Urgent need for COVID-19 mass testing facilities
Your editorial on 19 March (BMJ 2020;368:m1101) calls attention to the urgent need for increased capacity to test frontline healthcare workers serologically to verify their immunity to the COVID-19 virus. Even more urgent is capacity for viral detection in the whole population. This, together with social distancing and intensive contact tracing, could enable the country to resume fairly normal life with long periods between 3-week lock-downs. Central facilities with the capacity to test the entire UK population simultaneously (say within 6 days at 10 million tests per day) can be available much more quickly than a vaccine, probably within weeks. This would require a crash programme to manufacture the PCR reagents and commission (or commandeer) all existing public and commercial PCR facilities. (For example, the Roche COBAS machines used in the NHS for HPV screening are already FDA-authorised for COVID-19 detection.)
All GP-registered patients would be sent a test kit (a swab for throat and nasal self-sample, and a transport tube labelled with their name, NHS no. and a barcode). The Post Office, Amazon and other companies already have the combined capacity to collect swabs from every household on the same day. All essential workers not in lock-down should be tested at least weekly. At the end of (say) 3 weeks of lock-down all households and care homes would return self-taken swabs taken on that date from all residents. All residents would test negative in most homes, so most people could resume normal life within a month of starting the lock-down. Everyone must carry the card certifying their status (date and result of latest test, and essential/other work status) that would be returned with the test result.
This should be modelled to determine the maximum period between national lock-downs. Weekly or fortnightly universal testing following the first lock-down, together with behavioural changes and efficient contact tracing, would detect most non-trivial new infections and might control the epidemic without further lock-downs until a vaccine is available.
Competing interests: No competing interests