Will Operation Moonshot pass its first test fighting Covid in Liverpool?


Operation Moonshot, the government’s ambitious plan to deploy exciting new technologies to test the entire population for coronavirus infection, launches in Liverpool on Friday. Yet, even as the army arrives and testing sites are set up, questions are being asked about the accuracy of the tests and the information people will be given about their results.

Liverpool is the pilot project for ministers’ big vision of weekly testing of the entire population – covering up to 10 million people across England a day. Many people support mass testing, which could allow a return to workplaces, socialising and going to the theatre and football matches without the fear of spreading infection.

But in the drive to bring about a return to normal life as quickly as possible, the government appears to be endorsing technologies that have limited or questionable accuracy data.

Great hope is being invested in saliva tests, but there is no good published data yet, and it is clear they will often miss low levels of the virus in people who have no symptoms. The main one to be offered to the general public in Liverpool is the Innova test, which Porton Down has approved as effective – but only using nose swabs. No data has so far been published on its effectiveness with saliva.

The test is a lateral flow device, which looks and works like a pregnancy test, and is made in China by Biotime Biotechnology for the US company Innova Medical. It is supplied in the UK and Europe by a micro-company called Tried and Tested, which has no office and operates out of a house in Wallingford, Oxfordshire.

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The government has signed a contract worth £138m with Innova without a tender, as is permitted in the emergency. “The lateral flow tests were identified as strictly necessary to meet the demand to scale up the mass testing programme in the UK,” says the contract.

British companies say they are perplexed. “I’m surprised and disappointed as a UK manufacturer and having worked in the industry for some time. There are lots of people with tests available in the UK at the moment,” said Christian Stephenson, the chief development officer at the Manchester-based Medusa 19.

It has been unable to get its rapid test evaluated by the government because it works using antibodies – although it is an infection test. But it is now in a trial in Spain, which is likely to lead to orders there.

Dr Emily Adams, a senior lecturer in diagnostics for infectious disease at the Liverpool School of Tropical Medicine, said her team was trying to help with the choice of tests for the city. They evaluated rapid lateral flow tests for the international NGO Foundation for Innovative New Diagnostics (Find), which led to tests developed by SD Biosensor and Abbott being approved by the World Health Organization.

“Our data is not being used nationally, which is a shame,” she said. “In principle, I really agree with mass testing, especially in high-prevalence areas and high-risk groups.” But, she added, “the right tests need to be implemented and we need to make sure that locally that will be the case”.

Evaluation data was needed for the tests that had been chosen for Liverpool, she said. She was disappointed that England was not embracing the WHO-approved tests, as many other countries are.

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If somebody tests positive with a lateral flow test, they will be offered a second, PCR test, to confirm it. PCR swab tests are the gold standard for diagnosis but have to be run on lab equipment, so are slower.

Picking up any infections that would otherwise have gone unnoticed because people have no symptoms has to be good. But there are concerns that a false negative test may lead people to assume they have no infection when they do.

Crucially, for mass testing to work there has to be trust in the tests and the results from local people, who face self-isolation if they get a positive result. The government has already signalled that quarantine may be reduced from 14 days to seven to persuade more people to comply.

From Friday, with the help of 2,000 army personnel, Liverpool will build up capacity to test nearly 500,000 residents every seven to 10 days. How many people will volunteer for a test is the first big question. Joe Anderson, the Liverpool mayor, said he realistically expected 10,000 to 15,000 people a day – about 100,000 people a week – to come forward for a test, but he hoped it would be more.



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