Health researchers have provided a series of recommendations to fix the struggling test, trace, and isolate system in England.
The researchers from the University College London and the London School of Hygiene & Tropical Medicine have recommended pooled COVID-19 testing to significantly increase testing capacity in a short space of time, and to help with the identification of asymptomatic cases in key workers.
The recommendations have been published in the Journal of the Royal Society of Medicine.
Pooled testing
According to the researchers, evaluating samples in batches rather than individually, and re-testing only the groups that come up positive means fewer tests overall would be needed.
This method has been used by several countries, including China, USA, Germany, Portugal, New Zealand, Rwanda, Uruguay, Israel, and Vietnam, in order to considerably increase testing capacity and decrease pressure on lab reagents and operators. The authors warn, however, that as positive cases of COVID-19 rise, pooling becomes less efficient because more samples have to be tested.
Co-author Alex Crozier, from the Division of Biosciences at University College London, said: “We are close to missing that window of opportunity in England unless we can control transmission quickly. For now, pooling may be best reserved for surveillance testing and asymptomatic screening of healthcare workers, care homes and hospital pre-admissions.”
The recommendations include government investment in NHS and Public Health England labs to scale up additional testing locally and making use of unused lab capacity in universities and research institutes where possible, as well as the initiation of environmental surveillance by testing wastewater as an early warning system for COVID-19 outbreaks.
Further recommendations include increasing resources to enable a greater focus on identifying clusters using retrospective tracing, as well as a major investment in people on the ground to support contact tracing, with the authors noting that this approach is much less costly than the UK government’s £100bn (€110.55bn) ‘Operation Moonshot’. This method, used in Massachusetts, cost $4.4m (€3.75m) and has reached 91.8% of cases and 78.8% of contacts.
Another of the authors, Professor Martin Mckee, of the London School of Hygiene & Tropical Medicine, said: “England stands on the edge of a precipice: find, test, trace, isolate, and support strategies need to be re-thought to have any chance of avoiding a considerable rise in cases over the coming months requiring a return to stricter social distancing measures nationwide.
“Our recommendations are feasible, do not require further individual sacrifice and would likely have a significant impact on driving down the reproductive number and reducing the socio-economic impact of the pandemic if they were implemented quickly.”
