Hello Lateral Flow, Farewell PCR

This marks the end of a busy week for Testing For All where the requirements for entry into the UK largely flipped from super sensitive lab based PCR testing to cost effective lateral flow. As the market flipped, on Tuesday 26th October we performed 6,422 PCR tests, and 4,216 lateral flow tests marking for us the tidal switch point from PCR to lateral flow.

The last month was uncertain as it was not clear that the private sector would be asked to provide this service, what the “minimum standards” would be or how the private sector would price it. Earlier in October, Greg Shapps had mentioned that lateral flows would be given out at airports, and in a conflicting message the UK Health Security Agency had asked private providers to express interest in offering the service.

The key aspects of the service is that the lateral flow must be used on Day 0, 1 or 2 of your entry into the UK, that a photo must be uploaded and validated by the service provider and that you must have a method for ensuring that the lateral flow is provided by you and unique. If positive, the confirmatory PCR test and sequencing of variants is provided by the NHS.

The service went live on Friday 22nd October, for arrivals on 24th October. Testing For All was pleased to set the most affordable market price at £19.00 and as a result we received a huge amount of traffic. At 7AM we had over 10,000 visitors on our website, by 9AM both the government and our website had crashed. We were able to pause sales, recover the website and implement a queue enabling us to process 26,000 orders that day. One of our best decisions to date is that we control how many arrivals we accept per day making it much easier to control the quality of service for those who purchase from us.

At the end of this first week, we wanted to see how the level of positive cases differed across the move from PCR to lateral flow. We looked at the specific cohort of individuals eligible for PCR tests before 24th Oct, and then became eligible for Lateral Flow from 24th Oct. This cohort is the catchily named “Non Red-Route Country Vaccinated Citizens.” In week 43: 25th October to 31st October we saw the following positivity rates across the two test types.

PCR Lateral Flow
Number of Tests 8,770 17,803
Positive 0.82% 0.45%
Negative 97.98% 99.10%
Void 1.20% 0.44%

What does this really mean? Well, that is hard to say as there are many factors but it is clear that in this method of “self-test” where kits are sent to people’s home to complete without supervision (the most scalable and accessible mass testing method), PCR tests pick up significantly more positive cases than lateral flow. This may be due to PCR detecting the virus after the individual has stopped being infectious or due to PCR picking up individuals earlier while they are about to become infectious.

The team at TFA is as ever good at dealing with uncertainty. We are lucky to have our own proprietary tech platform, built to enable continuous and rapid release of features without breaking existing services; we have understanding and patient suppliers who are willing to work with us in this uncertain market and the leadership team including Kelly, Luka, Samantha, David and Dan are tenacious and resilient.

In all of this we are hugely grateful to our laboratory partners who through their own entrepreneurial spirit built some of the most efficient, most accurate, PCR test capability available in the world. We are excited to look to the future with our lab partners, to bring the most innovative diagnostics to the UK market. And given the accuracy and sensitivity of PCR we are saying “farewell” and not “goodbye” to this remarkable genetic diagnostic technology.

In the next few months we will significantly drive down the cost of lateral flow testing, as we increase scale and automate the way we process the uploaded images as Testing For All’s final push to make testing for COVID-19 more accessible and affordable.