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Covid-19: Use lateral flow tests in schools to find cases, urges Independent SAGE

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n75 (Published 11 January 2021) Cite this as: BMJ 2021;372:n75

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  1. Matthew Limb
  1. London

The Independent Scientific Advisory Group for Emergencies has endorsed the use of mass lateral flow testing in schools to screen staff and pupils for coronavirus. It said this should be one element of a comprehensive “safe schools” strategy that ministers should implement through a new national education taskforce to enable pupils to return to school.1

Independent SAGE’s strategy calls for properly trained staff to conduct the tests, with effective oversight and clear clinical care and advice being provided to pupils who test positive and their families. It has also set out a range of measures to tackle the “substantial harms” caused by school closures, including to school students’ mental health and their long term prospects.

Deenan Pillay, a member of the group and virology professor at University College London, said, “Testing is not a panacea: testing alone will not actually protect schools; it will not make them safe.

“But of course positive tests are an indication for action, both clinical and infection control. There needs to be proper space and other infection control processes when schools reopen [fully],” he told a virtual meeting of Independent Sage on 8 January.

The move comes amid growing concern over more widespread use of lateral flow testing. The rapid test kits most widely used in UK universities, schools, and care homes were shown to detect just 48.89% of covid-19 infections in people without symptoms when compared with a polymerase chain reaction (PCR) test, in real world data from the Liverpool pilot scheme.2

The Innova test failed to detect three in 10 cases with the highest viral loads, in preliminary data released from the field evaluation of testing in asymptomatic people.

In its latest report proposing a comprehensive “safe schools policy,” Independent Sage said testing should be used as a means of “finding cases rather than as a means of determining whether or not people are infected, given the high negative rates.”

“A negative test should not be taken as an indication that someone is not infected or to relax other mitigations at either an individual or collective level,” it said. It added, “Testing itself is meaningless without a clear pathway of response to a positive or negative test result.”

Susan Michie, a member of Independent Sage and professor of health psychology and director of the Centre for Behaviour Change at University College London, told The BMJ that lateral flow tests, if done repeatedly, could be “really helpful” as part of a package of other measures. “Nothing is a silver bullet here, not even vaccines, and we just need to use every tool in the tool box we have,” she said.

She said that testing should be preceded by a clear information campaign to make sure people understood that a negative test “does not mean you don’t have covid.” She added, “It is important everybody understands it before they get given it, not afterwards, because otherwise people can have developed a mental model of it which is much more difficult to shift.”

The government had planned for schools to introduce mass testing after the Christmas holidays before it authorised closure of primary and secondary schools on 4 January until at least the February half term.

Independent Sage said the policy caused confusion but closing schools was the right thing to do to control the pandemic and stop the NHS being overwhelmed. “However, closing schools is only acceptable as part of a broader strategy aimed at mitigating the harms caused by the closure and making schools safer so that they can be reopened as soon as possible,” it said.

A new national education taskforce should involve government, local authorities, teachers, parents, and pupils, it said. Measures should include making environments covid secure, with sufficient spatial distancing and ventilation, hiring extra teachers and extra teaching spaces where possible, and organising resources to enable remote learning.

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