The proposal is to select a small town of 200,000 people. While the rest of the UK follows the exit strategy proposed by the government, this small town will experimentally use a much stricter strategy. Everyone in the town gets tested for Covid-19 - whether they have symptoms or not. This is voluntary but they assume 90% compliance.
Letter with signatures here:
Article in the Lancet:
The authors sent this proposal to the UK government on the 10th April.
Their proposal is a strategy similar to the one that cleared Vo Euganeo of the virus in Italy. See my
- Good news from Italy: COVID 19 outbreak halted in Italian town of Vo Euganeo at record speed - 90 cases to no new cases in two weeks
To test 200,000 people every week with 90% compliance needs 26,000 tests a day, plus some extra tests for the NHS workers.
Anyone who tests positive has to isolate, and the rest of their household also isolate until all the household simultaneously test negative.
They say that if this experiment is successful that we then roll out the same approach over the entire country.
This could be done by permitting local laboratories to test for Covid-19 and to get the PCR reagents from manufacturers rather than clinical test companies.
A voluntary Dunkirk spirit would be the only way for 10 million tests to be done daily by collaborating university and com mercial laboratories with the necessary quality-checked equipment (PCR machines). PCR reagents should be obtained from manufacturers, rather than clinical test companies, and exempt from regulatory requirements on medical testing to limit costs and ensure supplies. This might require emergency legislation.
This approach of using PCR reagents directly from manufacturers and using commercial laboratories is the same approach used in the Faroe Isles to protect their population.
In the online letter they explain in detail how the UK can achieve 10 million PCR tests per day. The machines to do this are already available in the UK.
The facilities needed are:
- A register of names, dates of birth and addresses of all residents registered with a GP, to be updated as necessary with test results, changes of address and addition of unregistered subjects. Anonymous registration with local outlets for sample collection and delivery is needed for those reluctant to give name and address.
- The equivalent of 14,000 96-well PCR machines running night and day. Enough machines and experienced staff to operate them are already in place in large and small academic and commercial labs throughout the UK, including possible demonstration sites. Posts for three 8-hour shifts might be needed.
- Self-sample swabs, sample transport tubes individually labelled with name, date of birth and barcoded ID, PCR reagents and microtiter plates for 10 million tests per day. Additional production facilities must be commissioned if necessary.
- Arrangements to deliver and collect samples from every household once a week, with delivery to a testing lab within a few hours. Results would be entered online by the lab within a day of sample collection. Positive results in those without phone or email would be delivered by courier.
This high throughput would depend on various regulatory emergency waivers:
- Lab staff would wear PPE where necessary but would not be accredited to conduct medical tests.
- Laboratories would be advised on precautions but not accredited for handling infectious samples.
- PCR reagent production with normal non-medical quality control cannot be hampered by patents or regulations on medical test manufacture.
The idea of conducting regular population-wide mass testing, which has never been tried in a large country, is unusual in two respects. First, a voluntary “Dunkirk spirit” collaboration of all university and commercial labs that already have the necessary equipment (a PCR machine) is the only way for 10 million tests to be done daily. Second, manufacture and testing would be arranged in consultation with chemical manufacturers rather than clinical test companies and exempt from regulatory requirements on medical testing. This requires emergency legislation.
HOW MUCH WOULD IT COST?
They envision it continuing through to a vaccine at a cost of £14 billion a year or about $17.5 billion a year. This is less than £300 million a week, around $340 million a week, and much less than the cost of repeated lockdowns
A ballpark cost-benefit analysis shows a total cost per year following national roll-out of £14 billion, the most speculative components being £100 million to expand facilities for manufacturing reagents and £2 per test for PCR reagents (£7 billion per year for 10 million tests per day).
This is a small fraction of the economic costs of lockdown. Chemical manufacturers rather than clinical test companies must be involved to limit costs and ensure supplies. Quality control can be minimal because PCR is sensitive and any false negatives tend to be the least infectious cases, and because both false negatives and false positives will be retested a week later.
[I think they are being pessimistic there - by analogy with Vo Euganeo where they reduced it from 3% prevalence to no new cases in two weeks, there would probably be no new cases within a month or so, and after that - we could do test trace isolate of imported cases and maybe once monthly country wide tests.]
[Again by analogy with Vo Euganio, if other countries followed our model then we could eliminate it from much of the world by this method once the diagnostic testing capability is scaled up in the same way in all the high GDP countries and they could also help fund tests in the low GDP countries]
I have done a meme type graphic to help with sharing:
Text: Faroe Isles adapted lab for virus in salmon to test for COVID-19
UK has labs like this for 10 million PCR tests per day
Est. cost £14 billion a year
(Estimate in The Lancet)
The photo there is of Debes Christiansen in his laboratory. Photograph: Therese Soltveit / Forside - Kyst.no:
“It is very easy to adapt. The only thing I changed were some of the ingredients. In our normal work it is specific to fish virus and fish bacteria and in this case I just changed the three components specific to the coronavirus.”
He could do 1000 tests a day if he needed to.
See also my:
- Faroe Isles - example of COVID-19 case isolation, contact tracing and quarantine done properly
- Can suppress COVID-19 in regions, islands, urban districts until gone - as for Bahrain & Faroe Isles
I release this article and the graphics in it under CC by SA 4.0 - you are welcome to use this article and adapt the content so long as you attribute me as the author.