January 2022 – What is the future for COVID testing in the UK?

By Dr Anthony Cooke, CEO Cambridge Clinical Laboratories, Chair of The Laboratory and Testing Industry Organisation (LTIO) Scientific Advisory Board

The UK now appears to be in a good place when it comes to resolving the Covid-19 pandemic with Omicron (BA1) infections in the adult population continuing to fall, a well vaccinated population (over 90% of 12+ with one jab and 64% boosted), new treatments in the NHS, and the added bonus that spring is just around the corner. The removal of travel testing has improved the outlook for people to get away to the sunshine after two years, with reduced hassle and cost, but at what price?

The Government will always be on the losing side. They have to balance peoples physical and mental health, the burden on the NHS, costs and trying to get the economy back up and running. Nobody has the perfect answer and things may not always go smoothly.

With regards to Covid-19 testing, we know that it formed, and will continue to provide, a vital part of the overall Covid-19 monitoring and prevention/control process. The use of lateral flow devices (LFD’s or LFT’s) has vastly increased our testing capacity and turn-around times, sometimes as much at two million tests per day in total have been reported and I suspect far more actually conducted. Laboratory based PCR tests and sequencing have given us better quality results and identified new variants of concern (VoC’s) but at a more substantial cost. Laboratory testing has been provided by a number of different providers; NHS, PHE/UKHSA, University labs, and private labs. Many specialist new public and private labs have appeared over the last 24 months just to provide Covid-19 testing. It is estimated that we now have a PCR testing capacity of around one million tests per day in the UK, it wasn’t long ago that a certain Minster for Health was challenging us to provide 120,000 tests per day.

What’s going to happen to Covid-19 testing moving forward?

As we see the current Covid-19 spike falling and the rate of hospitalisations and deaths from Covid-19 remain stable or also falling, then it is inevitable that testing numbers will reduce. If we look back over the past 24 months of the pandemic, infection rates during late spring and summer were vastly reduced, down to single figures per day. The expectation appears to be that the same will happen again this year. If that is the case, then the need to test becomes much reduced. Covid-19 will still be around, albeit at low numbers - we may need to test any symptomatic individuals to see whether its Covid-19 or a cold. With travel opening up we also need keep an eye on any new potential VoC’s coming in from abroad. In the Southern hemisphere it will be winter and potentially major Covid-19 outbreaks could still be occurring and the chances for a new variant evolving are highly likely. We need to know as soon as possible whether these new variants are more infectious, could potentially overcome vaccine protection or are more pathogenic. A recent research project by Oxera and Hedge Health, for Manchester Airports and Airlines UK, has indicated that statistically a full regime of travel testing would only give us six days delay on any new variant peak of infection. But that is also six days of advanced early warning for the country to prepare, which could save a lot of lives. Whatever happens the need for testing will remain.

What has already happened, and is likely to continue, is that the requirement for testing by private providers will reduce dramatically. We have already seen this with travel testing. It is therefore likely that the new labs that set up just to provide Covid-19 PCR testing will either close or adapt to provide other forms of testing. However, it is unlikely that without some significant change in the diagnostics business in the UK there will be anything requiring testing that comes anywhere near the volumes needed for Covid-19.

Do we let this new capability disappear or can we take advantage of it?

There is a huge potential opportunity that could be exploited to radically improve the health of the nation. We know the NHS now has a huge backlog of patients due to the pandemic, which it has been said may take five years to get back to normal. One solution could be to use the spare testing capacity from the Covid-19 testing labs and use it for mass screening programs within the UK. These could be for diseases that we know are still challenging the NHS; Cancer, antibiotic resistance, diabetes, and obesity. The cost benefits for early detection of diseases are undisputed and we now have available testing capacity to do these tests without any additional burden to the NHS, in fact they would provide a significant benefit to the NHS in reducing the backlog.

We could revolutionize healthcare in the UK. The new Integrated Care System (ICS) being introduced to replace CCG’s in the NHS could greatly benefit from this. These new partnerships between the organisations that meet health and care needs across an area are designed to coordinate services and to plan in a way that improves population health and reduce inequalities between different groups. We could also use the UK’s astounding capabilities and capacity for next generation sequencing (NGS), which leads the world in SARS-CoV-2 variant analysis, to not only provide much better treatment outcomes for cancer patients but also look more at predictive/prognostic medicine for the prevention of diseases within the UK population.

We potentially have a unique opportunity to take our newly found biotech capabilities and capacities and use them to remodel our healthcare provision in the UK, making it world-leading again and doing so cost effectively.