Researchers say a ‘human bottleneck’, due to historical cuts in public health funding, delayed the UK’s scale-up of COVID-19 testing in the early stages of the country’s pandemic response.
The researchers, who were on the front line of the UK’s early response to COVID-19 in 2020, say a system of reservist lab scientists should be set up now to provide surge capacity that will help the country respond faster – and more effectively – to future outbreaks of infectious disease.
They considered a number of options for providing scientific surge capacity and concluded that the best scenario would be a mix of highly skilled paid reservists, and volunteers who could be called on when required and trained rapidly.
Dr Anna Smielewska from the University of Liverpool is the senior author of the new report, published in The BMJ, which says the lack of early COVID-19 PCR testing capacity had a knock-on effect on other health services in 2020. This included delaying the ability to make sure hospitals were COVID-secure and patients had surgery as safely as possible, and slowing down the identification of people with COVID-19 in the community – which delayed contact tracing.
In early 2020, PCR testing for SARS-CoV-2, the virus that causes COVID-19, was a highly skilled job that required lab staff to undergo lengthy training. As the testing process was developed it became increasingly automated.
The researchers say that the risk of another pandemic like COVID-19 happening is ever-present: there have been outbreaks of infectious disease throughout history. But nobody can say for sure when it will happen.
They suggest that effective preparation for the next pandemic includes recruiting a relatively small number of highly skilled scientists, who would be paid on retainer, to help in the initial phases of an emergency.
It would also involve a large reserve of volunteer staff to provide essential testing capacity; these people would not need to have specialist skills but could be trained quickly in an emergency and paid only when needed. Those working in sectors of the economy likely to close during a pandemic – such as entertainment and hospitality – would be ideal candidates as voluntary reserves, the researchers say.
In their paper the scientists compare COVID-19 with other large-scale emergencies including war, where the military has a system of reservists for built-in surge capacity. But they say that unlike the military where reservists serve to deter warfare, having an ‘always-on’ capacity to deal with public health emergencies wouldn’t do anything to deter a new pandemic from emerging – and that’s why there has always been a pressure to close labs and streamline public health services.
Their suggested solution does not require sustained, cross-party political will to fund so is more likely to succeed; the researchers acknowledge there are many other pressures on the UK economy that must take priority.
They recommend that other countries should consider their requirements for surge capacity based on their own circumstances.
UK laboratories have now conducted over 200 million PCR tests for SARS-CoV-2, the virus that causes COVID-19.
Research reference:
Skittrall J P, Bentley N, Wreghitt T, Silverston P, Yang H, Aliyu S H et al. Preparing for the next pandemic: reserve laboratory staff are crucial BMJ 2022; 378 :e072467 doi:10.1136/bmj-2022-072467