Operation Moonshot: experts are sceptical about Matt Hancock’s mass testing strategy

The government is betting on a new mass testing regime to help control the spread of coronavirus and restore a degree of normality to daily life. The details of “Operation Moonshot” were laid out in documents which were leaked on Wednesday to the British Medical Journal (BMJ). Boris Johnson provided further information at his press conference that evening as he scrambled to get ahead of the story.

The plan centres on easy-to-use coronavirus tests which only require a small spit or swab sample of saliva and can deliver results in 20-90 minutes. Millions of people will take these tests each day and if they test negative can go on with their daily life as normal. If it works, those going to the theatre or football matches will be safe in the knowledge that everyone there has tested negative. If they test positive, they can self-isolate and keep everyone else safe. According to the government’s proposals, by December there should be two to four million tests taking place every day, a number rising to 10 million in early 2021.

The price tag for this programme is hefty – £100 billion, or roughly the same amount as the entire education budget. However, according to the leaked document, Boris sees it as the only way to avoid an even more costly second national lockdown.

There are just a few hitches, the first one being that the technology needed to make this work has yet to be proven to be effective. One potential test, a rapid spit test, has been trialled in Southampton and Hampshire with plans for a larger pilot in Salford. Results so far, while apparently promising, have not been conclusive.

Indeed, even as Boris Johnson touted mass testing as a potential solution to the country’s woes, he also admitted: “There are a number of challenges. We need the technology to work. We need to source the necessary materials to manufacture so many tests. We need to put in place an efficient distribution network. And we need to work through the numerous logistical challenges.”

Patrick Vallance, the government’s chief scientific adviser, and Chris Whitty, the government’s chief medical officer, were even more cautious in their pronouncements at the press conference.

Vallance said: “There are as always with technologies unknowns and we would be completely wrong to assume this is a slam dunk that can definitely happen,” he said. “I think this needs to be tested properly.”

For his part, Whitty said it was “likely” there would be new rapid tests in the “not too distant future.” However, he added that this “covers quite a wide time range” and people shouldn’t pin their hopes on a specific date.

Other scientific experts have been sceptical that such a test can be developed so rapidly. Dr David Strain, a senior lecturer at the University of Exeter and chair of the British Medical Association’s Academic Staff Committee, said: “The prime minister’s suggestion that this will be as simple as “getting a pregnancy test” that will give results within 15 minutes, is unlikely if not impossible in the timescale he was suggesting to get the country back on track.”

Others have raised concerns about the sheer logistical challenge this. Speaking on Radio Four’s Today programme this morning Allan Wilson, president of the Institute of Biomedical Science, said: “The numbers are a bit dramatic. For example, with rapid tests that are available at the moment, you probably can do no more than about 100 a day. So if he’s aiming for 10 million a day, that’s quite a target to aim for.”

Indeed, given the track record of this government on delivering big ambitious projects to help tame coronavirus – be it antibody tests or a track and trace programme – one can be forgiven for being sceptical.

Finally, even if these hurdles are overcome, experts disagree as to whether mass testing will be effective.

On the one hand, Professor Jose Vazquez-Boland, Chair of Infectious Diseases at the University of Edinburgh, expressed support for the scheme. “The focus of testing currently remains on confirmation of suspected cases (people with symptoms), thus missing the point that most community transmission comes from those who are asymptomatic. “

He added: “Only a mass screening programme, such as this alternative plan announced by the prime minister, which involves the regular testing of all the population for asymptomatic transmitters can keep covid-19 under control and eventually lead to its eradication.”

However, others have raised worries about the potential for false positive to throw the entire system out of kilter. Speaking on the Today programme this morning Prof David Spiegelhalter, Professor of the Public Understanding of Risk at University of Cambridge, claimed the idea had statisticians “banging their heads on a wall”.

The problem, as Spiegelhalter put it, was: “Mass screening always seems like a good idea. But the huge danger is false positives. No tests are perfect. It is not a simply yes-no thing. And if you are going to have a test that would allow someone into a theatre, or allow them back to work, you have to be really sure they are not infectious. So, you have to set a threshold that is not very sensitive, that would pick up anything that hints at being infectious. That means that such a test will always generate a very large number of false positives.”

Indeed, even if the tests were 99% accurate, carrying out 10 million tests a day would still see 100,000 people falsely labelled as coronavirus positive every day. If one adds up the numbers this seems to quickly become unsustainable, or require a vast number of secondary tests to confirm the results.

Notably, a recent report by SAGE, released on August 31, was also lukewarm about the prospect of mass testing, noting the need to overcome the challenges which outside experts are now flagging up. That the government has nonetheless pressed ahead is perhaps an indicator of just how desperate it has become.