An open letter to Grant Shapps
This is an open letter to Grant Shapps, Secretary of State for Transport.
My name is Dr Anthony Cooke, I run a COVID-19 testing laboratory in Cambridge which has been working in virology for over 15 years. We have been doing testing for the SARS-CoV-2 virus for just over 18 months now using Real Time PCR. I have nearly 40 years experience in the diagnostics industry and feel I really need to comment on your latest announcement.
“Follow the Science”, “Protect the NHS” have been major aims during this pandemic but I have to ask, how are you doing this with your latest announcement on moving to lateral flow testing (LFT) for day 2 travel testing?
Currently in the UK we have a highly vaccinated population but nothing else to limit viral spread (face masks, social distancing, etc). We currently have a massive infection rate, 40,000 per day and the NHS is hanging on by a thread in terms of capacity. We are just entering the cold and flu season which is going to seriously challenge that capacity and the latest change to travel testing will not reduce this pressure.
We have been doing day 2 travel testing for around 6 months now and find somewhere between 0.5% and 2% positive rate, that’s 1-4 individuals per aircraft. These are people who tested negative, usually by lateral flow, only a few days before. So we know this is a major route for new infections to enter the UK. These positives can then be sequenced to see if there is any new variant of concern, ?one that could potentially break through our vaccine barrier. All of this testing is following good scientific principles and designed to minimize any infection increase and so protect the NHS.
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However, you say that PCR tests are “cumbersome” and “costly”, I respond by saying that they are scientifically elegant but more importantly they are very sensitive and accurate. A PCR test can easily detect an asymptomatic individual. Our tests can detect around 25 copies of the virus in a sample. The BMJ published a paper earlier this year showing that the best LFT’s can detect around 500,000 copies of the virus in a sample but most are around 2,000,000 copies and that they are really only good for confirming symptomatic infections. As an example of how not to use LFT’s for screening you only have to look at schools. The latest figures from school infection rates for children aged 2-11 all show significant increases, and these are all using lateral flow testing to control infections.
Not only are PCR tests highly sensitive they are also extremely accurate. Lateral flow tests miss a large proportion of positives. Another BMJ paper shows that at best they could miss 3 out of 10 positives and at worst 7 out of 10.
You also say they are “costly”, well maybe they would have been more reasonably priced if the Government hadn’t allowed a Private Provider system to evolve which could exploit consumers in such a way. As a testing lab, we charge around ￡25 for a single PCR test, our logistics can cost us an additional ￡20-￡30. It is some of the front-end providers that market and sell tests, but actually do little testing themselves, who are really taking advantage of the situation which the Government mandated and controls.
It is very clear that the Holiday industry has put tremendous pressure on the government to improve the current situation, and I totally agree that we need to get our industries back and functioning. However, moving away from PCR testing to LFT’s is not following the science in any way and potentially could see huge pressure or collapse of the NHS if a variant of concern enters the UK undetected. Our vaccination program is our only defence at the moment and using just LFT’s for inbound travel testing is a monumental risk to that program. If it’s a cost issue then regulate the cost in the market place but do not risk our only way of protecting the future health of the country. We know that variants of the SARS-CoV-2 virus already exist that could evade vaccine protection. The recent MU variant was one which luckily was not highly infectious, but that does not mean a MU/DELTA type variant couldn’t evolve to challenge us and its most likely to come in from abroad undetected under the new scheme.
We are teetering on the edge of normality in the UK. Our vaccination program has been a phenomenal success but the vaccines are not 100% effective and it would take very little to push infection rates, hospitalization and deaths back to a point where we have to almost start again. For me the travel testing move to LFT’s could be the final straw, I hope you know what you are doing.
Helping organisations drive their AI initiatives
3 年I am not a trained molecular biologist but when i worked for a small biotech company I was taught how to run PCR tests and also successfully trained people in the food industry to run these for meat speciation. PCR is phenomenally accurate and can be made more accessible. More labs and equipment is required and a little training. This is not going away anytime soon and will not be the last pandemic. Let's invest and get it right.
Commercial Organoid Innovation Director @ Molecular Devices | Advanced Cell Models
3 年Well said Tony!?
Regulatory Affairs Manager at Cepheid
3 年We’ll said Tony! Completely agree with you ??
Explorer of wild and remote places
3 年Self-isolation (following a test), masks and other measures (like social distancing) will only slow the spread of the virus. Ultimately, everyone in the UK will be exposed to it. Those who have been vaccinated have little to fear (and I assume exposure will boost their immunity). Most of the unvaccinated are healthy and young, and so should also have little to fear (and I assume that infection will give them future immunity). We will have to learn to live with virus in a similar way that we live with the flu, and this will inevitably mean moving away from testing and other preventative measures (other than vaccination).
Staff Software Engineer and Technical Architect at INTO University Partnerships
3 年On one hand, I understand your point of view, but on the other, we have companies like Boots who charge ￡80 and then take weeks to get back with PCR test responses -- well after the infectious period, endangering lives in the process. I also don't think it's reasonable to expect labs like yours to offer a direct to consumer product because the labs aren't designed for large numbers of consumers to visit, and we don't have the national infrastructure to own the logistics (we can largely blame privatisation of institutions like the Post Office for this) of sample gathering and transportation. Nonetheless, the true matter at hand is whether PCR can compete with LFT at scale: If a LFT can be 85% as effective at positive results compared with PCR test, but scales so that tests can be cheaper, done sooner (or at multiple points), more convenient for people, have faster responses, and have a much much reduced carbon impact (+ no expensive logistics), then more lives will be saved overall, less money will be spent and people can get back to normal faster. Overall I am persuaded that LFT is the lesser evil, especially when looking 1-2 years into the future. The democratisation and accessibility of testing will make society fairer and safer. Having said that, I think the intelligent solution is more complicated; something like: 1) mandate migration from 'safe' countries to have a LFT and a 1% randomised sample of PCR tests to monitor ongoing effectiveness of LFTs (+, of course, confirm and sequence positive results with PCR) and 2) mandate PCR from 'at risk' countries or at risk travellers.