The problems with mass Covid testing

Britain started a £100 billion Covid testing program, Operation Moonshot, which is supposed to catch asymptomatic cases so people can quarantine themselves instead of transmitting the disease and life can return to normal. The plan is to screen millions of asymptomatic people every week, and it’s being tried out in Liverpool as I type. 

Which sounds great, but Dr. Angela Raffle, a consultant to the UK national screening programmes, said, “It worries me that ministers . . . can wake up one morning saying let’s spend £100 billioin on this and not have it scrutinised–it would be like building a Channel tunnel without asking civil engineers to look at the plans. . . . This seemed to me to be the most unethical proposal for use of public funds or for screening that I’d ever seen.”

Other than that, though, it’s a good plan.

Irrelevant photo: apple blossoms–a photo I stole from last spring. 

The program relies on the Innova lateral flow test, which when it’s used by research nurses catches 76.8% of positive cases. When it’s used in the real world by what the article I read called “self-trained staff,” though, it picks up only 57% of positive cases. And Jon Deeks, professor of biostatistics, said people aren’t being told that they still might be carrying the disease, so if they test negative they feel safe to do–well, whatever they haven’t felt safe to do. Visit granny in the nursing home or tear off their masks and run through twelve supermarkets breathing heavily on staff and fellow shoppers. 

Nursing homes in three counties, including mine, are trying out rapid tests to allow visitors in. The publicity I’ve seen doesn’t mention the possibility of false negatives. It’s all how great it is that granny got a visitor. And up to a point it is great. I’m sure granny was pleased. I also hope it doesn’t end up killing her.

The good news is that the test doesn’t generate a lot of false positives. 

Italy was the first country to use mass testing–they used antigen tests–to control the virus, and it seemed to be working, which encouraged other countries to try it, including Britain. Italy’s now in its second wave of Covid. It went from  500 cases a day in August to more than 35,000.

So what went wrong?

Andrea Crisanti of the University of Padua says the tests were used the wrong way and that using them to protect vulnerable people in care homes was “absolutely criminal,” because of the infected people they miss–the false negatives.

The tests they used are 80% to 90% accurate and give both false negatives and false positives, but they’re quick and they’re cheap. If they’re used, say, before people catch a train, they could reduce travelers’ exposure. But they wouldn’t eliminate it because, again, they don’t catch every case.

Crisanti said, “If your objective is to screen a community to know if transmission is there, fine.” But the quick tests, he said, need to be backed up with the more accurate but slower PCR tests, along with stay-at-home orders.

There doesn’t seem to have been–or to be–any strategy for what to do with the information beyond simply boosting the number of tests.

In an article about how antigen tests were used in the US, the website ProPublica writes that “When health care workers in Nevada and Vermont reported false positives [from the tests], HHS [that’s Health and Human Services, a federal agency] defended the tests and threatened Nevada with unspecified sanctions until state officials agreed to continue using them in nursing homes. It took several more weeks for the U.S. Food and Drug Administration to issue an alert . . . that confirmed what Nevada had experienced: Antigen tests were prone to giving false positives.”

In nursing homes, false positives are as dangerous as false negatives. A person who tests positive will be moved in with other people who test positive. If the test gives out some false positives, healthy people will be exposed to Covid, making the test a self-fulfilling prophecy.

The tests HHS recommended are meant for people with Covid symptoms, and when they’re used that way they produce virtually no false positives and catch 84% to 97%  of positive samples in a lab test. But a study–like many Covid studies, it hasn’t been peer reviewed yet–found them catching only 32% of positives in people without symptoms.

Still, HHS is recommending them for use on nursing home residents without symptoms and suggesting repeated tests to reduce false negatives. An October survey found that a third of nursing homes hadn’t touched the antigen tests they’d been given. They didn’t trust them, they didn’t have the staff time, and the paperwork and reporting requirements were more than they wanted to deal with.

Dr. Rebecca Lee Smith, an epidemiology at the University of Illinois, said, “It’s how you use the tests, not just how many tests you have.” If you have a million tests, is it better to test a million people once, or test half a million people who are at high risk twice, or test essential workers five or 10 times? 

If anyone has an answer to that question, I haven’t seen it in print yet.

*

Earlier this week I introduced the game Where’d the Money Go? and missed some of the more outrageous examples of where the money’s gone. I plead extenuating circumstances, because a National Audit Office report hadn’t hit the news yet. So let’s make up for my lapse. 

Sorry. I do try to sneak some good news into these posts. Some weeks, it’s like fighting gravity.

Early in the pandemic, in an effort to get protective gear for the health and social care systems, the government set up a high priority contracting channel for businesses that were recommended by ministers’ offices, lords, politicians, or officials. Oddly enough, those lords and politicians seem to all have ties to the ruling party, the Conservatives.

The rule of the playground is that we don’t share.

Their bids that went through that channel were ten times more likely to be successful than the bids that went through ordinary channels. One source said their pitches were automatically treated as credible. The documentation is–

Quick, someone, what’s a shoddier word than shoddy? Paperwork documenting why a particular supplier was chosen is sometimes missing. Contracts were sometimes drawn up after the work had been started. 

The person who recommended the company to the priority channel is documented less than half the time. No rules for how the priority channel should operate seem to have been written.

This was in the first six months of the pandemic, when £18 billion was spent on Covid-related contracts.

Liz David-Barrett, a professor of governance and integrity (that’s what she studies–I’m not commenting on her personal qualities), said that firms recommended in this way are usually treated as higher risk rather than lower.  

In a related story, although I can’t say what channel this contract went through, Gabriel Gonzales Andersson made £21 million for wandering through a deal between the UK government and an American jewellery designer, Michael Saiger, to procure protective gloves and gowns from China. 

According to the BBC, Gonzales Andersson was paid to find a manufacturer for deals that had already been arranged.

If you can figure out what happened between the two, you’re doing better than I am, but they’re both in court in Florida–suing each other, I think, although I can’t swear to that. Saiger had several follow-up contracts, and the gear he was supposed to supply was delayed, possibly because the relationship between the two men fell apart.

One more example before I stop: Lord Feldman, a former chair of the Conservative Party, and a managing director of the lobbying firm Tulchan Communications, acted as an unpaid advisor on Covid. 

Tulchan is also called a public relations firm; flip a coin if you care.

After the firm Oxford Nanopore signed a £28 million contract with the Department of Health, and also after Feldman stepped down as an unpaid advisor, Nanopore hired Tulchan. The health secretary, Matt Hancock, happens to have met with both Feldman and Oxford Nanopore before the contract was signed. I have no idea what they talked about. Movies, probably. Pornography. Gummi bears. Surely not whose money would end up in whose pockets. I wasn’t there. That’s how the gummi bears came into it. 

Tulchan says Oxford Nanopore was already in discussions with the Department of Health before the meetings, so everything’s fine.

Nanopore later picked up another £100 million in contracts.

*

The British Medical Association has gone public with advice on how to lift the current lockdown. The approach last time was, “Wheeee, that’s over. Go out, have fun, spend money. Don’t work from home. The economy needs you.”

That was followed by a faint, “And, oh, do be careful, okay? Wash your hands or something.” 

Which is one of several reasons that we’re now in a second lockdown. 

What the BMA advises includes giving local public health teams more of the test and trace budget, along with more oversight of the program; limiting socializing to two households instead of six people; keeping the local tiered lockdown system that imposes varying restrictions depending on an area’s level of infection but banning travel between areas in different tiers; encouraging people to work from home if they can; and replacing guidance about how to keep workplaces and public areas safe with rules about how to keep workplaces etc. safe. The theory goes that rules are enforceable and might be taken more seriously.

Dr. Chaand Nagpaul, the BMA’s chair of council, said, “The big question in practical terms is can we reopen hospitality venues–pubs and restaurants–in the run-up to Christmas and still avoid infection levels increasing?

“I suspect we can’t, but the decision may be made to do so anyhow on the basis that any increase will be slow and may be able to be counteracted later.”

Because what the hell, it’s Christmas. What do a few extra deaths matter?

*

If I haven’t managed to be funny this time–and I’m pretty sure I haven’t–I’ll try to do better next time. It’s not that this stuff isn’t funny, in a demented sort of way. But it takes time to find the humor and I want to get this posted before the next wave on insanity breaks over us. 

Stay well. It’s dangerous out there.

 

40 thoughts on “The problems with mass Covid testing

  1. A family friend of ours died a few weeks ago. She had dementia and was in a nursing home. At least one family member used to visit every day. When the visits stopped, she couldn’t understand what was going on, and went downhill rapidly. I’m sure she’s one of many. But the virus can spread rapidly through care homes, where you’ve got a lot of clinically vulnerable people living in close proximity. So I don’t know what the answer is :-( .

    Liked by 1 person

  2. If everyone wore a mask, social-distanced and washed their hands (I’ve counted: I do it about 20 times a day) we’d be in a very different situation today. You mention Christmas. I just cannot believe governments all over are considering it’ll be normal to celebrate, and just too bad about the extra deaths…

    Liked by 2 people

    • Somehow, they never say, “Too bad about the extra deaths.” This whole focus on Christmas baffles me. I’d think the prospect of everybody living to see future holidays would make up for missing this one. But, hey, maybe that’s just me.

      Liked by 3 people

      • The Premier of Western Australia, Mark McGowan, said recently he wasn’t having a bar of easing interstate travel restrictions. “Christmas is important but the health of West Australians is more important and setting up an artificial deadline for Christmas, I don’t think, is wise and so that’s why we didn’t agree to it.” He also strongly supported and praised Victorian Premier Daniel Andrews. “They are an example to the world.” Now into their third week of no community transmissions following a very hard lockdown (which had the Murdoch press foaming at the mouth), Dan the Man is showing admirable restraint, with nary a ‘I told you so’. Meanwhile, in my home State of South Australia, we’ve had a significant cluster break out in Adelaide and we’ve just entered a snap six-day ‘circuit breaker’ while authorities try to get a handle on the extent of spread. And yes, by yesterday afternoon, police were having to be called to some supermarkets to control panic buyers of, you guessed it, toilet paper.

        Liked by 1 person

      • One report, which admittedly may be rubbish. says that we’ll be able to hold gatherings of 3 households for 5 days over the Christmas period – Christmas Eve is a Friday, so the Monday and Tuesday will be Bank Holidays as Christmas Day and Boxing Day fall over the weekend – but will then be put into another 4 week lockdown in the new year to make up for it. It may well just be media speculation but, much as I love Christmas and am desperate for my sister to be able to visit, 5 days in return for 4 weeks just doesn’t seem worth it. And a lot of “non-essential” businesses won’t make it through yet another lockdown – they may be deemed “non-essential”, but they’re pretty essential to the people whose wages they pay.

        Liked by 2 people

  3. I read somewhere that Cornwall is a particularly dangerous place right now. I thought of you and Ida and know you are trying to stay safe, but just in case you need encouragement, I’ll add my keep safe and sane admonitions.

    Liked by 2 people

    • It’s not that it’s gotten more dangerous than the rest of the country, but it’s more dangerous than it was. We’ve been lucky up to now, but ironically now that we’re in lockdown (although with the schools open) the number of local cases is going up. Thanks for the encouragement, the warning, all of that. We’re being more cautious than we were.

      Liked by 1 person

  4. In a related development, the head of US Cyber Security overseeing the election did his job well, there were (despite what Some People are Saying) no instances of election fraud or etc. The gentleman announced this after the election : It was the safest election in US history. So yesterday Dear Leader fired him in a tweet – which is how he learned of it. Except that he said he expected to be fired after he did a good job and told the truth about the elections.There were some other stupider more venal things (involving Sen. Lindsay Graham in one way and the board of something or other in Michigan, but they are not worth explaining here as I am already on 3 blood pressure medicines.)

    Liked by 2 people

  5. Very difficult to find humour amidst all this, it’s all such a bloody mess. I suspect that the only way any government or health care organisation (not just the NHS as this affects all countries, it seems) is going to get a grip and come up with ‘rules’ that actually work, is when far too many more people have died. I gather it’s hitting children more during the so-called second wave (which is probably the first wave that just took a slight breather) and my guess is that that is what will bring people to their senses. No kids, no future. :(

    Liked by 1 person

    • I haven’t seen anything–although I also haven’t been looking for it–that more kids are getting sick from it, only that infection is passing from kids to adults. Surprise, surprise. I don’t know how anyone’s going to get a grip on it either, especially now that it’s spread widely enough that the genie doesn’t fit back in the bottle. Vaccines will help, and I pinning a lot of my hopes on them. I keep reading about one thing and another that either is or may be a treatment, which would, presumably, make the beast less lethal. I’ve stopped covering them for the most part, because from the perspective of the average lay person they drop out of sight right after you read about them. From a medical perspective, they probably don’t–you could keep your eye on them and see what happens–but from mine and I assume most of my readers’ it’s just a tantalizing bit of information that we’re unlikely to hear about again.

      I’ll keep my eyes open and see if I find anything about more kids getting sick from Covid. Thanks for mentioning it.

      Liked by 1 person

  6. I read a very sensible suggestion, which was to give schools longer “holidays” to help the exhausted (and cold) teachers recover and to help stop the spread of covid. Large percentages of children are self-isolating anyway. As my mother siad, why not cancel everything, Christmas, exam, Olympics and just move them on to next year instead. I am totally sick of the news going on about Christmas, by the way. They are obsessed with it. Why dont they mention the looming food shortages come Jan 1st instead?

    Liked by 1 person

    • Good question. The best I can do is that it’s more fun to obsess about a created problem (one that’s only a problem if we decide it is) than a real one (we need to eat whether we think we do or not).

      They certainly could have coordinated the lockdown with an extended half term holiday without much of a loss and with quite a bit of gain.

      Liked by 1 person

  7. Well Ellen, you hit a lot of nails squarely on the head there, and some of those heads really do need hitting!
    I’ve reached the point where a government endorsement of any statement pretty much negates it’s value as far as I’m concerned. I try to get past headline statements and slogans and look at the data behind them. Honestly, I am appalled by the lack of care being exercised in the messages being dished out left, right, and centre.
    You really have to listen so very carefully to exactly what scientists are saying, rather than what pundits of one kind or another would like them to be saying, in order to make any sense of this UK fiasco.
    Anyway, enough of this. I’m off to visit my “open for essential service” Garden Centre (?). Maybe plants ward off evil spirits.

    Liked by 1 person

    • “Here’s rue for you / and some for me….”

      I’m working from memory there and may be misquoting, but there should be plenty of rue to go around. Although, come to think of it, I don’t remember ever seeing it for sale in a garden center.

      Like

  8. 100 billion here. 100 billion there… The money printing machines are at full speed all across Europe and the US. Question: isn’t that how the Weimar Republic started hyper-inflation? I still have German stamps worth 1 million Marks…
    (And we all know what followed the Weimar republic)
    Stay safe

    Liked by 1 person

    • I don’t actually know how Weimar entered hyperinflation. I do know that the peace treaty, in which the countries from the other side of WWI stripped Germany’s industry and shipping, had a lot to do with it. Beyond that, I’ll have to consult the resident historian. (Consultation done: She says it was a combination of the two. The money printing was a desperate response.)

      I do know that no country can borrow endlessly, or print money endlessly, but I also know (or, let’s be honest here, think I know, anyway) that economic theory has developed an obsession with lowering state borrowing, mostly as a way to undercut social programs, because there’s always money for a war or two, or the military, or whatever really matters. Here they didn’t want to spend money on the holiday meals for the poorest schoolkids and cut foreign aid, but just found money to bump up military spending.

      Stop me before I write an entire unfunny post on this.

      Liked by 1 person

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