Operation Moonshot – the government’s bid to accelerate testing from around 200,000 a day to 10m a day by early 2021 – was met with derision by Labour MPs in the House of Commons on Thursday when the health and care secretary Matt Hancock set out the scale of the ambition. They were “naysayers”, Hancock responded. “They would do far better to support their constituents and get with the programme.”
Here are five key parts of that programme as revealed in the leaked official documents obtained by the British Medical Journal and the Guardian.
Boris Johnson is so convinced mass testing is the only way to avoid a second national lockdown he is said to have asked for an UK-wide organisational set up like the Manhattan Project, the top secret war time endeavour led by the US to develop a nuclear bomb. Only such a structure can deliver “the level of innovation/pace required” says one official document. “This is described by the prime minister as our only hope for avoiding a second national lockdown before a vaccine, something the country cannot afford,” one government official wrote about the project in late August.
The files propose an intense daily “cadence” of meetings and situation reports running for at least 13 hours a day with twice weekly updates for the secretary of state Matt Hancock and weekly briefings for Boris Johnson every Wednesday.
Downing Street has already roped in the Treasury to estimate of the benefit to the economy of what is described as an £100bn plus endeavour, and Sage, the scientific advisory group for emergencies, has started at least, modelling the potential impact of the proposal on R, according to one of the documents dated 21 August.
What does the ‘R’ number of coronavirus mean?
R, or the ‘effective reproduction number’, is a way of rating a disease’s ability to spread. It’s the average number of people on to whom one infected person will pass the virus. For an R of anything above 1, an epidemic will grow exponentially. Anything below 1 and an outbreak will fizzle out – eventually.
At the start of the coronavirus pandemic, the estimated R for coronavirus was between 2 and 3 – higher than the value for seasonal flu, but lower than for measles. That means each person would pass it on to between two and three people on average, before either recovering or dying, and each of those people would pass it on to a further two to three others, causing the total number of cases to snowball over time.
The reproduction number is not fixed, though. It depends on the biology of the virus; people’s behaviour, such as social distancing; and a population’s immunity. A country may see regional variations in its R number, depending on local factors like population density and transport patterns.
Hannah Devlin Science correspondent
However a Sage consensus document published on 28 August was highly sceptical about mass testing. It insisted on “careful consideration … to ensure that any mass testing programme provides additional benefit over investing equivalent resources into improving the speed and coverage of NHS test and trace for symptomatic cases and the rate of self-isolation and quarantine for those that test positive. It said the idea of using testing to enable passport style access to sports or cultural events, as envisaged “require superb organisation and logistics with rapid, highly sensitive tests” and would have minimal impact on R. It also warns about an increase in false positives and negatives and that mass testing “can only lead to decreased transmission if individuals with a positive test rapidly undertake effective isolation”.
Getting football crowds back
As well as catching asymptomatic carriers, the new system would allow people to test negative and so attend mass-gathering events, in theory at least. The draft “UK government mass testing narrative” suggests that testing can also be used to give people assurance that, at least for a limited time, they are unlikely to have the virus and are at low risk of transmitting it to others.
“This could be tied to a specific event or activity – taking a test directly before attending a football stadium or theatre or visiting elderly relatives,” it suggests. “Or it could potentially be used to confer ‘safe status’ on an individual – testing to confirm they are negative now and so at low risk of transmitting for several days, or to confirm a level of immunity that will prevent them from becoming infected again for a defined, longer period of time via confirming a previous positive [virus] or antibody test, or, in time, vaccination.”
A 50-fold increase in testing in six months
The current testing rate of around 200,000 per day is being limited by laboratory capacity which means people with symptoms of coronavirus are being offered tests hundreds of miles from home or not at all. The third slide in the Department of Health and Social Care’s “Moonshot Mobilisation” briefing pack sets put plans to increase that to between two and four million tests by December driven by testing by “communities, institutions and employers” and then further still to 10m by “full rollout in early 2021”. It says “private sector/ business led testing plays a key enabling role”.
Deloitte, the accountancy and consultancy firm which already has a major contract with the NHS test and trace operation, is identified as a key partner alongside at least sixteen other companies, universities and parts of the UK government infrastructure. The strategy involves “buying their large scale capabilities to build a large-scale testing organisation” and they include the pharmaceutical giants, GSK, Astra Zeneca and Smith & Nephew as well as retailers Sainsbury’s and Boots.
More commercial partners are involved in the form of testing companies such as Oxford Nanopore and OptiGene.