U.S. should look to Liverpool as model for frequent rapid testing
By Michael J. Mina, MD, PhD
Now Joe Biden has been sworn in as the 46th President of the United States, there is much scrutiny on how he deals with the Covid crisis which has now claimed its 400,000 US victim.
In this letter from America, Harvard School of Public Health Professor Michael J Mina explains why he has been watching the Covid smart testing programme in Liverpool with growing interest, and believes the new US administration should use the model to help it tackle coronavirus.
Nearly one year into the global pandemic, despite the acceleration of several promising vaccines, Covid-19 is still spreading, including at uncontrolled levels in the United States. For much of the past year, I have been advocating for frequent, accessible rapid antigen testing, a public health solution that if implemented properly, could stop the spread of the virus, allow us to reopen economies, and ultimately save thousands of lives.
Last autumn, Liverpool launched an ambitious pilot programme that utilized frequent rapid antigen testing, and the programme’s success is now being recognised as a model for the UK and the world. The city used rapid antigen testing to test people frequently and give them immediate results, which identified asymptomatic (no symptoms), infectious individuals before they could infect others.
We have learned with Covid-19 that individuals transmit high viral loads typically three to five days after an infection and usually before symptoms arise. Rapid antigen tests register the virus regardless of symptoms, making this a powerful tool to identify cases before the virus spreads.
Frequent testing of a large fraction of a community — like what is currently happening in Liverpool and soon across the entire UK — can induce vaccine-like herd effects. Testing just half of a community once or twice per week, with rapid return of results, can detect enough infected people early enough in their transmission window to stop them from spreading, on average, to more than one individual. Like a vaccine given to half of a community to induce herd immunity by blocking onward transmission, frequent rapid testing also blocks onward transmission, and can bring the reproduction of the virus (“R”) to below one in weeks.
I commend the City of Liverpool and the UK government for listening to the scientific community, understanding this critical principle of epidemiology, and taking bold action to make frequent rapid testing one of their key weapons against COVID-19.
As Liverpudlians know, frequent rapid testing doesn’t only curb the spread of COVID-19; it also helps to regain a sense of normalcy in our lives. For example, the results of Liverpool’s first pilot programme were so successful that the city was able to re-open critical parts of the economy again right before the Christmas holiday. This included the safe reopening of the hospitality and leisure job sectors, which employs 50,000 people and is worth £5 billion to the Liverpool economy. Liverpool educated residents about the importance of frequent testing, using a “test before you go” campaign to encourage people to get tested before they did their Christmas shopping or went to a football match.
As someone who has been advocating for this type of frequent rapid testing, I’ve been fascinated watching the Liverpool programme in action. In the first week of January, more than 36,500 Liverpool residents got tested, which was a regional record. People are building the process of getting tested into their daily lives. They understand the value. They want to do their part to keep their loved ones safe. The city has also done a good job with expanding testing sites throughout the community so that residents don’t have to go out of their way to get tested. We need testing to be as accessible as possible for a frequent rapid testing programme to work.
Liverpool’s anecdotal evidence is yet another reason why frequent rapid testing should be embraced by the United States and other countries around the world. As an informal advisor to my country’s policymakers, I am encouraging them to look at Liverpool’s success story and learn from the city’s best practices and lessons. This pandemic has ravaged local economies and created so much hardship. By making frequent testing with rapid results available to all citizens, especially in homes, schools, workplaces, retail shops and restaurants, entertainment venues and long-term care facilities, the economy can reopen safely and we can quickly stop the spread of Covid-19. 11 months into the pandemic, we should be trying everything we can to stop it — and Liverpool’s example is a good one to follow.
Michael Mina, MD, PhD, is an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health and a core member of the School’s Center for Communicable Disease Dynamics (CCDD). He is additionally an assistant professor in immunology and infectious diseases at the Harvard Chan School and associate medical director in clinical microbiology (molecular diagnostics) in the Department of Pathology at Brigham and Women’s Hospital, Harvard Medical School. Follow Dr. Mina on Twitter at @michaelmina_lab.
