Mass testing. Results from the Liverpool trial. A thread. And a big problem.

gov.uk/government/pub…
A bit of background. To get out of national Lockdown 1, we were promised a test trace and isolate system. That uses PCR tests. These are accurate, but take time to get results back. There were also significant issues in the way that the Government organized 'NHS' Test & Trace
The Government is now relying on a less accurate technology, Lateral Flow tests. In order to roll these out nationally, the Government tested these.
In October, the first test was to see if they 'passed'.

They did, but we weren't told what this meant.

So, more detailed results were published here
Which showed

"It has an overall sensitivity of 76.8% for all PCR positive individuals but detects over 95% of individuals with high viral loads"

But these were from ideal situations. What about when they are used in the field? That's where the Liverpool pilot came in.
And we now have results from that Liverpool pilot here:

gov.uk/government/pub…
In the Liverpool trial, only *5 out of 10* cases were detected (and *7 out of 10* cases with 'higher' viral loads).

Not the same as the 76.8% and 95% from ideal conditions. Very far from it.
So... we have a mass testing regime that has large numbers of false negatives.

The problem with this is that people may take tests, be told the test is negative, and then *believe* they are negative.
This can put vulnerable people at risk, and those in the communities in which they reside, such as residents in care homes.

The vital message is - if you have a negative test *IT DOES NOT MEAN YOU ARE NOT INFECTIOUS OR WILL NOT BE INEFECTIOUS*
And this is why the risk of Covid entering care homes is so great - although important to say LFD testing may not be relevant in this particular case.

There are two critical points:
1. Not enabling changes of behaviour at the same time eg promoting more visits or more visitors to care homes
2. Messaging for negative results - eg see this from university LFD testing from a couple of weeks ago

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More from @Dr_D_Robertson

2 Dec
MHRA / JCVI Briefing live
First phase JCVI prioritization overview Image
First phase prioritization. Only difference is confirmation of 16 as minimum age for recieving the vaccine (for phase 1 only higher risk younger people) Image
Read 7 tweets
26 Nov
Here is the justification document for which regions were placed into each tier from 2 December.

A walkthrough thread.

assets.publishing.service.gov.uk/government/upl…
This updates the Government's prior systems, documented here:
Here's the summary chart.
Read 24 tweets
26 Nov
As soon as we come out of lockdown, we will have one million students moving around the country returning home. Some of these will be infected and will go on to spread the virus. Here's the latest data from PHE showing transmission last week in lockdown

We also have a significant issue when schools break up. These are the latest data for outbreaks in schools

Schools break up around 19 December. What happens if children are infected on the last day of term?
Read 5 tweets
26 Nov
Here are my heatmaps for the data published by @PHE_uk on 26 November. A thread.
Detected cases falling in each age group. Smallest relative fall in 5-9 year olds. Largest relative fall in 20-29 year olds
Here is the monochrome version.
Read 7 tweets
26 Nov
Here is my commentary on @PHE_uk's Covid surveillance report for week 48 (up to week 47 data) released on 26 November 2020.

The headline:
"Surveillance indicators suggest that COVID-19 activity at a national level has decreased during week 47."
Cases and positivity have finallly decreased. This is very good news, but expected taking into account the effects of Lockdown 2.
Where are the detected cases this week?
Read 12 tweets
26 Nov
With Tier 3 regions now having access to mass testing, this could lead to higher case rates (due to more positive cases being detected from these tests) and the likelihood that these areas stay in Tier 3 for longer.
When areas are reviewed on 16 December, we should take into account the number and type of tests being performed in each area.

Unfortunately, the data we now have doesn't distinguish between symptomatic (PCR) and asymptomatice (LFD with positives confirmed by PCR)
Demand for testing has also fallen, with the number of tests undertaken not following the trajectory of ONS survey data.

One way of analyzing this is to look at positivity (see here: ) by area rather than age.

Unfortunately, this data is not published.
Read 4 tweets

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