July 24, 2020 / 8:10 AM / 19 days ago

Exclusive: UK's home testing dogged by delays, undermining push to reduce virus transmission

LONDON (Reuters) - When Rachel Holdsworth recently developed a fever, she went online and looked up the location of the nearest government coronavirus testing centre. It was an hour away by foot. So she ordered a home test kit through the National Health Service.

A handout image shows a COVID-19 home test kit offered by the UK government to people showing symptoms of the coronavirus disease (COVID-19), in Britain July 8, 2020. RACHEL HOLDSWORTH/Handout via REUTERS THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY. NO RESALES. NO ARCHIVES.

It didn’t arrive for two days. Her sample wasn’t delivered to a laboratory until two days after that. By the time she received the test result in a text message – it was negative – five days had passed.

“It could be so much shorter,” she says. “The idea of going somewhere nearby and having the result much more quickly makes a lot more sense.”

To expand badly needed COVID-19 testing, the UK government has bet heavily on home testing, a strategy other countries severely affected by the virus haven’t tried. To date, the UK has dispatched 1,327,791 home test kits, the Department of Health & Social Care told Reuters on July 17.

The health department said mass home testing is “one of the biggest innovations we have made” and “a game changer” because it has greatly increased the availability of tests for the new coronavirus, including for those self-isolating and living in rural areas. Home tests are now offered to anyone who exhibits symptoms.

But since it began three months ago, the UK’s home-testing experiment has experienced some significant issues – including delays that experts say can defeat efforts to reduce disease transmission, tens of thousands of delivered test kits that were never returned to laboratories for processing, and kits containing faulty sampling swabs.

The problems are among the latest to blight the UK’s response to the COVID-19 pandemic. With the exception of Belgium, Britain currently has the highest per-capita mortality rate from COVID-19 among major economies. As Reuters has previously reported, the government’s decision to abandon mass testing and widespread contact tracing in mid-March blinded it to the spread of the virus.

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In the case of the UK’s home-testing programme, as of June 3 – the most recent date the health department has provided figures for – only 62% of the kits were returned to labs. The department told Reuters it was consulting with leading behavioural science experts to help improve return rates.

On July 16, Health Minister Matt Hancock disclosed to parliament that some sampling swabs from one of the companies providing home-test kits were “not up to the usual high standard that we expect” and shouldn’t be used. He didn’t say how many home test kits were affected. The Northern Ireland-based company, Randox Laboratories Ltd, didn’t respond to questions about the faulty swabs sent by Reuters.

Some medical scientists question whether untrained people are capable of conducting a swab test to detect COVID-19 correctly. “Many of us believe that quite a substantial rate of false negatives is a consequence of inaccurate swabbing,” said Lawrence Young, a professor of molecular oncology at Warwick Medical School in Coventry. “It’s quite difficult to access the back of the nose and throat.”

Holdsworth, the Londoner who took the test at home, says: “I may well have gotten it wrong.”

In Germany, which has been praised for its widespread early testing of the coronavirus, the German College of General Practitioners and Family Physicians recommends that tests be carried out by healthcare professionals.

Asked how it knows if people administering home tests are doing it correctly, the UK health department cited unspecified studies it said show self-swabbing is as effective as tests conducted by a clinician.

Meanwhile, a growing body of research, including at Oxford University, suggests that home testing often takes too long for effective contact tracing – a critical tool to reduce virus transmission in which people who have come into close contact with those who test positive are tracked down and told to self-isolate.

The research shows that contact tracing is most effective when it’s done as soon as possible after a patient develops symptoms. The benefits greatly begin to decline after 48 hours, modelling studies show.

According to the health department, of those home tests in England sent to labs between May 28 and July 15, 45% of the results were received within 48 hours of the test being taken, and nearly nine in ten results were reported within three days.

But the department’s figures don’t include the time it takes to deliver the tests. That can add another day or two to the time between showing symptoms and receiving a test result. The department didn’t explain to Reuters why it doesn’t include delivery time in its statistics.

By contrast, the department’s most recent statistics on COVID-19 tests performed at public testing sites show that almost all of those results are received within 48 hours after booking an appointment online.

Adam Kucharski, an associate professor at London School of Hygiene & Tropical Medicine who has studied the effectiveness of contact tracing on COVID-19 transmission, said that from the onset of symptoms, “if it takes four or five days to get a result and then one or two days to contact trace, then in terms of contact tracing a lot of these contacts would have already infected others.”

Delays in COVID-19 test results aren’t unique to the UK. Although more than 1,400 CVS Health pharmacies in the United States with drive-through facilities offer tests, results in some locations currently can take six to 10 days because of extremely high demand, according to the company.

UNRELIABLE ANTIBODY TESTS

Secrecy surrounds the UK’s home-testing programme, including its costs. The department said it can’t comment on contracts that have been awarded because “they are commercially sensitive.”

In response to questions from Reuters, the health department also didn’t say who first came up with the idea of home testing and when.

Government officials first began mentioning home tests in late March when they disclosed that the UK had purchased 3.5 million rapid antibody tests – a blood analysis that would be performed by a finger prick to see if a person has ever had the virus – that they hoped could be conducted at home in the near future.

By then, COVID-19 was sweeping through the country. Prime Minister Boris Johnson on March 23 put the UK into a lockdown, instructing people to stay at home to slow a surge in new cases. Health authorities had carried out nearly 84,000 tests at that point, with 6,650 positive cases recorded, according to official data released that day.

But the UK’s failure to test widely – it had stopped community testing on March 12 to focus on hospital cases – meant the statistics didn’t accurately reflect the real scale of the outbreak. A Reuters analysis using mortality statistics estimated that in Britain the number of newly infected people per week peaked at 899,000 in the final week of March.

On April 2, Hancock publicly conceded that the UK hadn’t been testing enough. He announced a new goal of 100,000 tests a day by the end of the month – roughly ten times more than the number of daily tests then being conducted.

UK researchers soon found that the antibody tests the government had purchased weren’t reliable. But it didn’t give up on home testing.

Instead of delivering antibody tests, the National Health Service that month began offering home viral tests – delivered by Amazon at no charge to the government – that can show if a person currently has the virus. Initially offered only to essential workers showing symptoms, by the end of April they became available to any symptomatic person over 65, and those who were required to leave home to work and their families.

With great fanfare, Hancock announced on May 1 that the government had blown past its target of 100,000 tests a day the day before. But it turned out the 122,000 tests his department reported for April 30 included more than 27,000 home tests delivered to private residences that hadn’t yet been sent to labs for processing.

‘A BIT FIDDLY’

Rachel Holdsworth’s recent experience ordering a home test shows the programme’s complexities.

After developing a fever on Monday, July 6, she said she followed the government’s advice and began self-isolating for seven days. But she was hoping to attend a friend’s birthday party that Saturday afternoon so she decided to order a home test.

“It just seemed overly complicated,” she said. “When the email instructions came through, I couldn’t focus on them. I had a fever. I couldn’t follow the instructions until I was feeling better.”

The instructions stated that when the test kit arrived, she needed to book a courier online to send it to a laboratory and, just before taking the test, to register the kit online.

She also was told to watch a five-minute video featuring a NHS doctor to learn how to perform the test, which involves inserting a swab up the nose and down the throat.

Slideshow (3 Images)

“Bear with me – it is a bit fiddly but we’ll go through it together,” the doctor says.

Holdsworth said she found that “the most complicated bit” wasn’t taking the test, but assembling the box to send it to the lab. The courier arrived early Thursday and it was delivered early Friday. But she didn’t get her negative result until Saturday evening – and missed the birthday party.

“I honestly felt like I shouldn’t have bothered,” she said.

Reporting by Steve Stecklow and Tommy Wilkes in London. Edited by Peter Hirschberg.

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