Fears over ‘test and trace’ with more than 70,000 'missing' tests over two weeks

Yesterday, Nicola Sturgeon said the new "test and protect" strategy will go live on Thursday and would see testing on a scale that has never been done before in Scotland.

It has emerged RCN Scotland, which represents key workers such as nurses, health care support workers and nursing students across Scotland laid out its concerns in advance of the future track and trace strategy.

It said the nation had to "go further" on testing and roll out more routine tests for health and care workers, care home residents and hospital patients to "help detect cases early, reduce and prevent transmission in hospital and community health settings and better protect staff and the patients they care for".

Analysis of official figures yesterday showed that in the last 14 day period, 72,720 tests were carried out across Scotland in all settings, including hospitals, care homes or the community, including checks done at regional and drive-through centres operated by the UK Government.

But the Scottish Government had ramped the ability to deal with tests - referred to as capacity - to carry out at least double that number as calls continue to be made for better and more checks of health care workers as well as improved ability to screen the community.

Over the two weeks at least 143,626 tests were capable of being dealt with in NHS labs and the Lighthouse Laboratory in Glasgow.

Yesterday Nicola Sturgeon said the country was now able to carry out 15,000 tests for Covid-19 every day through a combination of NHS labs, universities, the Scottish Blood Transfusion Service and the UK government's Lighthouse lab in Glasgow.

But the Scottish Tories said Ms Sturgeon’s pledge on testing would be “meaningless” unless the Government made full use of capacity, after previously failing to do so.

Tory leader Jackson Carlaw said: “Nicola Sturgeon could have as large a testing capacity as she likes – but it won’t matter a bit if people aren’t actually being tested."

Further analysis reveals that an average of 5,194 tests a day were being carried out in Scotland over the past two weeks.

Over two weeks ago officials confirmed that that capacity had been boosted to carry out 10,259 tests a day which was to increase to 12,000 by the middle of this month.

READ MORE: Coronavirus - Scotland actually tests only one-third of capacity, new figures show

On April 3, the First Minister set out an aim to "proportionately" match with 10% of a pledge by UK health secretary Matt Hancock to carry out 100,000-tests-a-day by the end of last month.

The most tests carried out in any one day in recent weeks was 6519, eleven days ago. 

On Monday 4425 coronavirus tests were carried out across Scotland.  

On the same day Westminster said 109,979 tests were done across the UK - although unlike the Scottish figures includes a number of home testing kits distributed across the whole of the UK, including Scotland. The Scottish Government does not currently include figures on home testing kits issued to people in Scotland, and has said it is continuing to verify the data provided by the UK Government.

RCN Scotland said that in the light of emerging evidence over those who are either pre-symptomatic or asymptomatic, they want wider routine testing of all health and care workers in order to "improve capability to identify and contain potential Covid outbreaks".

While the Scottish Government emphasises that all health and care workers can access testing through the NHS, RCN Scotland say this is aimed at confirming whether someone has the virus if they or family members are showing symptoms and therefore whether they can return to work or must continue to self-isolate.

"As a minimum, testing should be universally available to all staff, irrespective of whether they present with symptoms or have been caring for patients with Covid-19," the body said.

"Without this, frontline health and care staff cannot be safe nor can they be deployed safely or effectively."

The RCN note put forward last week, seen by the Herald, which has been submitted to ministers points stresses the need for improved testing and points out that in England social care workers and residents in care homes, with or without symptoms, are being tested both to investigate outbreaks and as part of a rolling programme to test all care homes. And all asymptomatic NHS workers are also eligible for testing in England.

"We note the research published by Imperial College London on April 23 which estimates that weekly screening of healthcare workers and other at-risk groups irrespective of symptoms, would reduce their contribution to transmission by 25-33 per cent, on top of reductions achieved by self-isolation following symptoms.

"Expanding testing in this way would also reduce anxiety amongst staff that they could be unknowingly spreading the virus if they are either asymptomatic or pre-symptomatic.

"We continue to receive calls from RCN members who are concerned that they could be asymptomatic or pre-symptomatic, as they have been working with a patient or colleague who later tested positive for the virus. We know from these calls that there continues to be confusion about access to testing and whether or not you can be tested if you are not symptomatic."

A recent RCN survey showed that 43% of nursing staff who had not been offered a test, did not know how to access testing.

For respondents who had not been offered a test who work in care homes, over half (52%) didn’t know how to access testing.

RCN said action was needed to ensure health and care staff are clear about how to access testing, particularly those out-with the NHS.

It said that while the First Minister emphasised that care home managers can put symptomatic staff forward for NHS testing and there should be no barriers to that, they had heard from members who had difficulty accessing testing as they had been told to get tested via the drive through facilities.

Tests need to be both "available and accessible", including to those who do not have access to a car, it said.

One RCN member had said that drive through was all that had been offered for care homes "and a I don't drive" while a taxi service that was set up was for NHS staff only.

"As we are a nursing home, we asked if we could do our own staff swabs... but were told no. It feels like unless you are well enough to afford a car or in the NHS, you don't matter," said the member.

The RCN added: "While the government highlights that care home workers should be able to access testing locally through the NHS, rather than rely on the drive through testing facilities, it is clear that this message isn’t getting through to all in the sector.

The latest analysis comes two weeks after Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, warned the Scottish Government that testing capacity, turnaround times and the ability to test locally has to be up to speed for test, trace and isolate to work.

He said he could "see no reason" why any laboratory conducting the Covid-19 RT-PCR tests "could not significantly increase" testing capacity.

And public health professor Linda Bauld warned there was a “big problem” with the test, trace, isolate strategy – with the turnaround for test results currently averaging 30 hours. Other countries were doing it in four hours.

RCN Scotland raised its concerns about test, trace and isolate, saying:"Testing capacity needs to continue to increase, particularly as we move towards the Test, Trace, Isolate, Support (TTIS) approach.

"While improving availability under the current approach to testing is vital, this will become even more important as we move into the TTIS phase. The Scottish Government need to provide a clear plan showing how everyone will be able to access a test as part of the TTIS strategy, including people who are unable to access a hub or an NHS test or test themselves at home – the three current test access routes.

"The role that nurses – especially those working in community settings – will play in implementing this strategy needs to be discussed and agreed, and adequate training, protection and recognition put in place.

"The government must also set out a robust workforce plan for the workforce required to implement testing and tracing elements of the Test, Trace, Isolate strategy."

A Scottish Government spokesman said: “We are following clinical guidance on who should be tested including all over 70s in Scotland and recently expanded to all those in care homes with or without outbreaks and children over five years with symptoms.

“Testing alone will not keep infection rates down but alongside key measures including the vital guidance to stay at home to save lives it can help to suppress the virus.

"As the First Minister announced last week, testing is now available to anyone over the age of five. Health and social care workers will continue to be primarily routed through NHS testing at local NHS facilities. These workers continue to be prioritised to ensure critical staff can return to work as soon as it is safe to do so.

“The UK government has established a network of Covid testing facilities. This programme runs alongside the existing programme of testing in the NHS for clinical purposes and testing of key workers in health and social care.

“The UK Government testing programme in Scotland is additional capacity to supplement NHS testing.”