Anthony Costello, former WHO director and professor of global health and sustainable development at University College London
On virus testing, it is good that they are solving the swabs and reagents issues. It’s good that they are galvanising the scientific community to help and it’s good that they are setting a target for 25,000 tests [antigen tests that show if people have the virus] per day by the end of April [Hancock aspires to reach 100,000 a day in England for all types of tests, including antibody tests] that will hopefully help to cover health workers and patients.
If the blood tests for immunity come online, that will be a very valuable tool for looking at the scale of immunity in the population, as will their surveillance plan from Porton Down, to look at the rates of infection and spread in a sample survey. Whether or not the immunity blood tests will be sufficiently specific for Covid-19 is a big issue because if they give out false positives it will be dangerous for people believing themselves to be immune to go back into the front line and infect patients.
Nonetheless, none of these strategies address the fundamental problem of stopping the spread of the virus.
Eleanor Riley, professor of immunology and infectious disease at the University of Edinburgh
Under normal circumstances Public Health England (PHE) (and Health Protection Scotland) have extremely strict testing protocols, all validated to the highest certification standards. This has many benefits: providing robust results in which clinicians have complete faith, aligning to standard criteria that allow national and international comparison, and regular re-validation of individual laboratories. On a normal day this works. It is clinically robust and allows the NHS to benefit by bulk ordering reagents from a single supplier at a competitive price.
But these are not normal times. There is an urgent need to scale up testing. This might require that we adapt protocols to use whichever reagents and equipment are available. Research labs, that tend to operate in a less regimented manner, have the skills, equipment and (quite possibly) sufficient reagents to contribute to this effort. They won’t be exactly the same items that PHE use, but they will work just as well.
Crucially, almost all academic research that is not related to Covid-19 has been put on hold; the labs have been mothballed and the staff sent home. This represents a tremendous available resource for outsourcing and scaling up the testing. The academic community has the skills, resources and willingness to contribute if only someone would take the sensible, pragmatic decision to cede a little control. There is a glimmer of hope in Matt Hancock’s “5 pillar programme” presented at the press briefing today, but still precious little detail.
Dr Michael Head, senior research fellow in global health, University of Southampton
It is good to finally hear the explanation from the minister of health about the difficulties in scaling up testing. This is down to a lack of preparedness in advance of a pandemic, which then impacts upon the ability to greatly and rapidly increase a national response, as we have seen in Germany. These are issues also being faced in other countries, for example France has carried out fewer tests than the UK.
The minister has promised 100,000 tests a day by the end of April. We shall see if this level is delivered. But throughout the coming weeks, we need to remember the lessons learned and realise that spare capacity in a health service or public health infrastructure is not “a waste of money”. It’s vital in times of urgent need, and there will be a “next time”.
Mark Harris, professor of virology at the University of Leeds
[Hancock’s five pillars] seems like the right approach. I am a little bit concerned about the timescale, that we are having to wait to the end of April [for high levels of testing]. We would hope that within the next few weeks we would start to see some effects of the social distancing and the lockdown so it would be nicer if we could be testing quicker than that. But I understand what [Hancock] said about the fact that we didn’t have a big diagnostic industry, unlike some other countries, so we are having to build up from scratch – I think that is quite honest and open of him.
[Population sampling] is an excellent way forward. The challenge will be: what population do you sample? Also, what is the statistical analysis will you apply to the data you get from that? If you went into London you’d probably find there is a much higher proportion [of infection] than other parts of the country – maybe that is information that we need to know.
I think we can always be critical of what has happened in the past, but I don’t think that is appropriate at this stage. This is a crisis and we are where we are, we need to try to make sure that going forward we are doing the right things, the time for recrimination and looking back and learning the lessons will be in the future. For now I think [Hancock] is doing everything he can. Let’s hope those words that were spoken today are actually translated into actions over the coming few days.
Charlie Swanton, chief clinician of Cancer Research UK, who is setting up a testing lab in the Francis Crick Institute
It all sounds very sensible. Testing is absolutely essential to get healthcare workers back to the front line, when they don’t present a risk to those around them and to patients. With a significant proportion of the workforce off right now with presumed coronavirus infection, having tests will be vital to frontline services already stretched because of the crisis.
The sensible thing would be to staff coronavirus units with doctors and nurses who have had exposure to coronavirus exposure, and that’s why the antibody test is so important.
We’re obviously delighted to be playing a part. We will make a small but significant contribution, we hope. It is going to require collaboration on a national scale. We will be sharing our operating procedures, our assays [investigative procedures] and the development of those assays with other labs upon request very happily and provide training to get people up and running relatively quickly.
On building a new British diagnostic industry, this pandemic has exposed the extreme vulnerability of every country. We are so dependent on a globalised diagnostic and clinical network. When the barriers come down and our supply lines fail, it is clear very rapidly how vulnerable we are. We need some way of being able to secure our pipelines to access vital diagnostic reagents and kits and if we can’t, we need some way of manufacturing them ourselves from scratch very quickly.
All of this is possible because the technology is not complex but finding approaches to rapidly validate and qualify a diagnostic test for clinical use are challenging but all solvable with the right networks of collaborators and established diagnostic labs.