No test, no entry: How Liverpool’s mass-testing pilot may offer glimpse of a future living with coronavirus

It is a pilot scheme that Boris Johnson hopes could provide a roadmap through the nightmare of coronavirus back to “more normal" times.

Plans to repeatedly and rapidly mass test every single person for Covid-19 in Liverpool beginning on Friday have been cautiously hailed as a potential game-changer in controlling — and living with — the virus.

Advocates say such a scheme will allow authorities to identify infected people early and have them self-isolate; while those who are negative can carry on with their everyday lives.

Crucially, if successful, it will likely be rolled out to other areas of England from early 2021.

Which means that what happens in Liverpool over the next four or five weeks may offer a glimpse of all our futures. It will, one way or another, profoundly impact the way we live our lives — at least until a vaccine is developed.

Which, in turn, leads to a whole host of questions. What exactly would testing look like on such scale? Could it allow us to get back to the office, to the theatre and to sporting events safely? Most importantly, will it eventually mean we need proof of a negative test before going for a pint and a curry?

Also: could the country’s infrastructure even cope with such a vast logistical challenge?

These are, it’s worth saying from the start, not easy questions to answer — partially because the exact details of how the Liverpool trial will work remain, just a day before it begins, unclear.

What we do know is that 2.000 troops are being dispatched to the city to coordinate the operation, which will see rapid lateral flow tests offered in hospitals, care homes, schools, universities, health centres and specially set-up sites. Those who test negative will be allowed to go about their life as usual (albeit within the context of a national lockdown), while those who are positive will be encouraged to self-isolate. Financial support will be available.

The idea is that, by identifying cases early — often before symptoms show — infection rates can be driven down, while giving authorities clear and precise data on potential outbreak clusters.

“In principle, I don’t think there’s any doubt that it’s a good idea,” says Jon Deeks, professor of biostatistics at Birmingham University’s Institute of Applied Health Research. “If virus levels are to be brought and kept down, then widespread testing in one form or another will certainly have to play a part.”

The first problem is that no one knows just how accurate the new rapid lateral flow tests actually are. So untried are they that they still come with a manufacturer’s warning: "negative results do not preclude infection”.

The fear is that significant numbers of people could falsely receive the all clear — meaning that a system designed to control the virus is consistently not detecting it and allowing contagion.

“These tests are known not to have a very good sensitivity,” says Deeks. “They miss people …  And one of the big problems is they miss people who have lower levels of virus. So people who have just become infected and are becoming more contagious — it may miss those and tell them they’re fine — and they go off with a false sense of security while actually spreading the infection.”

While the government says it has run laboratory trials and is satisfied with accuracy rates, it has not published any data. In any case, lab trials are different from those conducted in real world situations, says Deeks.

“I’m trying to persuade the Department of Health to build in an evaluation of the accuracy into the pilot,” he tells The Independent today.

Another potential issue, which may be in need of similar evaluation, is people’s willingness to actually partake in the scheme.

Initial unscientific feedback suggests many residents in Liverpool would be happy to get tested on a regular basis if it means more businesses could open again and offered a chance of returning to some kind of normality.

Yet whether such willingness in theory translates to action in practice is something that is to be seen.

“Going to get a test when you feel well and healthy is an imposition for people,” says Deeks. “We are asking the public to take time out of their day to do something that may lead to them then being told to self-isolate, even when they have no symptoms. It is not an easy argument to make, so the full force of everything we have needs to be there to support that ask.”

By full force, he means huge publicity campaigns to encourage people to come forward, test centres created in convenient locations, and, most crucially perhaps, financial and social support for anyone who is ordered to quarantine.

“The logistics of doing something like this go beyond just making half a million tests available,” he says. “That’s the starting point really. There needs to be a whole infrastructure in place to support it.”

Indeed, it is the sheer extent of this required infrastructure that has caused doubts about the viability of mass testing beyond intense limited bursts in regions experiencing sudden clusters or spikes (similar in fact to how it has been used in Chinese cities where outbreaks have been identified).

All the same, when the prime minister first talked about the proposals in September — he called it Operation Moonshot back then — he said he believed mass testing could eventually be used across the country to get us safely back in offices, and to football matches and restaurants.

Could it, though? Or was that the same Boris bluster that previously promised a “world beating” test-and-trace system by summer?

In fact, possibly it could, reckons Dr Nathalie MacDermott, lectuer in infectious diseases at King’s College London.

“If the UK entered a situation where everybody was tested once a week — and that is a huge if; there would need to be a debate on the benefits of that — but if there was no vaccine on the horizon and a decision was made to go this way, I think you could start to see developments towards test results recorded on an app or some kind of device that could then be used to enter a venue,” she says. “You would show that you were negative in the day, maybe two days, before entering, and that would really minimise, though not eliminate, the chance of infection in that venue.”

Crucially, in those venues, social distancing and mask-wearing would probably remain in place, at least initially, as a kind of belt-and-braces approach to public health.

Along similar lines, private companies, schools and universities might start demanding workers have a negative test before coming onto site, much like professional footballers already have to do.

“This is something we’re already starting to see in some industries,” says MacDermott. “And I think it’s likely it will become more widely used if the ease and accuracy of tests improves. Certainly, if there is an accurate home-test developed, I could envisage employers asking workers to do that to minimise risk in the work place.”

If that is all the logical conclusion of what is starting in Liverpool, then — and certainly that’s what the Mr Johnson appeared to suggest in that September riff — the ultimate question may be: how soon do we get from here to there?

Again, predictably, the answer remains unclear.

Different scientists have different views on how and when a successful sass testing pilot should be rolled out. Some suggest resources should initially be focused nationwide but on vulnerable groups — hospital patients and visitors; care homes; work places that cannot socially distance. Others believe a per-city basis would be better, with resources directed into areas experiencing a sudden spike which a more regular testing regime has not been able to help quell. Others still say that this remains a preemptive debate; that a full analysis of desirability still needs to be carried out as happens before any major screening process.

“These do start to become political decisions,” says Deeks again.

Either way, for now, one thing is certain: all eyes are very much on Liverpool.