Mass testing

Serco and Mitie Awarded New Testing Contracts That Could Last for 18 Months

The Government is sticking to its line that lockdown will end on July 19th and that this unlocking of restrictions will be irreversible. But, once again, its actions point in the opposite direction. Most recently, Serco and Mitie have been handed new testing contracts – worth up to £687 million collectively – to support the Test and Trace system. The contracts will run for 12 months but could be extended by another six. Reuters has the story.

The [Test and Trace] scheme, which Prime Minister Boris Johnson pledged would be world-beating when he launched it with a £22 billion budget in May 2020, has repeatedly missed targets…

Serco’s contract, which is worth up to £322 million, covers services such as site operations, cleaning and security at around 20% of test sites in England and Northern Ireland, down from the roughly 25% of sites covered by its previous deal.

Mitie’s deal, worth up to £365 million, covers the management of around 28% of testing sites across England, Scotland and Wales, up from about 23% of sites in its former contract.

The two agreements are focussed on testing only but form part of the Test and Trace scheme, which oversees testing of people who think they have Covid, and then tracing contacts of those who test positive to require them to isolate.

While Serco also holds contracts for contact tracing, Mitie only looks after testing sites.

Parliament’s spending watchdog said on Friday the scheme had improved but was still missing targets, and the results of millions of tests to find asymptomatic cases had not been reported.

Worth reading in full.

The Truth About the Covid ‘Crisis’ in India

Now that Chile is settling down a bit, the latest Covid cautionary tale is India, which never seems to be out of the news at the moment as its positive cases and deaths have rocketed in the past few weeks.

Even the usually level-headed Kate Andrews in the Spectator has been painting the situation in lurid colours.

As it happened, the UK’s worst nightmares were never realised. The Nightingale hospitals built to increase capacity were barely used. But what the British Government feared most is now taking place elsewhere. India is suffering an exponential growth in infections, with more than 349,000 cases reported yesterday, as well as nearly 3,000 deaths. Hospitals are running out of oxygen for patients and wards are overflowing. There are reports of long queues as the sick wait to be seen by medical professionals. It’s expected the situation will deteriorate further before it gets better.

Jo Nash, who lived in India until recently and still has many contacts out there, has written a very good piece for Left Lockdown Sceptics putting the current figures in context – something no mainstream outlet seems to have any interest in doing.

Jo makes the crucial point that we need to keep in mind the massive difference in scale between India and the UK. At 1.4 billion people, India is more than 20 times larger than the UK, so to compare Covid figures fairly we must divide India’s by 20. So 2,000 deaths a day is equivalent to a UK toll of 100. India’s current official total Covid deaths of approaching 200,000 is equivalent to just 10,000 in the UK.

In a country the size of India and with the huge number of health challenges faced by the population, the number of Covid deaths needs to be kept in perspective. As Sanjeev Sabhlock observes in the Times of India, 27,000 people die everyday in India. This includes 2,000 from diarrhoea and 1,200 from TB (vaccinations for which have been disrupted by the pandemic). The lack of adequate hospital provision for Covid patients may be more a reflection of the state of the health service than the severity of the disease.

Jo Nash also points out that poor air quality plays a role.

Delhi, the focus of the media’s messaging, and the source of many of the media’s horrifying scenes of suffering, has the most toxic air in the world which often leads to the city having to close down due to the widespread effects on respiratory health…

Respiratory diseases including COPD, TB, and respiratory tract infections like bronchitis leading to pneumonia are always among the top ten killers in India. These conditions are severely aggravated by air pollution and often require oxygen which can be in short supply during air pollution crises…

According to my contacts on the ground, people in Delhi are suffering from untreated respiratory and lung conditions that are now becoming serious. I’ve also had breathing problems there when perfectly healthy and started to mask up to keep the particulate matter out of my lungs. I used to suffer from serious chest infections twice yearly during the big changes in weather in India, usually November/December and April/May. When I reluctantly masked up that stopped. My contacts have reported that the usual seasonal bronchial infections have not been properly treated by doctors afraid of getting Covid, and people’s avoidance of government hospitals due to fear of getting Covid. Undoubtedly, these fears will have been fuelled by the media’s alarmist coverage of the situation. Consequently, the lack of early intervention means many respiratory conditions have developed life-threatening complications. Also, people from surrounding rural areas often travel to Delhi for treatment as it has the best healthcare facilities and people can go there for a few rupees by train. This puts pressure on Delhi’s healthcare system during respiratory virus seasons.

Positive cases look like they may be peaking in many regions now.

Boris is the Great Appeaser Who Caves in to the “Experts” at the Expense of Ordinary People

There follows a guest post by Dr Timothy Bradshaw, a retired Oxford Theological Lecturer.

Allegra Stratton, Boris’s replacement for Lee Cain as policy communicator in No.10, has gone, to the BBC as an eco-analyst, after a short spell of announcing nothing, maybe she offended Carrie too? And that communications room, fitted out for a couple of million, won’t be used. So that “reset” of No 10 has itself been reset, maintaining that sense of fairground chaos so beloved of our leader.

But his utterances are, as Janet Daley has shown in her Telegraph column, less and less convincing and being taken as incoherent by a growing number of intelligent people, not just “conspiracy theorists”. He bizarrely proclaimed that the successful lowering of Covid cases and deaths in the UK was not caused by the vaccination programme but by… the lockdowns, which therefore must remain the chief weapon against the epidemic – if the epidemic should return. Hence the shutting of the Nightingale hospitals and no plan for future epidemics being developed. As Daley said, this statement was surely plain wrong, and also politically a gaffe as it portrayed his one massive success as an irrelevance. It also would discourage the population from offering to be vaccinated, a Macronic blunder. Why this idiocy from our leader?    

“Save lockdowning” is the only credible answer, combined with the fact of Boris being, apparently willingly like Patty Hearst, held hostage by that strange and frightening gang of “experts”. Boris is in effect their glove puppet. Their latest utterance through him is that “a third wave is definitely coming” – “hurricane Boris” is building up in India and will soon be blowing us away. Really, or is this just more “precautionary” weather forecasting to get us to board up the economy again, more fear-inducing talk?

At present we can hardly be said to be in an epidemic, but the “experts” are very keen to keep finding Covid wherever they can, and so “save lockdowning”, as if hoping to keep this phenomenon going to maintain their grip on the population. 

The grotesque plan is to keep perfectly healthy and non-vulnerable people taking two home tests per week, followed up by a PCR test for positive results, and these go to a central lab. These tests are for the Covid “genome sequencing” programme and can hardly be defended as a sensible use of the health budget. It is predicated on scanning for and locking down any tiny group of people infected with a new variant, and not on getting a medically based plan for treating future SARS viruses. It is clearly in line with keeping the lockdown hammer available, permanently. 

Mass Covid Testing a “Waste of Time and Money”, MPs Told

Biostatistics Professor Jon Deeks has criticised the Government’s mass Covid testing plan as a waste of “time and money”, highlighting that in some areas only one positive case has been found after 10,000 tests. Professor Deeks, a Senior Researcher at the Institute of Applied Health Research at Birmingham University, told the All Party Parliamentary Group (APPG) on Coronavirus that there is “no evidence” to show mass testing works. He is quoted in the Telegraph:

“For this mass test, the Innova test, we have the Liverpool study and the University of Birmingham study, that’s a total of 78 cases where we know how well it detects (positive cases).

“That is absolutely outrageous that we are now testing the whole population based effectively on data from 78 people, which actually showed it doesn’t work very well…

“In the South West at the moment, I think we are down to 0.09% prevalence and that probably means we would be using 10,000 tests to find one case in the next few weeks.

“I don’t think that’s a good use of people’s time or money or public health capital to do that. There are far better things we could be doing.”

The APPG is chaired by Liberal Democrat MP Layla Moran, who said: “[Mass testing] seems to be the panacea at the moment… [but] how reliable is it?”

Earlier this month, the Government promised twice-weekly Covid tests for everyone in England. Sky News had the story.

The Government says the offer is currently for England only and the devolved administrations in Scotland, Wales and Northern Ireland will make their own decisions.

A major marketing campaign encouraging people to take up the offer of twice-weekly lateral flow tests will also start in England this Friday…

The programme is effectively the long-delayed “Operation Moonshot” of 10 million Covid tests a day, costing an estimated £100 billion, promised by Health Secretary Matt Hancock last summer.

When he told the Commons it would start as early as December, MPs laughed, prompting Mr Hancock to brand them “nay-sayers” and telling them to “get with the programme”.

Now the Government says that alongside vaccination, regular Covid testing will be an essential part of easing lockdown restrictions and help quickly suppress the spread of variants.

The Telegraph report is worth reading in full.

Offering Everyone in England Two Tests a Week Is a Waste of Resources

Everyone in England is to be offered two rapid COVID-19 tests per week as part of the Government’s plans to “ease” the lockdown. According to the BBC, these tests “are aimed at those without any Covid symptoms and can be taken at home”. The kits will be available through community and workplace testing schemes, as well as via local pharmacies and an online home-ordering service.

However, this seems like a huge waste of resources. Recall that the Government has already spent an eye-watering £22 billion on Test and Trace – a scheme that, at best, had only a marginal impact on transmission. The BBC quotes Allyson Pollock, Professor of Public Health at Newcastle University, as saying, “Mass testing is a scandalous waste of money.”

According to the ONS, around 50% of people in England now have COVID-19 antibodies, including more than 80% of those aged 65 and over:

This means that the vast majority of vulnerable people have at least some immunity to the virus. What would make more sense is focusing protection on those vulnerable people who have not yet had the virus or been vaccinated.

As the Great Barrington Declaration notes, this could be done via frequent testing of staff at care homes and hospitals, as well as by offering tests to those who want to visit elderly relatives living at home. (In a recent article for Lockdown Sceptics, I outlined what a focused protection strategy would have looked like.) At this stage of the pandemic, it’s difficult to see how mass testing of young, healthy people could possibly pass a cost-benefit test.

Stop Press: Matt Hancock has tweeted: “Reclaiming our lost freedoms & getting back to normal hinges on us all getting tested regularly.” Yet back in January, he said it was vaccinating the vulnerable that would let us “Cry freedom”. Here’s the relevant excerpt from his interview with The Spectator:

When Covid hospital cases fall and pressure on the NHS is lifted, he says, “That is the point at which we can look to lift the restrictions.” So what about herd immunity, vaccinating so many people that the virus dies out? “The goal is not to ensure that we vaccinate the whole population before that point, it is to vaccinate those who are vulnerable. Then that’s the moment at which we can carefully start to lift the restrictions.” But at that point the majority would remain unprotected. Would he – as Health Secretary – still say it’s time to abolish the restrictions? “Cry freedom,” he replies.

The goalposts keep shifting. First it was vaccinate the vulnerable; then vaccinate everyone; now weekly mass testing… Will we ever be allowed to get back to normal?

Lateral Flow Tests Too Inaccurate for Mass Testing, Major Review Finds

Lateral flow tests (LFTs) are too inaccurate to be used in mass screening in schools and workplaces, a major review led by Jon Deeks, Professor of Biostatistics at the University of Birmingham, has concluded. The Telegraph has the details.

A Cochrane review of 64 studies found that asymptomatic testing only picked up around 50% of cases, and picked up far more false than real positives when infection rates were low in the community.

False results from lateral flow Covid tests may mean workplaces and schools will be needlessly forced to close even though the scheme was set up to keep them open, experts cautioned.

The group concluded that mass testing policies had been implemented “without any supporting real-world evidence”.

Jon Deeks, the review author and a Professor of Biostatistics at the University of Birmingham, said it was “shocking” that the Government had allowed the rollout of such a “large, invasive and expensive” testing programme without the data to back it up. 

“One of the issues which should have been picked up is these tests work a lot less well in people who are asymptomatic, and the Government has not been clear about that,” he said.

“It is being used in ways which actually risk people getting false reassurance when they miss cases, and getting false positives, and that has been a big problem in schools. There are instances when whole classes have been sent home – effectively, 100 people put into isolation.”

Prof Deeks added: “So I think there are big problems in the way that we’re using this. And when prevalence drops you get more false positives and fewer true positives, that’s a mathematical certainty, and there is a point where you should stop. We may already be at that point.

“When is it that we are actually going to be doing more harm than good? These testing policies have been implemented without any supporting real-world evidence.”

The review calculates that at current virus prevalence rates of 0.5%, around 72% of positives would be false.

In terms of not missing infections, the review found the tests correctly identified only 58% of those who were infected but had no symptoms, and missed 42%. It did not acknowledge, though, that where these asymptomatic infections are identified by PCR tests (as most of them are), the PCR positives are likely to be false or cold positives themselves.

The review found the tests to be more accurate in people with symptoms, estimating the LFTs would correctly identify around 72% of people with symptoms who had Covid, and miss 28%.

The researchers suggested the tests would be better used for symptomatic people, and that any positives should also be re-tested with a PCR test to reduce the chance of false positives (though they didn’t note that PCR tests are more sensitive than LFTs so are more not less likely to pick up cold positives).

Dr Susan Hopkins, PHE’s COVID-19 Strategic Response Director, defended the testing programme, essentially saying every little helps:

Rapid tests are effective at detecting Covid in people that are highly infectious, both with and without symptoms. Every day, rapid testing is helping us find cases of COVID-19 that we wouldn’t otherwise know about, breaking chains of transmission and potentially saving lives.

Mass screening of asymptomatic people to try to pick up invisible, isolated infections is an exercise fraught with pitfalls, as experts have been warning for months and Professor Deeks’ review now confirms. The Government needs to heed the lessons of this review and abandon its costly and invasive effort to make reopening society dependent on constant testing for a disease almost no one has. Ministers need to plot a much clearer and swifter path back to normal – a normal which doesn’t involve testing week in, week out for a disease for which you have no symptoms.

0.06% of School Covid Tests Positive Last Week

In the week that all students returned to school, only 0.06% of rapid Covid tests produced positive results. The TES has the story.

Only 0.06% of the rapid Covid tests carried out in schools in the week that all pupils returned were positive, new statistics reveal.

More than 4.5 million lateral flow tests were taken in schools and colleges in the week between March 4th and March 10th according to Department of Heath statistics. 

But they only picked up 2796 positive cases.

The question is, how many of these positive results really were positive? Earlier this month, Will Jones wrote here that “mass testing in schools was always a bad idea – cruel, intrusive, pointless. The high proportion of false positives, with their needless and disruptive requirement to self-isolate, only underlines that fact”. A report in the Telegraph also explained that infection levels are now so low that the majority of positive results could be false.

Biostaticians are concerned that infections in the community are now so low, that false positives and negatives are vastly outnumbering true cases, leading to real cases being missed and families needlessly being asked to isolate.

Pupils are currently being tested twice a week for coronavirus using lateral flow devices, but real-world data has shown they miss positive cases around 50% of the time.

Worth reading in full.

Stop Press: Figures show that children returning to school has not led to a rise in Covid infections. The Telegraph has the story.

A detailed analysis by Prof Jon Deeks, an expert in biostatistics at Birmingham University, has found that the number of positive cases among pupils are far lower than ministers expected.

“The big question is why is that happening? There are two explanations,” he said. “The first is that this test doesn’t work very well in children and it doesn’t detect the cases. And the other is that asymptomatic infection is much less common in children.

“If the reason is that there aren’t many cases, then this is good news. But if the reason is that the tests are missing cases this is bad news. And if we don’t know – that is very bad news.”

Worth reading in full.

Two Thirds of Covid Cases in Schoolchildren Are False Positives Say Experts

Mass testing in schools as children returned this week is resulting in hundreds of positives – but viral prevalence is now so low that the large majority of them are wrong and result in children and their contacts isolating needlessly. Sarah Knapton in the Telegraph explains.

Biostaticians are concerned that infections in the community are now so low, that false positives and negatives are vastly outnumbering true cases, leading to real cases being missed and families needlessly being asked to isolate.

Pupils are currently being tested twice a week for coronavirus using lateral flow devices, but real-world data has shown they miss positive cases around 50% of the time.

Similarly, although they pick up 99.9% of negative cases, meaning fewer than 0.1% will be false positives, the prevalence rate is now low enough that false positives will be making a significant contribution to the overall figure.

Previously, positive tests were confirmed using a more accurate polymerase chain reaction (PCR) lab test, but this week the Government admitted it had quietly scrapped the process at the end of January.

It means that thousands of pupils and their families are having to isolate needlessly, and missing more school after months away from classrooms.

The latest figures from NHS Test and Trace in secondary schools found 328 positives out of 663,332 tests between February 25th and March 5th. That’s 1 in 2,000 pupils, which is far lower than the 1 in 270 that the latest ONS survey suggests is the current community prevalence. Some are concerned this means large numbers of cases are being missed, though the PCR-based ONS survey picks up many of the non-infectious cold positives which the less sensitive lateral flow tests (LFTs) do not. There is no reason to regard missing cold positives as a problem, particularly given the personal and economic cost of isolating positive cases.

In primary schools, 613 positives were found from 721,546 tests, or about 85 in 100,000. This gives an overall school prevalence rate of about 0.067%.

At this rate (if it were the true prevalence), out of a million tests 670 should come back as true positives. However, with a 0.1% false positive rate (a conservative estimate for LFTs, which were found in a report to have a 0.32% false positive rate) there would also be 1,000 false positives. That means 1,000 out of 1,670 positives, or around 60%, would be false. Of course, the 670 positives per million from the last couple of weeks of testing include the false positives, so the actual proportion of false positives will be higher.

Professor Jon Deeks, a biostatistician from the University of Birmingham, told the Telegraph:

We would expect far more false positives than true positives amongst those testing positives in schools. There are many uncertainties but given the DHSC data it seems likely that over 70% of positive test results are false positives, potentially many more. Addition of a confirmatory PCR would add little cost and would most likely reduce false positives to 1 in 1,000,000. The refusal to confirm lateral flow results with PCR is at best perplexing, will make testing less attractive, and create harm by wrongly isolating individuals, families and other close contacts.

Confirmatory PCR testing for LFT positives is unlikely to help, however, in terms of weeding out cold positives, as the PCR tests are much more sensitive than the LFTs (picking up many more cold positives) and so are unlikely to give a negative where an LFT has come out as a cold positive.

There is also the question of how many of the tests have been incorrectly carried out, perhaps on purpose, if self-administered, to avoid having to isolate?

Mass testing in schools was always a bad idea – cruel, intrusive, pointless. The high proportion of false positives, with their needless and disruptive requirement to self-isolate, only underlines that fact.