When we look back at this pandemic, we may find that one of the most expensive and harmful policies was the mass testing of the population, including school children. The guidance across Britain continues to be that school kids should test regularly, sometimes two to three times a week.
Testing healthy children for disease is a form of screening. The supposed purpose of screening is to allow for early intervention to prevent disease. Yet, as there is no widely-distributed early treatment for Covid, the only intervention is to break the chain of infection and transmission, which is why people are being told to quarantine and contacts to self isolate once testing positive.
But is there a need for this form of screening at all? Despite the vast amounts the Government has spent on mass testing, a report by the Public Accounts Committee stated that Test and Trace had not achieved its main objective of preventing transmission. It also described the programme as “muddled, overstated and eye-wateringly expensive”.
It is high time we heeded the ten classic principles for the screening or mass testing of healthy people as set out in a report for the World Health Organisation in 1968 by James Wilson and Gunnar Jungner. Dr Wilson was himself a senior medical officer in the Ministry of Health in England, and no doubt he would be turning in his grave today.
One of the screening principles is that there should be a suitable test. The current lateral flow tests were initially tested on symptomatic people, presumably as an aid to clinical diagnosis. My view is that the original intent did not seem to have been for use in healthy people through mass testing. In Britain they are being deployed for mass use on asymptomatic people through an exceptional use authorisation.
No test is perfect. False negative tests will occur when the prevalence of disease is high, thus giving false reassurance. Similarly, false positives are a problem, especially as case numbers fall, resulting in unnecessary quarantine of people and isolation of contacts. These false results appear more likely to occur in self-administered tests, which have not been properly evaluated in the population, let alone in children. Despite this, the Government recommends large parts of the population test twice weekly.
Another key principle of screening is that the cost of testing, case finding and contact tracing should be economically balanced in relation to both expenditure on medical care as a whole and its wider impact on economy. I have not seen a substantial evaluation conducted into this.
Nor has there been enough analysis of the balance to be struck when it comes to testing school kids. Covid infection in children is generally mild or asymptomatic, with research evidence showing that for most children Covid symptoms resolve in a matter of weeks. Given that we believe a substantial number of 16 to 17 year olds already have antibodies to Covid, the rationale for repeat testing is difficult to understand, especially if reinfection is mild.
Moreover, although the prevalence of the omicron variant is very high, early data appears to suggest that it is not as likely as delta to result in serious disease and hospitalisation. The extent to which this is due to the variant, or a combination of boosters and high levels of prior infection having established high population immunity, is unknown.
Forcing healthy contacts to isolate and test unnecessarily was always going to lead to a rerun of the “pingdemic” farce we saw last summer, which ground public services to a halt because of staff absences among generally healthy people responding to the NHS app. What matters more is targeted interventions on the groups who are most at risk and vulnerable, and rebuilding staffing and capacity in health and social care.
It is time the Government reassessed the risk and revised its guidance. The take home messages should be: stay at home with symptoms and that way you will avoid spreading flu and a host of other viral infections. Tests can give false reassurance and can create false alarms and unnecessary isolation.
Medicalising children in the absence of good evidence of benefit is harmful and unethical. Governments should support people financially who are ill with symptoms and address the main risk factor for poor outcomes from Covid, which is poverty. Mass testing should be wound down and testing reintegrated into clinical service.
Professor Allyson Pollock is clinical professor of public health at Newcastle University