A new research study comparing the UK's Covid testing response to five other nations suggests the failure of NHS Test and Trace to provide medical oversight over access to testing explains the faltering Coronavirus testing programme, rather than frivolous overuse by members of the public.
The UK is the only country of those studied to both provide tests without first going through healthcare experts and to heavily rely on self-sample collection rather than have experts take swabs for patients, explains a study led by Prof Michael Hopkins in the Science Policy Research Unit (SPRU) at the University of Sussex Business School.
Study authors at SPRU, Prof Hopkins and Dr Joshua Moon, add that the UK has neglected citizens in isolation and quarantine by failing to follow WHO guidelines that suggest maintaining of contact, ensuring compliance, and overseeing physical and mental wellbeing.
Prof Hopkins, from the Science Policy Research Unit at the University of Sussex Business School, said: "There is a lack of proper supervision in the UK testing system. Tests are offered without suitable triage by medical experts. The UK is an outlier internationally because primary healthcare are not involved in Coronavirus testing. Instead the use of DIY self-swabbing by patients may lead to false negative tests and void tests where proper procedures are not followed. The result is that NHS Test and Trace is processing many more tests than other countries, yet many of these should not have been offered in the first place."
A new preprint article published this week on SSRN presents early results from a comparative analysis led by SPRU academics at the University of Sussex Business School of the five elements of Find, Test, Trace, Isolate, Support (FTTIS) systems of six countries; Germany, Ireland, Spain, South Africa, South Korea, and the UK.
The authors find that no single study country has a fully optimised FTTIS system, with lessons to be learned for all from international comparisons. In particular, the need for openness and evaluation is emphasised as an integral part of the FTTIS system, to support continual assessment, learning, evolution and international sharing of good practice.
With particular reference to the UK, the study has the following key findings:
Coronavirus testing in the community in the UK is being delivered outside of the usual NHS structures, with access to testing and sample collection undertaken without the high levels of medical supervision seen in other countries (e.g. Germany, Ireland, S. Korea)
In most study countries, testing has been undertaken in accredited laboratories with experience of clinical testing for infectious diseases, overseen by a nominated laboratory. Notably in the UK, the commissioning of new, private, large scale testing in Lighthouse Laboratories has bypassed accreditation and raises quality concerns.
The UK has the highest proven test capacity with 12,985 tests recorded per week per million capita in July (and rising).
In the UK there appears to be no systematic follow-up of isolating or quarantining individuals, except for travellers returning from designated countries. This is against WHO advice.
Low levels of sick pay may not be enough to prevent the financially insecure from continuing to work, even when unwell. The daily maximum levels of sick pay for isolating employees in Germany are equivalent to the UK's weekly rate.
Dr Moon, research fellow in the Science Policy Research Unit at the University of Sussex Business School, said: "It is not right to point the finger of blame at the public for using NHS test and trace when their reaction is the logical step in trying to rule out Covid-19 so they can get back to work, school etc. The Lighthouse labs are struggling to cope with demand because they are newly established, unaccredited and inexperienced compared to more well-established labs mainly used in other countries, and indeed in the UK.
"These and other policy failures, such as the lack of monitoring isolation in those quarantining and limited material support for those isolating, means the UK currently lacks the tools it needs to effectively fight the coronavirus pandemic. Remedying this will require policies which extend isolation support, improve follow-up on quarantine, and better leverage existing decentralised capacities."
