Scientists have complained that “precious time has been wasted” before the implementation of the government’s new, Dunkirk-style approach to boost Covid-19 testing.
In the past week, the Francis Crick Institute in London, Cancer Research UK units in Glasgow, Manchester and Cambridge, and laboratories at leading universities have been transformed into diagnostic facilities that will double the current levels of testing being achieved by Public Heath England (PHE).
Addenbrooke’s hospital in Cambridge has become the first to roll out a 90-minute test to triage patients and says it will soon have sufficient capacity to not need to rely on PHE labs.
These initiatives have happened locally, without government coordination, which until now has stuck to a centralised approach of testing only in PHE laboratories. However, on Thursday, the health secretary, Matt Hancock, signalled a shift in approach that will see a new target of 100,000 tests each day relying on a network of companies, universities and research institutes.
Prof Eleanor Riley, an infectious disease expert at the University of Edinburgh and former director of the Roslin Institute, said these resources could have been tapped into far earlier and, in some cases, laboratories’ offers were not taken up. “This could’ve happened a month ago,” she said. “PHE has been plugging on in its very blinkered way and meanwhile there’s a revolution going on on the shop floor. It’s like hospitals have decided, ‘We’re just going to go ahead and do it.’”
Ahead of Hancock’s briefing, Sir Paul Nurse, director of the Crick Institute, said in the past 10 days a cancer genetics laboratory at the Crick had been transformed into a high-throughput testing lab. It will carry out 500 tests for healthcare workers from Monday, ramping up to 2,000 within a couple of weeks in what he described as the “Dunkirk approach”.
“We made a deliberate policy choice … to go ahead with this and to divert resources from research,” he said. “We’re one of the little boats – well, moderate-sized boats. Once we get the destroyers in there to pick people up, it’ll be a game-changer, but until then institutes like ours can have a huge impact on the national endeavour.”
However, many universities have opted to close labs, on the assumption that decentralised efforts were not required, in order to protect staff.
Prof Matthew Freeman, head of the Dunn school of pathology in Oxford, said: “It’s a policy question and the government has to take responsibility for that. Either they decide they don’t want a cottage industry doing this and they want it all centralised, or you talk about Dunkirk. If the view is that this decentralised approach can be helpful, the offers have been there for weeks.”
After offering to redeploy his lab, equipment and scientists to Covid testing weeks ago and not hearing back, Freeman said he felt some frustration at seeing efforts going ahead elsewhere. “I’m slightly regretting [not setting things up] after seeing that the Crick has gone ahead and done it,” he said, adding that the offer stood.
In Thursday’s briefing, Hancock laid out a new five-pillar strategy for testing, which included a partnership with universities, research institutions and companies such as Amazon and Boots to build a network of new labs to provide swab testing for frontline health workers and their families. Trials at five unnamed sites had been completed, he said.
In advance of this, several major research institutes had started ramping up testing capabilities without this being an explicit part of the government’s approach.
Cancer Research UK is replicating the Crick’s setup at three major research institutes in Glasgow, Manchester and Cambridge, and anticipates that the sites will be running roughly 6,000 per day in total within seven to 14 days.
In Edinburgh, the Medical Research Council’s (MRC) Human Genetics Laboratory has shipped in polymerase chain reaction (PCR) machines from across the university campus and by the middle of next week expects to be running 1,000 tests per day. King’s College London and the universities of Dundee and Aberdeen have also repurposed labs and are expected to have a similar capacity.
“In an ideal world, we would’ve had more testing capacity online earlier,” said Sir Professor Robert Lechler, senior vice-president of King’s College London. “I’m hesitant to point the finger of blame. It’s remarkable that we’ve moved at the pace we have and the upheaval that this new world has caused is difficult to exaggerate.”
Prof Wendy Bickmore, director of the MRC human genetics unit at the University of Edinburgh, said: “This is very much a bottom-up local initiative with local NHS labs. It was recognising there’s an immediate need in the NHS and that we can help meet that.”
Other large labs that could have been capable of similar efforts, but which did not have close ties with NHS testing facilities, might have been encouraged to do the same, she said. “We can probably look back on this from a happier future and see how we might be more ready next time to harness the capabilities that are out there.”
Addenbrooke’s hospital has become the first in the UK to use a new, rapid Covid-19 test for staff and patients, called Samba Two, that delivers results in 90 minutes. The hospital has installed four machines in the triage area and is running parallel tests on patient samples for the next three days, after which it plans to install a further 16 Samba machines, which should cover the hospital’s entire requirements for patient and staff testing without needing to rely on PHE labs.
Separately, Cambridge University labs will start running tests for healthcare workers in the region, and the scientists expect to be conducting 600 tests per week soon.
Some experts expressed concerns that not all cities or regions had large universities or research facilities that could contribute to local testing capacity, meaning regional disparities could emerge, particularly in tests on healthcare workers.
“There is definitely a potential for inequality,” said Prof Ravi Gupta, who is leading the assessment of the Samba testing at Cambridge. “That’s where government testing should be directed – that needs to be factored in.”
