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The latest analysis of the first ever voluntary ‘mass testing’ programme for people without covid symptoms, Liverpool’s Covid-SMART pilot, has been published in The BMJ today (23 November 2022).
The study, led by researchers from the University of Liverpool, found that the city’s Covid-SMART pilot was associated with an overall 25% reduction in covid-19 related hospital admissions, including a 43% reduction in the pilot’s first month.
Researchers say that, if causal, the effects of the pilot prevented 6,829 infections and led to 239 fewer hospital admissions across the city of Liverpool, before being rolled out to the rest of the UK.
This study, which analyses the impact of voluntary rapid testing in Liverpool on covid-19 related hospital admissions, complements a wider evaluation undertaken by the researchers in 2021.
Corresponding author Professor Iain Buchan said: “The world’s first voluntary asymptomatic mass testing for covid-19 in Liverpool likely reduced covid-19 hospital admissions by more than many of us had anticipated, and we report a conservative estimate in this paper.
“A possible explanation for this large impact is that testing protected more people than those taking the test, for example, one family member’s testing may affect the whole family’s covid risk awareness and behaviours.
“Community testing for covid-19 was a complex public health intervention for communities, not just a medical test for individuals.
“Liverpool’s covid testing pilot slowed spread of the virus and enabled the City to reopen when all surrounding cities were closed, benefiting the economy and social wellbeing as well as reducing disease – it generated hope in dark times.
“This policy-relevant evidence could have been produced in early 2021 if the research team had access to all-England data on covid testing and hospitalisation sooner – there is considerable room for improvement in data access and analysis in future pandemic responses.”
The pilot offered supervised voluntary lateral flow testing to all people over the age of five years without symptoms who were living or working in Liverpool from 6 November 2020 to 2 January 2021. The aim was to identify infectious people sooner and disrupt transmission.
Covid-SMART coincided with the start of the second national UK lockdown (5 November to 2 December 2020). At the time, the unvaccinated population of Liverpool had the highest covid-19 case rate in the country.
The researchers wanted to find out whether such large-scale testing was effective at reducing covid-19 related hospital admissions.
To do this, they compared weekly covid-19 related hospital admissions among the pilot (intervention) population with a control population selected from the rest of England with similar previous covid-19 hospital admissions and sociodemographic factors to the intervention population.
When analysis was restricted to the first month of the pilot (6 November to 3 December 2020), the results show that it was associated with a 43% reduction in covid-19 related hospital admissions in Liverpool compared with the control population.
In absolute numbers this is the equivalent of 146 fewer admissions in the period up to 3 December 2020.
However, the researchers stress that this was a time of intensive testing with military assistance when Liverpool was under higher (tier 3) lockdown restrictions than many other areas of the country.
When analysis was extended across the full intervention period (6 November 2020 to 2 January 2021), and regional differences in lockdown restrictions were taken into account, a 25% reduction in covid-19 related hospital admissions was seen (equivalent to 239 fewer admissions) compared with the control population.
The findings nevertheless suggest that even when uptake is unequal and barriers to effective isolation exist, widespread community testing can potentially reduce transmission and subsequent hospital admissions at least in the short term.
Click here to access the full study.
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