Large-scale program needed before lockdown can end

The United Kingdom can learn important lessons from Germany as it strives to test 100,000 people a day for COVID-19, a target it needs to reach before there is any hope of the country's lockdown ending.

Chris Whitty, chief medical officer for England, who often appears along with other senior officials at daily government briefings on the novel coronavirus, said the high testing rate in Germany, and the relatively low death rate in that country, offer the UK a blueprint for success.

"We all know that Germany got ahead in terms of its ability to do testing for the virus. There's a lot to learn from that, and we've been trying to learn the lessons from that," he said at one of the briefings.

Germany, which has a population of 83 million, has kept its death toll from the virus well below that of the UK, which has a population of 65 million.

As of Sunday, Germany had reported 2,871 deaths from the virus, while in the UK, the figure was 9,875.

Experts believe the ability to test large numbers of people quickly ensures that authorities can properly isolate those who are infected, reducing the number of new cases and the spread of the virus.

For weeks, Germany has been testing more than 70,000 of its citizens every day. However, the UK has only recently managed to raise its daily rate to about 14,000, despite eyeing a target of testing 100,000 people a day by the end of this month.

A leaked document from Germany's Interior Ministry shows that there are plans to end the country's lockdown, once the infection rate is lowered further, from the 4 percent day-on-day rise seen last week, to about 1 percent.

Germany can dream of lifting its lockdown, as it is able to test many more people than the UK, which is in the grips of a worsening pandemic.

The reason so many people can be tested in Germany is that the country is self-sufficient in producing testing kits, whereas the UK has had to rely on imports.

UK Foreign Secretary Dominic Raab, who is leading the nation's fight against the virus as Prime Minister Boris Johnson is treated for it in a London hospital, believes the target of conducting 100,000 tests a day can be reached if British companies start developing and making testing kits.

"We are doing everything we can on every front to get all of the testing capabilities we need. The health secretary's 100,000-per-day target still stands," Raab said.

Antibody test appeal

UK Health Secretary Matt Hancock, who, like Johnson, was infected by the virus, but has made a full recovery, has asked industry leaders to help the country find an antibody test that works, and to start production.

He issued the appeal on Wednesday, after making a similar plea a few days earlier, in which he urged companies to make ventilators.

Cambridge University is among the academic institutions and enterprises that have accepted Hancock's challenge.

The university is collaborating with pharmaceutical companies AstraZeneca and GlaxoSmithKline in establishing a facility at its Anne McLaren Lab, where it will process 30,000 novel coronavirus tests a day by next month. The lab's scientists will also attempt to find alternative chemical reagents to those being used now.

They hope to identify new reagents－chemicals that extract the genetic code of the virus from testing swabs, as there is a shortage of the reagents being used in the UK.

A joint statement issued by the university and the two companies said, "Alongside this new testing facility, GSK and Astra-Zeneca are working together to provide support to the UK national testing centers… to help the national testing system to continue to expand capacity."

Thermo Fisher, a scientific equipment maker in the United States, has also taken up the challenge. On Thursday, its CEO, Mark Stevenson, said on the BBC radio program Today that the company can supply more than 100,000 tests per day and will soon increase its manufacturing capacity in the UK.

Hancock hopes many more biotech companies will start developing and mass-producing finger-prick tests for the virus in sufficient quantities to enable them to be rolled out for the public.

In addition, the UK government has announced plans to set up three huge new laboratories to analyze testing kit samples.

Large-scale testing has worked in countries such as South Korea where, along with isolation programs and contact tracing, they have quickly reduced the number of cases.

Success in countries with large-scale testing programs inspired the World Health Organization to state that nations should "test, test, test".

While testing is clearly important and a key part of any nation's battle against the virus, critics said the UK was slow to increase its testing capacity.

As the country is still not able to conduct reliable and quick finger-prick tests on a significant scale, it has to rely on slower laboratory tests to detect cases of infection. Due to capacity constraints, these tests are limited to 14,000 a day. Attempts to buy finger-prick tests from overseas have ended in frustration, with products either being unavailable or considered inaccurate.

Because of the relative shortage of tests, those being examined for the virus tend to be hospital patients, National Health Service workers, care home residents, or prisoners.

Edward Argar, a junior health minister, has insisted the UK "hasn't got the testing issue wrong" but agrees that ways need to be found to test many more people.

He told Sky News: "I would absolutely expect (Chris Whitty) to say we need to look at what other countries have done that has had a really positive impact. But…he did also say there were a whole range of factors for why Germany's death rate does, at the moment, appear to be lower."

Patrick Vallance, the UK's chief scientific adviser, said at a recent briefing on the virus: "The German curve looks as though it's lower at the moment … and there are obviously two things that we look at in terms of any response to any outbreak. One is the virus itself, and the other is the society into which that virus comes, and there are things to do with demographics, there are things to do with the way systems are organized, and, of course, there may be differences in the way certain responses have been taken."

Argar said on the Today program: "The government's been very clear that we'll get to 100,000 tests a day by the end of the month. We are seeing rapid increases. I think the latest figures I saw were around 14,000 tests a day－that's significantly up on where it was even a few days ago, so I think we are firmly on target for that."

Measures needed

The Independent, an online newspaper, reported that widespread testing for the virus is likely to be a prerequisite before the lockdown in the UK can end.

Leading scientists told the publication ending the lockdown would need to be accompanied by a raft of measures aimed at quickly finding and isolating new infections resulting from expected second and third waves of the outbreak.

Gabriel Leung, a professor of population health at the University of Hong Kong and an adviser to the special administrative region's government, told The Independent most European nations would have to "adjust to a new normal" that includes ongoing mass testing.

"Testing has to be seen as a package, rather than just in isolation," he said.

Adjunct Associate Professor of Public Health at the National University of Singapore, Vernon Lee, who is also director of communicable diseases for the city state's Ministry of Health, believes that after lockdowns end, there will need to be not only large-scale testing but rigorous quarantine "at least until a vaccine is available".

In the meantime, UK politicians are increasingly being asked when the lockdown, which was introduced on March 23, will end.

Under UK law, the health secretary must review the lockdown restrictions at least once every 21 days, which means a decision must be made before Thursday.

UK Culture Secretary Oliver Dowden said on the television news program BBC Breakfast that the lockdown is not likely to be lifted until the nation is conducting more tests, and certainly not before it is clear that person-to-person infections have fallen. Because the disease has an incubation rate of as long as two weeks, the impact of the lockdown is only now starting to show, he said.

"I don't think it's very likely these measures are going to be changed, given they're just starting to have an effect but, as we said, we will review them," he said.

UK Chancellor Rishi Sunak said it will only be possible to make the decision after the lockdown has been in place for about three weeks, because the evidence base will not be apparent earlier than this.

"I think, rather than speculate about the future, we should focus very seriously on the here and now and the present," he said.

The question remains whether the UK can develop sufficient testing capacity to enable the lockdown to end in an orderly manner.

John Newton, chief knowledge officer at Public Health England, who is the government's main adviser on testing, said at a House of Commons inquiry on Wednesday that the goal of testing 100,000 people a day is feasible.

But Keir Starmer, new leader of the opposition Labour Party, said on ITV News that the UK is well behind where it needs to be in terms of testing, and lamented that the government had not acted sooner.

"I think there are things to learn from Germany as a result of that," he said, echoing the comments of Whitty, the chief medical officer. "We do need to ask probing questions of the government about that."

Starmer said the government should level with the public and tell people not only how and when it will increase testing capacity, but also when the lockdown might end.

"Because, as I see it, a vaccine is obviously the long-term solution, but it looks like that won't be ready for 12 to 18 months," he said. "Therefore, all the focus is on testing."