PEOPLE in Scotland have had to cope with many changes to our daily lives over the past year. We’ve been asked to modify our behaviour in a whole range of ways.

One recurring message from government has been to follow the FACTS campaign that sets out actions each individual can take to reduce the risk of Covid to them and others. The ‘S’ in FACTS is to self-isolate and book a test if you have symptoms. Since the start of April 2020 more than four million tests have been conducted involving almost 1.8 million people. In other words, around one in three people in Scotland has had a test for Covid-19.

This week the Scottish government published an update of the national testing strategy. It makes clear that testing is going to be available to even more of us in the coming months. This might seem strange at a time when we seem to be on a route out of the current crisis, but in reality testing is part of recovery. Testing helps find cases more quickly and means action can be taken to prevent the virus spreading again and restrictions needing to be re-imposed.

So what are the main reasons for testing? The strategy sets out six of these. First for diagnosis, to confirm if someone has the disease and inform treatment. Then to test people receiving care in hospital or who are moving into a care home. There is also testing of health and social care staff to protect themselves and those they care for.

A big focus of testing recently has been to find people without symptoms in the community, so we’ve seen hubs set up where people who are asymptomatic can get tested.

Testing is needed for surveillance through lots of different types of studies, to get a local and national overview of cases, and understand more about the virus, variants and the disease.

A final reason to test is to maintain services and mitigate social and economic harms. This explains why routine testing is now increasingly available for school pupils and teachers, university students and in some workplaces.

What the strategy doesn’t cover is the human experience behind this huge, mostly new system. Most people understand why it’s needed, but we shouldn’t forget that testing can be unpleasant and inconvenient. Booking an appointment, travelling to the venue, administering the test (which in most instances involves a swab up the nose as well as at the back of the throat), waiting anxiously for the results.

With asymptomatic testing (via lateral flow devices that provide rapid results) false positives are not uncommon, and so people may need to book a second confirmatory test with the NHS that involves more accurate PCR testing.

The consequences of testing positive are substantial – the need to self-isolate and provide details of close contacts who in turn may need to get tested and self-isolate. The system is expensive and the staffing and logistical requirements vast.

Some of these issues are addressed in a new report published from a study funded by the Chief Scientist Office and conducted by researchers at the University of Edinburgh. Led by Dr Alice Street, the team interviewed 70 people in Lothian about their perceptions and experiences of Covid-19 testing from June to September 2020. This focused on the PCR testing for people with symptoms rather than any of the new testing developments that have emerged since. The study results are both reassuring and challenging.

What they found was that people were willing to seek a test and follow government guidelines, and that being tested had a ‘social value’. Taking a test was useful to the individual who was tested – finding out if they had Covid-19 or not – but also was seen as ‘doing the right thing’ and contributing to protecting loved ones and others in the community. Testing was seen as something that many people had to engage with and that getting tested when symptoms appeared was a contribution to a collective pandemic response.

The study also found that trust (or lack of it) in the system was a key feature. For it to work and deliver the results expected, it has to be trusted. Study participants had good levels of trust in the NHS and health care staff, private contractors, testing technologies, other members of the public and the Scottish government.

Views were expressed that were less trusting of online systems, private testing providers, the UK government and, importantly, people’s own ability to collect a sample for testing.

The study highlighted that Covid-19 testing involves a ‘diagnostic burden’. This involved trying to interpret information from different sources, being unsure in some instances about testing criteria, problems with booking and obtaining a test and the various consequences when the result was negative or positive. In other words, there was a lot more to it than just ‘getting’ a test. People’s experiences of the system were different from public messaging that testing is easily accessible.

As the number of testing centres, types of tests and categories of people who can get tested expands, this study reminds us that we need to consider each step in the testing process and what it means for the individuals involved. Public guidance about who is eligible for testing needs to be clear. The strengths and weaknesses of different types of tests need to be explained. Any practical barriers to getting to testing sites or booking appointments should be minimised. Employers should support and encourage staff to take up testing if needed.

Once better technologies are available (saliva testing rather than the need for swabs) these should be rolled out. All these things will be important to maintain public trust in testing systems. One day ‘getting a Covid test’ will be unusual, but that day is still a long way off.

 

Professor Linda Bauld is Chair of Public Health at the University of Edinburgh.

Our columns are a platform for writers to express their opinions. They do not necessarily represent the views of The Herald.