UK makes £8B bet on rapid tests as route out of lockdown

The U.K. plans to test its way out of lockdown at a price tag of £8 billion, despite concerns about the accuracy of rapid self-tests. 

The government’s push for rapid community testing is already underway, with more than 48,000 businesses having ordered these rapid tests as part of a plan to help businesses reopen. Schools across the country are also using them to ensure that pupils are coronavirus-free. 

According to the pre-information notice, published by the government on March 19 and unearthed on the Tussell procurement database, the U.K. is willing to spend £8 billion on the tests. In a briefing for interested companies published alongside the notice, the government explains that 75 percent of these tests need to be capable of asymptomatic use as self-tests, meaning that those without symptoms can use the test at home to tell if they have the virus. Rapid tests usually give results in 30 minutes and don’t require the sample to be returned to a laboratory. 

The procurement process is open for 12 months, with many competitions set to be run under the so-called “Dynamic Purchasing System,” which was launched on March 5. 

Leaked documents in October indicated £100 billion would be spent on the entire expansion of the testing program. 

Concerns about the tests’ accuracy, however, have plagued their rollout for months. Experts have pointed to an array of potential issues with the tests, including high numbers of false negatives and failure to detect cases in the early stages of illness. 

In late January, several experts, including Jon Deeks, the lead of the Cochrane COVID-19 test evaluation reviews, wrote in the BMJ that the expansion of lateral flow testing “may cause serious harm.” They asserted that the government is “relying on mathematical models rather than real world evaluations.”

Taking a similar view, the Royal College of Pathologists warned on March 10 that “the currently-used versions of these tests are not of sufficient sensitivity or accuracy to rule out the possibility that a negative result may not be correct.” 

Specificity and sensitivity are the two indicators used to assess these tests: The calculation for specificity relates to how accurately it detects negative cases, whereas sensitivity relates to how accurately it detects positive cases. The World Health Organization recommends rapid diagnostic tests to have a specificity of 97 percent and a sensitivity of at least 80 percent. 

However, since the stark warning in the BMJ, the government has pushed back to vouch for the tests’ usefulness. On March 10, it published post-marketing surveillance of the tests in use, reporting a remarkably high specificity of 99.9 percent.

More broadly, the tests have been embraced by the British government, which has stipulated that any household containing someone either attending or working at a school, college or nursery may order up to seven tests each day. A scheme for large businesses is already underway, with reports that smaller businesses may soon follow suit.

Meanwhile, the Times has reported that all adults will be encouraged to test themselves for coronavirus twice a week to help move the country out of lockdown. 

There are no plans to slow down rapid testing, with the government awarding two new contracts for up to 200 million lateral flow tests on March 15. Another contract worth over £152 million was awarded to Innova in October, with the award being published on March 23.

“Rapid lateral flow tests are essential to help us identify cases of the virus we otherwise wouldn’t find, [thereby] preventing the virus spreading in our workplaces and communities,” said Health Secretary Matt Hancock when announcing the new contracts. “These tests will help keep businesses open, our children return to school, people to visit their loved ones in care homes safely.”