Lateral flow testing strategy for York
Background
Lateral flow tests (LFTs) are a rapid way of assessing an individual’s covid status. They can be used on asymptomatic individuals, and provide results without the need for laboratory processing. They are not as accurate as PCR tests. The preliminary report from the Joint PHE Porton Down and University of Oxford SARS-CoV-2 test development and validation group shows a specificity of 99.68% and an overall sensitivity of 76.8%. However at higher viral loads (Ct <25.5) the test detects over 90% of infections. This means that the chances of a false positive (giving a positive test result when the individual is in fact negative) are low, but there is a higher chance of a false negative (giving a negative result when in fact the person is positive). This is why even after a negative test result it is important for everyone to follow public health risk reduction measures.
There are a number of programmes currently operating that enable people to access lateral flow tests.
Workplace
There are a number of workplace-based schemes. Initially LFTs were rolled out for health and social care staff. More recently programmes for teachers and businesses with over 50 staff could set up workplace programmes. The businesses programme has recently been extended to cover organisations of any size.
Community Testing Sites
Local Authorities were able to apply to operate community testing facilities. York applied and opened its first community testing facility on 14th December 2020 at York St John University. We have since opened further sites at the University of York and at the Leisure Complex at the Stadium. Our current offer of testing is for anyone that has to leave home for work, and anyone that is providing care to a vulnerable person.
Students
University students have had access to lateral flow tests since they were tested prior to traveling home for the Christmas break. Students that are still on campus can access the community testing sites, which are run in partnership between the local authority and the universities. Pupils at secondary schools and colleges were offered supervised testing prior to return to school from 1st March. This was done in partnership with the schools and colleges across York, with some pupils being tested in the school/college environment, and some coming to our community venues to be tested. From 15th March, secondary school and college pupils will be given tests to undertake regular testing at home. Testing is not recommended for primary school pupils.
Community Collect for school bubbles
With the return of all pupils to school and college, from 8th March the Government introduced Community Collect for school bubbles. This means that anyone with a child at school can access lateral flow tests for the rest of the family (adults) via community collect. In York, this means collection of test kits in the afternoon from the Poppleton Bar drive through site, or the Wentworth Way walk-in site. There is also an option for people to have kits posted to them if they are unable to travel to the collection point.
Future for lateral flow testing in York
It is clear that the Government’s ambition is for there to be easy access by a large proportion of the population to lateral flow tests, as one tool in helping us to come out of lockdown. As such, a number of further testing programmes are likely to come on stream soon.
Pharmacy collect
This is where lateral flow test kits can be picked up from a local pharmacy. There are no further details on the eligibility for this programme yet, and local pharmacies are currently not aware of this.
Community collect
Whilst this is currently only for families of school pupils, this is likely to be expanded to wider groups. Local authorities can apply to establish their own community collect venues. These can be the same as existing community testing venues or new venues.
Students
We are still waiting for clarity on national expectations about testing for university students in the future.
Options for lateral flow testing model in York
Any testing model in York should be accessible to all, but particularly to those communities where covid rates are higher or where the consequences of contracting covid are greater. For example in more deprived communities or in BAME communities. Any testing that is carried out should be of high quality to reduce the likelihood of false results. Testing should be seen as one tool in the easing of lockdown.
Option 1
Continue with our current approach to testing. This means we continue to offer testing through our three community sites, and let the other initiatives through workplaces and community collect roll out.
Analysis
With the other access routes to testing coming online, we are likely to see a reduction in demand for testing at our community sites. Therefore, to continue providing these as we currently do may not be the best use of resources. There is some concern that greater access to home testing may lead to a decline in testing quality. This approach does not provide a tailored response to the needs of our population.
Option 2
Move to a model of community collect ensuring that all communities are covered.
Analysis
This option would not provide an offer for those people that do not want to do their own home testing. It would also mean that we do not have a facility available if we needed to do testing of specific groups, for example students. Shifting people to the home testing model could compromise quality of testing.
Option 3
A dual approach whereby our test centres can offer tests for those that want it, as well as provide community collect for people choosing this route. The test centres can also offer a demonstration of testing, or the ability to answer questions from people wishing to do home testing but requiring more guidance.
Analysis
This is our preferred option. It allows access to both options of testing, and looks to provide support and guidance for people wishing to do home testing in order to ensure quality of testing is maintained. This model can be flexed so that if we are required to undertake testing of a particular population group we still have the facility and trained staff to be able to do this.
If this option is supported by the Board, we will look to provide other venues where this model can be taken forward, most notably in the South West of the City. We will also seek to work with Community Pharmacy North Yorkshire in terms of the roll out of the pharmacy collect model.
Fiona Phillips
Assistant Director of Public Health
15th March 2021