The UK has been a world leader in free coronavirus testing throughout the pandemic. On an average day it runs around 300,000 PCR (polymerase chain reaction) tests, and about a million people take LFTs (lateral flow tests), at no charge to the individual. These tests have provided surveillance data for new variants, and allowed infected people to rapidly isolate, protecting others from infection. Testing has also reduced anxiety among those returning to work or school environments through knowing that those sharing their space were testing regularly.
As we move towards the government’s “Living with Covid-19” strategy, it is expected that widespread access to free testing will be removed, or at least greatly reduced. Some will celebrate the freedom from having to check their infection status, while others are likely to have anxiety and concerns given that there are still considerable community transmission levels. Without access to free testing – and without public health guidance to test often – some may also feel pressured to continue to work when unwell. Management of sickness in the workplace will need consideration.
The advantages include cost-saving and a move towards “normalisation” of living with Covid-19. Testing at the levels we witnessed during the pandemic is not sustainable indefinitely. Of more concern is how removing or limiting free testing will affect the number of people staying home when infected to reduce the spread. It will also affect whether we will have sufficient early warning of changes in infection patterns, for example detecting the emergence of new variants of concern. These warnings are essential to mitigate future waves of infection.
A more sensible approach would be to make free tests available in particular situations, such as when visiting hospitals or care facilities and for staff working in environments where being infectious could have serious consequences. Indeed, this is more appropriate than mandatory vaccination for healthcare staff, given that the vaccine does not always prevent infection.
Population surveillance for emerging variants and to gauge overall levels of community infection can also be done through wastewater testing. As the virus passes through our body and is excreted, it can be detected at testing points in the sewer system. The Environmental Monitoring for Health Protection programme, part of NHS Test and Trace, has been doing this to map emerging spikes of infection, and gathering genomic sequence data to identify variants of interest or concern. This also provides anonymised evaluation of Covid levels in communities – no one has to submit to testing individually.
I hope that we will see a tailored approach to testing in the future, rather than an all or nothing approach. We need to cautiously ease ourselves into living a relatively normal life with Covid.
I would not rush into these final release measures until March, ideally when case numbers decline even further, and when we are emerging from winter. I would encourage further testing, but in a targeted manner to protect those with extreme vulnerability, and encourage surveillance through wastewater testing so that we can have early warning of changes in the situation.
The removal of legal isolation requirements is a reasonable progression, but hopefully it will still be supported by guidance to isolate. This needs to stipulate that those feeling unwell should avoid crowds, educational, social or workplace mixing and employers should support those who withdraw from mixing while unwell. Given the lack of incentives for those on low pay or zero-hours contracts to stay home though, I suspect many will continue with work and potentially put others at risk.
We have to ask: how big is this risk? Given the sheer number of Omicron infections, most of the population is probably now protected (until a new variant emerges). So I doubt we will see a huge upturn in infections. However, we will probably see a slower decline in cases than we would with stronger policy. Changes to guidance and testing should wait until March, when we are more likely to open windows and start to be outside more.
I urge caution. Let’s not rush into a full release again and keep doing all we can to keep people as safe as possible.
Sally Cutler is professor in medical microbiology at the University of East London
