This post is lengthy but I make no apologies. Scroll through it if you will. I concentrate on the vexed issue of “test, test test.”
First a caveat. We must accept that western countries were much less prepared than eastern countries for another plague because they unlike the east they were barely affected by SARS . Nevertheless this fails to explain the still mystifying reasons why the UK in particular has failed to mobilise the resources that are actually available. There is either a fierce dispute raging quietly among experts or a systemic failure within government. Up to now as the most insignificant of observers, I was glad to give them the benefit of the doubt Now the doubts are deafening.
But first.. any sign of breakthrough from today’s little north-south hookup? I thought not.
The chief medical officers in the Republic of Ireland and Northern Ireland will sign a Memorandum of Understanding formalising co-ordination and cooperation between the Irish Government and the Northern Ireland Executive this week.
Big deal. It would be expecting far too much for the south to share out their scarce resources equally. We can only look on with envy.
…the Health Service Executive says it hopes to have all its testing centres open again today as supplies of testing kit are replenished.
A number of testing centres, including one of the largest at Páirc Uí Chaoimh in Cork, closed at the weekend due to equipment shortages.
Since Sunday, testing capacity has been “constrained” due to limited stock of testing kits, according to the HSE.
In addition, the agency says it has had challenges obtaining sufficient supplies of reagent for testing laboratories. “This is a global challenge with major suppliers having to ration provision across the world. We are making every effort to procure new stocks.”
By Sunday, about 38,000 people had been offered appointments for testing in community testing clinics established across the country in mid-March.
However, the criteria for testing were changed on March 24th to ensure the service was targeted on high-risk groups and those at risk of exposure to Covid-19, such as healthcare workers.
This has had the effect of reducing the number of people referred for testing.
“As the total number of people requiring testing reduces, there will be a change in the number of locations required to offer testing,” the HSE told The Irish Times in a statement.
The statement did not say how long the current backlog for testing and processing samples is. It said stock were replenished stocks on Monday “and while not all centres had sufficient supplies to recommence testing yesterday, we hope to be fully operation across all sites today”.
In addition to the National Virus Reference Laboratory in UCD, 12 hospital labs are also testing for coronavirus, as is a HSE public analyst lab and one in the Department of Agriculture.
“Discussions are ongoing with other laboratories to increase capacity. However provision of reagent and extraction kits will remain a major challenge for the foreseeable future until the major suppliers ramp up production.”
A solution along Irish lines for the UK from Julian Peto an English statistician and epidemiologist at the London School of Hygiene and Tropical Medicine, writing in the FT.
… countries can gradually relax lockdowns and let the pandemic run its course slowly, which China and Taiwan have done and the UK seems to be planning. This “flattens the curve” and prevents overload of health services. But by the time herd immunity is developed, at least one in 300 people are likely to die (about 200,000 in the UK).
A far better approach would be weekly testing of whole populations, with immediate quarantine of infectious people and their contacts. This would allow the lockdown to be released while protecting lives and controlling the epidemic.
Many say it cannot be done. But Britain may be one of the few countries that could do it immediately. Every household would receive and return self-sample nasal and throat swabs every week in barcoded tubes pre-printed with their names and date of birth. These self-administered tests would result in some inaccuracies. But this would not matter. The tests are not for the benefit of infected patients. They are to quarantine infected households earlier and so reduce the infection rate in the whole population.
To test everyone weekly in the UK, about 10m tests per day would be needed, a hundred times the government’s eventual target and 600 times more than Germany is now doing. This seemingly impossible feat may be possible if every polymerase chain reaction machine in the country is diverted to 24-hour testing.
PCR is an amazing technology that locates a particular coronavirus gene sequence and creates multiple copies that can then be easily detected. They are inexpensive. One 96-sample PCR machine, which costs well under £1,000, can test almost 5,000 people a week if it runs continuously.
Globally, that translates into ending economic disaster for a capital outlay of about £1 a head: 20p for PCR machines and 80p for reagent production and other facilities.
The UK, with a population of 66m, needs about 14,000 machines. My hunch is that the UK already has that capacity. Every biology department in every university has dozens of PCRs; the genome project at the Wellcome Sanger Institute has thousands. Most academic labs have machines that can make the PCR primers that the test requires. The limit then would be mass production of other reagents. As a first step, the government should ask every biotech firm what they can make. Recruiting every little lab in Britain with a PCR machine to do Covid-19 testing would see old PCR machines chugging alongside modern automated systems. If processing 10m tests a day can’t be achieved immediately, the programme should start in selected cities — and then expand as capacity increases. If successful, it would be a wonderful achievement.
Stopping the epidemic and the lockdown would save about 200,000 lives. That is 1 per cent of about a third of the population — the eventual number predicted to become infected under current policy. It would also save the UK billions from otherwise lost economic activity, at little cost.
I believe it promises to be at least as good, if not a better, system than South Korea’s, which has been praised for its use of intensive contact tracing, often via cell phone tracking, to control the epidemic. In Daegu, where the virus in that country originated, lockdown reduced the daily number of new cases from about 500 at the beginning of March to about 20 last week. But an upward trend may now be emerging elsewhere in South Korea.
By contrast, weekly testing of whole populations would detect new infections more rapidly and completely, and then be extended to biweekly and then monthly testing as virus prevalence falls. It would also be less intrusive than contact tracing, and guard civil liberties better.
Can more be extracted from those increasingly frustrating Downing St briefings? A tweet from former arch spin doctor Alistair Campbell
Suggestion to journalists re tomorrow briefing. Q1. Why can’t you deliver more tests for NHS workers? Q2. You didn’t answer that question. Why can’t you deliver more tests for NHS workers? Q3. You’re still not answering the bloody question. Why … till we get a bloody answer
The gist of the UK government’s reply to criticisms is twofold. Lockdown is a quicker way to reduce infection than waiting for enough testing equipment; and there is a time lag between the manufacture of personal protection (PPE) and its distribution to the front line.
Latest from today’s Downing St briefing.
Michael Gove says thousands of new ventilators will begin “rolling off the production line” this weekend, manufactured by a group of businesses including GKN and Mercedes. That’s the good news.
The bad news he says is that he UK had a lack of domestic manufacturing capacity for mechanical ventilators – vital for treating the poorest coronavirus patients – before the pandemic. These will be “rapidly distributed” to the NHS front line early next week.
Why is there is a mismatch between the claims of much more equipment being distributed and the repeated claims of inadequacy from the front line, asked Robert Peston.
Michael Gove said just now that the difficulty in increasing number of #COVID19 tests was due to a shortage of the relevant “chemical reagents”. Well I’ve just talked to the Chemical Industries Association, which represents the UK’s very substantial chemicals industry. It..has contacted its members, and they’ve said there is no shortage of the relevant reagents. So the Association has now been in touch with Gove’s office to find out what he means, because it is stumped.
The Association also points out there was an industry chat with… business minister today, who made no attempt to find out if there was a supply problem for the vital ingredients of Covid19 testing kits. So this question of why there aren’t enough tests for the virus is an even bigger mystery. Also, if it turns out there is a shortage…These manufacturers are more than happy to increase their production.
But they need to be asked, which has not happened.
So tomorrow, will you ask the government why Michael Gove lied? No long winded monologue containing several questions, just hit them with this info followed by a short, straight-forward question?
This morning the Times had an English critic of the UK government’s strategy to match Scally’s about Northern Ireland.
A former director of the World Health Organisation has claimed that existing resources weren’t being properly used. Anthony Costello, professor of global health and sustainable development at University College London (UCL), criticised efforts to increase testing and said that moving to mass testing was the key to lifting sanctions on people’s lives.
Speaking to Radio 4’s Today programme, Professor Antony Costello said a policy of mass community testing was essential to detect hotspots and eventually end the lockdown.
“In answer to ‘can we do it?, we have 44 molecular virology labs in the UK. If they were doing 400 tests a day, we would be up to Germany levels of testing and that is perfectly feasible.“Public Health Englandwere slow and controlled and only allowed non-PHE labs to start testing two weeks ago, but that was after the strategy shift to end community tests.”
He said the UK needed to be “more like” South Korea, adding: “If you look at Korea, they have done 490,000 tests. Their death rate is three per million and they have suppressed the virus.”
Asked whether Britain had capacity, he said: “I don’t see why we can’t get these 44 labs up and running, finding cases and testing.
“We must go to mass testing and when we remove the lockdown — I don’t think it will take six months, in all the Asian states it was six to eight weeks, even in Wuhan — then we will have a control mechanism which will enable us to wait, without socially distancing the whole country, and wait until we can get drugs or a vaccine for herd immunity.
“We do need a national lockdown for now but we want to get that lifted as soon as we can. Mass testing will be a way to do that.”
Public Health England was forced to apologise to Matt Hancock, the health secretary, after giving him incorrect information over the weekend, as they, the government and the NHS sought to dodge responsibility for slow progress.
It also became clear that not all the tests that could be carried out were being conducted despite huge demand from frontline staff. Fewer than 5,000 people were tested according to most recent figures, with about 9,000 daily tests carried out despite capacity officially standing at 11,000. Some people were tested more than once in order to confirm a result.
There is also so far no sign of a second test, which would show whether people have had the infection, despite official claims last week that it was in the “last stages of evaluation”.The antibody test has been described by Mr Johnson as a “game-changer” but it remains unclear whether it will be cleared for use by an Oxford University team that is evaluating it for the government.
Downing Street said it was for PHE and the NHS to answer detailed questions over the roll-out of testing. However, both agencies have passed on requests to the Department of Health.
NHS chiefs told hospitals at the weekend to start using 15 per cent of their testing capacity to check staff and their families, to avoid the need for all doctors and nurses to isolate for 14 days if their partners or children had a cough or fever.
Pressed on what the government was doing to address the shortages of test components the spokesman said it was in discussion with the industry over how to access more chemicals and swabs.
The highly absorbent swabs are made principally by two companies, Copan in Italy and Puritan in the US, which are both operating at capacity. More than ten days ago, President Trump sent a military plane to bring back more than half a million testing kits from Copan.
Testing in the UK has largely focused on hospital patients after a shift in strategy on March 13 when ministers accepted the virus could no longer be contained.
Critics including Jeremy Hunt, the former health secretary, have urged the government to test all suspected cases to help bring the epidemic under control, but the government has deemed this a “low priority”.
Photo by padrinan is licensed under CC BY-NC-SA
Former BBC journalist and manager in Belfast, Manchester and London, Editor Spolight; Political Editor BBC NI; Current Affairs Commissioning editor BBC Radio 4; Editor Political and Parliamentary Programmes, BBC Westminster; former London Editor Belfast Telegraph. Hon Senior Research Fellow, The Constitution Unit, Univ Coll. London
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