Several European international locations are drastically lowering the variety of COVID exams carried out. Sweden has already restricted free exams to healthcare employees, social care staff and clinically susceptible individuals, and provided that they’re symptomatic. The UK authorities has introduced that free exams for symptomatic and asymptomatic individuals in England will finish on April 1, aside from exams for social care staff and people most in danger.
The motivation to place an finish to mass testing is partly monetary. Current ranges of testing come at a staggering value of round £2 billion a month to the UK authorities. Though, one other motivation is to ship a message to the general public. By scrapping mass testing, governments intend to sign that the pandemic is coming to an finish and that normality is returning.
Billions of COVID exams have been carried out globally. Half a billion outcomes have been reported up to now within the UK alone, with many extra lateral movement exams remaining unreported. Such intensive diagnostic testing of asymptomatic individuals is unprecedented and has dramatically modified society’s angle in the direction of respiratory viruses. National dashboards displaying day by day case numbers have develop into a defining characteristic of the pandemic, and many individuals have adopted COVID testing as a routine precautionary measure.
But the epidemiological influence of mass testing is considerably blended. Extensive testing is most helpful to cut back transmission when coupled with the power to hint contacts of these testing constructive, which quickly turns into not possible when the variety of contaminated individuals is excessive, because it has been continuously within the UK for the reason that summer time of 2021. There isn’t any clear-cut relationship between the variety of exams carried out by international locations and the COVID circumstances, hospitalisations and deaths they expertise.
The quantity of coronavirus genome sequences produced in the course of the pandemic is equally unprecedented. The variety of coronavirus genomes deposited in Gisaid, the shared, international database of viral genetic sequences, has now reached 8.5 million, with over 2 million from the UK. This is greater than for some other virus, together with the flu, which has been routinely sequenced for many years.
The real-world worth of the large sequencing effort can also be questionable. Genome sequencing has had basically no impact on informing pandemic mitigation insurance policies. It additionally contributed solely marginally to the early detection of variants of concern. Alpha, delta and omicron emerged months earlier than they had been recognized by sequencing. Sequencing has, although, allowed us to observe the evolution of the virus in exceptional element in close to real-time.
But is now the time to cut back?
While the present quantity of testing and sequencing is unsustainable in the long run, there are main questions over when these schemes needs to be scrapped and what components of viral surveillance needs to be saved in place or launched as replacements.
As said, one main goal of the discontinuation of routine testing is to permit the inhabitants to regain a way of normality and cut back nervousness. This would most likely be psychologically efficient for individuals who have cheap belief in authorities and are usually not overly apprehensive about being contaminated by the virus.
But amongst those that are most apprehensive, the untimely scrapping of mass testing might improve worry. Unrestricted entry to exams supplies a way of security, accountability and empowerment. Rapid testing can also be important for profitable therapy. We now have potent COVID medicine, however these work finest when taken early in an an infection. We want to ensure we’re not shedding a approach of defending individuals from extreme illness or sowing panic.
Rolling again testing additionally dangers fuelling conspiracies that the pandemic is being swept beneath the carpet by governments for financial causes. Therefore, it could be finest for mass testing to be scrapped when circumstances are low and when pandemic nervousness has largely receded. But it’s tough to foretell whether or not these situations will likely be met by early April in England.
Surveillance sooner or later
Realistically, lowering testing and sequencing is a matter of when, not if. But that doesn’t imply COVID surveillance ought to cease. Elements must be saved in place to permit for monitoring of case numbers, ideally with the aptitude to quickly scale up if wanted.
The UK Office for National Statistics’ Infection Survey supplies dependable and unbiased COVID prevalence surveillance. The examine has confirmed extremely priceless and is taken into account gold commonplace in epidemiological surveillance. It would appear prudent to maintain it in place at the very least till subsequent winter, presumably in a barely decreased kind.
Surveillance might additionally reap the benefits of wastewater monitoring of the coronavirus. Sewage surveillance is a dependable, sensible and non-invasive methodology for monitoring viral prevalence locally. Sequencing of wastewater even permits for efficient characterisation of viral variants.
It will likely be essential to keep up cautious monitoring of the evolution of the virus to tell future vaccine updates. Early flagging of rising variants would profit from improved worldwide surveillance. A scheme the place a restricted variety of strains had been sequenced every week from each nation on this planet might be ample for the early detection of rising variants.
A very international surveillance framework would in impact be preferable to the present state of affairs, the place the overwhelming majority of viral sequences come from a handful of wealthy international locations. Despite the large sequencing effort, there may be little genomic information obtainable from massive components of Asia, Africa and South America. This results in blind spots within the surveillance of rising viral variants. Alternatively, international surveillance might depend on the systematic sequencing of viral strains carried by incoming worldwide travellers, for instance.
Pandemics of respiratory illnesses finish, not as a result of the virus goes away, however as a result of the related illness and deaths fall under a threshold deemed acceptable, with the inhabitants shedding curiosity. The scrapping of mass testing will characterize a serious step on this delicate transition. This will be the final stage of the pandemic. It could be preferrred if we managed to navigate it higher than some earlier steps and completed the pandemic on a excessive notice.
Francois Balloux receives funding from the Wellcome Trust, the Biotechnology and Biological Sciences Research Council and the Medical Research Council.