Attempts to contain regional outbreaks of coronavirus are being hampered by a failure to share comprehensive test results with local health authorities. Beyond Leicester, where lockdown restrictions are being reimposed, there are fears of further flare-ups, with Bradford, Barnsley and Rochdale all recording high levels of infection. Testing capacity has expanded dramatically in recent months, so why are the results not being acted upon faster?
How are coronavirus tests provided?
When the outbreak began, the most comprehensive testing was directed at Covid-19 patients in hospitals. The tests look for live infection by detecting traces of the virus’s genetic code on swabs taken from the nose and throat. The swabs are processed at regional labs run by Public Health England or at NHS labs across the country. As capacity ramped up, these labs expanded their testing to key healthcare workers. This is known as pillar one of the national testing programme.
More facilities were set up to provide tests for other key workers and these have enabled testing to be rolled out to far more people. The swabs are taken at drive-through and walk-in centres, by mobile units, or in the home, and are processed by the Lighthouse megalabs set up in Milton Keynes, Alderley Park, Glasgow and Cambridge. This is pillar two of the national testing programme.
Further tests are performed for disease surveillance purposes, such as the weekly virus and antibody tests run by the Office for National Statistics. These give scientists an idea of how prevalent the disease is in the community – and so whether the epidemic is growing or in decline – and what proportion of the population have had the virus and recovered.
Can virus results flag up new outbreaks?
Beyond the immediate medical value of knowing a person is infected, coronavirus tests are fundamental to keeping the disease under control as the UK emerges from lockdown. Testing revealed an outbreak at Weston general hospital, in Weston-super-Mare, in May, a localised flare-up that was tackled by closing the hospital temporarily for a deep clean. But the need to reimpose lockdown on Leicester this week because of an outbreak shows that the system is not working as it should.
What went wrong in Leicester?
A number of factors, such as population density, probably contributed to the outbreak in the first place. But arguably more important is why the outbreak was acted on so late, a full 11 days after it was spotted.
Local health officials say the problem arose because they were not given access to accurate and up-to-date information on where the infections were. It meant that the local public health team had to contain an outbreak without knowing precisely the sources. Sir Peter Soulsby, the mayor of Leicester, complained that the council had tried for weeks to find out detailed test results in the city.
Why are test results not shared immediately?
The problem is that while some results are passed straight to regional public health authorities, others are often held back. A common situation is that local health teams receive only pillar one test results, which help them clamp down on outbreaks in hospitals and care homes. But the pillar two results, which show who has tested positive in the community, are only shared if the recipient has signed the Data Protection Act. This means that local health authorities may have only patchy data on who is infected in their area.
Prof Deenan Pillay, a virologist at University College London, said: “The data problem has probably spawned a whole load of other infections in Leicester which could of course lead to deaths.” One senior director of public health told the Guardian it made dealing with outbreaks like “playing a game of battleships”.
What is the solution?
Public Health England has just signed a number of data sharing agreements with local authorities that, in principle at least, should give regional public health teams swift access to comprehensive and up-to-date test results. The British Medical Association has weighed in and urged government to share “timely, comprehensive and reliable information” to help local teams fight outbreaks, and proposed “trigger points” that would signal when local or national restrictions should be reimposed.