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.

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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.

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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?

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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.