Rachel is a community nurse in the north of England. She has the symptoms of Covid-19, including a cough, a fever and heavy chest. However, she has no idea if Covid-19 is the disease she’s got. She’s asked her GP and her employer, a healthcare social enterprise, if they will test her. Both have given her the same reply: for now, no.
“I’m a nurse,” she says. “My patients and colleagues need help, not me stuck in the house.”
Rachel (not her real name) explains that she has transferable skills that could be useful in emergency departments and wards. She adds that her young son has similar symptoms, and asthma, but she has not been able to get him tested either. Without knowing their Covid-19 status, Rachel will likely have to remain at home after recovery for several days under the latest government guidelines.
“I want to work as soon as I can,” she says. On March 18, prime minister Boris Johnson announced that the UK intended to scale up testing to 25,000 tests per day. In the past two days, the results of around 6,000 tests per day have been reported. Achieving the new target would clearly mean a massive increase in testing. “The public and particularly our key workers want to understand their health status,” said, Jenny Harries, England’s deputy chief medical officer, acknowledging the situation. She was speaking at a Number 10 press conference on the same day that the new testing goal was unveiled.
WIRED has contacted PHE and a number of university labs to ask what it will take for the 25,000 tests per day goal to be achieved but has not received a response at the time of publication.
However, a revamped testing regime cannot be rolled out overnight. Some, including the editor of medical journal The Lancet, Richard Horton, have accused the UK of wasting time over the pandemic. “This crisis was entirely preventable,” he wrote on Twitter.
Preventable or not, the UK’s response now is unequivocally fragmented. Scottish and Northern Irish authorities have independently made clear that health workers will be given priority for testing. And NHS trusts across England are showing differences in their approach to the problem as well. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has confirmed that it has now begun making efforts to test frontline healthcare staff “following requests from our colleagues and in line with national guidance,” says David Purdue, deputy chief executive at the trust. “If the test comes back negative, staff can safely come back into the workforce after a shorter period of self-isolation.”
Rachel has heard about divergence between NHS trusts from a colleague. She describes the situation as “very frustrating”. And as soon as you begin asking around the health system, it becomes clear that a lack of clarity and consistency is cropping up everywhere.
Stephanie de Giorgio is a GP based in Kent. She says that given the current rules around self-isolation and the lack of testing, many GP practices have found themselves short-staffed. “If there aren’t enough tests to enable [healthcare practitioners] to be tested, then we need to ensure only those who are entitled to a test, have one,” she says. Another GP told WIRED that testing was needed “so we can keep the NHS running”.
We have also spoken to a trainee nurse, who like Rachel asked to remain anonymous. Emma (not her real name) says that she chose not to attend a nursing placement because of the pandemic but fears this will delay her getting the hours needed to qualify. “We’ve been put in a position to choose either our own health and that of our loved ones or getting placement hours,” she says.
“My last shift was Friday and I had still not been fit-tested for [personal protective equipment].” Emma says she has also not received any information about testing for Covid-19. “A couple of my student nurse colleagues are still going in for now. None of us are comfortable with what’s going on.”
There are private test kits available – but they are not cheap. Large businesses have bought more than 2,000 coronavirus tests at £375 each from a private London lab on Harley Street, according to The Telegraph. As WIRED has reported, there are two types of test for the new coronavirus. Tests that detect viral DNA in throat or nasal samples, which take a few hours to a few days to process, and tests that detect antibodies in the blood. The latter take just a few minutes to give a result and could be used to find out if someone has had the virus in the past – going back weeks or even months.
Both kinds of test are commercially available but UK authorities have questioned the accuracy of current antibody tests and these have not been prioritised by Public Health England (PHE). Chief medical officer for England Chris Whitty described these existing antibody tests as “not reliable” this week. On Wednesday the prime minister announced that an antibody test was “coming down the track” and was “progressing very fast”.
For now, coronavirus tests are being carried out at PHE and hospital labs. How many more tests can be processed this way? A worker at a London-based hospital lab processing samples from suspected Covid-19 patients told says that the facility had capacity to take on a few hundred more tests.
Mark (not his real name) explains that swabs from patients are brought to the lab by courier. The clinical request for the sample is checked and its packaging is decontaminated. Then, testing with a PCR machine – a device that amplifies viral RNA so it can be easily detected – is carried out to confirm the presence of the new coronavirus. “We’ve done quite a few positives,” Mark says. “It’s no different to any other positive but when you see the swab has come from [an intensive care unit] you do wonder if the [patient] will be OK.”
Staff at university biomedical labs are also stepping up to help process samples. Liz Tunbridge and five colleagues at a University of Oxford psychiatry lab have already volunteered their services. She says that the team is well-versed in processing biological samples, albeit in a non-clinical context, and could assist.
“We have the skills needed, we just need to be given access to the samples,” she explains. If their offer of help is accepted, she expects that the team will be asked to work in a local health authority lab where patient samples are being tested.
Since tweeting about the initiative, Tunbridge has been approached by many others in a similar position. “I have been contacted by academics from all over the place who are willing to help – it’s incredibly gratifying to see, people just really want to help,” she says.
PHE is also looking for biologists with relevant skills and experience who could be seconded to its lab in Colindale, north London, in order to help process tests. An email shared on social media asks for suitable individuals to come forward suggesting they might be required to work five days on, five days off, including weekends.
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