Alan McNally: It is hard to understand the logic behind the government’s new testing strategy

Late in the evening on Wednesday 2 September, Matt Hancock, the secretary of state for health and social care, announced a range of new testing initiatives. These are aimed at improving the United Kingdom’s covid-19 testing capacity and infrastructure as we approach the autumn/winter respiratory infection season. This £100 billion “moonshot project” includes funding for pilot projects investigating the feasibility and efficacy of community wide testing schemes in Southampton and Salford, and the validation of “rapid and portable” diagnostic tests, promising test results in 20 minutes and capable of being delivered from mobile test units.

And yet this announcement came on the very day that millions of children around the country returned to school. Schools reopened last week, despite the absence of any transparent covid-19 surveillance plan to support the commencement of full time education. And just a few weeks before universities across the country began to attempt to deliver something like a student experience to hundreds of thousands of students migrating from all across the country to their chosen place of study. Again, this all happened in the absence of a clear and concerted effort to support this return with appropriate testing and contact tracing for covid-19. And it came just days after the government’s clear message that the UK workforce had to return to their offices and places of work to help support the economy. 

In March this year, I was seconded from the University of Birmingham to help lead the development of the Milton Keynes Lighthouse testing lab, becoming Infectious Disease lead and a shift manager. When I left the lab in June, it was capable of delivering 30,000 covid-19 PCR swab tests per day. At that time, the UK was, relatively, covid secure. That was the time when the government should have seriously implemented wider surveillance and community testing pilots in order to be ready for winter, At that time prevalence was low and the lower pressure on the system would have allowed for trips and stumbles during a research pilot phase. It would have left plenty of time to deliver a coherent community testing and surveillance strategy as schools, universities, colleges, and businesses returned to action. I personally suggested this to the Department for Health and Social Care and the wider Lighthouse management structure at more than one teleconference, but it appeared to fall on deaf ears. Questions have to be asked as to why we are only now running two small scale community testing pilots, at a scale involving just a couple of hundred tests per day. Particularly when there are already public data, for example the Norwich surveillance collective at the Earlham institute, which show the scale at which this can be performed and its clear benefits.

The lion’s share of the “moonshot” funding is underpinning the validation of “rapid” diagnostic methods, such as a quicker “20 minute” saliva test, which the government appears to have invested its entire faith in for the upcoming winter. This rapid swab-to-test device is said to be capable of detecting SARS CoV-2 in 20 minutes, although no data are publicly available to scrutinise this. However, it is currently only being developed for deployment in hospital labs, who already have a range of validated and kite-marked rapid diagnostics for respiratory infections and for whom this represents virtually no improvement on their current testing capacity. Its true that saliva is a less invasive and more pleasant sample to provide than the current nasal and throat swabs, however anyone who has ever performed high-throughput diagnostics will tell you that sample consistency and uniformity is key to automating diagnostics, and that saliva samples differ enormously from person to person, making them extremely difficult to automate. 

As a seasoned academic researcher I would never belittle any funding poured into infectious disease research and development. However, it is hard not to feel this “moonshot” has wildly missed the moon. Working on a rough but well-informed cost estimate of £15 per test, the initial announcement of £500M could have funded around 33 million standard swab PCR tests that could have been run in well-equipped university labs with existing experience and expertise while widening the network of mobile and walk-through test centres feeding into these satellite labs. As a scientist I am always happy to debate and refresh opinions and ideas, but as I struggle to find a way to get our Institute back up and running coming into winter, I find it hard to understand the logic behind the government’s new strategy.

Alan McNally is professor in Microbial Genomics at the University of Birmingham

Competing interests: I confirm I have no competing interests