Transcript: Episode 45

Why should you get tested for COVID-19?

Vivienne Parry  0:04  
Hello and welcome to Coronavirus the whole story UCLA award winning podcast that brings you the latest news on Coronavirus, as told through UCL research and community outreach. My name is Vivienne Parry. I'm a writer, broadcaster, UCL alumna and your host for this splendid port. As we record the sun is beaming down, and the darkness of the last year seems just a bit less oppressive. Could the light at the end of the tunnel that we now glimpse be genuine this time? Or is it yet another oncoming train? The answers depend on the two pillars that underpin hope in the future vaccines and testing. This week I'm joined by guests who have been instrumental to testing programmes both here at UCL and across the country. We're going to be discussing the benefits of testing especially as the country is starting to reopen as well as the drawbacks, because with Coronavirus, nothing is ever straightforward, is it. My first guest today are Becky Witham and Sian Minett. Becky is Director of Strategy and Operations in the Office of the Vice Provost Health. And Sian is the Director of Estate's Portfolio and Business Services. Together they've set up a testing programme here at UCL, which includes providing tests for staff and students as well as information and guidance and monitoring the spread in the UCL community through a Reporting Service and the app Connect to Protect. I'm also joined by Professor Irene Peterson, Professor of Epidemiology and Health Informatics in the Institute of Epidemiology and Health. During the pandemic, Irene has been providing analysis on the spread of Coronavirus, particularly through asymptomatic transmission, and therefore the role of testing in stopping the virus. So Irene, let's start with you with a bit of an overview about testing because it's something that's been happening since very early in the pandemic. First of all, just exactly what is test and trace and how does it work.

Irene Petersen  2:04  
So there are different ways of testing if you have symptoms, or near the symptoms of Coronavirus, a cough and loss of smell and taste or a fever that government recommend that you go and have a PCR test. So that was the first test we have in UK and there are about 300,000 people every day who are getting a PCR test and that is to confirm whether any of these symptoms are actually Coronavirus. So if you then test positive, they will start to do contact tracing where they help you to get in contact with the people you were in contact with before you've got the diagnosis of corona. And this is a way to stop transmission of Coronavirus. So that's one way of getting tested.

Vivienne Parry  3:07  
And that's very much what we were doing initially. But now we've got a lot of other tests. Tell us a bit more about those.

Irene Petersen  3:14  
Yeah, so recently, we have introduced what we call rapid antigen test or lateral flow test. And these are tests that are meant to be used in the community. Because we know that about 1/3 of people who are infected with Coronavirus, do not have any symptoms. And we also know that many people have very mild symptoms, and therefore they are unlikely to get tested with a PCR test. So that's why we can use the lateral flow test. And that's how they are used at the moment because they are used to test people in the community on regular basis to find out if there truly are infected.

Vivienne Parry  4:04  
And those are the sorts of tasks that are now being used in schools, for instance,

Irene Petersen  4:10  
they're used in schools, but you can also use them in your workplace. Most local authorities now have a testing centre where you can walk in and say, Can I have a test please? And within 30 minutes you have an answer

Vivienne Parry  4:25  
and having changed the condition for symptoms, so for instance, I know that when I had Coronavirus because I suspect I had the Kent variant as we call it where anosmia, loss smell is not the major symptom neither is fever. Have the indications for having one of those PCR tests changed with the changing symptomatology of Coronavirus.

Unknown Speaker  4:51  
Not yet it is still the three common symptoms that indicates a PCR test and that is also why many people may have missed it because they didn't have any of these symptoms. 

Vivienne Parry  5:04  
Indeed.  That was exactly what's happened to me. I have none of those symptoms, but I definitely have Coronavirus. So we've seen a lot of changes in the whole testing programme and the much criticised test and trace now up and running under the respect to all the people who've developed all the laboratories and the facilities because they've put in some extraordinary work. What is testing now look like across the UK compared to what it was like at the beginning?

Unknown Speaker  5:34  
I think it's very good. And I think we are in a very lucky situation. So yes, there are about 1.2 million who are tested every day at the moment, which is astonishing. It is astonishing. And I suspect that that number is gonna go up when they start to get out of lockdown. So many workplaces will ask their employees to test twice a week. At UCL, for example, we have that offer in place now to anybody coming on site, that they can have a test twice a week.

Vivienne Parry  6:16  
That's a perfect segue into Becky and Sian, because they've been running the testing programme at UCL. And what does the programme entail? And how did you get it started? Let's start with Becky.

Becky Whitham  6:28  
So we actually started with our testing plans back in sort of april of 2020. Really, as soon as we could because we recognised this was going to be a big issue for the university. Our Cancer Institute team put together a pilot for testing, which we then scaled up for September to be a symptomatic testing offer. And that was using a PCR lab at that time. Since then, we then partnered with Camden and with the NHS to launch a symptomatic walk in testing site, which is based at Ramsey Hall. And that's for UCL and also for the wider community. So it's the it's the largest symptomatic walk-in site in the borough. And then in December, we set up as Irene was talking about the the lateral flow rapid testing, and that was part of the government's University testing scheme. And we established a site at a Bidborough House on campus, which now provides symptom free testing for all staff and students that come onto campus. And we set that up in around two weeks as part of the government scheme.

Vivienne Parry  7:32  
And we think of UCL perhaps those who are not on the campus as being silent as the grave and hardly anybody there. But that's not the case, is it?

Sian Minett  7:41  
No, it's not. It's very quiet compared to a normal day in UCL. But we do have students on campus, we have PhD students as well as taught students. And we have a core of a staff that are attending regularly, particularly estates, ISD, and some academics, and also a contractor community that we also offer the service to,

Vivienne Parry  8:06  
for how many tests can you do a day,

Sian Minett  8:08  
we're able to flex really depending on demand, so we could do anything up to about 1200. So in December, when we were getting students home, we were operating quite long hours. So opening at eight and going on until nine or 10 o'clock at night. We're currently because demand is is limited, operating between eight and three. But we've got a very flexible service. And we do monitor demand regularly. So we can flex accordingly. Where we're currently doing about it does vary, but around about 300 tests a day.

Vivienne Parry  8:45  
And from what I hear, it's a very much appreciated service. So fantastic to both of you for setting this up, because presumably, this is on top of the day job.

Unknown Speaker  8:57  
It is yes,

Vivienne Parry  8:59  
they answer in unison Yes, it is. Becky, yes. On top of your day job,

Becky Whitham  9:06  
which is Yeah, definitely. I think we've all we've all taken on a new sort of a new role as part of COVID. And I often hear or meetings people saying, you know, my my normal job is this and my COVID job is this. But I think what's really important to say is it was a huge team effort. So the setting up the site involve people from across UCL, including our students as well. We've got a huge number of students that support in actually operating the site. So it's definitely been a team effort.

Vivienne Parry  9:35  
Well, well done all of you. Let me move on now to the advantages of testing. Irene, just spell it out for us How is testing helping us to slow the spread of Coronavirus?

Irene Petersen  9:49  
So if we have 100 people who are infected, they can eat go on and let's say if they have no kind of mitigation, they may eat, in fact, on average five individuals. And as you can imagine, that grows really, really fast, you have exponential growth. And the only way we can stop that growth is to prevent people infect other people. But if you don't know that you are infectious, it's very difficult to stop the transmission. So I think that two tools that is very, very important. One is the vaccine, which has demonstrated that it is stopping transmission, as well as protecting. And the other one is regular testing, they can both help to get the number of people we are infecting if we are infectious, down to less than one. And that's what we need to get the epidemic under control.

Vivienne Parry  11:02  
Irene, do you think that testing systems also have some disadvantages? I mean, obviously, we're not saying that you shouldn't have a testing system? Of course, you should. But for example, people who think because they've got a negative test, that they don't need to take any other precautions, like washing their hand or wearing a mask.

Irene Petersen  11:23  
Yeah, but I think we also got to be realistic, I think, we are trying to open up our society. And there are many situations where we cannot wear a mask all the time or where we cannot wash our hands every other minute, or we are in a room where we cannot keep social distancing. And there will be more and more of these kind of situations. But if we can keep the number of people coming into that room with Coronavirus at an absolute minimum, then, yeah, in a better situation, then, without

Vivienne Parry  12:06  
More broadly, particularly amongst our local community here, we've heard that testing systems that incur penalties are less likely to be used because people aren't in a position to deal with a positive test. So for instance, if they're going to lose income, if they needed to be a carer, and all of those kinds of things, prevent people from going for testing, and we're seeing that testing is being taken up in some income groups, but actually not in other income groups where they are really most at risk. Should they have a positive test, and not just from the virus?

Irene Petersen  12:45  
Yeah, I've heard that argument many times. I actually think we should leave it up to people themselves to decide whether they want to test or not, I think the other argument, I find it a little bit patronising because it's not just about whether you can completely isolate or whether you can't, it's also about if you know that you are positive, there are still a number of things you can do to mitigate the transmission. And of course, I think we should do more to for example, give people a proper pay, if they are infectious with Coronavirus so that they can afford to stay at home. But on the other hand, we cannot wait for that to happen.

Vivienne Parry  13:40  
It's interesting as well, that the situation in schools at the moment because you particularly feel for parents, where perhaps they've got two or three children in different classes all coming home, you know, their bubble has somebody has got a positive test, and then suddenly the whole family are yet again, into self isolation. That's really difficult. And we need to think sometimes that these the practical impact of what positive tests mean for families.

Irene Petersen  14:12  
Absolutely. And oh,l I really feel for those families, I have colleagues where they have been had their children in and out in and out of school that was in particular in in the autumn. But again, I think if we can keep the number of infected individuals, low in schools, it will happen this and this. So again, I think if we have testing on regular basis, we will see these outbreaks will come down. The other thing is that at the moment there is a randomised control trial where they are trying to find or examine whether you can test near contacts of a person who tested positive for let them stay in school rather than let them also to stay off school for another 10 days. We don't know the answer of this trial yet. But if it turns out positive, it will reduce the number of days of school substantially.

Vivienne Parry  15:23  
Becky, what kind of things can we do to mitigate this problem, particularly those ones about people being a bit casual referred to as negative? What kind of information campaigns do you need to run alongside your testing campaign?

Becky Whitham  15:38  
So at UCL, we've taken a very open approach to our communications on the testing we offer. And we've taken advice from our internal Public Health Advisory Panel, they've been incredibly helpful in terms of explaining the kind of the science behind some of this and how we communicate that and we've been open that certainly lateral flow testing isn't, isn't 100% perfect. It's something that the media certainly picks up on. And we don't want to say that rapid test is the solution. It's part of the solution. And we know that it doesn't pick up every single positive case, it detects the most infectious and there are possibilities that it will miss others. And so we've been very committed very open about that in our communication strategy, and really reinforced the message that is everybody shared responsibility to test in order to be as safe as possible, and to keep campus open. And that's been our core message.

Vivienne Parry  16:31  
Now, we've been talking a lot about the future in these podcasts, particularly recently. And we've concentrated on something in particular, which is about building pandemic resilience, Irani motors, your work monitoring the spread over the past year taught you about how we might slow the spread going forward, and in future pandemics? What is this torture?

Irene Petersen  16:55  
I think I've heard a lot I've been thinking about. Imagine if we had a test capacity, that the one we have now, at the start of the pandemic, we would have been in a completely different situation, because we would have been able to stop this small outbreaks before they became epidemic. So I think the future is that we will need to continue to monitor not only for Coronavirus, but for other potential infectious diseases. And then different ways we can do this. For example, by sewage monitoring, you can pick up cases very early on. So I would suspect that is going to happen in many places in the future, but also to build up potential test capacity, not only for Corona, or for other conditions.

Vivienne Parry  17:55  
What about the capacity because we've built up this extraordinary capacity, you know, 1.2 million tests a day, if you'd said that at the beginning, nobody would have believed you. But there will come a time when we have to mothball some of these facilities. How do we keep the capacity available, but actually under wraps or hibernating?

Irene Petersen  18:17  
Well, I think in the beginning, we had PCR laboratories, we didn't have enough capacity of those, I think with the lateral flow test, there may be a different question of capacity, because they're actually relatively cheap to develop. And they're also much cheaper than PCR testing. So my guess is that you will have a some laboratory capacity on standby, but also that it will be a different type of testing we'll see in the future.

Vivienne Parry  18:55  
So a big part of the testing for the future is going to involve the genomic sequencing and which of course, UCL has played a really important role of the variants that come up. And then, as you say, really pursuing that hotly every single case in a way that actually at the beginning of the pandemic wasn't possible. Is that how you see the future?

Irene Petersen  19:22  
Yes, and I think there may be other monitoring ways that we are not aware of yet. But I think what we have learned here is that we can't sleep walk into another pandemic. I don't think any of us would want that to happen again. We need to be on standby and need to be ready to deal with it at a much earlier stage.

Vivienne Parry  19:48  
Shannon Beckett, what have you learned from implementing the UCLA testing system? I mean, is there something that you would do differently if you had to do it all over again? Gain haven't helped tomorrow.

Sian Minett  20:02  
I think for me, and this may sound a bit trite, but the biggest learning was really what's amazing things can be achieved so quickly when you bring together the right team of people at UCL, it was a fantastic project to work on. As Becky said, we had two weeks to find a site, set up clinical testing facility to recruit over 100 staff, and to then train them and then to be open. I've never worked on a project like this before. But everybody pulled together and supported each other working towards a common goals. So it was a really rewarding project to work on a quite apart from what we were actually doing. Once we were up and running, I think it's fair to say that the centre has run seamlessly, pretty much from day one, space is great staff fantastic, and the operation is smooth. So possibly the only thing that I would have wanted to do differently personally was maybe to have a longer lead time to to deliver the project under a little bit less pressure.

Vivienne Parry  21:06  
I fear that right that we're going to be able to ever do things to counter that one, I'm afraid.

Sian Minett  21:12  
No, but it's very hard, really, for me to think about how we could have delivered that a given the circumstances how we would have done things differently. It was it's just been an amazing project and very rewarding to work on.

Vivienne Parry  21:25  
It really does focus the mind, doesn't it to have such a major threat? And it's interesting, because at the beginning, of course, we really didn't have any idea of the scale of asymptomatic transmission. You know, the big thing I think, for me in this whole thing has been how we completely underestimated that asymptomatic transmission in the spread of the virus Irani Was that something that took you by surprise as well?

Irene Petersen  21:53  
Absolutely, absolutely. I did a study very early on on data from the Ernesto COVID survey where we compared the number of people who had symptoms on the day that they were tested, and found that more than a three quarters of those who were tested positive, did not have any symptoms on the day. That was where it all started. For me. However, I'm aware that that was PCR testing. So some of those who tested positive would no longer be infectious. Because the PCR test, keep growing positive for a number of weeks after you have been infectious.

Vivienne Parry  22:45  
Okay, what about you? Is there anything you would have done differently? Or is there something that you can think about that you would want to do to make ourselves resilient for the future?

Becky Whitham  22:59  
I think that's something that's been incredibly useful and and is now much more established is a network across the government discussion involving Department of Education, Department health and social care with all the universities and we have a weekly discussion now where we all share experiences, different approaches, different feedback, and that that network, I think, is proving really, really useful and stands us in really good stead in terms of how we prepare for the coming months, and especially for the next academic year.

Vivienne Parry  23:30  
So collaboration is key. The teams in UCL are fantastic. The threat that hung over us back in March last year enabled this extraordinary rollout of testing at UCL. And how long Becky, do you think that we will go on providing testing for?

Becky Whitham  23:49  
It's difficult to know because a lot depends on government policy around around testing. And we do suspect that there will be greater move towards home testing in the future at the moment we our university sector is offering on site testing. And we expect given moves for schools and employers to provide home testing that we may see more availability in the future. UCL is absolutely committed to there being a testing offer for our community. We see it as really important.

Vivienne Parry  24:17  
Well, thank you, Becky, and thank you to you all, not only for being on our podcast today, but actually for everything you've done to keep everybody safe at UCL.

Irene Petersen  24:29  
I was very proud in your team because UCL was one of the front runner in testing at the university level, so well done and getting that open running. You've been listening to Coronavirus the whole story

Vivienne Parry  24:46  
This episode was presented by myself Vivienne Parry produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the wonderful Cerys Bradley I was joined today by Becky Whitham, Sian Minett and Professor Irene Petersen. If you'd like to hear more of these podcasts from UCL Minds, subscribe wherever you download your podcasts or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. Hope to be with you again soon. Bye for now.