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Mass testing is widely seen as the key to the coronavirus lockdown. Unless people who have the virus can be pinpointed and their contacts traced and isolated, any lifting of the lockdown risks setting off a new deadly wave of cases. But even now, more than four weeks into the UK's lockdown, the country's testing capacity is still far short of the target, and the number of actual tests being carried out is lower still.
Health secretary Matt Hancock has pledged a goal of 100,000 tests a day by the end of April — just one week away — and is pinning his hopes on an exponential rise in the number of samples being processed by the UK’s “mega labs”, formally known as Lighthouse Labs. But with 23,560 tests carried out in the 24 hours before 9am on Thursday — way short of the 48,000 tests that labs were able to process — scientists say this “ramping up” is happening too late and warn that vital laboratory time is being wasted.
Volunteers inside the UK’s new Lighthouse Labs have told how they have been sitting on their hands waiting for samples to come in. Meanwhile, NHS and university lab workers are infuriated that their equipment and chemicals have been sent to these privately backed labs, when their own skills and expertise could have been put to use.
BuzzFeed News has gathered testimony from lab workers, NHS clinicians and their families, and business leaders over the last 10 days documenting their experiences with the UK’s testing policy. The overwhelming mood is clear: Whether or not the government reaches its arbitrary end-of-April target, its efforts on testing so far have been haphazard, ill-communicated, and maddening for both those who are desperate to help and those urgently seeking clarity on whether they have the disease.
Up until now, coronavirus testing has been largely limited to seriously ill patients in hospital, and NHS workers and carers — but crucially, only if these workers have coronavirus symptoms. Even then, it has been incredibly difficult for many staff to get tested at all; some have been told they would have to travel dozens of miles to a drive-thru testing centre, and others simply haven’t heard back after asking their trust managers for a referral.
As the testing target draws nearer, the government has announced that all essential workers and their families with coronavirus symptoms are now allowed to apply for tests. Tests are also expected to be offered to NHS staff without symptoms within the next few days, as studies show that many are likely to be infected without knowing it. The government has pledged to almost double the number of drive-thru centres from 27 to 50 by the end of April, set up more mobile testing sites, and is “rapidly developing” a home testing kit.
But scientists argue this should all have been happening already to make sure the number of tests keeps pace with the growing lab capacity. This is the diagnostic test, also known as PCR (polymerise chain reaction) test, which determines whether somebody currently has COVID-19. A swab is taken fro the nose or throat and is sent off to a lab, with results back a few days later. It’s different to the antibody test, a blood test that checks whether people have had coronavirus and therefore could have immunity.
Care minister Helen Whately admitted on Wednesday it was “really troubling” that Britain was not using all its testing capacity. Hancock has repeatedly blamed this on “lower than expected” demand from NHS and care workers; after the Easter weekend he said “staff haven’t wanted to come forward for testing”. His language has angered many on the frontline who have regularly been exposed to COVID-19 and say they have been unable to get a test.
One NHS nurse from central Scotland, who asked not to be named, told BuzzFeed News she was offered a test when she started feeling ill — but only at a centre that was 50 miles away from home. “I was too ill with COVID symptoms to drive 50 miles, so no test,” she said. “This will be the same for many people and will be why the test take-up is not what it should be. There must be a safe way of doing community testing using mobile units.”
Another NHS worker from Manchester said his colleague had coronavirus symptoms and was promised a test by trust bosses but she only heard back from them three days after making the request. “My big concern is the test location itself,” he said. “It all seems well-run, once people are there. But the centres are miles away and my colleague saw lots of cars in the test queue that were full of kids. She was too unwell to drive and relied on her asymptomatic partner to drive. Most people can't get babysitters so the whole family is in the car for one hour of driving and confined coughing exposure.”
The focus on big drive-thru centres has been particularly detrimental to care workers, a large proportion of whom rely on public transport. The National Care Forum (NCF), which represents adult social care workers, said this week that staff were travelling an average of 62 miles on a round trip to test centres. As of Tuesday, only 25% of eligible care home staff had been tested, and only 7% of eligible carers who support people in their own homes, according to the NCF.
One UK businessperson told BuzzFeed News how he had repeatedly offered to help the government build a localised network of mobile coronavirus testing units — but his proposals were ignored.
Michael Saunders, director of the Little Box Company, offered to build temporary testing stations across the country, at cost price. These units have been designed for the German government by its manufacturing partner ELA Container, with over 500 in use across Europe.
But after submitting his proposal through the dedicated government website on March 23, he only received a standard response thanking him for getting in touch.
“Our idea was to put them in public car parks, supermarket car parks, and other easily accessible areas where the public can reach them,” he said.
“I work with a number of local authorities and have dealt with NHS trusts too in the recent past, so I am horribly familiar with the bureaucratic minefield that surrounds even the simplest decision-making process, which is why I'm not entirely surprised about what is happening here.
"The entire system appears to be designed to be reactive rather than proactive. There is no central organisation so decisions are sent through a chain of departments and seconded companies who are incapable of responding quickly or coherently.
“The sad thing is that there are hundreds of companies like mine who are able and willing to work, but the system is too inflexible. Many are too worried about putting their heads above the parapet to make a fuss.”
Government sources said they had received a “large volume of offers” and were “carefully considering” how best to work with organisations. They said they were unable to respond to all offers of help individually.
Saunders said he also approached a number of NHS contacts about providing mobile units for testing sites or temporary accommodation — and at one point was asked by a local NHS body in London to draw up detailed plans. But despite working through the weekend to develop the plan, he was then informed that the idea had quietly been shelved three days before; nobody had told him.
A spokesperson for North Central London Sustainability and Transformation Plan said: "After careful consideration, we did not proceed with the option of a new site, but were grateful for this company’s approach."
Meanwhile NHS workers have complained of delays in securing a test and the red tape involved with requesting one from bosses. The wife of a medical consultant in London told how their son came down with a high temperature and cough, and a test was requested on day two of his symptoms — but they didn’t hear back from the NHS trust for five days. “By the time he was offered a test, it was day eight and his symptoms were gone, he tested negative,” she said.
“The same thing happened with me; also negative. Our daughter also has symptoms and loss of smell and taste. It is extremely unlikely we did not all have COVID — the symptoms were blatant, but in theory my husband was safe to return to work. He and his colleagues made the decision that he work from home until day 14 as the tests were probably inaccurate.”
They experienced delays of several days in getting the tests back from the lab; even though the tests were done in the O2 arena in London, they were sent to Belfast for analysis.
There has also been a fundamental problem with the criteria for tests: many NHS workers on the frontline are distressed that they have so far been unable to get one because they are not showing symptoms.
Anthony Mcilwee, a nurse from Birmingham who has treated multiple confirmed COVID patients, told in a viral Facebook post how he went to the testing site in Edgbaston to find out if he had the disease. But he was turned away, with one worker telling him: “We’ve been told that tests are expensive and we’re not to do tests on people who are not symptomatic.”
The Department of Health and Social Care has insisted its testing policy is not based on cost, but that testing centres are appointment-only to make sure every key worker who needs a test can get one without waiting.
Another nurse at Guy’s and St Thomas’ in London told BuzzFeed News how up until last week, access to testing for staff was restricted to those with very specific symptoms — a new continuous cough and/or a fever of more than 37.8 degrees C — and they needed to get to the hospital or the O2 centre to be tested. In recent days, the policy at this trust has been widened so that mobile testing teams can visit staff with symptoms at home.
Dr Jeremy Rossman, senior lecturer in virology at the University of Kent, said the decision by the UK government to focus its testing only on those NHS staff who are symptomatic was “concerning”.
“We know that the majority of the spread of the virus is occurring at the early stages of being symptomatic or even pre-symptomatic,” he said. “So making sure that you are testing people who may have been exposed is so important if they’re then going to be working with people, especially working with people with underlying health issues.
“Another issue is that for many NHS units, if you’ve been exposed or tested positive then after you’ve recovered it’s only a one-week quarantine window. The problem is that the data shows people can shed the virus for many weeks after they’ve resolved their symptoms. For the general public I think the risk of transmitting, because it’s a very low amount of virus, are relatively low but in an NHS environment if your health care worker is still shedding a little bit of virus — especially if they’re in a situation where they don’t have enough personal protective equipment (PPE) — then the risks are really great.”
Rossman called for a far more open policy on testing of NHS staff and care workers. “We need a much more open testing programme in general, especially as we think about exiting lockdown, but if you’re going to start anywhere I would start that with NHS workers,” he said.
The government said its approach was led by clinical guidance from chief medical officer Chris Whitty, which was clear that asymptomatic testing was more likely to result in “false negatives” and give incorrect reassurance to those tested.
Meanwhile lab workers are waiting for more tests to arrive. Gianmarco Raddi, a student doctor at Cambridge University who is volunteering in the Milton Keynes mega lab, told last week how there are not enough samples to keep staff busy.
Just over 1,000 samples were processed there on April 14, he said: “Our shifts were meant to be excruciating 12-hour marathons. In reality, they are rather more like laid-back morning jogs. Dozens of academics and laboratory personnel from all over the UK languish in a hotel with nothing to do. Millions of pounds of equipment borrowed from universities and companies rests silently in the evening hours, when the noise of our collective toil should be deafening.”
Government sources did not dispute Raddi’s account, saying that demand had been “lower than expected” but ministers were taking steps to boost take-up.
These stories from inside the mega labs have left NHS lab workers reeling. They are ready and willing to take on the biggest challenge of their careers; but many feel cast aside at the expense of the centralised labs that are being staffed by volunteers.
“It is infuriating in NHS labs at the moment as we have the qualified staff that are trained, we have got staff from other areas of pathology to train up to take over our routine work, we had rotas in place to cover a 24/7 service — but the government requisitioned everything from us, analysers and testing kits, and therefore we are basically sitting on our hands,” one NHS lab worker said.
“Obviously we have other work to do — however, as GP work has slowed, we have a considerable drop in patient samples and more than enough manpower to have started doing testing for COVID-19. Everyone wants to be a part of this and help the country but our hands are tied and we cannot test. This is endemic around all virology labs in the country.
“It is even more infuriating to us to hear that these scientists, many that would have halted their research to work on COVID testing, are also sitting around with hardly any testing being produced.”
Another scientist working in an NHS trust said their lab “has the equipment ready and waiting — but we are not allocated any kits for testing”. It means that any tests done in that hospital on NHS staff and patients are being sent to another hospital for analysis.
The government has insisted that mega labs are running “in parallel” to NHS labs, not replacing them. But lab workers are deeply frustrated with what they say is a “secretive” attitude from the government over the creation of the mega labs, with NHS trusts and universities given no warning of what was happening.
One academic biomedical scientist told how her university donated all their lab equipment and chemical reagents to the Milton Keynes lab last month, only to find out that it wasn’t going to open for a number of weeks. “I personally believe NHS and university labs could have handled the workload instead of waiting for mega labs to open, or at least we could have been prepared to hold the fort in the meantime,” she said. “RT-PCR [reverse transcription PCR]] technique is our bread and butter.”
Rossman said more localised testing labs, like that in Germany, could be more effective. “Because the UK is consolidating the testing in a few mega labs, it removes the testing from the local population and tends to delay the timeliness of the reporting a little bit,” he said. “It’s vital to make sure, with the transmission of an infectious disease, that people who have been affected are notified so they can isolate as early as possible.
“So I think there is a strong argument for a more distributed network of testing, utilising more academic labs, more local, maybe even city-level facilities.”
He said the UK was “unusual” among countries to have dropped community testing early on, after it became clear that the virus could not be contained. “We’ve seen a lot of countries that are testing and doing basic infection protocols such as contact tracing, finding out who’s infected — this is something we are starting to scale up and do now and I think if we’d done that earlier on, it could have been very effective,” he said. “But of course this is all hindsight, and it’s incredibly easy to say this is what we should have done.”