The Association of Directors of Public Health and the Faculty of Public Health share the Government’s determination to see prevalence and transmission of COVID-19 reduced rapidly, effectively, and sustainably. Testing and contact tracing will continue to be part of the solution, alongside the daily efforts of everyone to maintain physical distance from others, wash our hands regularly and wear a face covering, until vaccines are rolled out and beyond.
The advent of rapid localised testing technologies offers real opportunities to improve our response to the pandemic, striking a better balance between health protection and social, economic, and personal liberty. However, the technology and real-world application are at a very early stage and pilots have yet to be fully evaluated.
The ambition to deliver a further substantial increase in testing is important, but the key priority needs to be targeted community testing where it can be both effective and safe, such as in hospitals, universities, and schools. We support our members and colleagues who are working constructively with the Department of Health and Social Care on the focussed deployment of lateral flow testing for individuals in settings or locations of higher risk of transmission and/or where the consequence of infection is higher. Extreme caution will be required in settings with vulnerable people, including care homes.
Our understanding of how asymptomatic testing using lateral flow tests can reduce transmission, how communities and groups engage with these types of programmes and the considerable operational, capacity, and clinical processes required, is still emerging. We must be up front about what is not yet known and the significant challenges that remain. Issues range from concerns that the sensitivity of the test may reduce considerably if training is inadequate, to whether a negative test might offer false reassurance and lead to less compliance with the basic measures we all need to take.
There is an enormous price tag attached to this programme, and the resources and capacity needed come at a time of overwhelming and competing priorities, including making sure all those who are symptomatic get tested and self-isolate to planning and rolling out vaccines.
Improving the existing Test and Trace Service so that people who have symptoms are rapidly tested and supported to self-isolate, and their contacts reached, must remain the top focus in relation to testing. A high performing Test and Trace Service needs to move fast, be led by local intelligence, and prioritise those groups and settings where COVID-19 can either spread quickly and/or harm the most vulnerable.
Pilots are at an early stage; we need to be open and responsive to the insight and lessons that are emerging daily from Directors of Public Health and others who are involved in local communities. As lateral flow tests become more widely used, we urge the Government to be mindful of three main considerations.
Firstly, substantial resources – human and financial - are needed to deliver lateral flow testing at scale. The additional logistical capacity provided to Liverpool to set up and manage testing sites alone has been enormous, and it is difficult to envisage how or even whether this could be replicated at the pace being proposed across the country. This threatens to be a distraction from other activities, like planning and rolling out vaccines.
Secondly, communities need to be engaged and supported to participate in lateral flow testing. Encouraging appropriate groups, particularly in disadvantaged areas already deeply affected by health inequalities or high-risk settings, where the prevalence and consequences of COVID-19 may be higher, is a challenging task and requires extensive communication and messaging.
Thirdly, the science and evidence around the reliability and accuracy of lateral flow tests in different circumstances is evolving. Risk will be higher without the appropriate training, guidance, and clinical governance – and without roles and responsibilities clearly articulated.
Rapid testing capability provides a valuable addition to the public health toolbox, but it must be deployed in a targeted, effective, and safe way, as part of the overall response to COVID-19.