Home testing to track infection levels in community

Imperial College London is to lead a major programme of testing for COVID-19 to track the progress of the infection across the UK.

The programme will help to improve understanding of how many people are currently infected with the virus, and potentially how many have been infected and recovered since the COVID-19 outbreak began.

The work, announced today (Thursday) by the Government, is being led by a world-class team of Imperial scientists, clinicians and researchers, alongside colleagues at Imperial College Healthcare NHS Trust and IpsosMori, and has been commissioned by the Department of Health and Social Care.

Accurate testing for the virus on a wide scale is vital to lifting Britain’s nationwide lockdown by providing authorities with a clearer picture of the current burden of the disease and of the number of people who have previously caught it.

Self-sampling is widely used in health care, for example in the management of diabetes and the diagnosis of HIV. But the accuracy of coronavirus antibody tests has been questioned and their usability by members of the public is untested.

Professor the Lord Darzi, FRS, Director of the Institute of Global Health Innovation and the sponsor of the programme at Imperial, said: “Short of a vaccine, testing is the only way out of lockdown. But the testing landscape is like the Wild West with no rules, no standards and widely varying reliability. Even the most accurate test is useless unless it is usable. With this ambitious programme, the biggest in England, we aim to establish a viable testing programme on which the Government can rely.”

Professor Paul Elliott, director of the programme at Imperial College London, said: “Community testing is a vital next step in ongoing efforts to mitigate the pandemic, but to be successful this must be based on robust scientific evidence. Through this important programme we will gather the critical knowledge base necessary to underpin community testing programmes and facilitate a greater understanding of the prevalence of COVID-19 in the UK.”

In the first part of the REal-time Assessment of Community Transmission (REACT-1) programme, 100,000 randomly selected people from 315 local authorities across England will be invited to provide nose and throat swabs, which will be tested for antigens indicating the presence of the virus. This kind of test looks for evidence that someone is currently infected with the coronavirus.

In the second part of the programme (REACT-2), a number of different antibody tests will be assessed for their accuracy and how easily people can use them at home without assistance from a healthcare professional. Antibody testing is used to assess how far the infection has spread and what proportion of the population has been infected and is necessary both to identify individuals who may have some immunity to the virus and to plan services for those who do not.

The antibody tests will first be carried out on volunteers from Imperial Healthcare NHS Trust who are known to have had the virus to establish their accuracy.

A group of 300 members of the public will also be given a sample test to self-administer, which requires them to place a finger prick of blood onto a testing kit and read off the result. Researchers will then assess its acceptability and whether people understand the guidance on how to use it.

If successful, the test will then be distributed to a larger cohort of up to 10,000 people. The aim is solely to ensure that people can properly self-administer the test, rather than to provide an accurate assessment of antibody levels.

A further stage will involve up to 5,000 key workers, who will both self-test and have the test administered by a health professional. These the results will also be compared with gold-standard laboratory testing on participants’ blood samples. This will provide more information about the accuracy of the tests.

If antibody self-testing is found to work with a high degree of accuracy, acceptability and usability, it will be rolled out to 100,000 people later this year, to provide an indication of the prevalence of Covid-19 based on the presence of coronavirus antibodies.

Professor Helen Ward, Professor of Public Health at Imperial College London, said: “As part of this project we will work with public volunteers and patient advisors to see how easy it is for people to do these tests at home, and co-design the information and packaging that will go out with the tests. We have already had an excellent response from members of the public who are keen to support our research.”

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