Testing times

by Tim Tonkin At a time when the NHS is coming to terms with the most significant and unprecedented public health challenge it has ever faced, the idea of pulling desperately needed doctors out of frontline service for up to two weeks is hugely daunting.
Location: UK
Published: Monday 23 March 2020

While the two defining symptoms of COVID-19 – a fever and a persistent cough, are well known – the only definitive way to know if someone has been infected is through testing.

Despite this, many doctors have reported having to go into isolation without having a positive result for the virus, with many taking to social media demanding to know why testing for the virus is not being made more readily available for NHS staff.

Cumbria-based specialty trainee 1 Rebecca McCauley went into self-isolation on 17 March having developed a cough at the end of last week.

Despite feeling well enough to work she was told she couldn’t be tested and had to self-isolate at home for the next seven days.

‘I asked to be tested and said that I was willing to work if my result came back negative and was told “sorry” and that I just had to self-isolate,’ she says.

‘There’s not even an option of being tested at the moment.’

‘It’s March, everybody has coughs, colds and fevers at this time of year and they’re often nothing. Without testing us, people are having to stay away from work for up to 14 days.’

After setting up a petition on 15 March calling for testing of all NHS staff to be made a priority, the campaign has since garnered more than a million signatures.

Under the previous guidance, only those with fevers and coughs who had recently visited high-risk regions for the virus were being swabbed. This guidance was extended to anyone admitted to hospital with respiratory symptoms.


Unsafe practice

Dr McCauley says guidance for healthcare staff was ‘so unclear’, and that the lack of access to PPE (personal protection equipment) was also a huge concern for staff.

She said that unless action was taken to increase testing to enable those staff who were fit and able to work to do so, the staffing of the health service was going to rapidly become unsustainable.

‘Even at the best of times when we’re running at full staff, we [the NHS] struggle. I think we’re underestimating how this is going to hit us.

‘I worry that if more than half the workforce is off sick for up to two weeks at a time, either because they or someone in their family or household having minor symptoms, that we’re not going to have a workforce.’

While the Welsh and Scottish governments have formally pledged to prioritise testing for frontline NHS staff, health leaders in England have equivocated.

Speaking at the Parliamentary health select committee on 17 March, the Government’s chief scientific adviser Sir Patrick Vallance said the UK had carried out around 44,000 tests with Public Heath England having a testing capacity of around 4,000 per day.

He admitted to the committee, however, that this was ‘clearly not going to be enough going forward’, while insisting that PHE were aiming to ramp up testing for key workers, which includes those who work in the NHS, as a matter of priority.

GP registrar Hannah Barham-Brown (picture, top) put herself into self-isolation on 13 March after developing a cough – in line with the Government’s official guidance. Although Dr Barham-Brown expects to return to work on 20 March she was not offered testing to see whether she had in fact contracted COVID-19.

‘I am very aware that there are quite a lot of worried and frustrated people out there, particularly among medical communities,’ she says.

‘If somebody had been able to swab me or do a serology test and definitively say whether I had the virus, I could be back at work this week.

‘Instead I’m now sitting at home thinking “this is ridiculous, I want to be at work”. There is so much going on and I’m very aware that my colleagues are really struggling. To be sat at home feeling like I can’t help is hugely frustrating.’


Little guidance

After starting to feel unwell Dr Barham-Brown, who is working in a community nursing home for older people, contacted her supervisor and then put herself into isolation.

She says, however, that she was not offered any testing – something that she believes might be owing to a lack of resources.

‘I think there is a problem with resources: I think there is definitely a shortage of resources,’ she says.

‘While I’ve spent a lot of time travelling around for the past few weeks and while I have contact with a lot of people, none of them as far as I’m aware have been confirmed as having the virus.

‘According to the official guidance I don’t need testing and one of the problems of the guidance we’re having is there’s very little guidance specifically for healthcare professionals.

‘We [doctors] seem to be getting different information – a lot of it coming from trusts themselves, so I think there is a lot of confusion out there about what doctors need to do and how we can get testing if we feel we need it.’

‘I think we do need more guidance for healthcare practitioners. I think there are obviously problems in that this is a very new virus.’

Dr Barham-Brown says that while there needs to be more guidance for healthcare professionals, she recognises the pandemic poses significant challenges owing to it being a newly discovered virus about which there was still much to learn.

‘There’s definitely some things we need to consider in terms of testing, but I think given there’s so much confusion, and it’s such a fast-moving situation, we really need to keeping doctors abreast of what’s going on as there is a lot of confusion out there unfortunately.’

Newcastle-based foundation year 2 Claire Brash went voluntarily into self-isolation while on annual leave on 11 March, after she and her partner, who is also a doctor, had contact with someone who was suspected as having the virus.

After consulting NHS 111, she was initially told she did not need to self-isolate, but after developing a very mild cough two days after her isolation, Dr Brash was told by her employer not to come into work.

This was despite the fact the person responsible for Dr Brash’s potential exposure was never confirmed to have had the virus and had already returned to their home country before being tested.

To add to the confusion, while Dr Brash was told to isolate herself, her partner was told by their trust that they could continue to come to work, until they too developed symptoms and joined Dr Brash in isolation.

‘It’s been a really confusing time. We both have argued that we should be tested. We have both developed symptoms so self-isolation does seem appropriate and timely, but it could be that we just have a normal cough or normal cold.

‘My trust has been very supportive and covered my on-call shifts and have done the same to other colleagues in the same position, but it seems odd to a lot of medics that testing isn’t being offered because it could eliminate the need to self-isolate.’

Dr Brash and her partner asked their respective employers whether they could be tested and were told it wasn’t something that was at time being offered and that they were simply advising staff to self-isolate.


Family factor

The official guidance on how to appropriately respond to an exposure to the virus or to the development of symptoms that potentially indicate infection, do appear to send mixed messages.

Government guidance for healthcare workers states that those who come into contact with a patients with COVID-19, even if not wearing PPE, can still remain at work, but must notify their line managers and immediately self-isolate if they develop symptoms.

Anyone with symptoms is obliged to remain in isolation for a period of seven days from the onset of their symptoms. However, this period of isolation is doubled in the event that someone in an individual’s household or family develops symptoms.

This means that a doctor whose partner or children were to become ill would need to remain in isolation for a fortnight, even if they themselves were not displaying symptoms.

She added that the various lengths of isolation depending on the type of exposure were confusing and potentially problematic when it came to ensuring the NHS remained adequately staffed during the pandemic.

‘I have colleagues who have a sick child who are now taking 14 days off and who feel perfectly well themselves,’ Dr Brash says.

‘The Government’s policies keep changing which leads to confusion for the public and it also has an extra burden on the health service’s resources for staffing.

‘If I have not had the virus and I have not been tested, I may go back to work again [and] develop a cough [and] I will not know whether I have any immunity to COVID-19 and would have to start the process of self-isolation again.

‘That’s a huge burden on the NHS [and] it doesn’t seem sustainable.’