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The Alderley Park mega-lab in Cheshire, part of the “critical national infrastructure for Covid-10 testing on a massive scale,” in Matt Hancock’s words.

Testing facilities improve but testing statistics still confuse

Life for key workers living locally who need testing for coronavirus has been made easier by the opening of a drive-through testing centre in Bexhill. Meanwhile the government is to provide funding to local authorities as it prepares to move into test-and-trace operations. However, the true testing capacity appears to a lot less than the government claims. Nick Terdre reports.

Hastings and Rother is served by a drive-through testing centre at the Wainwright Road car park in Bexhill – much more convenient than Gatwick to which staff in local care homes were previously directed. There is a third testing centre in Brighton serving the Sussex area.

The Bexhill site, which is currently conducting about 30 tests a day, is one of a number of local drive-through testing sites available for key workers across Sussex, HOT was told by East Sussex NHS Healthcare Trust, which runs the Bexhill facility.

“These are in addition to the nationally run network of testing sites, which include Gatwick and Brighton. The drive-through testing facility in Bexhill opened on Monday 20 April, initially to test NHS staff and household members who had symptoms of Covid-19,” a trust spokesperson told HOT.

“Working with health and care partners across Sussex, this quickly expanded to cover all essential key workers in Sussex with symptoms – such as social workers, care home and hospice staff and police – and any of their symptomatic household members.

“Key worker testing is by appointment only and is organised through a Sussex Booking Hub. Key workers can be referred through the organisation they work with. Key workers requiring a test will be directed to their closest facility, with six mobile vehicles to test key workers at home if they are unable to travel.”

Members of the public with symptoms can get tested if they are aged over 65 or if they have to leave home to work – for example, construction workers, shop workers, emergency plumbers and delivery drivers, the spokesperson said. Members of the public can apply for testing through a government website which has access to all nationally-run drive-through sites, as well as having a number of home testing kits available for sending out each day.

The main message for the public is to stay at home, protect the NHS and save lives, the spokesperson said.

Funding for test-and-trace

Meanwhile the government has announced that £300 million is to be made available to local authorities to fund test-and-trace activities. Local authorities, which will work with the test-and-trace service, local NHS bodies and other partners, will be responsible for developing “tailored outbreak control plans, focusing on identifying and containing potential outbreaks in locations such as workplaces, housing complexes, care homes and schools.”

“Local authorities will be vital in the effort to contain Covid-19 at a community level,” said Nadine Dorries, minister for Patient Safety, Suicide Prevention and Mental Health. “The pandemic requires a national effort but that will only be effective as a result of local authorities working hand in hand with Public Health England and contact tracers to focus on the containment of local outbreaks, in order to control the transmission and the spread of the virus.”

 Five-pillar testing strategy

The government’s testing strategy rests on five pillars.

Pillar 1 An antigen test to establish the presence of the infection. Carried out by NHS staff,  it involves taking a swab from throat and nose and analysing it by means of a polymerase chain reaction test.

Pillar 2 Swab testing and analysis as in Pillar 1 but carried out by non NHS partners.

Pillar 3 Antibody testing to identify those who have had the virus and may enjoy some form of immunity.

Pillar 4 Surveillance testing for research purposes to help establish the rate of infection in the wider population. It is not used for diagnosing the presence of the virus in individuals.

Pillar 5 Building a large-scale testing capability to ensure everyone who needs either antigen or antibody testing can get it.

Testing capacity is obviously central to the test-and-trace operation and other initiatives to map the extent of infection as a prerequisite to bringing the virus under control. The aim is to expand testing capacity to 200,000 tests a day by the end of May. Current testing levels appear to be some way short of that, though getting a clear picture from the daily statistics provided by the government is not straightforward.

As the notes to the statistics make clear, reported test numbers are made up of two components: (i) tests processed through Public Health England labs, and (ii) tests sent to individuals at home or to satellite testing locations. It is unlikely that any self-respecting statistician would compile a series aggregating such different aspects of testing, but this was the means whereby health secretary Matt Hancock claimed to have hit his target of 100,000 tests daily on 30 April.

The number of processed tests on that day was reported to have been around 80,000, so without the addition of test kits put in the post, he would have been seen to fall far short of the target.

Chart of testing and confirmed cases on 25 May, as provided at the government’s daily briefing. The number of “daily tests” is an aggregate of processed tests and test kits put in the post (source: NHS England and devolved administrations).

The number of processed tests is not the same as the number of people tested – for clinical reasons, some have to be tested more than once. The discrepancy can be quite large: on 25 May, 26,780 Pillar 1 type tests were carried out on 16,575 people – so the number of people tested was just 62% of the number of tests carried out (the testing statistics also include Pillar 2 and Pillar 4 tests; the number of people undergoing Pillar 2 tests is not available for this day, and for Pillar 4 tests it is not reported).

Questions about kit numbers

The kits are Pillar 2 type tests. How many were actually used and yielded results has not been revealed. Some were dispatched without a return address. Many go to care homes, where the testing of frail residents and those with dementia is far from straightforward, and a certain amount of wastage must be assumed.

On 25 May 49,503 kits were put in the post. As overall test figures for that day totalled 109,979, the kits accounted for 45% of the total. Cumulatively 930,091 kits had been sent out by 25 May, equivalent to 25.3% of the overall total of 3,681,295 tests reported.

As kits enter the count at the point of dispatch, statisticians compiling the figures have to be sure to exclude them from the number of tests processed in order to avoid distorting the figures through double-counting.

BBC Radio 4’s More or Less programme broadcast on 20 May took up the question of Pillar 4 tests which are carried out for research rather than diagnostic purposes. Now running at some 30,000 a day, the presenters reported, they make a significant contribution to the overall test numbers. On 15 May, they calculated, after subtracting tests done for research purposes and kits put in the post, 69,900 tests out of a total 136,486 were actually done for diagnostic purposes. And the actual number of people tested was 43,298 – accounting for just 31.7% of the total of tests reported.

In fact, the presenters  concluded, the number of tests processed has never actually reached 100,000 a day. With just a week to the end of the month, one may legitimately wonder how the 200,000 target is to be reached.

If it is true, as Hancock has said, that “we have built a critical national infrastructure for testing on a massive scale,” we are far from making full use of this capability.

 

Posted 10:22 Wednesday, May 27, 2020 In: Covid-19

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