Thread by @ScienceShared, The important thing to note with operation moonshot is that, realistically, it’s [...]

The important thing to note with operation moonshot is that, realistically, it’s not going to be ready in time to even potentially prevent another second wave.

Is it just another PR stunt, or is it something more sinister?

A thread

https://www.bmj.com/content/370/bmj.m3520

Covid-19: Government plans to spend £100bn on expanding testing to 10 million a day

The UK government has drawn up plans to carry out up to 10 million covid-19 tests a day by early next year as part of a huge £100bn (€110bn; $130bn) expansion of its national testing programme,...

https://www.bmj.com/content/370/bmj.m3520

The tests used for #moonshot would most likely be rapid at-home kits, which do have huge potential. These are more transmission indicators and not diagnostic kits.

@michaelmina_lab has spoken a lot on how and why these would be effective:

https://twitter.com/michaelmina_lab/status/1297218718490140675?s=20
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https://twitter.com/michaelmina_lab/status/1297218718490140675?s=20

The main points are that they give rapid results, & lower sensitivity means that they are more likely to catch just infectious people &, if orthogonal assays are included, overall specificity is high which decreases the chance of false positives.
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But, government ministers themselves have admitted the technology hasn’t even been fully developed yet. It would then have to go through evaluation & validation. These things take a long time.

Winter will come first.

We need improvement today, not for Xmas. Or Spring.
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The gov hasn’t been able to switch to pooled qPCR testing which, compared to mass testing, is a relatively simple modification to an existing workflow which can increase testing capacity by 5-fold almost overnight & has overwhelming supporting evidence.
https://www.medrxiv.org/content/10.1101/2020.04.06.20052159v2
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Efficient and Practical Sample Pooling for High-Throughput PCR Diagnosis of COVID-19

Diagnostic assays using quantitative Polymerase Chain Reaction (qPCR) most commonly process patient samples one by one. While this is usually an effective and reliable method, the current efforts...

https://www.medrxiv.org/content/10.1101/2020.04.06.20052159v2

How do we expect them to roll-out testing of the whole population, something which only really China has attempted so far?

The best predictor of future performance is past performance. And the past performance has been catastrophic.
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Even if the technology was ready this is a huge job, as SAGE outlined in their excellent document on mass testing last week.

If you want to understand mass testing properly, I would really recommend reading this document in full.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/914931/s0712-tfms-consensus-statement-sage.pdf
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There are many advantages to mass testing & it is very appealing in that, if done well, it would enable us to find nearly all cases within a few weeks & re-open society.

But it is a huge job, and there are many limitations and possible pitfalls..
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When testing millions a week, there will be masses of false neg/false pos/non-infectious pos, as SAGE outline.

What is the plan to deal w/ these?

The opportunity cost (& £ cost) of this programme also needs to be evaluated.
Would just a robust TTI be more effective overall?
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And again, this whole programme would all still depend on people isolating when they test positive, for which they need support. The UK is bottom of the list in Europe for paying workers enough who need to stay off sick because they test positive...

Support is key.
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They could pass laws tomorrow which support people to isolate when necessary, massively increasing the effectiveness of the existing system, but they don’t.

Instead, they announce a £100bn project, which will all be pointless if people aren’t supported to isolate.
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Public health communication has been a disaster since day 1 of the pandemic. For mass testing to be effective, it would require a huge amount of coordination, & engagement & compliance from the public. Is this government capable of organising this...?
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This same government can’t even get the basics of test and trace right. It is 9 months since WHO declared a public health emergency and, after pumping hundreds of millions into a privatised system, the UK doesn’t have the capacity to test symptomatic patients.
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Many care homes still don't receive regular tests either, or turnaround time is so long the results are pointless. SERCO tracing is a joke too. The outsourced & centralised test & trace system is a monumental failure, as any public health expert worth their salt said it would be.

And yet, the person in charge of this shambles of a system @didoharding, got given a promotion...

This is as clear as day an example of cronyism if I have ever seen it.

An absolute joke and national scandal.
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What we is a need properly funded regional FTTIS led by local public health experts & engagement with local communities, not corporate jargon & arbitrary targets.

Millions have been paid to consultancy firms whilst the FREE advice of leading scientific experts has been ignored.

As @GabrielScally says, above all, there is a need for a strategy. It is astounding that the government still has no strategic plan and no publicly stated goal for controlling the virus.
What is the purpose of this mass testing?
Elimination? Control?

https://www.newstatesman.com/politics/uk/2020/09/government-s-shambolic-approach-covid-19-endangering-public
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The government’s shambolic approach to Covid-19 is endangering the public

It is astounding that the UK has no strategic plan for controlling and eliminating the virus.

https://www.newstatesman.com/politics/uk/2020/09/government-s-shambolic-approach-covid-19-endangering-public

I would love to be able to support a comprehensive mass testing strategy. It is arguably the best way out.

And is it even going to come in time?

But we simply cannot trust this incompetent, corrupt, lying government to carry it out properly.
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The budget for operation #moonshot is apparently £100bn, nearly the whole NHS budget. Where is this money coming from, & who is it going to? Why are we talking about a massively complex mass testing programme the government still doesn’t have even a function test & trace system.

Operation moonshot needs to be grilled by the Health Select committee before, not after, multi-billion-pound contracts are signed off.

At best, operation moonshot is a pie in the sky operation, announced purely to distract from the news of the failings of the current system.
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At worst, it is just another way of lining the pockets of their mates, except this time it's not hundreds of millions, its hundreds of billions.

This government has shown time and time again it is a lying, corrupt, crony, criminal enterprise.

We need to hold them to account.

Before we even talk about mass testing again, we should ensure we have a functioning, and then an effective and robust, Find, Test, Trace, Isolate Support system.

With enough, public, political, and media pressure, this is very achievable.

https://twitter.com/ScienceShared/status/1303742756142092288?s=20

End.