When the government’s Operation Moonshot plans for mass testing of the population for Covid-19 were first revealed, the intention was to use that as the route out of perpetual cycles of lockdown.
It was described as a £100bn-plus endeavour, with resources likened to the Manhattan Project, the top-secret wartime endeavour led by the US to develop a nuclear bomb.
By early 2021, 10m quick-result tests a day would be taken by the British public. People would get tests with their sports tickets, swab on the way to school andbe tested with the same morning monotony as brushing their teeth.
It may have seemed fanciful but at the time it was grasped with both hands by the prime minister as the only way to return to normal life.
But then another way out emerged – multiple vaccines were proved to be effective and safe. Now the mass vaccination programme appears a much less far-fetched way out of the crisis to the outside observer. So why continue with grand plans of mass testing?
Though Whitehall never calls it Moonshot nowadays, testing is still a key part of the fight against Covid, particularly when it comes to identifying and isolating new variants of the virus that pose the biggest threat to the vaccine programme. Across swathes of the UK, lateral flow tests are easily available for residents. PCR surge testing is in place in areas where there are concerns about variants.
Now it has been revealed that as part of Boris Johnson’s roadmap for easing lockdown, NHS test and trace is aiming to eventually send 400,000 rapid lateral flow tests by post to homes and workplaces every day. There will be a huge public information campaign to encourage asymptomatic testing.
The medicines regulator has previously expressed extreme caution about lateral flow tests being conducted by untrained people and it is unclear whether the government has formally sought its advice.
The government is in advanced talks with the hospitality and events industries about how testing can be part of the reopening plan. One day, a Beyoncé concert or a Champions League game could involve tens of thousands being tested on entry, providing vital data for monitoring infection rates.
However, the system is far from foolproof. The general scientific consensus is that rapid-result lateral flow tests are less sensitive than polymerase chain reaction (PCR) tests, which have generally been used to test people showing symptoms and the results are analysed in labs and generally returned one or two days later.
Lateral flow tests are thought to be particularly poor at identifying the early stages of infection, when a person may still be asymptomatic and at the highest risk of infecting others. There is also scientific concern that their use by untrained people makes false negatives more likely.
The government also seems set on pushing ahead with its ill-fated schools testing programme, which was announced and then halted after the Medicines and Healthcare products Regulatory Agency did not authorise the daily use of rapid-turnaround tests as an alternative to self-isolation. Pupils are set to be tested twice a week, rather than daily, from 8 March when schools are expected to begin reopening.
The vast expense of the programme, and doubts over its accuracy, are likely to lead to questions as to why the government will continue for many months – and perhaps years to come – with mass testing when it looks on course to vaccinate every adult in the UK by August.
Yet officials still believe mass testing will play a big role in monitoring rates of infection – a criteria that has become increasingly important in Johnson’s thinking, influenced by government scientists, when previously the focus had been on vaccination rates and hospitalisations.
It is also important to continue to use PCR testing to monitor new variants, though mutations are riskier when infection rates are higher, which government scientists believe is the biggest threat to a return to normality. If Johnson wants to make good on his promise that this lockdown will be the last, monitoring mutations that could threaten vaccines’ progress is paramount.