Matt Hancock has announced his ‘Moonshot’ project of achieving population-wide mass testing for Covid-19. He should be congratulated for this shift in strategy. The previous strategy of 'Test, Trace and Isolate' relied on people with the virus feeling ill and so taking a test. Those who tested positive would then be called by one of the NHS tracers to ask for their recent close contacts, who the tracer would in turn contact and ask to self-isolate.
While this approach has worked in the past with illnesses such as Middle East Respiratory Syndrome in countries such as South Korea, it is unlikely to work in the UK for Covid-19. The main reason for this is that up to 80 per cent of people with Covid-19 are asymptomatic, compared with around 15 per cent for Middle East Respiratory Syndrome, and so are unlikely to feel ill enough to need to be tested in the first place. As a result of this – and the British tendency to not ‘grass on our friends’ – for every individual that 'Test, Trace and Isolate' successfully isolates, around 20 are still missed.
The Moonshot strategy finds the asymptomatic through a programme of mass testing and then isolation. Mass testing could be applied at multiple locations, including at home, in schools, universities, offices, airports, care homes, and live arts or sports events. The draw back is that it is dependent on the next wave of testing technologies, including supplementing the current accurate (but slow, expensive and painful) swab-based laboratory analysed testing with cheaper and less painful saliva or breath-based mass tests. It means identifying individuals with Covid-19 using much more frequent but perhaps less accurate tests. Most importantly though, it does not rely on individuals feeling ill enough to arrange a test.
So how will this mass testing work? It could mean that, twice a week, every member of a household takes a test at home, with the results available within ten minutes. If the test is clear, they go to school, work, etc. If it shows some have the virus, they all isolate and take a more accurate test. Travellers arriving from overseas could be tested before check-in (for instance, by blowing into a tube connected to a Covid-19 test machine) and then, after arrival, self-testing every other day for a week. But this rigorous testing would mean they did not have to quarantine, assuming they get a negative result. Those in the queue for a live arts or sports event could take a saliva pregnancy-style test, giving results in minutes.
It would seem that the targets and much of the detail of project Moonshot is still being worked out. The Government’s commitment of £500 million for Covid-19 test trials, using the latest technology, is a good start, even if Matt Hancock wouldn't be drawn on numbers and the timetable.
But compare this to the other Moonshot project. In that, president Kennedy committed the United States to ‘achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth’. Kennedy did not describe the thrust that was going to be required or the budget. Instead, he provided an audacious, clear and compelling target for the whole of the United States to strive for. It captured hearts and minds across the country.
So, what could be a similar target for the UK’s Moonshot? How do we excite the country around a goal? One option might be this: ‘by this Christmas to have returned the UK back to near normal through a programme of mass testing’.
By Christmas, this would mean we would be able to go to the pub or the races, watch a football match, a pantomime or the Nutcracker, travel abroad, and welcome tourists to London. We could hold weddings, funerals and Christmas church services. We could meet up with friends and family. Grandparents could hug their grandchildren. We could start to roll back some social distancing measures. And families could sit down together for Christmas lunch.
Like the Kennedy Moonshot, this audacious target might feel impossible to achieve as we worry about rising Covid-19 cases. But how many of us believed in the dark days of late March that we could construct the Nightingale Hospitals in less than two weeks, deliver over two billion items of PPE, or achieve around a 30-fold increase in our testing capacity in three months?
We are going to need to harness the creativity behind these achievements, if we are to deliver our Moonshot. For mass testing to work, we will need the capacity for roughly two tests a week per person in the UK. These tests will come in many different shapes and sizes, including the current lab based nasal swaps, devices in sewers that pick up Covid-19 in a building, blow-in-a tube detectors, testing equipment that sits in a van, and rapid saliva-based tests.
Some of this testing can be achieved by pooled tests, where a group is tested rather than an individual. These pooled tests could include a single device in the sewer of a nursing home or office building, which, if triggered, is followed up by all individuals being tested. Family members could also take pooled tests, where their saliva samples are combined in one home test. So maybe we will need around 50 million tests a week – roughly two per household.
Delivering 50 million tests a week is a challenging 30-fold increase from today. It is particularly challenging as other countries will also be seeking to do this. The US company Abbott Laboratories developed one of the first rapid Covid-19 mass test and is ramping up production to produce more than ten million tests per week by October to meet high demand. However, the U.S. government has already ordered 150 million tests from Abbott, so it’s unclear that Abbott has any capacity for the UK.
The UK Government is evaluating a number of new technologies rapid tests at Porton Down, drawn from the UK and around the world (I have to declare a confict here as I have invested in some of the potential innovators). If they are successful, we will then hit a new challenge: how to manufacture around 50 million tests a week?
Once again, this will require us to deploy the same creativity we saw with the manufacture of PPE and ventilators, where manufacturing capacity was redeployed from the likes of Dyson, Burberry, local tailors and the Scottish Whisky industry.
So, should Lord Deighton and his team that delivered PPE be moved to focus on delivering mass testing manufacturing volume and value for money? Could Rolls Royce and the UK Formula 1 industry make the manufacturing machines needed for the assembly of the lateral flow rapid pregnancy-style tests? Could Dyson assemble the sewerage testing machines? Could the water companies install these devices at all hospitals and offices?
Manufacturing is not our only problem in getting mass testing to work. We need to address the growing apathy and individualism with our Covid-19 response. This individualism has been building since early in lockdown, fuelled by the likes of Lord Sumption, who argued that it should be down to individuals whether to isolate or not. I saw this apathy firsthand last month in the Isle of Wight, where the new NHS tracing app is being piloted, along with Newham in London. Despite asking around 50 people in the Isle of Wight, I was the only individual who had downloaded the new app (incidentally I have to use anecdotal evidence as the NHS is still, as far as I can tell, yet to publish any figures on downloads, which in itself does not bode well). My Isle of Wight postman there seemed to capture the mood best: ‘I don’t think anyone's bothering with that now’.
So, if Moonshot is going to be different, we are going to need to be creative on how we roll out mass testing to overcome this growing Covid apathy. We can do this by starting with using mass testing to allow people to start doing things they have really missed, such as watching sport or arts, or travelling without the need to quarantine. We could then roll out mass testing to Parliament and schools. Parliament would symbolise what it looks like to be back to normal. While schools have an advantage over other areas as children largely follow instructions. Getting children onside will then, in turn, encourage their parents as we later roll out mass testing to homes. This roll-out plan will need to be supplemented by better communication around the vision and the need for collective action to eliminate the virus. And we need to provide state financial support to those isolating.
‘It will all be over by Christmas’ was a refrain among the optimists in the First and Second World War. Today as we face our third world war, this time against a virus, it is harder to find optimists that we can overcome the virus before the arrival of a vaccine. But with the right leadership mobilising mass testing, we could be back to close to normal by Christmas.