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“I’m feeling worse,” says Ryan Gladwell, a barman at a pub in Derbyshire who is currently off work with Covid-19 symptoms. “I’ve still been unable to get a test. Day five of trying now.”
That’s day five of heading to the government’s website to book a test only to be told that none are available – either at drive-in satellite testing centres or via at-home testing kits. Gladwell has also called 119 several times to no avail. He’s worried about his own health but also that of his young son, who has a serious heart condition.
Gladwell’s experience of trying to get a test is not unique. Reports of people being unable to get a test despite having Covid-19 symptoms have become commonplace. Some have been asked to travel hundreds of miles or even to cross the Irish Sea in order to get tested. Others, like Gladwell, have simply been told no tests are available at all. “What a shambles,” he says.
So what is going on? The UK’s troubled system for Covid-19 testing has swollen into a complex network of public and private labs, which process various types of tests. These range from PCR tests that detect viral RNA and tell whether a person is currently infected or not; to antibody tests, which give a good indication of whether someone has recently had Covid-19.
Some PCR tests are processed via a section of the testing system called Pillar 1, which includes tests for hospital inpatients and healthcare workers. These are analysed at NHS and Public Health England labs, which appear to be meeting demand at the moment. A source in one NHS lab says that they have enough spare capacity to process hundreds more tests per day. Another, in a different Pillar 1 lab, also says they have spare capacity.
But Pillar 2, which focuses on testing people in the community, is a different story. In Pillar 2, swabs are collected via drive-in centres or posted kits. The infrastructure is not always reliable. At one site in Bolton at the weekend, a mobile testing unit failed to turn up, leaving people with symptoms waiting in a car park.
Then there are the labs that process swabs from such sources. Data published by the government last week suggest that Pillar 2 labs are running at around 90 per cent capacity. And some have noted that Pillar 4 antibody tests are being processed at Pillar 2 labs. So the number of Pillar 2 swabs that can be processed in a day may be even more limited than it seems. This could explain why people in some areas are being told that no tests are available to them.
A report in the Sunday Times revealed that some swabs collected in the UK are being sent to Germany and Italy for processing because there is not enough lab capacity to analyse them here. “I don’t understand what’s happening at all,” says Jon Deeks, professor of biostatistics at the University of Birmingham, “It’s desperate. The government has been very secretive about all sorts of things with testing. What actually the problem is, we need to know and we need to get it sorted.”
A spokesperson for the Department of Health and Social Care (DHSC) says the test and trace system is “working” and that capacity is higher than it has ever been. They add that new booking slots and home testing kits are being targeted at the areas that require them most, such as where an outbreak is known to be occurring.
Among the facilities that process Pillar 2 tests are the “lighthouse labs” that were specially set up in response to the pandemic. These have largely relied on equipment and volunteers sourced from universities and were tasked with expanding the UK’s Covid-19 testing capacity over the summer. How they are functioning at the moment is unknown, says Allan Wilson, president of the Institute of Biomedical Science. “We don’t have much of a handle of what’s going on in the lighthouse labs. They have been shrouded by secrecy, really,” he says.
One source who worked at a lighthouse lab, but who has now returned to their university, says that they were aware of staffing issues towards the end of the summer. “Masses of volunteers left and I know for a short stint there was a lack of hands,” they say.
According to the DHSC, the majority of tests are currently processed at lighthouse labs but Pillar 2 is also served by a growing number of smaller, privately owned laboratories at, for instance, pharmaceutical firms. Speaking to Sky News last week, the head of one commercial lab involved in Covid-19 testing said that out of around 120 accredited virology labs in the UK “probably 80 per cent” have now been contracted into the Pillar 2 programme. We approached five commercial labs involved in Pillar 2 in order to ask about their capacity for processing Covid-19 tests. Four failed to respond and one declined to comment.
One diagnostics equipment provider supplying such facilities who wished to remain anonymous says that some labs were facing a continued shortage of single-use equipment, which has plagued British efforts to tackle the pandemic since the start. “We have been telling [the government] to prepare for the next wave for months,” the supplier says. “They will ask the impossible but if they can [fund] it we can deliver.”
The whole approach to testing in the UK is wrong-headed, says Allyson Pollock, clinical professor of public health at Newcastle University. “It’s just a chaotic mess,” she says. Aiming to test hundreds of thousands of people in the next few months, including many who are not actually showing symptoms, is, in her words, “mad”.
“What we should be doing is reintegrating testing into the health service and focusing on getting the symptomatic people tested and diagnosed, and getting that right,” she adds.
The concerns expressed by Deeks and Pollock also apply to the recently revealed Operation Moonshot programme, in which the UK would aim to test up to ten million people every day from early next year. Such a scheme would be hampered by large numbers of false positives and much of it would have no sound precedent in public health, they argue.
Meanwhile, the number of positive Covid-19 cases detected in the UK every day is rising sharply. Even if the true number of cases is below the modelled estimates of how many there were back in April, the worry is that the UK is now entering a second spike of contagion – without a testing programme that is fit for purpose.
This article was originally published by WIRED UK
