Testing chaos leaves Britain woefully unprepared for a winter surge

A shortage of coronavirus tests is forcing NHS staff to stay at home and putting services at risk. This was the stark warning to the government issued by Chris Hopson, chief executive of NHS Providers. Speaking this morning, Hopson described how a lack of tests is jeopardising preparations for winter pressures from seasonal flu and coronavirus.

“The problem is that NHS trusts are working in the dark” said Hopson. “They don’t know why these shortages are occurring, how long they are likely to last, how geographically widespread they are likely to be and what priority will be given to healthcare workers and their families in accessing scarce tests. They need to know all this information so that they can plan accordingly.”

The warning adds to the government’s testing embarrassment and casts further doubt on the plausibility of Operation Moonshot, the wildly ambitious, £100 billion plan to test 10 million people a day by the spring.

Hopson’s comments follow a leaked Department of Health and Social Care report, marked “Official: sensitive”, seen by the Sunday Times over the weekend, which outlined the extent of testing “chaos” in the country. The document revealed a backlog of 185,000 unprocessed swab tests and that UK laboratories have been so overwhelmed by “significant demand” that they have had to send tests to German and Italian labs.

The backlog is all the more concerning given that the number of tests being carried out in recent weeks has been far less than the UK’s total capacity which, according to the government, is 375,000 a day. The number of people actually tested per day in the first week of September was just 62,000.

Leaked figures also show that 75% of all tests missed the government turnaround target of 24 hours between the test being booked and a result being received, while a quarter of tests took longer than 48 hours. In separate reports, vaccine trial volunteers have said that tests have been taking five days to come back for the past month even though their tests are supposed to be prioritised.

Speedy turnarounds are essential in order for the test and trace strategy to have a chance of working. The longer positive results are delayed, the more Britons will likely be infected and the harder it becomes for all their contacts to be traced and asked to isolate. As Dr Simon Clarke, Associate Professor in Cellular Microbiology at the University of Reading, told Reaction: “If you can’t test, you can’t trace. It is a means to an end. It’s not something to do in and of itself. You need to actually do something with the data. Time is key.”

A number of explanations for the failings have been offered. “Bottlenecks” in laboratories is the official line. Last week, Sarah-Jane Marsh, director of testing at NHS Test and Trace, apologised for delays, tweeting: “All of our testing sites have capacity, which is why they don’t look overcrowded, it’s our laboratory processing that is the critical pinch-point.”

But the continued stream of reports from those wanting a test but not being able to book a slot or being advised to travel hundreds of miles for one, despite assurances from officials that the problem was being fixed, suggests that the issue isn’t simply the result of limited laboratory capacity.

On Monday, Ben Kentish reported on LBC Radio that not a single test – walk-in, drive-through or home test – was available in any of the UK’s top ten coronavirus hotspots, including Manchester, Bolton and Blackburn. The investigation suggests that at least part of the problem lies outside the laboratory and undermines the government’s claim that tests are being diverted away from lower risk areas towards harder-hit regions.

The leaked documents also highlight issues with test supply chains, with 4.3% of tests having been “voided” – disposed of because of technical or human error – mainly due to “damaged tubes” or “swab leaks” during transit. Randox, the clinical diagnostics company awarded an uncontested £133 million contract to carry out testing for the government in May, has voided more than 35,000 test kits since the start of August.

Dorris-Ann Williams, chief executive of British In Vitro Diagnostics Association, put the problem down to a shortage of capable staff in the labs. “We’re facing an unprecedented demand for testing and there is a limited number of scientists and technicians who can perform the work.” She said. “I know they’re desperately trying to recruit scientific staff ready to ramp up testing capacity for the winter.”

As The Times reported, however, job advertisements posted last week by Randox to boost its laboratory workforce, read: “It is NOT essential to have a scientific background” and “no previous experience required.”

The revelations raise even more questions about whether the country is prepared for winter and an anticipated second wave. Students returning to university and children returning to school, coupled with colder temperatures, will mean the demand for tests will only grow.

The government has blamed symptomless citizens for clogging up testing capacity. Shortages now mean that all schools, regardless of size, will only receive 10 test kits to be used “in exceptional circumstances”. This comes despite a pledge made by Gavin Williamson on August 24 to expand testing in schools to ensure a safe return to the classroom.

The rationing and backlog of tests is particularly concerning for the high-risk care sector. Asked what further testing delays would mean, Robert Kilgour, executive chairman of Renaissance Care Homes, told Reaction: “It will be an absolute disaster. We’re fighting to keep a second wave out of care homes at the moment. We were getting our results back between 24 and 48 hours later up to a couple of weeks ago. Now the average is 5 to 7 days and in some cases longer than that.”

“What we need is what we were promised: weekly staff testing and quick results. That’s the key as we go into winter and spring. Not providing this is playing Russian roulette with the lives of the vulnerable elderly that we are charged with looking after. It’s not right and it’s not fair.”

The leak is yet another blow to the government. Doubt was already cast on the feasibility of mass testing because of the risk created by the likelihood of hundreds of thousands of false positives, even if the Moonshot target is reached. Even if mass testing is agreed to be the best policy available, the recent leaks will strengthen the impression that this government’s execution of ambitious testing plans so far has been woeful.