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By December 15, a deluge of emails brought London GP clinic SameDayDoctor to a complete standstill. Every single message had two things in common: they were all from people who had recently been on a plane, and they all demanded a coronavirus test immediately.
This private health practice was one of 11 companies involved in the chaotic launch of Test to Release, a government scheme that was meant to cut quarantine time in half for people travelling to the UK. But the passengers that flocked to these companies found that they were barred from booking slots, or that their results were going to be delayed by over a week. Many didn’t even get a response.
“The first evening, we had about 1,000 emails from people wanting Test to Release. By the following morning [there were] two or 3,000, to the extent that I begged the Department of Health to take us off the list because we simply couldn’t cope with the volume,” says Laurence Gerlis, SameDayDoctor’s chief executive. “We were filing these messages in a folder called ‘unanswered emails’. We couldn’t even acknowledge a single one.”
The botched launch of Test to Release is just one component of the UK’s Covid-19 strategy – but it is a crucial one. And in the coming weeks it will take on even great importance. The government has finally announced that all international travellers coming into the UK by plane, train or boat, including UK nationals, will have to take a test and receive a negative result up to 72 hours before leaving the country they are in. The latest U-turn has been made in response to growing concerns about the so-called South African variant of Covid-19. As well as the new test requirement, everyone entering the UK will still have to follow the ten-day self-isolation rule – unless they use Test to Release.
This greater focus on testing for people arriving into the UK is only likely to increase through 2021. “On site testing centres at airports are likely to become as familiar as the security arch to most travellers,” says Avi Lasarow, European chief executive of digital health company Prenetics. “We test in a number of airports internationally, and are looking at a number of ports of entry internationally. Those ports of entry are going to require testing, I would say, for the foreseeable future, so that I don’t think [business] will go away.”
Back on December 14, when the government announced the list of Test to Release providers, confusion reigned. Not only was the announcement made a day before the scheme was due to start, some companies had only found out they were going to be on the list a few hours before it was made public. As a result they were quickly overwhelmed by thousands of people who were told they could ask for tests to cut their isolation time in half. But the reality of what was on offer was rather different.
“We were one of the first to get approved [in December], naively thinking that the Test to Release scheme would be what it was originally set out to be, which was a massive reduction from 14 days [the government’s initial quarantine period] to five days plus the test time,” says one company manager who asked to remain anonymous. “It was very poorly explained. It wasn’t rolled out in the way that it was initially announced.”
The manager contends that a test result can be delivered around eight days into a quarantine, if you take into account a 24 to 48-hour testing turnaround. This means that people would be gaining back two days of freedom rather than the promised five. “I tried to explain to patients as politely as I could that it isn’t a huge game-changer in terms of cutting the quarantine period,” they say. “Patients completely misunderstood it. They were being aggressive on the phone, asking ‘why are you on the list if you can’t cope with demand?’, blaming us as if we knew we were going to be inundated.”
Part of the problem was the size of the list and the companies on it. The names were a peculiar lineup: a small private clinic from Harley Street in London and obscure mail-order test result companies were lumped in with the company that provides testing kits for the Premier League. By the end of the first day, many of the smaller players exited the scheme, or asked to be taken off the list until more providers were added because they couldn’t cope with demand.
Pricing was also an issue. The government’s assertion that private tests were going to be priced between £65 and £120 never held water — some providers began offering tests for £150 from the first day with the promise of providing results faster than the eight day average. Although over 50 new providers have been added to the list since, taking some of the pressure off of the remaining companies from the original lineup, prices have largely stayed the same.
Yet this is the only measure currently available to catch positive cases from people travelling through UK airports during the pandemic. Until last month, the government relied exclusively on passengers to voluntarily quarantine themselves for ten days when they land, unless they are travelling from countries on the travel corridor list. A Department for Transport spokesperson says this and Test to Release are “some of the strongest safeguards against importing Covid-19”. But this doesn’t factor in people not following government guidelines: although there is a £1,000 penalty for breaking the rules, spot checks by police have not yet resulted in any fines.
We’ve seen the flip side of the pre-flight testing system in action for some time, as many countries require negative tests from UK passengers within 72 hours of getting on a plane. A burgeoning private testing market has cropped up in locations like airport car parks and terminals across the country, as private testing companies cash in on the soaring demand for pre-flight Covid-19 testing. The first, run by testing company Collinson in October 2020, saw passengers from Heathrow to Hong Kong take a £80 test for results guaranteed within the hour. The five-star Sofitel Hotel at Heathrow Airport Terminal 5 is trialling a “Test and Rest” package for the night before guests’ flights, allowing them to take a Covid-19 test and have it processed by testing company Halo by the time they need to check out the next morning.
But, since the first lockdown in March, it’s been a one way system. Planes have arrived in the UK, transporting cargo and millions of passengers from around the world, without pre-flight restrictions – despite rolling lockdowns and soaring case rates, government data shows over 27 million passengers arrived between January and October 2020. Unlike other countries, the UK has neither shut its borders nor required travellers to isolate in hotel rooms and take a negative test before travelling. Research on international travel and the spread of coronavirus from December 2020 provides certain retrospective logic to this: it argues that stringent travel restrictions may have little impact on epidemic dynamics unless there are low numbers of cases and high amounts of travellers, or where epidemics are close to tipping points for exponential growth. Based on travel data, researchers said that most countries should consider controlling local rates of infection before restricting travel. Put simply, as long as the UK has higher cases than most other countries, restrictions to international inbound travel wouldn’t make a difference.
The time for decisive action was not in this third lockdown, says Sam Clifford, assistant professor at the Faculty of Epidemiology and Population Health of the London School of Hygiene and Tropical Medicine, and one of the authors of this study. It would have been the start of the pandemic, when people were travelling in from locations like Wuhan in China or northern Italy. “There are a lot of places where we didn’t know that outbreaks were occurring and spreading. Those people coming into the UK weren’t being told that they needed to isolate, or given guidance [saying] if you come from a particular region in Italy, or you’ve come from Iran, and you come from Wuhan, then do these things. Maybe we should have been a little bit more cautious about our quarantine back then, recognising that it could have been spreading.”
As a result of this lack of action, the hefty responsibility of policing people’s behaviour lies on the shoulders of testing companies giving the green light for people to leave, and the airlines transporting people to and from the country. One coronavirus testing company said that it is not unusual for it to relay positive results to clients and find out they are in public spaces like supermarkets or shops. Meanwhile airlines, already facing financial uncertainty, are reminding people of the quarantine rules when they book flights, send a reminder before the flight and remind them on board in addition to the compulsory passenger locator form. But they are not able to police people on board for symptoms, says Robert Griggs, policy and public affairs director of industry body Airlines UK.
“There are pretty punitive compensation measures in place for aviation. If you deny someone boarding onto an aircraft, and you don’t have good reasons to do that, under EU compensation rules it’s €200 to €400 [per passenger]. It’s an unenviable position for carriers to be in.”
He says airlines, which are given the same support as other industries despite lobbying for a bailout, have taken on crippling debt and need a strong summer season to survive the pandemic. During the current lockdown they have already begun campaigning to bring back more travel corridors in warmer months. Like many in the aviation sector, Griggs hopes that rapid tests (alongside the vaccine) will replace ten-day quarantining to make corridors — and the profitable pipeline of short-term business travel — viable again.
“We think that the UK was a bit behind the curve when it came to testing, whereas other countries got there already, we just need to move forward quickly. It’s difficult now, because we’re in a different world where travel has just essentially stopped again,” he says. “It  has been without doubt the most difficult year in the history of aviation, I don’t think there’s anything close to it.”
Natasha Bernal is WIRED’s business editor. She tweets from @TashaBernal
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