Professor Iain Buchan, a member of The Pandemic Institute’s Internal Scientific Advisory Panel, has recently provided evidence for Module 7 of the COVID-19 Inquiry. Module 7, or Test, Trace and Isolate, will look at and make recommendations on the approach to testing, tracing and isolation adopted during the pandemic in from January 2020 until 28 June 2022. 

During the COVID-19 pandemic, Liverpool embarked on a national pilot of mass community testing for the COVID-19 virus among people without symptoms. The pilot aimed to reduce or contain transmission of the virus while tackling the mounting harms to health, social and economic wellbeing from COVID-19 restrictions. Professor Iain Buchan led the evaluation work of the pilot at the University of Liverpool, and more recently a review to better understand how we might implement and exit future community testing schemes.

You can watch Professor Buchan’s evidence at the inquiry here, and a summary of his major points is included below.

Be clear about the testing purpose
Medical testing to see if a patient’s illness is due to infection is different to public health testing to see if a person is infectious, letting them know to isolate so as not to infect others. With Covid-19, the gold-standard PCR test remained positive after a person was no longer infectious, it needed a laboratory, and the results took a day or two to come back – time when a test-positive person could be spreading the virus. So, it was no good as a public health test. Similarly, rapid daily self-testing to get key workers back to work rather than staying longer than necessary in quarantine or isolation is a distinct purpose with different performance metrics to clinical diagnostic testing.

Address poverty and health inequalities
The Liverpool pilot showed that people living in poverty were more likely to test positive and less likely to get tested – they were concerned about not being able to afford to isolate. Income support was too hard to access and there was no job protection. Across the UK, adherence to isolation was estimated to be <30%.

Use public health professionals and researchers as the glue to help different groups such biologists, mathematical modellers and behavioural scientists work better together
For example, modellers would have benefited from knowing that care home staff work between homes and in the community, and that they often live together. Or that one person testing in a family may affect the whole family’s virus transmission risk behaviours. These insights are second nature to public health researchers.

Provide the right data to the right people at the right times to make the right decisions
All England hospital admissions data were not made available to the Liverpool Pilot team until 22 July 2021 – 9 months after the pilot and 7 months later than they could have been. The policies needed for this don’t have to wait until a pandemic, they can be prepared now. These data systems are useful for improving NHS, social care and other public services now. Pandemics are best managed with core data systems and not emergency ones.

Develop AI to enable quicker, more adaptable and scalable ways of tackling pandemics
For example, AI that can have a conversation with you about how to use tests, what to do about the results and if you are positive and ask who you’ve been in contact with. This AI can be trained and tested now, for example in pilots reducing winter pressures from seasonal viruses in specific workplaces or towns.

Link pandemic preparation to public service improvement and economic growth – in areas such as AI and diagnostics
For example, with lateral flow technology, data is the key to value – from identifying the proteins to test for to printing and packaging the devices, to optimising the supply chain and helping end users to take tests, capture the result and take best action. The UK has the data-sharing and public service collaboration potential to thrive in this area.

Rehearse well at all levels from top of Government to town halls
The rehearsals can help tackle other problems like reducing winter pressures on the NHS, social care and businesses. Similarly for science and industry, sleeper protocols can be drawn up now.