All individuals in England are eligible to receive regular rapid COVID-19 tests, even if they do not have symptoms. Rapid lateral flow tests can be self-administered at home and give a result in 30 minutes. Tests can be ordered through the gov.uk website, collected from a local pharmacy or testing centre or from a school, college, university, or nursery for those attending. People with COVID-19 symptoms must continue to get a PCR test.
Update 5th April 2021
Since 1st February, Surge testing has been carried out in local authorities in England where variants of concern are identified. Any positive tests in these areas are sent for genomic sequencing to continue mapping
and identifying variants of concern and monitor and suppress the spread of COVID-19. Surge testing is available to anyone in these areas, including those without symptoms, people who have been vaccinated or have previously had COVID-19 (but not
within the prior 90 days). Local authorities are providing testing to people without symptoms through home testing kits and at mobile testing sites.
Update 19th January 2021
Following identification of the new variant B117, findings now suggest that it has a mean growth rate that is 6% faster than other lineages. There are no age groups that appear to be more susceptible and this variant
can still be detected on both rapid antigen tests and PCR. Because there is a gene dropout of one of the key markers in the RNA code, it is possible to estimate the prevalence across the country fairly easily by looking at the % who don’t
test positive for the S gene, otherwise known as S gene drop out. This has shown that the variant has now spread to most parts of the country and is becoming the dominant strain. There is so far no evidence that this variant is more lethal or
that viral loads are higher, and it is instead thought that it is probably more transmissible because it has a stronger binding capacity to the ACE-2 receptor. While the response to the vaccine is as yet unknown it is not thought that this variant
will ‘escape’ the vaccine, although others might in future. However, studies are now looking to examine the antibody response in 80 year olds as the effects of the vaccine in this group were not clearly reported in the trials for Pfizer
or AstraZeneca, which were also tested before the new variant. Early results suggest a 50% efficacy in this group after one dose only and these results need to be followed closely.
For more details see here:
UK variant: https://www.gov.uk/government/collections/new-sars-cov-2-variant
Growth rates and susceptible groups: https://www.medrxiv.org/content/10.1101/2021.01.13.21249721v1
Vaccine efficacy for the new variant in the over 80s - Preprint awaited: https://twitter.com/GuptaR_lab/status/1350131633966493702?s=20
Meanwhile, mass repeated testing has now been rolled out to local authorities in high prevalence areas using lateral flow tests. Implementation of lateral flow tests has been contentious and guidance has been somewhat inconsistent. As this rolls out
at pace, it is hoped that evaluations will be conducted to highlight process outcomes, although it is unclear that this has been prioritised and some settings have reported low utility of these tests in Universities such as Birmingham. The current
emphasis is to perform repeat mass testing in key workers and school pupils and teachers and also to perform daily testing on school students who are identified as close exposure contacts of confirmed COVID-19 cases, allowing those who test negative
to remain at school.Update 24th December, 2020
Results from a mass testing pilot in Liverpool were published on 23rd December and highlighted that voluntary mass testing was susceptible to substantial inequalities as those from deprived backgrounds and those who were digitally excluded were less likely to present for testing. Although the test only detected about 50% of PCR positive cases, it did detect about 75% of the most infectious cases. This is lower than the initial pilots from Oxford had indicated and has led many to argue against their use. The government have announced that mass testing is effective because one third of newly detected cases in Liverpool were picked up on lateral flow tests and these would otherwise have remained undetected. The MHRA initially refused to authorise the LFD tests for mass testing purposes, but have now agreed that they can be used to detect positive cases as long as behaviours are not ‘enabled’ on the basis of a negative test.
Liverpool pilot evaluation: https://news.liverpool.ac.uk/2020/12/23/covid-19-liverpool-community-testing-pilot-interim-findings-published/
Oxford Lateral flow test evaluation: https://www.ox.ac.uk/news/2020-11-11-oxford-university-and-phe-confirm-lateral-flow-tests-show-high-specificity-and-are
Meanwhile, lateral flow tests have been distributed to care homes to facilitate care home visits with some potential direct contact, although some local public health departments in Sheffield and Manchester and Liverpool advised against their use to allow a potentially infected visitor to enter the home and stated that more information was required about the accuracy and logistics of these tests from the care home pilots that have been undertaken around the country. Since then, care homes have been asked to initiate biweekly lateral flow tests in staff, with one taken simultaneously with a PCR test to facilitate faster detection in care settings, where some outbreaks have been starting to spread faster recently, with the response slowed down by PCR tests. Residents will also be tested monthly using both tests, although resident testing was due to become more regular according to the winter plan.
Winter plan: https://www.gov.uk/government/publications/covid-19-winter-plan
Evidence summary for lateral flow tests: https://www.gov.uk/government/publications/evidence-on-the-accuracy-of-lateral-flow-device-testing/evidence-summary-for-lateral-flow-devices-lfd-in-relation-to-care-homes
From January, schools will also be sent lateral flow tests so that in the event of a single case, entire student bubbles can be tested daily to prevent mass isolation and school absence. Schools have been promised the provision of support and trained staff to administer the tests.
Mass testing asymptomatic has also been rolled out across the country in high risk areas to help detect positive asymptomatic cases to ensure that they self-isolate.
https://www.miragenews.com/targeted-community-testing-extended-to-17-more-areas/
Update 11th November, 2020
A programme of mass repeated testing is underway in Liverpool, where more than 23,000 tests have been conducted on the community in a programme of mass testing, using a combination of tests, but including the
lateral flow rapid antigen tests, which provide results on the spot within 30 minutes. City mayor Joe Anderson said 23,170 asymptomatic people have been tested since midday on Friday with 0.7% testing positive, with 154 cases testing positive.
Individuals will also be repeat tested after 5-7 days using 18 testing centres and some home kits. The army has also been recruited to support the logistics and roll out. An evaluation is taking place simultaneously. A system has now been developed
to also feed these results into the national data recording system to include these test results. This may have an impact on the data, although it is presumed that as this is a slightly less sensitive test than PCR, particularly when performed
by a lay individual, those cases identified would have a greater likelihood of being infectious than a positive PCR test, as it would often require a greater viral load to test positive.
Update 15th October, 2020
There have been concerns that health and safety in the coronavirus labs are inadequate, with whistle-blowers stating that those running the assays are underqualified and unsupported. This has been contested by
the UK Biocentre, which runs the lab.
Update 23rd September, 2020
A detailed report of the NHS Test and trace service has now been published, outlining the areas for improvement including improved identification of cases, by improving testing access and fixing laboratory access.
Also recommended is to make strides towards making contact with more of the cases identified, using local authorities, who should be appropriately funded and the contact tracing app. Compliance to isolate was also highlighted, stressing that the
£500 to isolate was cancelled out by the fines to those who breach isolation rules, which could dissuade individuals from getting tested or disclosing contacts. IT is advised that a rapid evaluation takes place immediately, focussing on
addressing disparities between regions and between population groups.
Update 22nd September, 2020
There are now approximately 50 testing sites in England. Judged by the number of tests conducted, the UK’s response to COVID-19 seems a success. About 16 million reverse transcriptase polymerase chain reaction
(RT-PCR) swabs were processed in hospitals and commercial laboratories between April 1st and September 10th, with over half a million in the second week of September alone. In terms of population, this is one of the highest rates anywhere. The
large-scale testing in England is prioritised by risk; in most areas community testing is, formally, restricted to those with one of cough, fever or anosmia. Exceptions include care home staff and residents, who have been offered regular asymptomatic
testing since July, hospital pre-admissions and people living in high incidence ‘areas of intervention,’ where asymptomatic testing may be undertaken through local initiatives. In practice, the system is struggling. Many of those seeking
tests are unable to access them and testing in care homes was unreliable until mid-August, with many tests unexplainably voided. Laboratories are not coping, with under 40% of tests reported the next day, and many taking over a week and samples
being sent abroad for testing. The Executive Chair of the National Institute for Health Protection admitted that testing demand is currently ‘multiples’ of capacity.
The government has recently announced a £100 billion
venture (approximately two-thirds of the entire national annual budget of the NHS), called Operation Moonshot, which involves regular mass population testing using rapid tests, which are typically less sensitive than RT-PCR. The details are unclear
as yet but it is believed that rapid antigen tests are currently being tested and validated for use in high risk settings including care homes and hospitals. This plan to use COVID testing as a screening test has not yet involved the National
Screening Committee or the National Institute for Clinical Excellence who usually oversee screening programmes.
The government has announced that staff in schools and healthcare will now receive priority tests for COVID-19.
The Welsh Government have also announced their new testing plans, increasing access to mobile testing units and expanding testing
in the lighthouse labs by 28,000 tests per week in addition to the existing 10,000 tests per day.