Has the government really hit 100,000 tests a day, and what happens next?
1st May 2020
The government claims that it has hit its pledge to carry out 100,000 Covid-19 tests a day by the end of April.
Health secretary Matt Hancock set the target on April 2. Figures he gave at the daily briefing today stated that testing figures had hit 122,347 on April 30.
However, some questions remain about whether the target has actually been hit. Responding to questions from journalists, Professor John Newton, Director of Health Improvement at Public Health England, confirmed that tests that are sent out to people at home or to satellite centres are counted at the point they are sent, rather than when the tests are completed. This issue was raised by the Health Service Journal earlier today.
Prof Newton said: “For any tests which go outside of the control of the programme, they are counted as soon as they leave the programme. That’s for the tests that go out to people home and in satellite centres.”
Of the 122,347 tests that the government has said were completed on April 30, 27,497 are home tests and 12,872 were sent out to satellite sites. This suggests that just 81,978 of the tests were actually processed.
Experts have told Full Fact of their concerns that the home tests may not provide results when they are processed, with one saying that “significant numbers” of the tests are likely to be “void or unsatisfactory”.
Additionally, the latest figures show 73,191 individual people were tested yesterday, meaning some of the 122,347 tests are likely to have been multiple tests of the same individual.
But how important even was the 100,000 testing target, and what happens now?
“Test, test, test”
On 16 March, the World Health Organisation’s director general Tedros Adhanom warned: “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.
“We have a simple message for all countries: test, test, test.”
Two days later, Prime Minister Boris Johnson committed to 25,000 tests a day in the coming weeks, a target which, as we have written before, the government did not manage to reach within its original mid-April timeframe.
The government achieved more than 25,000 tests a day on 23 April, and by this point had already committed to doing 100,000 tests a day by the end of the month. As with previous targets, the wording of this pledge varied in meaningful ways: on the government website, the pledge was to “carry out 100,000 tests” every day, while on social media Number 10 promised to “test 100,000 people per day”. These numbers aren’t equivalent, because people can be tested more than once for clinical reasons.
Nicola Stonehouse, professor in molecular virology at the University of Leeds, told Full Fact: “In terms of 100,000 as a target, I don’t know where that really came from and whether that was a plucked out of thin air target or whether that was based on any logic. But certainly what we really needed to do, and still need to do, is upscale our testing.
“I think testing is absolutely key. It’s been key the whole way through. We’re playing catch up now, but it’s not too late.”
Allan Wilson, president of the Institute of Biomedical Science, told Full Fact he doesn’t believe “there was any basis for that figure” of 100,000 tests.
“The figure was pretty meaningless. I think it’s been a real distraction. It would have been better just trying to provide a strategy and then quantifying what that strategy required and building that strategy slowly.
“What we’ve really needed to do is focus on is just covering the testing for those who needed it. And what we’ve done badly really is the linking between access to that testing and capacity for that testing.”
Asked about the basis of the 100,000 testing target, a spokesperson for DHSC told Full Fact: “Setting a challenging target galvanised government, but there is a lot more to be done.”
Who could get tested?
Initially, only people who had symptoms after returning from a country with an outbreak were tested for Covid-19. At the end of February, this was expanded to patients in hospitals with flu-like symptoms. By the end of March, this testing was expanded to frontline hospital staff in England (while Wales and Scotland had already started testing hospital staff and Northern Ireland starting testing staff in early April).
On April 4, the DHSC published a document outlining its ‘five pillar’ strategy for how it would scale up its testing, including by making the tests available for more people, and reiterating the commitment to carry out 100,000 tests per day by the end of April.
On April 23, it was announced that all essential workers in England, and members of their households, will be able to get coronavirus tests if they have symptoms. On April 29, this was expanded further to include anyone over 65 with symptoms, anyone with symptoms whose work cannot be done from home or anyone who lives with either of these categories, as well as all social care residents ,residents in care homes, NHS workers and patients with or without symptoms.
Where can you get a test?
The main testing centres are regional, drive-through centres located around the country, the first of which were piloted at the end of March. The government has also introduced mobile testing units, which can travel around the UK to test essential workers at sites including care homes, police stations and prisons. Testing kits are also being provided to satellite centres which have been set up at places like hospitals that have urgent or significant needs of tests. Testing within NHS facilities like hospitals is also available for patients and some NHS staff.
The government pledged to open 50 regional testing centres by the end of April. A spokesperson for DHSC confirmed to Full Fact that the target of 50 centres was still in place as of April 27 and said 43 regional test centres had opened.
An update to the government website on April 29 changed the target to 48 regional centres. DHSC has now confirmed to Full Fact that 49 regional testing centres were opened by April 30.
There’s been some concern over the accessibility of regional testing sites.
Professor Keith Neal, emeritus professor in the epidemiology of infectious diseases at the University of Nottingham, told Full Fact there was just one test centre for Derby, Nottingham and Leicester, while he had heard reports of people in Worcestershire having to do 75 or 80 mile round trips to get tests.
“People aren’t coming forward because they can’t get there, or they don’t need testing.”
Analysis by the Telegraph claims that more than a million people live over an hour from a regional testing site.
The government said its aim was that “most people” should not have to drive for more than 45 minutes to reach a regional testing site and has also introduced mobile testing units and satellite centres around the country to increase access.
The government has said the mobile testing network is expected to reach 70 units by the first weekend of May. As of 1 May, there are 77 mobile testing units in operation, and 22 satellite centres.
However there’s a more general concern about requiring people to travel to testing sites at all, including those who do not have a car.
Mr Wilson said: “Remember this is aimed at symptomatic people. So you’re talking about people who have symptoms of Covid-19, are ill, but are expected to drive considerable distances to testing centres.”
DHSC said the regional testing sites were set up in locations where there is space and good transport links.
Home testing has also been made available, to avoid people having to leave their homes to access a test. The tests take the form of a swab, which must be rubbed on the back of the throat and inside both nostrils.
But Mr Wilson told Full Fact it was “absolutely clear that significant numbers of these self-sample kits will be void or unsatisfactory”, as people doing the swabs themselves are less likely than clinicians to gather enough material to “generate a negative or positive result”.
Professor Stonehouse told Full Fact that home testing “is a concern”.
“The samples really do need to be taken by someone who knows what they are doing. It’s making sure those samples are taken properly and then handled properly.”
DHSC said the home test is “reliable and effective”. Different tests are in use in the home testing programme, and all have been assessed as performing to manufacturers’ specifications before being used, the department said.
At Prime Minister's Questions on April 29, First Secretary Dominic Raab confirmed the government was still hoping to reach 250,000 tests a day- a target initially set out by Prime Minister Boris Johnson in March – but insisted the figure was “still an aspiration” that he would not put a date on.
Mr Raab added that the 100,000 testing milestone was the “first stepping stone” towards a wider “testing, tracking and tracing regime”. An NHS contact tracing app is expected to be ready in a few weeks.
Professor Neal told Full Fact that tracing the contacts of people with coronavirus is the only way to control the outbreak.
“The 100,000 target is an irrelevance really. We need to test all those people in hospital who have symptoms. Ideally we need to test all those people in the community with Covid-19, and then contact trace.
“Testing everyone in the community without contact tracing will just tell us how many people have got it.”
So far, the tests referred to are tests for the presence of coronavirus. But it's also possible to test whether someone has had coronavirus in the past but no longer does, by looking to see whether they have antibodies. On April 29, the government announced new trials of antibody tests.
Professor Stonehouse told Full Fact that antigen and antibody testing, combined with contact tracing, was needed.
“We need all of those things. We needed it two months ago and we still need it now. I’m afraid we’ve got this virus for a while so we need to be able to manage.
“We have to work out a way through this and a way to manage this. All that testing and contact tracing is the way forward.”
A government spokesperson said: “Tracing and testing those with symptoms of Covid-19 is essential if we are to limit the spread of this virus and save lives.
“We are working with clinicians, scientists and other specialists to plan a safe, staged path to national rollout.”