Boris Johnson has announced his ambition for an unprecedented scaling up of testing for the coronavirus in the UK to 25,000 a day, as the World Health Organization urged all countries to go further, test everyone with symptoms and trace and isolate all their contacts – or risk the epidemic surging again once bans on social mixing are lifted.
Ramping up testing on this scale would put the UK ahead of the rest of Europe and most other countries, but it was unclear how quickly it would happen, with only 4,000 daily tests at the present time.
Frontline doctors and nurses have been calling to be tested when they have symptoms, so that they can warn their contacts and protect their patients.
Johnson said during prime minister’s questions in the House of Commons that health workers would get tested. “We are prioritising NHS staff for the obvious reason that we want them to be able to look after everybody else with confidence that they are not transmitting the disease.”
But the Department of Health and Social Care later said healthcare workers would not be first priority. “Testing will be based upon clinical need, with those in ITU [intensive care] first. Staff will follow at some point but clearly demand is high for both at the moment,” said a spokesman.
The scale-up appears to depend in part on the development of a test that is not yet available. “The ramping up of testing will include developing a point-of-care swab test outside of hospitals, so people with suspected symptoms can quickly find out if they have coronavirus. We have called on industry to rapidly develop this test,” said the DHSC statement.
Europe, where the Covid-19 pandemic is growing fastest, is generally not attempting to hunt down the virus by embracing tests and contact tracing in the way that China, South Korea, Singapore and Taiwan have done, to the concern of the WHO.
Dr Tedros Adhanom Ghebreyesus, the WHO’s director general, has again called on every country to adopt its recommended strategy.
The only way to slow the pandemic sufficiently to give time for treatments and a vaccine to become available is to test everyone who has symptoms and track and isolate their contacts, he said.
Social distancing measures help, “but to suppress the epidemic, countries must isolate, test, treat and trace,” he said. “If they don’t, transmission chains can continue at a lower level and then resurge once physical distancing [is] lifted.”
Testing, contact tracing and isolating those people with the virus or suspected of having it “must be the backbone of the response in every country. This is the best hope of preventing widespread country transmission,” he said.
Countries where the epidemic is taking off should not give up on testing and contact tracing. He cited South Korea, which was reporting 800 cases a day and is now down to 90. “A few months ago the Republic of Korea was faced with accelerating community transmission, but it didn’t surrender,” he said.
Since the outbreak began, South Korea has tested more than 250,000 people, and has the capacity to test 15,000 people a day. It has conducted 3,692 tests per million people, compared with five per million in the US.
South Korea has also pioneered drive-through tests, which allow people to be tested without leaving their vehicles – a system that also means health workers do not have to disinfect the premises after each test.
Smartphone alerts are sent out, informing people of an infected person’s previous movements, which allows everyone to work out whether they might have been in contact and to get a test. That has sparked concerns about personal privacy, however, with the South Korean human rights commission advising health authorities to withhold personal information unless it is essential to containing the virus.
Germany has the lowest mortality rate of the 10 countries with the most severe epidemics, at 0.3% compared to Italy’s 7.9%. Christian Drosten, a virologist at Berlin’s Charité hospital who advises the government, said one of the reasons may have to do with Germany’s relatively high number of tests compared with other countries in Europe. Catching even mild cases of the Covid-19 infection in the overall figures would push down the rate of lethal cases.
While Germany has not tested its citizens at the same high rate as South Korea, guidelines have been in place for over a month for people to be tested if they show the usual symptoms and have either had contact with an infected person or recently visited a “high-risk area” such as Lombardy or Wuhan.
According to Germany’s National Association of Statutory Health Insurance Physicians, the country has the capacity to conduct about 12,000 Covid-19 tests per day.
“Our laboratories are technically very well equipped,” said Drosten, “our regulations for the introduction of new test procedures are very flexible and our statutory health insurance association already introduced a code for these tests in January, which means that [insurers] are financially supported.”
Italy, which reported its highest daily coronavirus death toll of 475 on Wednesday, has zero cases in the small town of Vo’ in the Veneto region, which tested the entire population after it suffered the first coronavirus death in Italy. Medical experts and governors and mayors around the country have been pushing to carry out mass tests, including people who are asymptomatic.
“A test does no harm to anyone,” said Luca Zaia, the governor of Veneto, who is now taking action to test every single inhabitant of the region, “no matter how much it will cost”.
Vo’ is now “the healthiest place in Italy”, he said.
“This is proof that the testing system works. Here there were the first two cases. We tested everyone, even if the ‘experts’ told us this was a mistake: 3,000 tests. We found 66 positives, who we isolated for 14 days, and after that six of them were still positive. And that is how we ended it.”
Not everyone believes the experience of a small town will work on a large scale. Massimo Galli, director of infectious diseases at the Luigi Sacco hospital in Milan, told the Guardian that carrying out mass tests on the asymptomatic population could prove to be useless.
“The contagions are unfortunately constantly evolving,” Galli said. “A man who tests negative today could contract the disease tomorrow.”
France has the capacity to do just 2,500 tests a day and is prioritising healthcare professionals, those who are severely ill, the vulnerable and people in care homes. In the US, public health experts have been raising serious concerns about the unavailability of testing. In a four-day period from 8 March to the morning of 11 March, only 77 people in the country were tested.
Within the last few days, the US testing capacity has slowly started to increase. Earlier this month, the Centers for Disease Control said labs were conducting about 2,500 tests per day. On 16 March, the number rose to 8,200.