How CAN we fight the virus if we don’t know who’s got it?
As Boris faces urgent calls to ramp up tests to lock down infection hotspots...
WE ARE entering the eye of the storm. As Britain’s death toll from the Covid19 pandemic moves ever closer to 200 and cases top 4,000, the country is poised to become a ghost nation.
Transport is being scaled back, and schools, pubs, restaurants and cinemas are closed.
The past seven days have marked a significant escalation in the Government’s response to the worst health crisis in a century as Ministers urge unprecedented social distancing measures to curb infections.
But some of the world’s leading experts are issuing dire warnings that the UK has acted too little, too late. At the very heart of their criticism is the Government’s failure to test those with symptoms of the virus.
The World Health Organisation has been at the forefront of this backlash, pointedly urging countries like the UK to ‘test, test, test’ and insisting it ‘cannot fight a fire blindfolded’. Yet our strategy is that only the most severe cases admitted to hospital with respiratory problems are being screened for Covid-19, mainly to prevent the spread among the vulnerable on wards.
Meanwhile, doctors and nurses risking their lives on the NHS front line are also struggling to be tested. Boris Johnson and his senior advisers have, largely, been applauded for ‘following the science’ – yet it seems confidence is now waning in their approach as the number of cases soars.
Former health secretary Jeremy Hunt told the Today programme yesterday morning that a ‘huge national effort’ was needed to perform more tests, claiming the UK had to ‘do a huge amount more’ to save lives.
Infectious diseases expert Dr Bharat Pankhania from Exeter University, says: ‘This is the most serious situation the Government has faced with regard to the health and wellbeing of its population, and they have to unleash everything they have to control it.’
Social media is awash with people who claim they have symptoms but have no way of knowing whether they’re infected, or whether i t’s something more benign like the common cold.
Meanwhile, celebrities and sports stars, including Luther actor Idris Elba, confirm they have been tested positive. And thousands who can afford it are paying £375 for a private test from a Harley Street clinic.
Positive steps are now being taken. On Wednesday, the Government announced plans to increase the number of tests it performs to 10,000 a day by this week, and then up to 25,000 over the next four weeks. But Sir Jeremy Farrar, director of the Wellcome Trust, said a ‘ massive roll-out’ of tests – beyond 25,000 a day – for NHS staff and the community was ‘critical’.
There are also likely to be other new tests available in the coming weeks which could reveal not just those infected, but whether you’ve ever had the infection – and are now immune. But what does all of this mean – and will you be eligible for the tests? And, crucially, is it enough?
When the first cases of Covid19 emerged on UK soil in January, those with symptoms were urged to contact 111, the NHS non-emergency helpline.
Tests, initially fewer than 100 a day, were only offered to those who had returned from an affected country or had been in contact with a known case. The test itself, known as rt-PCR, involves swabs of the nostrils or throat. Each costs a couple of pounds.
Genetic material from t he swabs are examined for ‘signatures’ of the coronavirus – tiny bits of the virus’s DNA.
Results take a couple of days and are highly accurate.
It was developed by Government scientists after the SARS pandemic in 2004, and was ready to test for Covid- 19 – essentially a new form of SARS virus – as soon as China published the gene sequence of the new infection. The main point of testing in the midst of a pandemic is twofold: to diagnose people, but also to understand how far the virus has spread, which is known as surveillance testing.
This can involve testing people without symptoms who may still be infected.
But on March 12, the Government said it was ‘no longer necessary for us to identify every case’. It moved from ‘containing’ the virus to ‘delaying’ its spread – which meant testing only those with the most severe symptoms.
Teams trained to provide drivethrough testing facilities at sites across the country were disbanded. Some tests are still being carried out in residential community settings such as care homes and prisons to protect those small populations. And around 100 key GP practices are engaged in ‘sentinel’ screening – randomly testing patients to allow the Government to build up a picture of how the virus has spread. But otherwise, the true picture of the infection rate is unknown.
Anyone with the main symptoms – a new and persistent cough, and a fever – has been urged to self-isolate for seven days. Those l i vi ng with an infected person are being told to self-isolate for 14 days, in case the virus is passed on.
Professor Jonathan Ball, a molecular virologist at Nottingham University, said this advice doesn’t go far enough. ‘To have any impact on the spread of this virus, there has to be more widespread testing out in the community,’ he s ays. ‘ There is emerging evidence that in as many as 70 per cent of cases, the infection will present with symptoms similar to a common cold.
‘This is serious, as it means that most people who can potentially transmit will not be aware of the risk they pose to others and will not self-isolate.’
The Government’s latest aim, announced last week, is to carry out 25,000 tests a day within a month, and it appears to be a bid to address these concerns.
Dr Rupert Beale, group leader in the Cell Biology of Infection Laboratory at the Francis Crick Institute, says it is a ‘ crucial part of an effective response to the pandemic.’
DR Pankhania says there was ‘no shortage’ of testing kits and experts were told in government briefings earli er this month that there was capacity to perform 30,000 a day.
‘Then, suddenly, there was an about-turn on community testing – I don’t know why,’ he adds. ‘I don’t think it’s about capacity.’
On Thursday, the UK’s chief scientific adviser, Sir Patrick Vallance, insisted to MPs that ‘we don’t have mass testing available now’ and that ‘ when you only have capacity to do a certain number of tests’, you have to prioritise the most vulnerable. Officials say new machines are to be brought into NHS labs to boost
numbers of tests, and the Government is also said to be looking at whether university and private sites could be used to expand capacity. It is still unclear who will get access to the additional tests when they are finally offered.
Mr Johnson has said healthcare workers will be a priority so that they can continue to work and not self-isolate unnecessarily. But there are still no official plans which detail how this will be done. Meanwhile, doctors have taken to social media to complain about the risks they face, while some hospitals are said to be acting unilaterally, ordering their own tests to prevent staff shortages.
Dr Pankhania says key workers – such as those involved in providing essential services including food deliveries, electricity and gas – should also be tested. Proof of how vital testing is can been seen by looking overseas. South Korea has carried out more tests than any other country – 4,000 per million residents, four times as many as Italy. Up to 20,000 are carried out a day and anyone who wants a test can visit one of 50 drive-through testing stations.
South Korea has recorded almost 8,800 cases – more than double the UK total – but far fewer deaths.
Like the UK, Italy has performed only limited tests – and the nation has surpassed China in terms of deaths. But in the region of Veneto, there was a mass testing campaign. Italian biologist and disease expert Andrea Crisanti, who ran the campaign, says: ‘The moment we find a sufferer, we test all their friends, relatives and neighbourhood.’
This has proved crucial because – as is emerging from the evidence – many people who are infected may show only mild symptoms, or even no symptoms at all.
In one town, Vo’ Euganeo, Prof Crisanti tested all 3,300 residents and, of 89 who were positive and quarantined, half had no symptoms. Within days, the town had no new cases. Prof Cristanti says: ‘It’s the invisible positives with no symptoms who are most worrying.
‘For the UK I would advise systematic testing and targeted lockdowns where clusters are found.’
It means there is increasing pressure on the Government to roll out a DIY test to help experts to map the virus’s spread more accurately. Known as antibody or serological tests, they have been used in China, South Korea and Italy.
Mr Johnson announced last week that the Government was in negotiations to buy a ‘game-changing’ test that was as simple as a pregnancy test. ‘If it works as its proponents claim, we will buy hundreds of thousands,’ he said.
These finger-prick tests involve taking a blood sample and identifying antibodies which the body develops in response to the infection. They can provide a much quicker result – possibly within minutes – and at a similar cost.
But while it has been broadly welcomed, there is scepticism about its accuracy and how helpful the tests could be. Sir Patrick admitted it could be ‘weeks or months’ until they are ready, and cautioned that it might not be ‘reliable enough’.
Another antibody test is being developed by Public Health England (PHE) in order to track the virus in the community. It could tell who has had the virus previously, and could help the Government work out how far the outbreak could still spread. PHE said it would begin using the test ‘shortly’ with 1,500 tests a week in the first instance. Dr Pankhania says: ‘The antibody test has its uses but not in an active outbreak when what we need to do is control infection rates. Some may not have produced enough antibodies to prove they’ve been infected. It isn’ t precise enough.’
THE other way to be tested is privately – if you can afford it. London’s Private Harley Street Clinic is offering a £375 test which can be delivered to your home – and director Dr Mark Ali says he has sold thousands. Clients include celebrities and executives.
The tests involve taking swabs from the nostrils and throat and sending them to a UK laboratory, which returns the results within three working days.
Dr Pankhania says the test, which looks for genetic material produced by the virus, appeared to be similar to the NHS test. But the clinic failed to respond to questions about it.
A team from the engineering science department at Oxford University is developing a more rapid test which could deliver a result in 30 minutes. But these, and the latest Government promise to increase testing, may all come too late, warns Dr Pankhania. ‘We need testing now – we need to know where the threats are coming from. Think about a tsunami coming. What can you do about it after the wave has gone and everything has been destroyed?’