The pay-and-display sign still marks the entrance to the Milton Keynes coronavirus testing hub a cluster of tents in a car park across from a shuttered Toys R Us shop that is the heart of the UKs drive to contain and control the disease.

On Friday afternoon a queue of about 20 cars had formed up on the road outside, carrying key workers from schools, hospitals and care homes.

Men in high-vis jackets working for the accountancy giant Deloitte, which runs the centre, patrolled the street and tried to clear it of anyone not coming to be tested, even though they admitted they had no legal authority to do so.

Those who had arrived had been given the postcode to put into their satnavs but there were almost no signposts to the hub on nearby ring roads or streets, perhaps to keep it a secret from curious locals or passersby.

Less than 24 hours earlier, the health secretary, Matt Hancock desperate to ramp up testing (and then contact tracing) in the hope of getting somewhere near his target of 100,000 tests a day by the end of April had announced that all key workers with symptoms could apply to be checked for coronavirus.

Huge pent-up demand from people would defeat the system within hours of it going live. On Friday morning the testing website could not cope and it told applicants that there were no more tests available, an administrative hitch for which the government swiftly apologised.

Those in the queue on the outskirts of Milton Keynes had, however, logged on before the crash. Several told the Observer they wanted tests as much for their patients, or the people they worked and lived with, as for themselves. Many had signed up in the small hours, including a school key worker who had gone online at 2am to register.

I work around Covid patients, although we wear full PPE, said one nurse who asked not to be named. This is the first opportunity weve had to get tested. Its for my patients as well as myself, so I dont risk infecting them. She had travelled with her sister who works in care, and her parents who are isolating with them. Their fathers diabetes makes him a high risk if he contracts Covid-19.

Once inside the car park the symptom carriers were directed into one of five bays, and greeted by a worker in full protective equipment, holding up a mobile phone number to ring from inside the car. The person on the phone explained how to take the test, and then provided a kit.

You had to get a swab and rub it along the back of your throat and tonsils, and then use the same swab up your nose, said Charlie Dawkins, a pre-school worker who signed up for a test after coming down with a fever and sore chest. Im quite glad we got to do it ourselves, I feel that if someone else did it I would have been sick. We had to keep stopping.

Dawkins had driven for around half an hour with her mother, a key worker in a school who received an email saying she was eligible for tests the previous day. She too registered in the middle of the night.

Dawkins said she found the experience as smooth as testing for a terrifying disease could be ever be. The people were really nice, everyone was so friendly. She has been told to expect results by text or email within 48 hours, linked to a QR code she was given on registration, and scanned when collecting the test kits.

Across the country key workers and their families and friends, some who had worried about their exposure and health for weeks, were going through this extraordinary, novel and anxiety-inducing procedure.

Nic Mitchell, a property and financial services adviser, began developing symptoms a few days ago, which forced her partner, the head engineer at a food processing factory, to go into isolation with her. She has a complex underlying medical condition. A test would help me manage my other underlying conditions better, she said. The symptoms may be related to something else this would help me rule it in or rule it out. Mitchells partner is considered to be an essential worker, so they managed to book a test online.

The nearest centre for her was in Worcester, 22 miles from her home in Cheltenham. Before attending, she said it would be very scary because she hadnt left the house since 4 January when she got back from holiday incredibly ill. Actually, going into the outside world is something that gives me a high level of anxiety, so going 22 miles makes it worse, she added.

When Mitchell arrived at the testing site at Worcester Warriors rugby club just before 3pm on Saturday, she was told that there would be a two and a half hour wait but the centre would shut at 5pm regardless. The only option was to attempt to rebook. They told me they couldnt cope, she said. It was very disappointing.

The tents of the Milton Keynes test centre are visible from nearby roads, normally busy with shoppers and office workers, and now emptied by coronavirus. The silent streets, with the test queue the only sign of life, were a reminder of the abrupt distortion of normality.

The UK government has expanded the criteria for who qualifies for a free test for coronavirus to all essential workers and their families in England up to 10 million people. The list of essential workers is the same as the one used to allow the children of key workers to carry on going to school during the lockdown:

Health and social careFrontline health and social care staff such as doctors, nurses, midwives, paramedics, as well as support and specialist staff in the health and social care sector. In addition it includes those working in supply chains including producers and distributors of medicines and personal protective equipment.

Education and childcareNursery, teaching staff and social workers.

Key public servicesThose required to run the justice system, religious staff, as well as those responsible for managing the deceased, and journalists providing public service broadcasting.

Local and national governmentAdministrative occupations essential to the effective delivery of the Covid-19 response or delivering essential public services.

Food and other necessary goodsThose involved in the production, processing, distribution, sale and delivery of food.

Public safety and national securityPolice, support staff, Ministry of Defence civilian staff and armed forces personnel, fire and rescue staff, and those responsible for border security, prisons and probation.

TransportThose who will keep air, water, road and rail passenger and freight transport modes operating.

Utilities, communication and financial servicesStaff required to keep oil, gas, electricity, water and sewerage operations running. Staff in the civil nuclear, chemical and telecommunications sectors. Those in postal services and those working to provide essential financial services.

The swabs are not tested on site, because they need sophisticated laboratory processing. Milton Keynes has one of the biggest labs in the country, based at the UK Biocentre, just a few miles from the car park test centre, which handles swabs sent from at least 20 testing centres across the country.

The labs are largely manned by scientists who volunteered to step away from their usual research to carry out testing, which is labour-intensive work.

At Milton Keynes, the scientists operate in pairs working 12-hour shifts, and together can handle around 400 to 500 swabs a day. The labs daily capacity, at full stretch, is around 8,000 tests.

Inside the lab there are three work stations, the first of which is protected by a biosecurity hood, where samples are treated with a solution to kill everything inside. In the second, the viruss genetic material (or the material of anything picked up by the sample) is extracted. In the third, that genetic material is put through a machine that multiplies it, so that there is enough for the test to detect, then checked for coronavirus. The biggest challenge, experts say, is not the science but the logistics of getting the tests in, then scaling up and bringing in robots.

The Milton Keynes lab is part of a centralised approach to testing in the UK that has puzzled many scientists and may have been a key contributor to the slowincrease of testing capacity.

Other countries that have rolled out more rapid testing programmes have relied at least in part on letting existing labs become testing centres with their own teams and equipment, who are able to start testing almost immediately on site.

In the UK, by contrast, authorities have chosen to bring equipment and scientists together in government-established centres, which are slower to get going because logistics and supply issues need to be worked out.

Prof Allyson Pollock, of Newcastle University, says one of the many reasons the UKs reaction has been late and, until now at least, fairly ineffective is that it can no longer respond to local need, because of endless reorganisations and years of austerity. She also says the government is treating this pandemic as a national one, when actually it is a series of local ones, requiring dedicated local responses.

But what angers scientists, health workers, experts and others more is why it was left until so recently when Hancock was already admitting the peak was near for this mass process of testing and contact tracing to be ordered across the country. And why has it all seemed so chaotic and poorly planned?

The criticism of ministers and their advisers is all the greater because they know the UK started on the right road only to halt, change course, then resume when the virus had spread and all that could be achieved was damage limitation.

In early March, during the containment phase, Public Health England (PHE) began testing and contact tracing of the few cases identified. Just under 300 staff were hired at that time. The team, working around the clock, traced 3,500 people and supported the 3% of contacts found to be infected to self-isolate. But tracing was then scaled back when the UK moved to the delay phase.

Governments that have contained larger scale outbreaks once they are under way, perhaps most notably South Korea, which at one point was the worst affected country outside China, have done it through large-scale testing and rigorous tracing of the contacts of infected people.

The fact that we did not carry on and expand testing and tracing to a scale similar to South Korea was unfortunate, says Prof James Naismith, of Edinburgh University. We hit the iceberg without enough lifeboats and came to grief. We did not have the infrastructure in place to maintain a testing programme at that time. South Korea and Germany did. There is no doubt we have lagged behind them.

After the UK stopped its testing and contact tracing, the World Health Organization ordered all countries to test, test, test. But in a vital period last month, the UK resisted. Only recently, as pressure to limit the lockdown has grown from businesses, Conservative MPs and a frustrated public, and as Hancocks testing target looked in danger, has the government completely changed course.

There is dismay among health workers who see daily the effects of Covid-19, that early efforts to ramp up testing (before key workers were included from last Thursday) were suboptimal to say the least.

Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, said: There has been a lot of zig-zagging and veering on what is the policy, who is responsible for mobilising it, what is the plan. When Hancock first announced his target of 100,000 tests a day she says no one really knew how it would work. In our view it was not clear. It was just a number that was put out there. Cordery says it is not clear who the 100,000 should be initially, nor who would be involved in the testing. Should those to be tested include NHS staff, patients, who?

This lack of action was irksome for scientists, who last week pointed to the UKs massive but ignored capacity for carrying out genetic testing. Medical virology, molecular cancer and regional genetic laboratories as well as other academic centres around the country routinely use PCR [polymerase chain reaction] technology, which could easily have been turned to Covid-19 work a long time ago, they say.

Only the US has a greater capacity to do testing, said ProfGerome Breen, of Kings College London. But the NHS has refused to reply to many offers of help from research centres to supply tests. One of these offers came from Breen, a geneticist whose department already carries out PCR testing on a large scale. A month ago we offered to turn our laboratory over to Covid-19 work and test medical staff at Kings College Hospital to find out who might have been infected with the virus. We could have started within a fortnight and would have been doing thousands of tests a day by now. We had a couple of emails from the department but heard nothing from them after that. It was intensely frustrating.

Prof Martin Marshall, the chairman of the Royal College of GPs, suggested GPs should have been able to play a bigger role in referring patients for testing and helping the testing process. This admittedly would have required them to have the correct PPE, which has proved another challenge altogether.

Have they been a bit slow in getting to general practice, understanding the needs of general practice, understanding the PPE needs, for example, which took a time, understanding the role of general practice in identifying vulnerable patients understanding the testing needs for general practice? I think all of that has been slower than we would have liked to see.

Asked if the government knew who it ought to be testing, he said: I think the testing programme has been influenced more by the politics of the availability of testing than it has by the epidemiology of whats required.

You can have a good policy on testing, but you can only deliver it if youve actually got the kit.

This weekend, with the UK passing 20,000 hospital deaths from Covid-19 , and the WHO insisting that testing and contact tracing is essential before life can go back to normal, both are suddenly back at the heart of government policy.

But have the U-turns and the delays cost? And what if the lockdown has to continue for months more because effective testing and contact tracing has not been put in place?

Already business leaders and Conservative MPs are beginning to warn that without an easing of the lockdown based on testing and contact tracing, the economy faces ruin. Last week, the crisis facing small businesses and the need for a balance to be struck between saving lives and saving the economy was raised in a heated, virtual meeting of the 1922 Committee of Tory backbenchers.

The former cabinet minister, David Davis, said: There is deep concern among backbenchers about the fate of the vast numbers of small businesses, which will determine how fast we come out of this economic slump. Unless we are very quick and very effective at bringing as many as possible back into work in a few weeks time, the scars of this problem will go on for a decade.

Graham Brady, the chairman of the 1922 Committee, said: All members of parliament must be receiving representations from businesses large and small needing further assistance or some sense of when they can start to plan for at least a partial release from these measures.

Charles Walker, the committees vice-chair, added: Our inboxes are full of desperate people who own small businesses, some of which are their lives work, who now risk losing everything. We need to have a cabinet minister put in charge of small business.

World Health Organization (WHO) guidance on face masks has remained consistent during the coronavirus pandemic. It has stuck to the line that masks are for healthcare workers not the public.

Wearing a medical mask is one of the prevention measures that can limit the spread of certain respiratory viral diseases, including Covid-19. However, the use of a mask alone is insufficient to provide an adequate level of protection, and other measures should also be adopted, the WHO has stated.

There is no robust scientific evidence in the form of trials that ordinary masks block the virus from infecting people who wear them. There is also concerns the public will not understand how to use a mask properly, and may get infected if they come into contact with the virus when they take it off and then touch their faces.

Also underlying the WHOs concerns is the shortage of high-quality protective masks for frontline healthcare workers.

Nevertheless, masks do have a role when used by people who are already infected. It is accepted that they can block transmission to other people. Given that many people with Covid-19 do not show any symptoms for the first days after they are infected, masks clearly have a potential role to play if everyone wears them.

Sarah BoseleyHealth editor

-How to make a non-medical coronavirus face mask no sewing required

There is another, even more pressing need to start testing in increasing numbers, says Prof Charles Swanton, of the Francis Crick Institute in London, who is an oncologist and the chief clinician at Cancer Research UK. He said studies of infected hospital patients in Wuhan, in China, where Covid-19 first emerged, indicated that around 40% had contracted the disease inside the hospital. Hospital transmission is a very likely source of ongoing Covid-19 infection in the middle of a lockdown, he said.

For some patients for instance, those with life-threatening cancers this is a very serious issue. Patients are avoiding going to their GPs and GPs are making fewer hospital referrals. There are also 200,000 fewer cancer screenings taking place each week in the UK, due to the Covid-19 pandemic. That, in turn, means there are approximately 2,000 to 2,500 cancer diagnoses being missed each week.

Many scientists now believe reliable testing on a large scale really does offer the UK a route out of its Covid-19 crisis. However, merely reaching a figure of 100,000 tests a day on its own is not enough, warned Naismith.

It wont matter if we can test numbers of that order if we cannot then rapidly trace the contacts of those who are found to be positive and then isolate them. Once a person is found to be positive we will have to trace their contacts very, very quickly within a day and then test them.

Such tracing will inevitably require technological aids mainly by using mobile phones to track a persons movements, said Naismith. Inevitably, that will have privacy issues, he added. However, these will have to be dealt with because testing and tracing offers us the best chance we have for dealing with Covid-19 at the moment.

See more here:
Test, test, test: can Britain find a way out of lockdown? - The Guardian

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