TEST FAIL
Why is the UK so far behind countries like Germany in coronavirus testing?
MASS testing for coronavirus is the key to lifting the lockdown, experts have said.
But while countries like Germany test around 70,000 people a day, the figure here is a measly looking 8,000.
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Just 2,000 of the frontline NHS staff self-isolating with suspected coronavirus have been tested.
Yet as many as 85 per cent of NHS off sick may not even have the bug, experts say - and are being kept away from hospitals because of a failure to speed up testing rates.
Head of NHS Providers Chris Hopson said the health service is facing "some of the highest staff absences" ever seen.
One in four doctors and one in five nurses are believed to be off, heaping pressure on colleagues facing an influx of patients.
Yesterday, Michael Gove admitted the Government must go "further, faster" to increase testing capacity.
And Boris Johnson is said to have taken charge of efforts to source the kit needed to do that.
Hospitals were today told to test more of their workforce, yet the Government admits the nation's labs are short of the right equipment to do it.
So why is the UK's testing programme behind schedule? And what more needs to be done?
1. What tests are actually needed?
There are two main tests we need, to get a grip of the coronavirus epidemic.
The first is a nasal swab test - which is currently used in hospitals to tell if a person has the virus.
Known as an antigen test, it detects traces of the virus RNA or genetic code.
Samples are taken using a swab - a large cotton bud up your nose - to take samples from the back of the throat.
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The samples are then sent to the lab for testing. Results can take between a few hours to a couple of days to come back.
The second test is the much-awaited antibody test - hailed a "game-changer".
The test is a finger-prick test and is being designed to be performed at home, giving results almost instantly like a pregnancy test.
It detects antibodies that the immune system produces to fight coronavirus so can tell if you have had the bug, and are immune.
These tests would give the green light for NHS staff, key workers and the public to go back to work, and could help relax lockdown measures.
2. Why is testing so important?
Testing for coronavirus serves a number of important purposes.
The swab test can tell us how many people currently have Covid-19.
Meanwhile, the antibody test can tell us how many people in the population have had it.
It can also give an idea of the asymptomatic population - how many people have had coronavirus, but have shown no symptoms.
Knowing who's had the bug and who hasn't will drastically speed up our route out of lockdown.
It will allow us to identify who is safe to go back to work, and in some countries like Germany there are plans to give people certificates to identify they are safe to move about.
Labour deputy leadership candidate and A&E doctor, Rosena Allin-Khan, who has gone back to work on the NHS front line, said another important aspect is staff wellbeing.
She wrote to Matt Hancock telling him the "lack of testing is having a huge mental health impact on our NHS workforce".
Meanwhile, ex-health secretary Jeremy Hunt has expressed his concern over the lack of mass testing, branding it "very worrying".
He said it had been key to finally controlling the outbreak in Wuhan, the Chinese city where the pandemic originated in December.
3. How many tests are being done in the UK?
Yesterday, Department of Health figures showed 8,240 people had been tested for coronavirus, in the previous 24 hours.
That falls short of the Government's promise to test 10,000 people a day.
Last night, Deputy Chief Medical Officer Jenny Harries said we have capacity to test 12,700 people.
Meanwhile, the PM has expressed his desire to reach 250,000 tests a day.
Today, Health Secretary Matt Hancock told hospitals to test more of their workforce, lifting the restriction that trusts could only use 15 per cent of their capacity to test staff. The remaining 75 per cent was reserved for testing patients.
4. How do we compare to other countries?
In the UK around 8,000 people are being tested every day.
In total since the start of the outbreak 152,979 people have been tested, with 29,474 testing positive.
Meanwhile, in Germany, 70,000 tests are carried out each day - that's more than half a million a week.
In total, South Korea has tested around 490,000 people since the start of the outbreak.
Both countries have far fewer deaths than the UK.
5. So what's the problem?
Testing for viruses is not a simple process.
It requires the right equipment, testing conditions and as the Government's top doctor keeps reminding us, "one thing worse that no test, is a bad test."
But critics have pointed out, this crisis has been building since the start of the year, accusing the authorities of acting too late.
Tim Colbourn, associate professor of global health epidemiology at University College London, said: "The UK was complacent and didn't think it could happen here.
"We didn't see the signs quickly."
If they were doing 400 tests a day, we would be up to Germany levels of testing and that is perfectly feasible
Anthony Costello
Anthony Costello, professor of global health and sustainable development at UCL, said part of the blame rests with Public Health England.
He told Radio 4's Today programme: "We have 44 molecular virology labs in the UK.
"If they were doing 400 tests a day, we would be up to Germany levels of testing and that is perfectly feasible.
"Public Health England were slow and controlled and only allowed non-PHE labs to start testing two weeks ago, but that was after the strategy to shift to end community tests."
Prof Costello is referring to the announcement on March 13 to stop testing people in the community, as the Government announced a move from ";containment" to "delay" in their plan to tackle the outbreak.
From that point, only people in hospital have been tested for Covid-19.
6. What's the latest the Government is saying?
The Government has repeatedly said their goal is to increase testing capacity across the UK.
Boris Johnson has said he wants to reach 250,000 a day, while Deputy Chief Medical Officer Jenny Harries said at yesterday's daily briefing we have capacity to carry out 12,700 tests.
Michael Gove, the Cabinet Office Minister, said the Prime Minister and Health Secretary Matt Hancock, are in talks with pharmaceutical companies across the world, after admitting a shortage of chemicals is partly to blame.
The chemicals are needed for the antigen tests - or nasal swab tests currently being used to test NHS staff and patients.
Mr Gove said last night that the Government must "go further, faster" to increase testing.
"We are increasing the number of tests," he said.
One of the constraints on our capacity to increase testing overall is supply of the specific reagents
Michael Gove
"One of the constraints on our capacity to increase testing overall is supply of the specific reagents, the specific chemicals, that are needed in order to make sure that tests are reliable."
When asked when the Government started placing orders for key test parts, the PM's spokesman said today: "We've been working with industry throughout.
"But as the Chief Medical Officer and Deputy Chief Medical Officer have both set out, there is a global demand for reagents.
"It's clear from industry that they are working as hard as they can in order to support the NHS, and we are working alongside them."
7. What chemicals are we missing?
The chemical reagents the Government admits the UK is short of are needed for the nasal swab tests - the antigen test.
Dr Colin Butter, at the University of Lincoln, explained there are two main bits to the chemistry.
The first is how scientists remove the virus RNA - it's genetic code - from swabs.
"Many companies make suitable kits for this," he said. "Universities and others will have lots on the shelves."
The next step involves ingredients and chemicals to run the test itself.
Prof Lawrence Young from the University of Warwick explained: "The test is complicated, and requires many different synthetic components which probably accounts for the shortages given the unprecedented demand."
Coronavirus testing: What is the difference between antigen and antibody tests?
Coronavirus tests are key to getting a clearer idea of the scale of the outbreak in the UK.
In recent days, there's been a lot of talk about the two different types of tests that the government are ramping up.
The government refers to them as the 'have you got it' antigen test or the 'have you had it' antibody test.
Here we explain the difference between the two...
What is an antigen test?
Antigens are found on the surface of invading pathogens, including coronavirus.
Testing for antigens can determine whether someone is currently carrying the virus and are actively infectious.
The NHS is currently using antigen tests in hospitals to determine if someone is currently infected with Covid-19.
Samples are taken using a swab - which resemble a large cotton bud - from deep inside the nose and throat before being sent off to a lab for testing.
Most labs use a method called the polymerase chain reaction (PCR), which takes several hours to get a result.
It can take days for labs to run the tests and tell people their result.
Several companies are working on ways to fast track this type of testing.
What is an antibody test?
When a person gets infected with antigen, the body starts making specially designed proteins called antibodies in response - as a way to fight the infection.
After they recover, those antibodies float in the blood for months, maybe even years.
That's the body's way of defending itself in case it becomes infected with the virus again.
So an antibody test specifically looks for antibodies which will be able to tell whether you've already been exposed to Covid-19.
Anyone who has already had the illness is presumed to be immune to getting it again - at least, in the intermediate term.
This would allow them to go back to work safe in the knowledge that they are unlikely to become infected again or pass the virus on.
The check that has been developed for Covid-19 is a finger-prick blood test, with the samples sent to laboratories and results available within a few days.
Dr Hilary Jones, a GP and resident doctor on Good Morning Britain, explained that it works "almost like a pregnancy test, except you need a drop of blood".
These tests are being developed by several different firms and Public Health England (PHE) is also working on its own test.
They still need to be validated to ensure they give accurate results.
Dr Al Edwards at the University of Reading's School of Pharmacy added that there are a "lot of ingredients" that go into a swab test.
"Any of these might be hard to get hold of in the current rush," he said. "The world is seeing more of these virus tests conducted than ever before.
"This shortage could be the enzymes – called polymerase – that detect the virus.
"But they could also be simply the swabs or containers for collecting samples.
“The real catch is – we are very good at making a highly accurate test fast.
There is a massive demand for raw materials, this is not unique to the UK and many places no longer have stock of essential reagents
Prof Baker
"But to make that test accurate, you need to keep the ingredients fixed. So we are likely seeing a shortage of the exact ingredients used in the approved tests.
"Although other versions might work it’s not easy to simply switch to a different type.
"There can be tiny changes that make the test fail – for example, if you use the wrong swab to take the sample, the virus might not be detected."
Professor Stephen Baker, an expert in molecular microbiology at the University of Cambridge, said: "There is a massive demand for raw materials, this is not unique to the UK and many places no longer have stock of essential reagents."
8. What does the industry say?
The Chemical Industries Association told The Times that demand for key chemicals is "increasing".
But it said reagents are being made and they are being delivered to the NHS.
It said: "Every business here in the UK and globally is looking at what they can do to help meet the demand as a matter of urgency.
"To clarify the exact NHS need and meet it, all relevant UK industries are continuing to work closely with the Government."
9. How is South Korea doing better?
The first hint of the coronavirus pandemic emerged at the end of December in China.
While few countries could have predicted it's rapid spread, some, including South Korea were better prepared.
The nation had vast stocks of face masks and testing kids on standby, making them better placed to cope.
Having endured the 2003 Sars epidemic and the more recent Mers outbreak, South Korea built up huge stockpiles and had significant testing capacity ready and waiting.
10. What about Germany?
Germany, which is testing 500,000 patients a week and has plans to test 200,000 a day, was quick to learn from the response of countries in Asia and began ramping up testing at an early stage.
Professor Lawrence Young, from Warwick University, said countries like Germany also benefit from a more "joined up approach".
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A better relationship with the biotech industry, more German virologists producing tests in January and central coordination by the Robert Koch Institute all gave Germany a head start, he said.
When asked why this was such a challenge for the UK, he added: "It just requires better national coordination.
"It highlights a lack of investment in virology over many years."
11. What's the solution?
Professor Stephen Baker, of Cambridge Uni, said there is "no overnight solution".
He warned: "There are multiple steps to ensure that the methods used and results that are a correctly validated, as there is nothing more dangerous at the moment than reporting incorrect negative or positive results to staff or patients."
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