Too little, too late?

Testing for COVID-19 might have increased, but doctors have strong concerns about delays, efficacy, and the safety of patient data. Jennifer Trueland reports
Location: Scotland England
Published: Wednesday 13 May 2020

It was a Saturday, mid-April, when Amy Small noticed she had symptoms: headache, fever, a bit of dizziness but no cough. The following day, her husband also had a headache and a sore stomach.

‘On the Monday, we got tested by NHS Lothian because I’m a key worker,’ says Dr Small. ‘Our swabs came back negative.’

Dr Small, a GP in East Lothian, is young and fit and otherwise healthy, but 25 days on, she still has symptoms of COVID-19, including a temperature, breathlessness and crashing fatigue. She has been unable to return to work so far – yet, according to the test, she should have been back seeing patients weeks ago.

False sense of security

The risk of false negatives, potentially sending clinicians such as Dr Small back into the workplace while they are most likely swarming with coronavirus, is just one of the issues to emerge around testing.

This topic has been a vexed one almost since the virus emerged in the UK, with policies on whether to test, who to test, and in what circumstances and quantities constantly evolving.

Most recently, the UK Government either met or didn’t meet its target of 100,000 daily tests in England, Scotland and Wales by the end of April (depending on whose calculator you use) and all four UK countries have announced they are moving to some form of test, track and isolate system, albeit with varying names, remits and methods.

‘A mess’

BMA council deputy chair David Wrigley probably sums up the situation around testing for a lot of people. ‘It’s been a total mess, hasn’t it? There have been mixed messages: it was on and then it was off, and certainly for me as a GP, there’s been no testing at all in the community in England until this week.

‘So, we’re six to eight weeks into this and there’s been no ability for me to get my patients tested. It’s only been hospital-based, so we’ve had a neglect of general practice and the community yet again. I’ve had personal protective equipment on for every patient I’ve seen because we have to assume that everyone has got it.’

We’ve had a neglect of general practice and the community again
Dr Wrigley

The situation in Scotland, where Dr Small is based, is different. The Scottish Government has announced its own test, trace, isolate and support approach, which will test people in the community who have symptoms consistent with COVID-19. First minister Nicola Sturgeon said last week that more information was needed on the NHSX app and how it would interact with digital tools in Scotland.

The consistency and availability of testing in England is something that also exercises Peter Holden, who leads on the COVID-19 emergency response for the BMA.

‘Testing is a problem and it’s very patchy – we’re struggling to get them done easily, and every area is doing it slightly differently,’ he says. ‘Also, there’s been a real problem with capacity.’

The countries of the UK might now have the capacity to move to testing and contact testing, but plans are still causing concern. ‘One thing that really bothers me is that in England, we’ve got the private sector – Serco – involved,’ says Dr Wrigley.

‘I’m not happy about that at all. We’ve got very good policy at the BMA opposing outsourcing and privatisation and this has actually been done without any bids or tendering; it’s just been hot-handed to them on a plate.’

He believes it’s too early to say if the new testing policy will be effective, and echoes the concerns of those who worry about the data privacy issues with the contact tracing app being tested on the Isle of Wight.

Data concerns

Penelope Toff, BMA public health medicine committee member and past chair, welcomes the prospect of more widespread community testing but cautions that it has to be in the context of a proper strategy of test, trace, quarantine and support.

‘It’s not about the absolute number of tests but how they are used,’ she says. ‘Testing is being piloted on the Isle of Wight, but it’s been outsourced, with a centralised system of data collection, which is potentially very concerning from a medical ethics perspective. There is definitely a need for assurance about data protection.’

She believes local public health teams are best placed to run testing and tracing and that this presents an opportunity to reinvest in and recognise the importance of local public health after years of cuts.

‘Unfortunately, it appears that the direction the Government is going is outsourcing. In order to make testing effective and sustainable at local level, it should be public health-led, bringing in additional resources where necessary because directors of public health know their populations.’

There is definitely a need for assurance about data protection
Dr Toff

Meanwhile Dr Small is still recovering – despite having a second test that also showed negative. She also queries whether self-testing will work – as she points out, doing it properly is unpleasant, and many people will struggle to get a suitable sample.

Dr Wrigley seconds her warning about relying on the efficacy of the test itself, and stresses that people should not return to work if they have a fever, and that they should follow the latest guidance.

‘I suppose it’s positive that things are happening now, but it seems a bit late down the line. We might have missed the boat on this because the virus almost seems to be endemic in the population. We don’t know where it is or who’s had it. That’s why I think there’s a feeling that we’re going to have some restrictions until we get a vaccine.’