Coronavirus: The problem with the PM's plan for 'moonshot' tests is they don't exist
The government has some serious hurdles to overcome to achieve its mass testing scheme aimed at letting many venues reopen.
Thursday 10 September 2020 22:42, UK
The government鈥檚 "moonshot" testing plan contains several elements. Taken together they form what appears to be an ideological commitment to the principle of mass testing.
Yesterday the prime minister said his plan to "allow life to return closer to normality" was "based on mass testing".
Today the health secretary told the House of Commons he wanted to go "as fast as we can" and "as large as we reasonably can."
The question is: what is reasonable and what is simply wishful thinking?
Increasing the number of existing tests falls into the first category. Exactly how the government defines testing "capacity" is increasingly unclear, as the recent testing shortages show: they happened even though the system had plenty of spare capacity on paper.
Nevertheless, the government's promised to expand capacity to 500,000 tests a day by the end of October is a bold but achievable aim, because it involves doing more of what we do currently.
The same cannot be said of the plan to carry out up to 10 million COVID-19 tests a day by early next year, revealed this morning by the British Medical Journal. It got hold of leaked documents laying out a truly remarkable expansion of the national testing programme, expected to cost in the region of £100bn.
The problem with those documents, I understand, is that they are out of date.
Two sources close to the testing programme told me that they represent big ideas from a little time ago, not plans for today.
One source said the 10 million target was a "back of the fag packet calculation,": a rough indication of what it would take to do weekly tests for the entire population. To have 70 million people tested once a week, there would be 10 million tests a day.
"It's all still being worked out to be honest," the source said. But, they added, 10 million was "not what we are aiming at".
The real target, I understand, is closer to two to four million. A big step down from 10 million, but still an enormous increase on the current capacity.
Can it be done? Today I met a testing company which believes it can.
Founded by Craig Rochford, inventor of the Epipen, and Dr Nigel Kellow, a member of the master faculty of the NHS Nightingale Hospital, HALO has a contract to deliver regular tests to students and staff at Exeter University as well as several large private clients.
Yet, as recently as six months ago, it didn't exist. It was started in May as a response to the crisis. Most of its staff were, until recently, students at Oxford.
HALO's test uses the same PCR system as government operation, but with one huge advantage: instead of a swab rammed down the back of the throat, it runs on saliva. Samples can be collected at home without any loss of fidelity. The process is simple, easy and they promise it is accurate.
HALO isn't part of the government's plans, but its sudden emergence shows how testing can be expanded. Still, it's technology, not magic.
The test needs to be sent to a lab to be processed; even with the slickest operation in the world, that takes time. Results come back within 24 hours, not 20 minutes - the time the prime minister referred to yesterday.
At the briefing, Boris Johnson said the government was working on a rapid test that could let theatres and sports venues reopen. The plan, he said, was to "test all audience members on the day and let in those with a negative result, all those who are not infectious."
The trouble is, this test doesn't exist.
There are rapid tests, but their samples have to be collected by a medical professional, which makes it hard to do them for large numbers of people at a time. Imagine the queues if the crowd at the Young Vic, let alone at Wembley, tried to do that "on the day".
What's more, the quicker the test is, the less accurate it becomes: to get speed, it compromises on certainty of result.
This is particularly the case for the 20 minute antigen tests, which test for proteins rather than genetic material.
If you use these tests, you won't catch everyone with COVID-19.
If you're testing lots of people without symptoms, you'll also end up with a fair amount of false positives.
Faced with these difficulties, you begin to wonder why you're attempting mass testing at all.
And this is really the point.
For all the commitments to mass testing, we still don't know its exact purpose. Is it designed to identify where infections are, or to keep people safe? And when lines have to be drawn, how will we draw them?
If testing defeated the virus, we'd already have it beat: adjust for population and the UK is testing far more than comparable countries. Yet cases are beginning to rise all the same.
Sadly, it's not just how many tests you do that counts, it's how you use them, and, most importantly, the system and society that surrounds them.