Source · Select Committees · Public Accounts Committee
Recommendation 16
16
A number of significant commentators, including the British Medical Association and British Medical Journal, have...
Conclusion
A number of significant commentators, including the British Medical Association and British Medical Journal, have raised concerns about the effectiveness and risks of mass testing with LFD tests.55 A particular issue raised is the relative accuracy of LFD tests compared to PCR tests and the higher risk of false negatives.56 Published evidence indicates that LFD tests had a sensitivity of only 77% (broadly, if 100 people with the infection take the test, only 77 of them will return a positive result). NHST&T considers LFD tests a “very useful addition to our overall testing toolkit”.57 But the interim evaluation of the Liverpool mass testing pilot found that, when self-administered, LFD tests overall only detected 40% of positive cases detected by PCR tests. In the evaluation, LFD tests did detect a higher proportion of positive PCR tests—around two thirds—when individuals had a higher “viral load” and were more “substantially infectious”.58 While the authors of the Liverpool evaluation pointed out the benefits of LFD tests in identifying many infectious asymptomatic cases who would otherwise go undetected, they also stressed the need to communicate clearly that when people test negative, it does not provide assurance that they are not infectious.59
Government Response
Acknowledged
HM Government
Acknowledged
4.1 The government agrees with the Committee’s recommendation. Target implementation date: June 2021 4.2 Regular rapid tests are a vital tool in helping to identify cases of coronavirus that would otherwise not be found. Around one in three cases show no symptoms, and testing with rapid lateral flow devices (LFDs) helps find these cases and prevent the spread of infection. Regular rapid testing was initially focused on asymptomatic NHS and care home staff to support the resilience of health and care services and protect vulnerable people. It was then extended on a targeted basis to settings such as schools, universities and workplaces, and from April 2021 targeted eligibility has been replaced with a universal testing offer available to all. This includes a new pharmacy collect option alongside expanded home delivery. 4.3 Alongside the department’s universal testing offer, it is in the process of reviewing its plan on asymptomatic testing and intend to publish this information, with updates on progress in each setting, and with agreed targets focused on impact and outcomes. 4.4 All plans take account of the performance of available tests. Extensive and ongoing clinical evaluation, and MHRA approval, support the use of lateral flow devices and PCR (polymerase chain reaction) tests for asymptomatic people. With some limited exceptions, we have not identified circumstances where LFD testing is not suitable, but its use complements existing regular PCR testing which has higher sensitivity but longer processing times. There are some circumstances where individuals may have physical difficulty in taking LFD and PCR tests and we are rapidly exploring alternative solutions for these groups. LFD testing forms part of a wider strategy to identify asymptomatic carriers, which includes contact tracing (including ‘backward’ contact tracing) and wastewater analysis.