Why we need a local solution to the testing crisis

Rhun ap Iorwerth MS explores what has gone wrong with coronavirus testing in Wales  

“Test, test, test” – that was the clear message from the World Health Organization as far back as March. They’ve not changed that message, and yet here we are in September and Wales is still unable to offer a test to everyone who needs it.

I want to explore what’s gone wrong, but first I think it’s important to clarify why testing is so important. This question is quite simple to answer: If we can find out who has the virus, we have a chance of breaking the chain of infection. If everyone who has the virus can be identified and asked to isolate, it won’t get passed on. It really is as simple as that.

And yet here we are in September and the lack of testing is still headline news.

The time of year is important here. We know that autumn and winter are known as “flu season” – but perhaps it’s more true to say “virus season.” This means that this SARS-COV-2 coronavirus – already known to be very infectious and in some cases, deadly – is very likely to take hold again, alongside common colds and influenza, unless we can act to isolate cases.

And so we’re back to testing. The only way we can tell for certain if someone has coronavirus is to test them, and if they’re positive, to then isolate and test all their known contacts as quickly as possible. After six months of learning lessons, that “test, test, test” principle should now be well-established.

But the reality is that there is still a testing shortage. Why is this?

In July, the Health Minister made a statement to say “We are making increasing use of the UK-wide testing system and the Lighthouse Lab network. This will support our Test, Trace, Protect strategy by helping us get the testing capacity and turnaround times we need, and to be ready for the autumn.”

Pooling resources feels intuitive when you’re tackling a global pandemic, doesn’t it? A UK-based system gives you access to labs all across the four nations, and if your nearest test centre doesn’t have availability, it can let you know the next best option. That’s all well and good, but when you hear of people in Wales being offered tests in England, while people in England are being offered tests in Wales, suddenly the system doesn’t seem so great. What’s worse is when you hear that Rhondda Cynon Taf (RCT), when faced with increasing evidence of community transmission, had a limit placed on the number of tests they could have via the UK based Lighthouse Lab system – to just 60 tests! How could they ever hope to control the spread of the virus when they had no way to find out who had it in the first place?

The solution for RCT was to switch to testing facilities in Welsh laboratories to increase capacity. That is to say, they used resources that were already available locally to solve the problem. But this isn’t a new concept.

In June, Independent SAGE – that’s the independent group of scientists providing advice on how to recover from the COVID-19 crisis – concluded “the most effective implementation of a test, trace & protect system is led locally.” This means using existing networks, within local authorities, and being managed as locally as possible.

One of their leading scientists, Professor Deenan Pillay, told me in the Senedd Health Committee in June: “we have to develop a plan, for what is going to be an integrated, more local, embedded diagnostic service and testing service, utilising all the systems we've got in place. And that needs to be done now.” But rather than overseeing the “migration of testing back from the emergency Lighthouse laboratories” as Independent SAGE advised, Welsh Government did the opposite. In July, Welsh Government announced their intention to rely more heavily on a UK based testing system.

And now we’re suffering the consequences. The Lighthouse lab system is struggling. The solution is – at best – “weeks away” we’re told, and in the meantime, people are not getting the tests they need to help us manage local outbreaks.

The foundations for the solution already exists, we just need to take control of our testing capacity, then build on it to make sure we’re ready for the predicted second wave. Perhaps it’s with us already. Cooperation between countries is a positive thing, but the Welsh Government have to step in here to ensure the people they serve have the protection they need.

Originally published in Western Mail, 18 September 2020