LONDON — When Prime Minister Boris Johnson spoke to the British people from isolation on Wednesday, still suffering his own bout of the coronavirus, he said the key to overcoming the pandemic was more testing. “This is how we will unlock the coronavirus puzzle,” he said in a shaky, hand-held video.
In fact, the British government came very late to the recognition that testing for the virus is a key part of fighting it, by helping to slow transmission. That failure has set off an outcry in the country. The government’s tardiness has left Britain with an undersupplied and poorly coordinated testing program that has reached only a fraction of the people tested in countries like Germany or South Korea.
The shortfall has frustrated doctors and nurses, who often have not had access themselves to tests despite potential exposure to the virus and who cannot quickly determine if patients have it. It has angered public-health experts, who say Britain is squandering valuable time during the lockdown that it could be using to get a better fix on the spread of the virus in the population.
Front-line doctors and nurses in the United States, where testing is now being ramped up, complained for weeks of similar deficiencies.
In Britain, the testing gap has generated a flood of outraged headlines, even in newspapers normally cozy with Johnson’s Conservative government. “Virus testing plans in chaos,” said The Times of London. “Questions without answers,” declared The Daily Telegraph. “500,000 NHS Staff,” said The Daily Mail. “Only 2,000 Tested.”
Under intense pressure, the health secretary, Matt Hancock, rolled out an ambitious plan Thursday to rapidly expand testing, especially among health workers. Hancock, who himself had just emerged from isolation after contracting the virus, vowed that Britain would conduct 100,000 tests a day by the end of April, a tenfold increase over today.
“Our ultimate goal is that anyone who needs a test shall have one,” he said at a briefing at No. 10 Downing St.
Britain has conducted 163,194 coronavirus tests since the outbreak began, the vast majority on patients who are admitted to the hospital with symptoms of the disease. Germany has conducted more than 900,000 tests and is carrying out more than 50,000 a day — a disparity that many in Britain find inexplicable, given their country’s advanced research and medical industries.
Hancock fell back on a familiar defense — that Britain lacks a robust diagnostic industry like that in Germany. He said the government was grappling with a worldwide shortage in the swabs and chemical agents used in tests. But he said the government was now collaborating with an array of private companies to supply tests — a strategy that some have likened to the flotilla of boats that helped evacuate Allied troops from Dunkirk during World War II.
Britain’s sluggish start in testing, several experts said, is rooted in the government’s overly relaxed early response to the virus. In meetings from late January to early March, the government’s scientific advisory group underestimated both the lethality of the virus and how fast it was spreading, according to published minutes from several of those meetings.
Those miscalculations led the government to briefly consider a laissez-faire strategy in which the virus would be allowed to spread through the population with minimal checks, infecting a large percentage of people and building up their natural immunity. Such a “herd immunity,” experts said, would make the country more resilient to a second outbreak of the virus in the fall or winter.
In such a scenario, intensive testing and contract tracing — of the kind used in South Korea, Singapore and Germany — was deemed not worthwhile. And lacking the resources to rapidly mount a broad-scale testing program, the government decided to limit testing to people admitted to hospitals.
“Their thinking was, ‘Mass testing at that scale is not possible, it’s not feasible and what’s the point because the virus is already everywhere,’” said Devi Sridhar, director of the global health governance program at Edinburgh University. The government, she said, treated coronavirus like the ordinary flu.
Bureaucracy played a part, too. Unlike South Korea, where the government gathered private companies in January to encourage the speedy production of tests, Britain left testing in the hands of its main health agency, Public Health England. It kept tight control over the standards for tests and discouraged private clinics, labs or companies from developing their own tests.
“We could have gone to this industry and said to them, ‘We’re going to need testing kits, we’re going to need swabs, we’re going to need a shopping list of items,’” said Bharat Pankania, an expert in infectious disease at the University of Exeter Medical School. “If you never put that call out, you won’t get it.”
In mid-March, the government abruptly shifted course to a more aggressive strategy of trying to suppress the virus. That was prompted by a stark new report from Imperial College London which used data from Italy to project much higher rates for both hospitalizations and deaths. Letting the virus spread completely unchecked, it warned, would crush the health system and could lead to 510,000 deaths.
(Dire projections from that same study, U.S. officials said, helped persuade President Donald Trump to make an about-turn, from playing down the risks to Americans to embracing more stringent public health measures.)
But the government had lost precious time. “They made the unscientific decision not to test,” Pankania said. “Having made that critical decision, they didn’t put into process the things you need to do to test en masse.”
Now the government is racing to catch up. It has expanded testing among health workers and is setting up drive-through testing sites in the parking lots of large stores. A laboratory to process tests is opening soon in the town of Milton Keynes, with others to follow soon in Cheshire and in Glasgow, Scotland.
Hancock said Thursday that 5,000 employees of the National Health Service had been tested — an improvement over Wednesday, but still just 1% of the total workforce. He said that 5.7% of the doctors are out, either because they are sick or fear they are infected with the virus.
There are other signs of hope. Much as some American companies are developing new kinds of testing kits, a small technology company in Cambridge has adapted a machine used to test for HIV to test for the coronavirus. The machine delivers results in 90 minutes rather than 24 hours, which is the wait for most tests. It has been successfully tested at a hospital in Cambridge and could be mass-produced to test doctors, nurses and other health workers.
But there is also plenty of finger-pointing within the British health system. Paul Cosford, emeritus medical director at Public Health England, told the BBC on Thursday that it was the job of another organization, the Office for Life Sciences, to bring in other organizations, charities and the private sector.
As the political heat has intensified, so has the confusion. On Wednesday, as Johnson was issuing his video from isolation, the deputy chief medical officer, Jonathan Van Tam, told ITV that testing was a “side issue” when it comes to reducing fatalities. His argument was echoed by a government health minister, Nadine Dorries, who has herself recovered after being infected by the virus.
“Testing is not a cure, it won’t cut the number of deaths, it won’t make people feel better or stop them catching #coronavirus it will only tell you if you have or have had it,” she wrote on Twitter. She called it “media hype,” adding, “There is as yet, no treatment, no cure, no vaccine and no amount of tests will alter that fact.”
Medical experts lamented the mixed messages from health officials.
To lift the lockdown, they said, Britain would have to conduct further testing and pursue contact tracing of those who may have been exposed to the virus and if necessary isolate them. They pointed out that people would likely have to undergo repeated tests to make sure they are free of infection. Otherwise, the country will face another wave of contagion.
“We need to have a longer-term strategy,” Sridhar said. “We’re late, but there’s no other way out.”