Lateral flow tests in care homes failed to stop outbreaks

Lateral flow tests did not reduce the number or scale of Covid-19 outbreaks in England’s care homes, a study into the effects of testing staff and visitors has found.

The results, published through the Social Science Research Network, showed that six of the 11 care homes that piloted rapid tests had outbreaks of Covid-19 and that only one had a positive result from lateral flow testing before the outbreak. The findings have not yet been peer reviewed.

The Department of Health and Social Care commissioned researchers to compare outbreaks in care homes that piloted the rapid tests in Liverpool with those in homes in the same area that weren’t in the pilot.

Staff were tested twice a week with self-administered Innova rapid tests, while visitors were required to provide the care home with two negative rapid test results, taken within 24 hours before they visited. 

The research team interviewed staff and found that testing protocol adherence was poor, with just 8.6 per cent of staff achieving more than 75 per cent adherence to protocol and 25.3 per cent achieving more than or equal to 50 per cent. The team said that more focus is needed on the contextual and behavioural factors that influence protocol adherence.

The interviews also revealed that the lateral flow tests contributed to an excessive staff workload.

Researchers concluded that the combination of lateral flow and PCR testing added to an “already saturated workflow”, adding: “Failure to address this disconnect between testing regimes and the care home workforce risks an increase in staff dissatisfaction and its attendant potential for increased staff turnover and burnout.”

The findings come as a new government campaign urges everyone in England to get tested twice a week so as to take the “next step safely”. The government has made the free rapid lateral flow tests available to everyone in England up to twice a week in a bid to manage the spread of the virus as society starts to reopen.

The tests have been used in secondary schools for some time, but the government is looking at expanding their use to give people permission to go into crowded social spaces and travel without a PCR test.

Last month the government published analysis showing that lateral flow tests have a specificity of at least 99.9 per cent. The Department for Health and Social Care said the analysis “reinforces that lateral flow tests are accurate and reliable and have extremely low false positive rates” but scientists have expressed concern over the lack of data, false positives and the variability of self-administered tests.