, Queen Mary University London. He worked at The BMJ as the editorial registrar and Clinical Fellow, Faculty of Medical Leadership and Management, 2016-17.
Competing interests: None declared.