In the early days of the pandemic, ministers believed and told the public the UK was at the forefront of Covid testing. The government’s scientific advisers appeared to share the view and were perhaps even a factor in its widespread belief. At the first Sage meeting in January 2020, the assembled experts said a Covid test would be ready within days and that it could be “scalable across the UK in weeks”.
That assessment was way off the mark. The UK was indeed one of the first countries to develop a Covid test, but it squandered the advantage by failing to deliver them. The inability to ramp up testing capacity had serious knock-on effects. Scientists had no clear picture of the size of the outbreak, while prioritisation of what tests existed left many vulnerable people, including those in care homes, dangerously exposed.
The extent of the problem was clear from the figures. In late January 2020, Public Health England, now the UK Health Security Agency, was able to administer only 400 to 500 Covid tests a day. In the six weeks to 11 March 2020, less than two weeks before the first lockdown, the UK performed fewer than 30,000 Covid tests. That equates to less than one a day for each parliamentary constituency. At about the same time, in mid-March 2020, Germany was testing 50,000 people a day.
A month before the then health secretary, Matt Hancock, asked Prof Chris Whitty, England’s chief medical officer, for advice on testing for care home admissions, the UK abandoned all testing in the community. The decision, on 12 March 2020, ran counter to advice from the World Health Organization and marked a shift in England’s management of the pandemic from “containment” to “delay”, amounting to an acceptance that the virus was out of control.
Dr Jenny Harries, then the deputy chief medical officer for England, defended the decision to halt community testing, saying it was “not an appropriate intervention” given the prevalence of the virus. But two months later, she admitted to the Commons health select committee that the decision was partly due to a lack of testing capacity. Another factor was that the government’s strategy was modelled on a flu pandemic, which mandated an end to testing once community transmission was established.
Without the capacity to track the pandemic in the public, tests were prioritised for the NHS where staff and patients were at greater risk. But ministers knew that care home residents were extremely vulnerable to outbreaks too. According to Hancock’s messages, he received advice from Whitty on 14 April that anyone being admitted to a care home – whether from hospital or the community – should be tested for Covid and isolated if necessary. A spokesperson for Hancock said he accepted this, but was told at an operational meeting later that day it was not possible to test everyone going into a care home.
The main concern at the time was that patients could be discharged from hospitals, where Covid was often rampant, directly into care homes without being tested. Hancock sought to assure critics that “right from the start” government had thrown a “protective ring around our care homes”, but there were no requirements around admissions from the community, and government advice on 2 April 2020 stated that negative tests were “not required” before patients were transferred from hospitals to care homes.
It was not until mid-April that Covid tests were made a requirement for hospital patients being discharged into care homes. But even then, the guidance assumed patients could be safely isolated on arrival. In reality, many care homes lacked the facilities to do that.
There was even less protection for care home residents from people admitted from the community and from care workers themselves. The lack of testing of staff in particular meant social care workers spread the virus unwittingly, at times between several different homes where they were employed. The failure to prevent outbreaks in care homes led to more than 40,000 Covid deaths among residents between March 2020 and April 2021, more than a quarter of the Covid deaths in England over the same period of the pandemic.
