Who passes the test in the race to beat Covid?2020-11-03
Who passes the test in the race to beat Covid… and are other countries really doing better than us?
With previous reports of it taking days just to book a Covid test, and even now, some people still having to wait days for the results to come through, it’s little wonder Britain’s coronavirus testing system is widely perceived as a shambles.
But are other countries doing better?
Testing is crucial: identifying those who are infected allows them to self-isolate, breaking the chain of transmission.
And if you know who has the virus, you can trace those they have been in contact with to further check its spread.
Testing is crucial: identifying those who are infected allows them to self-isolate, breaking the chain of transmission
But the key is to have a robust system that is able to fulfil these complex needs.
Each country records its data slightly differently, but despite this, figures suggest the UK is now performing more tests than many other countries.
Experts, however, say it’s not so much how many tests you do, but what you do with the results, that is important.
Dr Joshua Moon, a research fellow at the science policy research unit at the University of Sussex, who is studying coronavirus testing around the world, says: ‘You can do all the testing you want, but if you’re not using the results to feed into contact tracing, or asking people to isolate and ensuring compliance, then you are not breaking the chains of transmission.’
Furthermore, testing speed ‘matters as much as testing capacity’, adds Professor Rowland Kao, an epidemiologist and data scientist at the University of Edinburgh.
‘If you can’t get the results back to people quickly, that means you can’t follow up and catch further infections — which can lead to more delays and it just steamrolls.’
Here, we look at the testing strategies a selection of countries are following, and ask the experts which — if any — pass the test.
POPULATION: 68 million
DAILY NUMBER OF TESTS: 282,736
POSITIVE TESTS: 7.7 per cent
DAILY TESTS PER 1,000 PEOPLE: 4.2
TOTAL DEATHS: 46,717
DEATHS AS PERCENTAGE OF POPULATION: 0.069
KEY FACT: The UK’s approach to testing has compared badly in a study of six countries, with researchers concluding that Britain was failing to test efficiently.
The concerns raised in the study, which has been submitted to the journal Health Policy, include our reliance on the setting up of six new ‘mega-labs’, rather than existing facilities, to process most tests.
The University of Sussex researchers said: ‘In most countries studied, testing has been undertaken in accredited laboratories with experience of clinical testing for infectious diseases. . . In the UK, the commissioning of new, private, large-scale testing . . . raises quality concerns.’
Each country records its data slightly differently, but despite this, figures suggest the UK is now performing more tests than many other countries
Even a small proportion of errors made due to ‘teething’ problems can have a big effect when a large number of tests are being processed, explains Dr Moon, who co-authored the report.
‘Setting up the labs is a decision that, in the short-term, made sense but has caused quite a lot of issues,’ he adds.
BEHIND THE FIGURES: Anyone who has these coronavirus symptoms — fever, new continuous cough or loss of smell or taste — is entitled to an NHS test.
The daily total includes tests done in hospitals, care homes, walk-in and drive-through centres and ‘DIY’ kits posted to people’s homes, as well as a small number of tests done randomly to monitor the spread of the disease.
Results should be sent by email or text within 72 hours, but some people are waiting more than a week.
A key figure is the proportion of tests that come back positive. The World Health Organisation says a positive rate of 5 per cent or lower is a sign the coronavirus is under control.
At the start of the pandemic, the UK rate was 25 per cent — a statistic largely due to testing being limited to hospital patients. Today, that figure, is 7.7 per cent.
POPULATION: 83.8 million
DAILY NUMBER OF TESTS: 194,101
POSITIVE TESTS: 4.9 per cent
DAILY TESTS PER 1,000 PEOPLE: 2.3
TOTAL DEATHS: 10,530
DEATHS AS PERCENTAGE OF POPULATION: 0.013
KEY FACT: One of the secrets of the German system is a technique called ‘pool testing’ — this involves combining samples from perhaps ten people and testing them together.
If the result is negative, only one test has been done instead of ten — saving time, manpower and money. If it is positive, the ten samples are tested individually (a little of each sample is set aside at the start), to pinpoint which are positive.
‘Pool testing takes more effort to set up, but if you are in a situation where the testing resources are under strain or there are delays, it is well worth doing,’ says Professor Kao. The UK is believed to be considering introducing pool testing.
However, it requires extra effort — for instance, you have to split the sample so that there’s some to use in the pool test and some set aside for an individual test if needed.
BEHIND THE FIGURES: Anyone who has symptoms, or who has been in contact with someone with symptoms, is entitled to a test — done at GP surgeries, A&Es, and drive-through centres, so residents don’t have to travel far. Results are available in around a day and a half.
Germany is often cited as a testing success story as it quickly built a system based on its network of regional health labs, allowing it to rapidly identify cases and contact trace. The strategy is thought to explain partly why Germany’s death toll is a fraction of the UK’s.
By the start of April, German labs were carrying out more than 50,000 tests a day and had the capacity to do more than 100,000, they claimed. The UK, in contrast, was doing less than 15,000 tests daily.
However, in Bavaria, the only area that offers free testing regardless of whether people have symptoms, there have been backlogs, and in August tens of thousands of people faced waits of up to two weeks for their results.
Germany went into an emergency lockdown yesterday to try to curb a second wave of coronavirus. Schools remain open but pubs have closed, restaurants are takeaway only and home working is advised.
‘We don’t know yet how significant the surge in cases is,’ says Dr Simon Clarke, a microbiologist at the University of Reading.
‘They might be able to head it off and minimise its effects and I expect its testing system to play a part in this.’
POPULATION: 10.3 million
DAILY NUMBER OF TESTS: 28,222
POSITIVE TESTS: 9.5 per cent
DAILY TESTS PER 1,000 PEOPLE: 2.8
TOTAL DEATHS: 2,544
DEATHS AS PERCENTAGE OF POPULATION: 0.025
KEY FACT: Early on, university labs were turned into testing centres and thousands of volunteers, from flight attendants to maths professors, answered a call to man the equipment, including the PCR machines that are key to reading the swabs, and Portugal was soon regarded as among the top ten testers in the world.
By July, 15 per cent of Portugal’s tests were being processed in centres mainly staffed by volunteers, according to the journal Lancet Infectious Diseases.
University labs could be a valuable additional testing resource in the UK, says Professor Kao. ‘Given that demand for tests is very likely to increase over winter, trying to exploit the resources we have would make sense.’
He cautions, however, that staffing labs with volunteers — who may make more mistakes than trained workers — isn’t necessarily the answer.
BEHIND THE FIGURES: Free testing is available to those with symptoms and close contacts. Tests are done at hospitals, drive-through centres and some labs, with most providing results within 48 hours. Temperature checks are taken at airports and those with a fever on arrival are referred for Covid-19 testing.
In Portugal, the death rate is about a third of that of the UK and of neighbouring Spain and the consensus is that testing is going well, with some isolated criticism.
The mayor of the northern city of Braganca recently complained that test results were taking up to four days.
Hernani Dias said: ‘It’s not acceptable that we have labs operating only on Mondays, Wednesdays and Fridays.’
POPULATION: 51.6 million
DAILY NUMBER OF TESTS: 11,375
POSITIVE TESTS: 1 per cent
DAILY TESTS PER 1,000 PEOPLE: 0.22
TOTAL DEATHS: 468
DEATHS AS PERCENTAGE OF POPULATION: 0.0009
KEY FACT: Scarred by the memories of an outbreak of another disease — MERS (Middle East Respiratory Syndrome) in 2015 — South Korea started setting up a coronavirus testing system in January, just days after identifying its first case.
‘Past experience always helps because you know what is required,’ says Professor Kao. ‘Why weren’t we as good initially and even now? It’s a lack of experience.’
BEHIND THE FIGURES: The government built hundreds of testing centres and worked with the private sector to ensure it had a good supply of testing kits.
The tests were free and the results sent to people’s phones within 24 hours. By mid-March, more than 250,000 people had been tested — roughly one in 200, the journal Transportation Research Interdisciplinary Perspectives reported in May.
Mobile phone technology was also used for contact tracing and text messages were sent to inform residents of locations, from nightclubs to hospitals, visited by people who had recently tested positive.
The efficiency of the system has been credited with helping the country control the virus without a national lockdown. To date, South Korea has reported fewer than 500 coronavirus deaths.
POPULATION: 331 million
DAILY NUMBER OF TESTS: 1.09 million
POSITIVE TESTS: 6.9 per cent
DAILY TESTS PER 1,000 PEOPLE: 3.3
TOTAL DEATHS: 230,996
DEATHS AS PERCENTAGE OF POPULATION: 0.07
KEY FACT: With a total standing at almost 150 million, the U.S. has carried out more tests so far than anywhere other than China. However, when population size is taken into account, countries including the UK are testing more people each day. Their experience shows that testing alone isn’t enough to control the spread of the virus, says Professor Kao.
He believes that frequent mass gatherings in the U.S. are helping spread coronavirus despite the vast testing.
‘You are not just talking about one person being in contact with one or two people but tens or hundreds of people each being in contact with dozens of others,’ he says.
BEHIND THE FIGURES: The national advice is for those with symptoms, or who have been in close contact with a confirmed case, to have a test.
But the policy varies from area to area. Residents of New York, for instance, are being advised ‘to get tested now, whether or not you have symptoms’. In Missouri, testing requires a doctor’s referral.
Tests are carried out in health centres and at drive-through sites and are covered by health insurance. But, in some cases, results have been taking weeks to come back.
POPULATION: 60.5 million
DAILY NUMBER OF TESTS: 187,702
POSITIVE TESTS: 13.3 per cent
DAILY TESTS PER 1,000 PEOPLE: 3.1
TOTAL DEATHS: 38,826
DEATHS AS PERCENTAGE OF POPULATION: 0.064
KEY FACT: Testing is conducted in health centres, hospitals — and drive-through centres. The latter use a more rapid test that delivers results in under 30 minutes compared with one to two days in the more conventional settings.
While standard tests look for traces of the virus’s genetic material, the rapid test looks for antigens — specific proteins found on the surface of the virus.
But the antigen test needs to detect thousands of virus particles to produce a positive result. This means people with a low amount of the virus in their bodies might be wrongly told they don’t have the virus when they actually do.
As a result, a rapid test might only pick up as few as 75 per cent of cases; whereas the standard test picks up almost 100 per cent when done properly, the journal Nature reported recently.
BEHIND THE FIGURES: Anyone with Covid symptoms is meant to phone their doctor, who will arrange a free test.
The speedy results provided by the ‘drive-through’ testing reduces delays in contact tracing and so should make it easier to curb the spread of the virus, says Professor Kao.
However, ‘if you allow people who test negative to go about their business, that can be dangerous, because of the high chance you have missed their infection and then it continues to spread,’ he says.
While Italy is also now experiencing a surge in cases — leading to new restrictions, including a 6pm curfew on bars and restaurants, coming into force yesterday — it has held off the second wave longer than many neighbouring countries, says Dr Clarke.
He adds that it remains to be seen whether the use of rapid tests will help Italy get a grip on the new cases.
‘Getting data back quickly is important, but the question is whether they have sacrificed some reliability for speed,’ he explains.
Not all countries post figures daily, so we have used averages compiled by Our World in Data, an online database compiled by University of Oxford scientists.
Can you run up the stairs?
I can run up a lot of stairs! I’m very fit. I used to run three to ten miles daily — but I’ve stopped to protect my knees and hips.
Get your five a day?
I exceed that. My wife [model and musician Renee Puente] and I love to cook for ourselves and our son [Revel, three].
If I have a big photoshoot coming up, I’ll do the sweet potato diet. All you eat are three sweet potatoes a day. It’s not good for you, but the six pack comes out! On the whole, I don’t worry about my weight. I’m 5 ft 11in and weigh around 12.5 st.
I love chocolate. I love chocolate buttons and also Revels, which I only bought because my son’s name is on the packet!
Any family ailments?
My grandma and dad suffered from psoriasis and I first noticed the problem in my mid-30s when I was in Glee. I tried various creams but nothing worked until the doctor prescribed Humira, which helps block inflammation.
A football injury when I was 11. I was running after the ball and as I turned my hip came out of its socket. The physio popped it back in but, every time I walk, I can feel a little click.
Pop any pills?
Whenever I’m getting sick, I take a capsule which contains things such as turmeric and ginger root to boost the immune system.
Had anything removed?
Three years ago, I had a benign cyst growing on my back, which was removed by local anaesthetic.
Ever have plastic surgery?
No, because I love ageing. It’s so natural and I love looking at our master citizens — that’s what I call senior citizens because they have mastered being human beings.
Cope well with pain?
Pretty well, but I have a flair for dramatic reactions.
Is sex important?
Absolutely. Not only sex but the anticipation of the act — going to dinner beforehand, flirting. . . That’s the stuff that I feed off and why my relationship with my wife is so strong.
Ever been depressed?
No. I’ve been let down or felt bad about situations but depression, no.
Fish and chips, pancakes — bad food.
What keeps you awake at night?
The wellbeing of my child. We live in such a harsh world. Revel sleeps with us.
Nothing scares me. I can handle spiders, heights and small spaces.
Like to live forever?
No, but I would like to live to 120.
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