A document published by the government on Friday reveals that Liverpool City Council temporarily advised care homes not to use rapid lateral flow tests (LFTs) to allow visitors due to fears over false negatives.
A notice written by researchers at the University of Liverpool, published by the government alongside other Scientific Advisory Group for Emergencies (Sage) documents on Friday but dated November 25, states that the Liverpool health -protection board had decided to pause plans to use LSTs in care home settings.
Authorities in Greater Manchester and Sheffield have also raised concerns that the tests, which can return results in a matter of minutes, had failed to detect enough infections. While the rollout of the care home test scheme was temporarily paused in Liverpool, it resumed from December 3 alongside rules against hugging or skin-to-skin contact.
The government recently changed its in advice for care homes, allowing visits across all tiers unless there’s an outbreak in the home. The LFTs are instrumental to this plan, with more than a million already sent to hundreds of England’s biggest care homes.
They are the same tests that are being sent to tier 3 areas as part of the government’s first wave of community testing, with 67 local authorities given approval to begin “testing support programmes” as soon as Monday to “drive down transmission rates in their areas.”
In a statement released on Saturday, health and social care secretary Matt Hancock said: “I am really pleased to announce the first areas embarking on enhanced community testing programmes - after the successful work in Liverpool.”
He did not mention the concern around false negatives, but a line in the release put out by the Department of Health and Social Care (DHSC) states: “Extensive clinical evaluation has been carried out on the lateral flow tests by Public Health England and the University of Oxford which show these tests are accurate and sensitive enough to be used in the community.”
The tests are intended to be used hand-in-hand with PCR tests, which can take days to return a result but are regarded as a more reliable indicator of whether or not someone has Covid-19, whereas asymptomatic people have been encouraged to use the LTFs to gauge rates in the community.
Experts have already raised serious concerns about LFT tests providing a false sense of reassurance. Earlier in December, government figures were released from the Liverpool pilot scheme which showed they missed half of all cases and a third of those with a high viral load who were likely to be the most infectious.
Professor Jon Deeks, of Birmingham University, said the tests were being used in ways for which they were never intended with potentially dangerous consequences.
“They are a low-tech test, they can’t detect low levels of the virus. The World Health Organisation has said ‘Don’t use it for this purpose,’ the manufacturer said ‘Don’t use it for this purpose’,” he told Today.
“We can’t see why the government is progressing with using this test when it is missing so many people.
“They have been sold to people with the idea that if you are negative you will be able to go and visit people, you will be able to be clear that you haven’t got Covid, and that it really dangerous.”
But Dr Susan Hopkins, chief medical adviser to NHS Test and Trace, has defended their use, saying the tests had enabled them to find many cases of infection in people without Covid-19 symptoms that would otherwise have been missed.
“What we are doing here is case detection. We are not saying people do not have the disease if their test is negative,” she told the BBC Radio 4 Today programme.
“We are trying to say (to people who test positive) ‘You do have the disease and now we want you to go and isolate for ten days’. That is a whole different game-changer.”
A Department of Health and Social Care spokesperson said: “Extensive testing has shown lateral flow devices are suitable for use in care homes where they can help to identify people who are the most likely to spread the virus further and therefore support the prevention of transmission of the disease from staff and visitors.
“Testing is only part of the approach and it’s essential visitors wear PPE and follow all infection control methods to keep their loved ones, other residents and staff as safe as possible.
“We have sent out millions of tests, provided free PPE and issued guidance to help bring families back together. Care home residents in all tiers will have the chance to see their relatives before Christmas and homes across the country are arranging visits now.”
Editor’s Note: An earlier version of this story stated that the current advice from Liverpool City Council to care homes was not to use LFTs. This has now been updated.