John Bye Profile picture
26 Dec, 19 tweets, 10 min read
This week's Test & Trace report covers the week to December 16th, when cases in London and the South East were surging and falls in the North and Midlands levelling off.

There were also issues in the Lighthouse Lab system, apparently caused by a shortage of reagents. Image
As demand soared, almost 2 million tests were done in a week in England, which is amazing when you consider we struggled to test a few thousand people 9 months ago.

Despite this, the number of positive results rose much faster than testing, with positivity rates climbing again. ImageImageImageImage
Breaking it down by type of test done:

The new Lateral Flow Tests are still only being used on people without symptoms, so positivity is very low but rose sharply this week.

Some (but not all) PCR tests are used on people with symptoms so have higher positivity. Over 10% again. Image
Meanwhile there's still a weird issue with data for Pillar 1 (hospital) tests in the week to November 4th, particularly in Hammersmith & Fulham.

Another 16,703 tests have been added to the total in the latest report, on top of 99,252 in previous revisions. Almost all in London. Image
There have been big revisions to data for that week in every report since.

Hammersmith & Fulham now reports doing 4 times as many tests that week as any other before or since!

It's not clear if this is an error, and if not why it's taking months to identify all the tests done. Image
The only possible explanation I've found is that during that week 24 staff had to self-isolate after being in close contact with two patients admitted to ICU for non-covid ailments who later tested positive.

Did they screen everyone after that?

londonnewsonline.co.uk/24-staff-membe…
Coming back to the latest week, there's a dip in performance for Pillar 2 labs, after several weeks of steady improvements in test turnaround times.

Only 34% of "in person" tests gave a result within 24 hours of taking the test, compared to 65% at the end of November. ImageImageImageImage
There are similar issues with turnaround times for Home and Satellite (care home) testing.

This means average turnaround times are up on last week by a few hours for every type of Pillar 2 PCR test. ImageImageImageImage
There was also a jump in the number of tests that hadn't delivered a result yet when the report was compiled, from 21,433 to 33,065.

Although as the number of tests done was also much higher this week, it's a fairly small increase in terms of the percentage of incomplete tests. Image
This is likely to be connected to a recent shortage of supplies such as chemical reagents needed to process the tests, which forced the Milton Keynes lab (at least) to cut working hours for their staff, just as demand for testing was rising rapidly.

bylinetimes.com/2020/12/21/uk-…
The contact tracing system seems to have held up well in the face of the sudden spike in demand though.

88% of new cases that were transferred to the contact tracing system were reached, which is a new record, and mostly within 24 hours of referral. ImageImageImageImage
Now that people who test positive are asked to tell everyone in their household to self-isolate, most household contacts count as "reached".

But with less time spent on repeat calls to the same home, 70% of non-household contacts were reached too, which is the best for 3 months. ImageImageImageImage
While recent improvements in the system are welcome, we need to get cases down again for contact tracing to be effective.

And it's all pointless if 89% of contacts don't self-isolate! Research suggests many don't understand why they need to stay at home.

medrxiv.org/content/10.110…
Messaging clearly needs to be improved (if it hasn't already).

10% of people said they didn't realise they needed to stay at home, 12% didn't self-isolate because they didn't have symptoms at the time, and 10% went out to help a vulnerable person .. who they could have infected! Image
This is also maybe somewhere lateral flow tests could be useful?

If most people reached by contact tracers aren't going to stay at home anyway, testing them every day during that period might be more effective, as long as it's clear they don't guarantee you don't have the virus.
Improving support for people told to self-isolate would also help.

The recent Liverpool mass testing trial found that people in poorer areas were far less likely to get tested, because they couldn't afford to self-isolate if they tested positive.

The study on adherence to testing and self-isolation guidance was done in September, but it's not clear if changes since then have improved the figures at all.

And this is really something that should have been done months ago, as numbers have been consistently dire since March.
This week's Test & Trace report and accompanying data can be found here, although over Christmas the reports are going to be fairly skinny.

gov.uk/government/pub…
And here's my analysis of last week's report for comparison.

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More from @_johnbye

28 Dec
It's sad we still need to say this, but false positives are NOT driving rising cases.

In the summer the False Positive Rate (FPR) at lots of labs was below 0.1%.

For example, Milton Keynes' FPR for the ONS Infection Survey was less than 0.04% in July.

ons.gov.uk/peoplepopulati… Image
In fact, when prevalence was low, labs all over the world had less than 0.1% of tests give a positive result.

So their FPR (the % of people they tested who didn't have the virus but got a positive result) must also have been less than 0.1% at the time.

So there's nothing fundamentally wrong with PCR. It doesn't conjure up lots of false positives out of thin air when nobody has the virus.

Any false positives would mostly come from cross contamination or errors, either when the sample is taken or at the lab when it's processed. Image
Read 26 tweets
22 Dec
2,800 lorries are now stranded in Kent, with many drivers not even having access to basic facilities. The government appears to have done nothing to help them.
Meanwhile a Sikh charity that's more used to aiding victims of wars and natural disasters is stepping in to provide bottled water and hundreds of hot meals for stranded drivers.

The good news is France has agreed to reopen the border.

The bad news is this only applies to EU nationals and residents, and they must have had a negative PCR test within the last 72 hours.

So it may be a couple of days before things get moving.

Read 6 tweets
21 Dec
In case you wonder why everyone's so alarmed, daily case numbers in London, the South East and the East of England are rising VERY rapidly.

Much faster than the second wave in the North and Midlands in the autumn.

And the rest of the country seems to be edging up again now too. Image
Hospital admissions in those areas are now rising rapidly as well, with the East of England actually seeing the most new admissions when you adjust for population. Image
Both the East of England and South East have now passed the number of covid patients they had in hospitals at the peak of the first wave.

London is half way to its first wave peak and rising rapidly.

And the first wave was in the spring, when hospitals are generally quieter. Image
Read 4 tweets
12 Dec
The full results of the Liverpool LFT trial have been released.

False positives are much lower than expected, but false negatives much worse.

Liverpool has now paused plans to use the tests on care home visitors, following Sheffield and Manchester.

gov.uk/government/pub…
The good news is the LFTs only gave 2 false positives out of 3,199 tests checked by PCR. That gives a false positive rate of 0.07%, far less than the 0.38% reported in initial tests.

The bad news is they missed 23 of the 45 PCR positives, giving a 51% false negative rate!
We already knew the Innova LFTs were less sensitive than PCR, but they were meant to catch 95% of people with "higher viral load".

In the Liverpool trial though they missed 15% of people who were positive at below 20 cycles on PCR, and 47% of people positive at 20-25 cycles!
Read 16 tweets
10 Dec
You'd think the Brexit Party would have other things on their mind at the moment, but instead they seem to have latched onto a misleading story about false positives.

Unsurprisingly it doesn't show what they think it shows.
For starters, Cambridge are using pooled testing, which none of the regular test system is.

This means mixing several samples together to reduce the number of tests you need to run, then if a pool is positive you individually test everyone in that pool to see who had the virus.
But a recent study suggests pooling causes false positives.

They tested 17,945 pools. 2,084 of them were positive. When they tested the people in those pools individually, they didn't get any positives from 92.

92 ÷ 17,945 = 0.5% false positive rate.

medrxiv.org/content/10.110…
Read 9 tweets
9 Dec
Covid sceptics like to dismiss most people dying from the virus as so old they were about to die anyway and somehow don't count.

Ambient music pioneer Harold Budd was 84 when he died yesterday.

His latest album was released last Friday.

He also composed a soundtrack this year.
We'll sadly never know how much more music he might have written had covid-19 not come along.

But people reaching that age have in many ways already beaten the odds. Life expectancy for an 85 year old male is about another 6 years, in both the UK and US.

ons.gov.uk/peoplepopulati… Image
Behind the statistics, every death from covid-19 is tragic.

Just because someone was old or had pre-existing conditions making them more vulnerable to covid doesn't mean they couldn't have led a full, happy and productive life for many more years if the virus hadn't intervened.
Read 4 tweets

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