In this ongoing Covid era of unexpected things, one of the more unexpected things is that everyone, it seems, is now an expert on epidemiology and the science of viruses.
A year ago, few of us had ever heard of a lateral flow test or vectors of transmission. Nostalgically, testing belonged to a different world – something we complained about on behalf of our Year 6 pupils, alongside the overweaning battery of GCSE exams faced by our secondary students.
Testing times then were so different from testing times now. We even talked about old-fangled things like teaching and learning – whereas now, for too many in leadership roles, educational concerns have been pushed to the margins, as we deal in wide-eyed disbelief with testing in a more clinical sense.
Most of us are not experts in this stuff at all. We have just picked up scientific knowledge at a surface level, without really understanding the nitty-gritty evidence that underpins what we think we know.
Coronavirus: How reliable are lateral flow tests?
Yes, we hear the pundits, the commentariat, the virtual pub bores, all dishing up opinions with the feisty confidence of actual scientific experts. But unnervingly, as we’ve seen again this week, even those actual scientific experts don’t appear to agree with each other.
The latest example is the troublesome question of the efficacy of lateral flow tests.
This is a crucial issue for the leaders and governors of our schools and colleges, because they are being asked by the government to carry out mass testing when schools fully reopen. Indeed, many of them are already using these tests in a more limited way.
As one trust leader said to me the other week, “I came into this job to run schools, not field hospitals.” He spoke poignantly of seeing the school hall – once upon a time serving up assemblies at breakfast time, hot dinners at midday – now partitioned with booths and full of signage, sanitiser, bits of testing kit and once-familiar school staff now garbed in full PPE.
And now we hear experts casting serous doubt over the government’s use of these tests, with some of their voices calling for them to be paused – in schools, too – and it sets the alarm bells ringing once again.
And this morning – on the day I’m writing this – the stakes are being raised further, as reports tell us that the Medicines and Healthcare products Regulatory Agency (MHRA) has informed the government that it had not authorised the daily use of 30-minute mass tests, as a result of concerns that they give people false reassurance if they test negative.
The danger of false negatives
In truth, we were already concerned before that warning was sounded, because our surface-level understanding of the science tells us what the MHRA appears to have confirmed: that lateral flow tests produce a number of false negatives – that is, people who test negative but are, in fact, positive.
This becomes a particular problem when the tests are applied in one of the ways that the government wants them to be applied in schools – what is referred to as serial testing.
To date, the process that has been in place when there is a coronavirus case is to ask all close contacts to self-isolate for a period of time. It is a blunt instrument, and it is highly disruptive, but it at least has the benefit of ensuring that all potential cases are out of school, and therefore breaks the chain of transmission.
But the government now wants schools to put in place daily lateral flow tests for all these close contacts, with the idea that those who test positive are sent home, and those who test negative are admitted into the school community.
The trouble here is that, if some of these are false negatives, you now have in your school more individuals who are infected with the virus than under the previous system. This seems completely counterproductive, because it appears to run the risk of more transmission of the virus and, ultimately, more disruption.
So our question to the government is, therefore, a very simple one: what is the scientific basis for recommending that schools use lateral flow tests in this way, and why would this be safer and more effective than asking close contacts to self-isolate?
The government has questions to answer – now
Presumably, the government’s scientific advisers think differently from the experts who have cast doubt on this programme. We need to hear from them, and we need them to set out their evidence. And, frankly, if this strand of government policy isn’t entirely to unravel by the end of the day, we need to hear from them urgently.
We have asked the government this question as a matter of overwhelming urgency, as have other individuals and organisations. All of us await an authoritative answer. Meanwhile, public confidence recedes further.
Of course, we recognise that the government has many demands in many directions, but wouldn’t it make the whole process a lot simpler if it supplied the scientific basis for important policy decisions in the first place? This would allow it, transparently and without the tendency to resort to windy and undeliverable promises, to explain what the science is saying that informs their decisions.
Instead, once again, here we are with serious doubts about a serious issue, while schools and colleges are moving heaven and earth to sort out the logistics to put these testing programmes in place, now increasingly uncertain of whether this is the right thing to be doing.
Obviously, everybody will be hoping that serial mass testing is an interim measure, in any case – that the rollout of the vaccination programme will bring the end of the pandemic and will return us to a more normal state of affairs.
But exactly when that will happen is uncertain, and it looks likely that there will continue to be risk of transmission and consequent disruption for some time to come.
One day, as we keep telling ourselves, these times shall pass. But in the meantime, the people on the frontline – those staff in our schools grappling with so many issues amid so much wider anxiety – most certainly deserve better.
Today, as on so many days over the past year, we find ourselves craving some certainty, some honesty, some clarity – some leadership.
Geoff Barton is general secretary of the Association of School and College Leaders