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Testing testing testing

Testing for COVID-19 has had the most airtime in the last week. As we move through this pandemic the focus is now shifting to ensuring that we feel safe and exploring what steps can be taken to protect us when we attend any medical space. This is new territory for everyone so much of the work being done at the moment is in pilot phase. For services to return to pre-COVID levels, the key is testing and screening for COVID-19, which looks like it will be here to stay.

Over the coming weeks patients who need important planned procedures – including surgery – will begin to be scheduled for that care, with specialists prioritising those with the most urgent clinical need.

So if you are waiting for surgery or other treatment, you will be required to isolate for 14 days and be clear of any symptoms before being admitted. Testing will also be offered if you are waiting to be admitted to provide further certainty you are COVID-free. This will help to protect patients from potentially catching the virus in hospital, and help staff to ensure they are using the correct infection control measures and protective equipment.

If you need urgent or emergency care you’ll be tested on arrival and streamed accordingly, with services split to make the risk of picking up the virus in hospital as low as possible. Those attending emergency departments and other ‘walk-in’ services will be required to maintain social distancing, with trusts expected to make any adjustments necessary to allow this.

So what types of testing are available for COVID-19?

There are three broad types of tests:

  1. A lab-based test to see if you have the virus, known as the virus PCR test, also sometimes called amolecular or nucleic acid test
  2. A lab-based test to see if you have developed antibodies to the virus, known as an antibody test, also sometimes called a serologytest
  3. rapid diagnostic test (RDT) or point-of-caretest to get quick results without needing to send the sample to a laboratory (different rapid diagnostic tests can be used to see whether the virus or antibodies are present)

The virus PCR test detects the presence of SARS-CoV-2. This requires a swab of your nose and throat which can be taken at home, testing centre, or hospital. This test is useful for identifying whether you are currently infected which is why it is recommended while you are experiencing symptoms. This is the test currently being made widely available by the NHS either as an at-home sampling kit or at regional drive-through centres.

The antibody test requires a sample of your blood (collected at home with a finger prick test, testing centre or hospital) and then sent to a laboratory to look for the presence of antibodies rather than the virus itself. Because it takes time for your immune system to make these antibodies, this test is best used to identify a past infection. This test may also be useful for those who have been infected but didn’t have symptoms or did not qualify for the virus PCR test.

The third type of testing that you may have heard of recently is rapid diagnostic tests (RDTs), also known as point-of-care tests. These are usually done in a doctor’s office and give results within minutes without the need to send the swab or blood sample to a laboratory. These tests can look either for virus antigens (rapid antigen test) to help diagnose current infection or antibodies (rapid antibody test) to determine a past infection. At present, the World Health Organisation recommends these tests only for research purposes but not for clinical decision making until more evidence on their validity and utility becomes available. Some companies have been illegally selling rapid diagnostic tests for at-home use. As it stands, there are no rapid diagnostic tests approved in the UK for at-home use.

There is still much that is unknown about COVID-19 and doctors and scientists are working hard to discover as much as they can as quickly as possible. Testing both for active infection with virus PCR swab tests, as well as previous infection with antibody blood tests, will play a very important role in our understanding of this disease and how to triage people in the future.

Up to date information on NHS testing can be found here.