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Covid-19: Shooting for the moon

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3509 (Published 10 September 2020) Cite this as: BMJ 2020;370:m3509

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  1. Kamran Abbasi, executive editor
  1. The BMJ
  1. kabbasi{at}BMJ.com
    Follow Kamran on Twitter @KamranAbbasi

What happens if a moonshot fails? John F Kennedy’s moonshot didn’t fail. It eventually got a man to the moon eight years later, and even if it hadn’t succeeded the world might not have been much different. Our exclusive news story revealed that the rocket scientists in the UK’s Cabinet Office are planning their own moonshot: to introduce mass testing for covid-19 on a scale that beats every other country.1 The financial commitment for mass population testing will be huge, considering an outlay of £500m (€550m; $650m) to merely support initial experiments.2 What if you spend billions on a moonshot to defeat covid-19 and you miss?

Indeed, England’s performance in implementing a routine test, trace, and isolate programme doesn’t inspire confidence for upscaling to a moonshot. Missed targets, misleading “facts,” slow results, and false bravado are everyday occurrences.3 Lucrative contracts are awarded to private companies by opaque processes, while money for patients is squeezed, as Helen Salisbury points out.4 All this without accountability or apology for mistakes and missteps.

Testing has its place but not in isolation. For example, there is a role for regular testing of frontline health and care workers and of students and teaching staff as schools and universities reopen.5 But testing alone is not a panacea. It must be part of a comprehensive strategy to control community transmission, ideally one that aims for elimination of covid-19.6

Mass testing beyond people with symptoms or groups at risk quickly becomes screening, with all its associated undesirable effects.7 All screening programmes produce false positives, with harmful consequences for individuals and the economy. Point-of-care and laboratory tests for covid-19 are hard to interpret separately from the clinical context.8 Hence, mass testing risks creating confusion and, if mishandled, will further erode public confidence—the exact opposite of its stated intent.

Covid-19 has magnified the flaws in modern healthcare. Policy is either rushed or introduced too late and is often divorced from science and evidence, instead engineered to meet political ends. We need better evidence for non-drug interventions for covid-19, argues Margaret McCartney.9 We also need to avoid outdated science and oversimplification, such as in the debate over physical distancing at one or two metres.10

Above all, sensationalist schemes that are based on rough and ready science, contracted out to opportunistic companies, and funded by vast amounts of taxpayers’ money risk diverting us from the direct challenges of keeping a persistent and damaging pandemic under control.

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