Stuart MacLennan – CEO, Circular1 Health

Mass testing continues to dominate the headlines and Government thinking in terms of getting people back to work and the economy moving. It is similarly being discussed as a tool to kick-start our leisure and hospitality sectors.

What has become particularly apparent as part of the debate, however, is that ‘mass testing’ as a phrase means different things to different people. To some, it signals an important investment that is key to protecting essential workers in mission-critical businesses, such as nuclear and defence. To others, it’s a perception of ‘compliance’, a cost that has to be met to tick a box to satisfy a vague diktat and a need to be seen to be doing something.

There is no doubt that ‘cost’ has been a factor in these debates, and that is understandable; an arguably more important element has been accuracy.

As a result, we seem, as a nation, to have been drawn to a conclusion that if you want a more expensive testing option with a higher degree of accuracy you have to take one route, whereas if you are prepared to sacrifice accuracy (within limits that are still acceptable/safe) in order to pay less then you have to take another.

The choices, however, are not binary: this is not a VHS versus Betamax moment, for those of us old enough to remember. There are many different paths available to us. We simply need to be more flexible in our thinking and more flexible in the solutions we propose.

‘Gold Standard’ testing that delivers the highest degree of accuracy involves a combination of LAMP/PCR tests conducted in series – which we have badged as ‘LampWorX’. They provide a very high degree of specificity (99.995%), which means the risk of a false positive is extremely rare (at 1 in 20,000 tests conducted) whilst the false-negative rate is vanishingly low due to the extremely high ‘gain’ in the initial LAMP reaction. Such testing is used actively in mission-critical industries – to keep staff and visitors safe.

A more widely known testing regime is Lateral Flow, the method being used by schools and colleges, for example, and being promoted in relation to events and stadia. Lateral Flow tests achieve fast results but have a lower level of accuracy, although it could be rationally argued that sensitivity, specificity, speed and ease of use are a trade-off, and so not necessarily a ‘disadvantage’ in the strictest sense.

Crucially, however, it doesn’t have to be an ‘either/or’ decision. One size does not need to be made to fit all needs.

LAMP/PCR tests, for example, and daily testing can be used when infection rates are high but adapted to become more of a managed, screening-led service as the risk declines; as implemented in our LampWorX process. Similarly, a Lateral Flow-based solution can be made more accurate through a laboratory-based testing approach, again with a second confirmatory test of the same swab to provide an additional level of Quality Control, thus virtually eliminating the problems caused by false positives. This is what we are calling ProteinWorX, based on the protein antigen ‘base-test’ of the process. Regardless of which process we initiate – LampWorX or ProteinWorX – the same swab, if returning a positive result, can then be followed by a sequencing test to identify the variant, ensuring we can immediately identify and respond to new strains.

The point is a simple one: we don’t need to fixate on one route or another. There are many combinations of options available to us, and different industries and audiences will have different needs. Those needs will also change, and we need to be able to respond accordingly. Vulnerability is rarely a permanent state.

What we do need to focus on is taking a flexible and open-minded approach to tackling what remains an ongoing challenge. With the fear of a third-wave and the constant need to identify and address new variants, the way that we manage, measure, and monitor our response in the future will play a huge part in how quickly and safely we can return to ‘business as usual. Flexibility will be key.