Thread by @_johnbye

The government failed to increase lab capacity AT ALL over the summer, despite their own policies leading to increased demand for tests that reduced the headroom available to deal with any second wave.

Now that cases are surging the system is collapsing.

This was all avoidable.

So what went wrong?

Pillar 2 capacity hit 135,000 tests a day on June 14.
But demand started rising from the start of July.
And capacity didn't go up again until August 27.

By then labs had been running near 100% capacity for a week, leading to widespread delays and backlogs.

This first became apparent in the Test & Trace reports, which showed longer and longer delays in delivering results for home and satellite site (mostly care home) tests, and over 10,000 tests a week never delivering a result at all!

https://twitter.com/_johnbye/status/1304123173961691142?s=20

Much of the increase in demand seems to have come from the government's own pledge to test care home staff every week and residents every month.

And was therefore entirely predictable.

But they did nothing to raise lab capacity to cover this.

https://twitter.com/_johnbye/status/1303234081170296833?s=20

After lengthy delays in rolling out regular testing of care homes, this now seems to account for about 250,000 tests a week in England.

A quarter of all available capacity in pillar 2 labs.

Even as labs hit 100% capacity in mid-August, they also announced a big increase in the ONS Infection Survey, from 28,000 to 150,000 tests a fortnight.

Some or all of these are processed in pillar 2 labs.

61,000 extra a week. 7% of capacity at the time.

ons.gov.uk/news/news/newi…

At the same time, cases were starting to rise in July and local lockdowns were being introduced across large parts of the Midlands and Northern England. High risk areas on the watchlist were promised more testing.

Again, no new lab capacity was added to support this.

All of which meant there was no spare capacity left in the system to process more tests when cases recently surged nationwide.

We squandered the summer, failing to raise capacity even as labs started to struggle, leaving us unable to handle the increased demand for testing now.

On top of this, the long planned return to school seems to have predictably caused a rise in demand for testing. As children get sick, parents and schools need them to be tested to know if they have coronavirus or just a cold.

Again, why was no new capacity prepared for this?

The return to university of students in their late teens and early twenties (age groups with some of the highest infection rates at the moment), seems likely to cause another spike in demand for testing.

Again, this has been planned for months. Why aren't we ready for it?

The end result is that testing is being rationed to avoid overloading labs, many people with symptoms are going untested, and once again NHS workers are having to self-isolate because they can't get a test to see if it's safe for them to return to work.

https://twitter.com/BBCNews/status/1305683298581180417?s=20

Lab capacity finally went up slightly this month, but last weekend's Times story suggests most if not all of this is due to tests being sent to private labs (mostly overseas).

Our capacity hasn't improved.
We paid labs in Europe to make up the shortfall.

https://twitter.com/Gabriel_Pogrund/status/1305047753983225858?s=20

By September 9th Pillar 2 lab capacity had risen by 26,000.

But the leaked performance report in the Times lists -

3,000 at SBS (Source BioScience in Nottingham?)
10,000 at Eurofina (in Germany)
10,000 at Immensa (in Italy)

23,000 total. Almost all of the new lab capacity.

This bought in lab capacity doesn't seem to be available every day, with total capacity varying between 138,000 and 161,000 last week.

Meanwhile thousands of swabs sent to Eurofina may have ended up in the bin because they were transported across Europe at the wrong temperature!

The last we heard about real capacity increases was that a new Lighthouse Lab will come online "this month", scaling up to process 50,000 tests a day .. by the end of the year.

Meanwhile the govt is promising 500,000 a day capacity by the end of October.

gov.uk/government/new…

Until then, with labs overstretched and a large backlog to clear (185,000 tests as of last week), it looks like test availability will continue to be limited.

And with care homes and NHS staff understandably prioritised, it will be harder than ever for anyone else to get a test.

Meanwhile the Guardian reports that NHS (pillar 1) labs received an urgent call for help to deal with the surge in demand for pillar 2 tests on August 24.

Two days after the data shows pillar 2 labs hit 100% capacity.

theguardian.com/world/2020/sep…

This explains the recent rise in pillar 1 testing. Which is also now nearing maximum capacity, having failed to scale up since early July.

It also muddies the data, as some pillar 1 tests are now really from pillar 2. And they don't seem to be counted in the right category. 🙄