How recent history shows us Boris Johnson's 'Moonshot' coronavirus testing plan will struggle to get off the ground

Tom Clarke

Former Science Editor

In a new series, Coronavirus: What Happened, ITV News looks at the decisions the government made during the early stages of the pandemic, examining issues such as why vulnerable residents in care homes were put at serious risk, why health care workers struggled to obtain vital protective equipment, and why the UK did not increase coronavirus testing capacity much earlier than it did.

They're now calling it a "moonshot" but the history of the UK's Covid-19 testing strategy is of one struggling to get airborne. But why?We interviewed three key players in our Covid response to understand what we got so wrong in the first place, how significant an impact that has had on the UK pandemic, and what we need to learn to ensure we don't continue to fail.

LACK OF CAPACITY The first problem is historic.

Under former health secretary Andrew Lansley, a body called Health Protection England was merged with other government and NHS lab services.

A new organisation Public Health England adopted its pandemic preparedness role, but with a fraction of the budget, staff and local laboratory network.

As civil servants, employees of Public Health England are prohibited from speaking to the media. We spoke to a public health registrar working for the organisation on condition of anonymity."There was no way that the local teams could deal with a widespread outbreak on the scale that we saw," he told us.

Even at the very start of the outbreak as the first cases of virus arrived in the UK the system wasn't coping that well.

"There were issues in terms of communication with people calling us up to try and organise tests, people calling the hospital to organise tests... back and forth it went," he said. A regional lab network already in place is now believed to be one of the main reasons Germany and South Korea were able to respond to a sharp rise in Covid cases rapidly. They had the infrastructure into which to expand testing. The UK didn't."I think that you would have reduced fatalities substantially had we got testing in place earlier," said Professor Alan McNally of the University of Birmingham who helped set up one of the first 'Lighthouse Labs', on behalf of the government.

OVERWHELMED BY COVIDWhat made things even harder for any testing system we had, was that we now know thousands of Covid cases were coming into the UK among returning travellers between mid-February and mid-March.

By this time the limited testing the UK had was shifted into hospitals, to ensure they could diagnose Covid and keep infected patients isolated from others."We were planning and analysing stuff in the dark. I and colleagues on SAGE [the government's Scientific Advisory Group for Emergencies] were pushing hard that we needed to stand up reliable, [what was called] sentinel surveillance in the community to get a handle on what was happening within the country," says Professor Neil Ferguson who was then the government's leading advisor on the pandemic.

Prof Ferguson says that as a result of this the true scale of the UK outbreak didn't become clear until mid-March, past the point at which the UK should have locked down.

The delay in locking down is now seen as one of the main reasons for our very high coronavirus death-toll compared to our European neighbours.CENTRALISED RESPONSEBy late March, Covid cases were rising exponentially and the government began massively scaling up testing to catch up.

The experts agreed the approach they took delivered a very rapid increase in testing, but it may have laid the ground for the problems they are experiencing now."The [prime minister] is right - we're dong the most Covid tests in Europe. But that means problems with logistics, transport, and it's putting all your eggs in one basket."said Prof McNally.STAYING ON TOP OF THE VIRUSOur failure to keep surveillance on the virus cost us dearly early in the outbreak. But the inflexibility of the testing system now, could prevent that from happening in future.

As people with mild, or without symptoms are encouraged not to get a test.According to Prof McNally, that comes back to having testing capacity distributed around the country: "Local is better, local is what works.

"If you want to contain an epidemic, contain it locally. It's like a forest fire.

"There's not one huge fire, there's lots of little ones that join up. A local intervention strategy stops the little fires joining up."

The other concern about the government's wider testing strategy is that it's been handed over to private companies like Deloitte and Serco.

While they have proven their ability to carry out hundreds of thousands of tests a day in short-order, its critics say it doesn't involve senior epidemiologists or public health experts.A failure to persuade politicians about the reality of the Covid crisis more quickly is one of Professor Ferguson's major regrets, telling us: "I always took the very strict view that it wasn't my job to tell government what to do... we were looking at these numbers week-after-week and almost the scale of what was seen in those numbers was not quite sinking in."

He added: "Maybe I could have been more forceful at saying, 'are you really sure you want to go through this?' I mean I did say that at various points, but I could have done so more forcibly and earlier."

The government has since announced that Public Health England will be replaced by a new National Institute for Health Protection to address some of the systematic problems that led to the problems around pandemic surveillance and scaling up testing.

The PHE insider we spoke had no criticism of the idea, but that the government would need to work to win back the trust of public health experts that will staff it.

Ministers failed to come to PHE's defence when it was blamed widely in the media for being responsible for our Covid failures. 

"It was a huge blow to moral," said the insider.

"The team was overstretched working 16 hour days seven days a week for six months with virtually no break. To then hear that 'PHE has messed this up' made people feel really undervalued," they added.

We invited the Department of Health and Public Health England to put spokespeople forward for interview, but none was available.

In a written statement to ITV News, the department said: “At every stage of our response we have been guided by the advice of experts and we took decisive action from the outset.

"We have built the largest diagnostic network in British history from scratch and we continue to work round the clock to make sure that everyone who needs a test can get one.

“There has been a spike in demand in recent weeks and we’re doing everything possible to overcome this challenge, bringing in more labs capable of processing tens of thousands of tests a day, opening new tests sites and trialling new rapid tests so the public can get their result on the spot.”