Research and analysis

COVID-19: asymptomatic testing in high contact professions

Published 3 November 2022

Applies to England

Executive summary

In summer 2020, NHS Test and Trace partnered with a number of private sector industries and local authorities to pilot targeted asymptomatic swab testing of high-risk groups and those within high contact professions. The pilot used polymerase chain reaction (PCR) tests (other types of test, including lateral flow tests, were not in widespread use at the time of the pilot). Participating organisations advertised the pilot to their employees as a single, voluntary opportunity to get tested.

The purpose of the pilot was to estimate the point prevalence of coronavirus (COVID-19) in the targeted population and explore how testing could be used to mitigate the risk of becoming infected.

The pilot generated insights into the operational aspects of setting up asymptomatic testing in high contact professions, the motivations and barriers employees could have to testing and the broader implications and impacts asymptomatic testing could have.

The pilot took place over a 6-week period, from early July to the middle of August 2020. Around 130,000 people were invited to take a test, either via one of the 7 organisations that were directly involved or via one of the 4 participating local authorities.

A total of 3,785 tests were carried out as part of this pilot. We were not able to ascertain from the data whether any individuals took more than one test, but we did not find any qualitative evidence to suggest that this was widespread. Of those where results were obtained (3,685), 25 (0.7%) were positive, or approximately 1 in 150 tests. There were 100 void results (2.6%) where a conclusive result could not be obtained from the sample provided.

The low uptake (2.9%) of the tests meant that we were unable to draw meaningful conclusions from this study about how the prevalence within this group compared to other populations. We conducted qualitative interviews with those involved with the pilot to gauge attitudes to testing.

Clear, neutral communication about the testing programme could dispel employees’ doubts

The level of information communicated to potential participants was broadly deemed sufficient for them to decide whether to get tested, and the content was felt to be clear and well signposted. Employees appreciated that information was conveyed in a neutral way that did not seek to enforce participation. But official communication about the programme also had to counter negative perceptions about the testing programme influenced by reports in the media at the time. Alongside this, a longer lead-in time between communication of the pilot and registration to take part may have resulted in greater uptake.

Varying perceptions of risk could influence the decision to get tested

We saw wide variety in employees’ perception of risk, which played a considerable role in their decision to get tested. Some employees believed that the safety measures their workplaces had implemented had sufficiently lowered the risk of catching COVID-19 to a level where testing was unnecessary. Others thought that being in the workplace inherently carried greater risk and were therefore more willing to get tested if asymptomatic. This finding suggests increasing testing uptake may be achieved through understanding the varying perceptions of risk people may have and addressing these with tailored messaging.

Clear direction from each organisation’s senior leadership could be used to motivate more people to get tested

Respondents said that endorsement from senior figures within each organisation may have had more impact on uptake than communication from government. Some employees also reported they would be willing to disclose their test results directly to their employers, despite there being no official mandate to do so. Encouragement from employers might therefore increase the participation rates of their employees.

Personal responsibility and civic duty do not always lead to increased desire to get tested

Personal responsibility and civic duty played dual roles as motivators and barriers to testing. Some people declined to get tested because they believed there were other people more deserving of a test. reflecting the waiting times for tests that existed when the pilot took place. (Capacity for PCR tests was around 200,000 tests per day at the time of the pilot. It has since expanded greatly and has been supplemented by other types of tests, such as lateral flow tests.)

Others saw it as their duty to get tested, in order not to play a role in spreading the virus. Some viewed the prospect of testing negative as a reward for following the rules of lockdown, which the country was in just before the start of the pilot. We can therefore suggest that the testing context affects how people’s personal motivations may or may not translate to increased propensity to get themselves tested.

There was preference for testing opportunities to be made more convenient to employees’ lives rather than for employees to fit it into their schedules

While some employees found the option to get tested at home reassuring, many thought that it would be more effective to get tested in the workplace itself. This was backed by evidence from other pilots suggesting that the proximity of a testing centre to the workplace was not enough of a motivator to getting tested – more employees would prefer the flexibility of testing in the workplace at times that suited them. In order to increase the uptake of asymptomatic testing, we could therefore conclude that increased tailoring of testing opportunities to suit the needs and schedules of employees may have led to increased uptake, rather than asking employees to fit testing into their routines.

Asymptomatic testing in high contact professions

Background

In July 2020 the Department of Health and Social Care began exploring the risks of catching COVID-19 for those working in high contact professions. As the country began to emerge from the first lockdown, the focus shifted to looking at how testing could be used to mitigate the risks of catching the virus while allowing employees to return to work. Up to this point, testing was largely limited to key workers and those who presented with symptoms; asymptomatic testing for non-essential workers was not widely available.

The Deputy Chief Medical Officer proposed that asymptomatic testing might be useful to reassure specific groups in high contact professions, particularly where concerns might affect the extent to which they could do their work effectively. Therefore, the main purposes of the pilot were to obtain information on point-prevalence of this group, to improve understanding of the relevant risks for groups working in high contact professions and to identify where further testing or investigation was required.

The pilot adopted a 2-pronged approach:

  1. Testing at volume via large scale employers of high contact professions.
  2. Setting up testing via local test sites in existing or new hyper-local test sites within several local authorities.

A total of 7 private sector industries and 4 local authorities took part in the pilot. Testing took place over a 6-week period in July to August 2020, using the existing testing channels at the time: the regional and local testing sites, and the at home self-test channel. All channels used polymerase chain reaction (PCR) tests. Other testing technology such as lateral flow tests were not widely available for COVID-19 at the time.

The pilot took place at a time of relatively low prevalence. According to figures from the ongoing Coronavirus Infection Survey by the Office for National Statistics, from 7 to 13 August, 0.05% of individuals in England had the coronavirus, or 1 in 2,200 people. During this period there were approximately 2,400 new infections per day.

From 7 to 13 August, 0.05% of individuals in England had the coronavirus (95% confidence interval 0.03% to 0.06%). Equivalent to around 1 in 2,200 people (95% confidence interval 1 in 3,200 to 1 in 1,600). There were around 2,400 new infections per day (95% confidence interval 1,200 to 4,200.

Safety measures implemented at the time included wearing masks indoors and maintaining a 2-metre social distance as much as possible.

Goals of the pilot and review questions

The purposes of the pilot were to:

  1. Obtain information on point-prevalence.
  2. Improve understanding of the relevant risks for groups working in high contact professions.
  3. Identify where further testing or investigation was required.

The pilot was a single arm observational review of a very fast-moving policy. The testing window took place between mid-July and late August 2020, and research activity was conducted from the end of July to mid-August. The review aimed to answer the following questions:

  1. Are the systems and processes suitable for asymptomatic testing across each business setting?
  2. What is the optimal DHSC engagement model with employers, local authorities and employees that would enable rollout of asymptomatic testing?
  3. Is there data to suggest a higher prevalence of infection amongst high contact employees compared to other employees and would there be benefit in further surveillance testing?
  4. Is there the demand for testing from asymptomatic high contact professionals?
  5. What motivates employees to get tested?
  6. What barriers do employees have to getting tested?

Methodology

Identifying and recruiting high contact professions participants

High contact professions were identified using data from the Office for National Statistics (ONS). The ONS used analysis from the United States to give insight into which occupations involve working in proximity with others and are regularly exposed to diseases. The study referred to disease exposure generally rather than COVID-19 specifically, which gave a useful indication of which roles may be more likely to come into contact with people with COVID-19.

Table 1. The categories of high contact professions and the corresponding employers

High contact profession category Relevant company included within pilot
Taxi and cab drivers Company 1 and Company 2
Security guards Company 3
Sales and retail assistants Company 4 and Company 5 (with in house engineers and call centre staff also being tested via Company 5)
Cleaners and domestics Company 3
Dental practitioners, dental nurses and dental technicians Not covered
Prison officers and residential wardens Existing testing planned via the prison surveillance study.
Veterinary nurses Not covered
Opticians Company 4
Pharmacists Company 4
Pharmaceutical technicians Company 4
Undertakers, mortuary and crematorium assistants Company 6
Food processing plants Confidential company (Company 7)
Bakers Not covered
Food preparation staff in hospitality Not covered

Participants were recruited onto the pilot through communication cascaded via employers. Some employers sent out electronic communications, while others used posters and word of mouth. Communication about the pilot included information about the testing opportunities available, when the pilot would be running and who would be eligible: all asymptomatic employees received the invitation.

The people invited to take tests as part of this pilot were:

  • more likely to come into contact with the general public
  • typically more likely to have close contact with people but not touching (unlike, for example, hairdressers or beauticians)
  • not in job roles such as healthcare, that could more frequently bring them into contact with infected people
  • in occupation types and companies that had higher proportions of employees from ethnic minority backgrounds (to reflect greater risk from COVID-19 among these populations)

Identifying and recruiting local authority participants

In addition to approaching employers directly, 4 local authorities took part in the pilot: Bradford, Brent, Newham and Oldham. Local authorities were responsible for identifying potential participants they believed to be at high risk.

This engagement encouraged the use of local test sites via the following means:

  • the gov.uk portal
  • through a local authority-owned booking system
  • through the local authority-owned contact centre
  • by turning up for a test during an agreed timeslot

The rationale for selecting each of the 5 local authorities is given below. All data are taken from the 2011 Census conducted by the ONS.

Bradford

From the 2011 ONS Census, Bradford had a population of 522,452. Bradford is an ethnically diverse city that includes the largest proportion of people of Pakistani ethnic origin (20.3%) in England. The city has a young demographic, with 30.2% of the population aged under 20.

The Bradford site was not targeted at any single part of the community but was chosen because it was highly accessible to a number of vulnerable groups, including low income workers, sex workers, and rough sleepers.

Brent

Brent has a population of 311,215. It has the largest proportion of ethnic minorities in London. Approximately 71% of the population are from an ethnic group other than White British. Brent is within the top 15% most deprived local authorities in the country.

A walkthrough testing site opened in Harlesden Town Garden for local residents on 10 June 2020. The area had at the time one of the highest death tolls form COVID-19 in the UK.

Newham

The population of Newham in the 2011 ONS Census was 307,984. Nearly a quarter of the population in Newham is under 18. A large proportion are from ethnic minority backgrounds, including 45% who are Asian or Asian British. Newham is within the top 10% most deprived local authorities in the country.

In order to improve testing accessibility to residents across the borough, a local testing site was established in a car park on Hilda Road, East Ham, on 30 June 2020.

Oldham

Oldham had a population of 224,897 in the 2011 ONS Census. Oldham has a predominantly White British population (77.5%), with over half the town living in the 3 most deprived deciles according to the 2019 Index of Multiple Deprivation.

Oldham set up the country’s first ‘pop up’ local testing site, which launched at the Southgate Street Oldham Library car park on 29 June 2020. The site was designed to be moved around the borough to flexibly meet local needs and respond to the council’s concerns about promoting community cohesion.

Evidence collection: quantitative data

Quantitative data was collected on those who participated via large scale employers. We were unable to gather equivalent data tor the local authority element of the pilot because we could not distinguish pilot participants from others being tested in local testing sites (LTS).

Pilot participants supplied personal data either through in-person registration at testing sites or through the home testing channel registration form, depending on the testing channel chosen. We identified pilot participants through one of 2 ways:

  • inclusion of the keyword ‘pilot’ in the employer field name of their registration form
  • attending the arranged local testing site at a timeslot reserved solely for pilot participants from their organisation

Given the need to include the keyword ‘pilot’ the employer field was restricted to free-text entries rather than a pre-coded drop-down box, and entries were therefore open to human error. The combination of these spelling errors and the omission of the word ‘pilot’ by some participants meant that the final figure of participants in the system may be less than the true number.

Evidence collection: qualitative data

To improve understanding of the relevant risks for groups in high contact professions, and to understand the operational feasibility of scaling up asymptomatic testing, we conducted a total of 31 interviews with:

  • 13 employees who had taken part in the pilot
  • 7 employees who had been invited to take part but declined
  • 7 senior leads, each representing one private sector company
  • 5 main figures in the local authorities (one interview had 2 participants from the local authority)

Additional insight was gleaned from a roundtable hosted by Lord Bethell in September, that brought together senior members of staff from each of the participating company. The roundtable used interim quantitative and qualitative findings as a starting point for discussions of the operational feasibility, benefits and barriers to scaling up asymptomatic testing in the workplace.

Employees were recruited via named contacts in each participating organisation, who were also responsible for recruitment to testing itself. Senior leadership were invited to take part in qualitative interviews and a ministerial roundtable at the pilot’s conclusion. At the roundtable, interim findings were presented and senior leaders were asked to discuss these findings to give additional comment and feedback to contribute to the final report. Key figures in local authorities who were approached to establish the testing pilot were also recruited to take part in the qualitative interviews.

Interviews were conducted over the phone and lasted between 30 and 45 minutes. Two members of the research team were present: one to conduct the interview and ask questions, the other to take notes. Consent from each participant was obtained at the start of each interview, and the session was not recorded. To protect the identity of research participants, notes were anonymised and personal details removed from the final report.

Results

Pilot numbers

A total of 131,410 invitations to take part were sent out to employees across the 7 organisations. Approximately 8,080 test kits were ordered via the home testing channel by employees from 13 July 2020, representing an uptake of 6.1% of the invitations to take part (assuming people ordered just one test).

Almost half the delivered test kits (49.6%) were registered, with nearly all results processed (97.3%) during the live period of the pilot (13 July 2020 to 28 August 2020).

Table 2. Results processed

Test result Number of results processed Percentage
Positive 25 0.7%
Negative 3,660 96.7%
Void 100 2.6%
Total 3,785 100%

These were results processed before 27 August 2020 and that were linked to an in-scope order. IT does not record any kit registered if the Order ID number is not entered. Note that numbers presented in the tables below may not equal 100% due to rounding.

Table 3. Orders by gender

Gender Percentage
Male 67.0%
Female 33.0%

Table 4. Orders by testing route

Testing route Percentage
Home testing 80.7%
Testing site 19.3%

Table 5. Orders by ethnicity

Ethnicity Percentage
White 78.8%
BAME 15.9%
Mixed 1.9%
Other 1.1%
Prefer not to say 2.3%

Table 6. Orders by age group

Age group (years old) Percentage
0-19 0.6%
20-24 5.8%
25-34 24.1%
35-44 23.1%
45-54 24.8%
55-64 19.0%
65+ 2.5%

Table 7. Orders by geographical location

Geographical location Percentage
London 24.8%
South East 13.0%
East of England 12.4%
North West 11.9%
Yorkshire & Humber 7.4%
East Midlands 7.4%
South West 7.2%
West Midlands 6.4%
North East 4.6%
Not applicable 5.0%

Operational feasibility

How did employers communicate about the testing programme to their employees?

Among employees who participated in interviews, it was thought that clear and neutral communication about the testing programme helped to dispel doubts they had about its purpose and the process involved. The level of information provided was thought to be sufficient, clearly communicated and well signposted. They reported that most process-related questions were answered by the gov.uk website, and the explanatory video was highly regarded:

There were links to websites with all the information, and a helpful video I watched a few times.

Employees particularly appreciated that information was conveyed in a neutral manner, and that there was no obligation to take part or any punitive measures for refusing.

Timing of communication was thought to be important; some employees said that the communication they received from their employers was rushed and that they would have benefitted from more time for discussion. Others reported a 24-hour window between being told about the pilot and the registration deadline, which was thought to be insufficient:

It was quite a quick turnaround, though – we found out on Tuesday and the scheme started on Wednesday. It might have been useful to know a bit more before that.

However, among employees who were not tested, it was noted that there had been numerous negative reports about testing and the testing programme in the media, which influenced their decision to not get tested. At the time the pilot was running, there was increasing media coverage about the government’s testing target reaching one million tests per day towards the latter half of the year. Some employees commented that the government’s stated intention to test a million people each day was unrealistic and they did not see how testing in the workplace could play a role in achieving this goal. Some reported that this lack of faith in the government’s ambition meant that it did not serve to motivate them to take part in the asymptomatic testing programme.

Finally, there was some confusion about the eligibility criteria for taking part and a lack of understanding of the differences between symptomatic and asymptomatic testing. Feedback from local authority respondents suggested that there was an overall lack of awareness that asymptomatic testing was even permitted. This may have affected the overall uptake of the pilot.

Some employers believed that employees did not read the information sent to them, leading to confusion about the nature of the pilot. A few companies did not have a formal email structure in place: frontline staff did not have company email addresses and so information had to be disseminated through line managers:

There was a briefing [about the testing] at work but they didn’t think to tell me because I wasn’t working on that day.

Other companies who did have staff email addresses suggested the pilot messaging was lost amidst regular communications regarding furlough and staff welfare. Employers who sent out repeat communication and follow-up emails reported better testing uptake as the pilot matured.

What did employers and employees think about the logistics involved in asymptomatic testing?

While there was a positive response overall from large businesses about setting up asymptomatic testing for their workforce, feedback from both employers and employees suggested some logistical aspects could have been improved. There was a desire for greater access to a variety of testing channels and information about each. Employees who opted for the home testing channel cited reassurance and the ability to be in control of swabbing as the main selling points:

For me to be in control made a huge difference to me. Not that it was pleasant, but I could do it properly, not feel embarrassed and could do it in the comfort of my own home.

The proximity of a testing site to each workplace was not perceived as a motivator to get tested for many employees, with few signing up for this option despite a push from employers and local authority figures:

I told them there was a test centre 10 minutes walk away and they could just pop along after work, but not many people signed up.

Some employees said that it would have been more effective to have testing made available in the workplace itself. This was of particular value to supermarket chains, who had selected hourly slots for their employees to attend at the nearest local testing site. This approach posed difficulties for some who reported that they felt they could not easily leave their post unattended:

They were only able to book a test on the day for the test sites. I wonder if offering a booking further ahead might have helped.

Overall, participants found the swabbing process involved in testing straightforward. Most proposed broadening the pilot out to as many people as possible, with greater flexibility at testing sites to encourage self-employed people to take part. Some companies (for example, taxi firms) were particularly in favour of this route because it allowed for more spontaneous testing at the convenience of each employee.

However, the process after swabbing proved to be a major hindrance to employees taking part in home testing. Sources of frustration and delay included the multiple steps involved to register a test kit, identifying bar codes for registration and the need to find the nearest priority post-box in order to return the test kit. These logistical difficulties were reported by employees, employers and local authority figures.

Scientific knowledge and public health

What was the prevalence in the pilot?

Of the 3,785 tests carried out as part of this pilot, there were 25 positive results (0.7%). There were 100 void tests (2.6%) where conclusive results could not be obtained from the sample provided. Of those where results were obtainable, 0.7% were positive, or approximately 1 in 150 tests.

These results are based on numbers of tests, not numbers of people. We were unable to ascertain whether individuals were taking more than one test. Qualitative data suggests that, while this was not widespread, a small number of employees did test more than once.

We were not able to draw meaningful conclusions about prevalence within this group, given that the uptake was low (2.9%). Furthermore, participants were self-selecting and did not form part of a random sample.

What can we say about results broken down by demographic characteristics?

On the whole, analysis by demographic characteristic results in numbers becoming too small for interpretation to be meaningful. There is also an additional risk that individuals would become identifiable from the data.

Numbers were too small for adequate disclosure control and meaningful analysis among most demographic groups, for example uptake by socio-demographic group.

The larger proportion tests taken by men (67% of the total) reflects the industries that were selected for inclusion in the pilot.

A total of 18.9% of tests were taken by people classifying themselves as Black and Minority Ethnic (15.9%), Mixed (1.9%) or Other (1.1%), which is higher than the figure for England and Wales (14%).

What comparisons can be made with asymptomatic individuals tested in the same period?

We can make a cautious comparison with asymptomatic individuals who were tested during the same period (13 July 2020 to 23 August 2020). In this time range, 0.8% of conclusive results in the home testing channel were positive – which is similar to the positivity rate for the pilot group (0.7%). (The positivity rates for both the pilot and home channel are based on the number of test results, not on the number of people.)

It should also be noted that those requesting tests through the home channel were not representative of the general population at the time. They are likely to have had reason to believe they had an increased likelihood of infection, for example, because another member of their household may have had symptoms.

Behaviours

How did perceptions of risk influence the decision to get tested?

Employees had varying perceptions of risk, which influenced their decision to get tested. Some employees were satisfied that measures implemented in their workplace, such as social distancing and regular surface cleaning, reduced the risk of infection, and therefore reduced the need to get tested:

I didn’t think I needed to get tested, the hygiene staff at work are doing a very good job of cleaning.

This was backed by some employers, who suggested that testing uptake may have been higher if the pilot had been introduced earlier, before safety measures had been implemented in the workplace.

But other employees had a different perspective: they believed that being in the workplace put them at greater risk of catching COVID-19:

I come into contact with up to forty people a day, I had to get tested.

Occasionally these opposing perspectives were found in colleagues working in the same area in the same company, highlighting the sliding scale of risk perception.

Some employees who lived with families believed they had a lower risk of catching the virus owing to lockdown and minimal contact with others beyond work and their household. These employees said they were less likely to get tested, viewing it as a waste of resource that could be given to people who they perceived to be more likely to test positive.

I live with my wife and kids and we don’t go out. None of us have been tested.

But most employees who lived with families felt the opposite: the risk of spreading the infection to loved ones and vulnerable groups such as elderly parents was often a motivator to getting tested:

I’ve got elderly parents and yeah, we practice social distancing but I can’t risk giving it to them.

Paradoxically, some of the most risk-averse employees refused to get tested because they perceived testing sites to be inherently high-risk places that could increase their exposure to the virus.

What role did trust in government play in employees’ decisions to get tested?

Both employees and employers indicated that trust in government played an important role in the testing pilot, particularly regarding the motivations behind implementing an asymptomatic testing programme.

Employees expressed concerns about how their data would be used. They suggested that more comprehensive support and information would have allayed their data concerns. Some lack of trust in authority (both central and local government) was apparently fuelled by conspiracy theories, with impending rollout of 5G across the country cited as a deterrent from taking part.

Others held a mistrust of authority that was borne out of political disagreement with government, which led to a lack of desire to get tested. This wider distrust was not limited to the COVID-19 response but refusal to take part in tests were perceived as personal acts of rebellion:

I listen to the news and heard the government were aiming to test X amount of people and knew that was not possible.

Local authorities reported that smaller business owners in their areas were distrustful of the motivations for rolling out asymptomatic testing to their key workers:

If you are saying you are doing this to help my business, what is in it for you?

Some reportedly did not understand why central and local government would be willing to allocate resource to their areas. A few businesses had reportedly previously been approached by either real or perceived scams selling COVID-19 related products and services. Local authorities thought these negative experiences led to raised suspicion when businesses were directly approached by local authorities. Engagement with key community figures, local champions and grassroot organisations was seen as key to countering this.

How did relationships between employers and employees influence testing uptake?

Interviewed employees suggested that they would accept being explicitly directed to get tested. It was widely reported that if testing became a mandatory part of the role it would boost employee participation:

If it were mandatory I would get it done.

But the perceived authority to mandate testing was limited to senior figures within their organisations, such as the chief executive officer or other senior leadership:

It came with a signature from the CEO of the company so we knew it was important for us.

We heard that peer pressure from colleagues did not play a role in influencing the decision to get tested.

Most employees were happy to disclose the results of their tests with their employers, viewing it as reassurance both for themselves and for their managers. While employees reported that they were more likely to be motivated by authority figures within their organisations, some employees expressed that Government authority was not enough to increase testing uptake. Some mentioned that it was a “privilege” to be chosen to take part as an organisation, but that they did not know many colleagues who had disclosed their participation:

It was a privilege to be chosen by the government to take part but I don’t know many people who got tested.

Employers believed that encouraging groups of employees to get tested together, for example, whole stores or workplaces, would increase the testing uptake. While some companies saw differences in uptake between regions, this was not the prevailing view given from the interviews with employees.

Are altruism and community spirit motivators to getting tested?

Personal responsibility and civic duty had some influence on people’s decision to get tested. Some employees who described themselves as fit and well thought that other people deserved to get tested more than they did, particularly vulnerable groups who could not easily access tests:

I didn’t get tested because I think there are more vulnerable people who should take priority.

At the time, testing in Leicester (where prevalence was high) was a major part of the news cycle and some employees believed that testing resources should have been focused there to reduce waiting times. Additionally, some employees refused to take part in testing because they viewed their role in the workplace as essential and non-replaceable. They viewed the impact of a positive test as having greater consequence for their organisation and their colleagues than for their own health or financial situation:

I’m in a skilled role, I couldn’t get tested because not just anyone can do my job if I’m positive.

Conversely, some employees saw it as their duty to get tested, in order not to spread the disease at work. Some employees were cognisant that they would encounter people on the commute to and from work, in the workplace and at home and that they could be exposed to the virus at multiple points:

I got tested because I don’t want to spread the disease.

For some who took part, testing negative for COVID-19 was seen as a validation for following the rules of lockdown. Some viewed it as “testament” to everything that they had to keep safe while trying to go about their lives as normal:

I was buzzing, I managed to keep myself safe and clear while I worked through the pandemic. Testament to myself that everything I had done had worked and kept us safe.

Some employers at the ministerial roundtable expressed surprise that disclosure was not perceived to be a major concern for some of their employees. Companies that only offered statutory sick pay when employees were off-sick assumed that employees would not disclose their test results. However, it was noted that the pool of employees interviewed were a self-selecting group who were aware of their companies’ sick pay procedures, and thus we cannot provide evidence that employees who did not understand their company’s sick pay procedures would have been as comfortable disclosing the results of their test.

What other motivations and barriers to testing exist?

Local authorities reported receiving multiple requests from people looking to use tests in order to go on holiday:

We are getting lots of inquiries saying I’m off to Dubai and so on next week, can I get tested?

The period in which the pilot took place coincided with the announcements of ‘travel corridors’, leading to a number of ineligible people seeking tests. Furthermore, feedback from employers suggested that drop-offs in the number of home testing kits delivered and the number registered could be explained by employees saving the test for a more suitable time, such as when visiting older relatives. While this was not verified by employees, some did report of colleagues looking to take part but to only use the home testing kit when they were symptomatic.

Wider societal benefit

Can this operating model be applied to smaller businesses?

Local authorities reported that several smaller businesses were not aware of the pilot, despite the local authorities’ attempts to engage with them. It was felt that a different approach may be needed to engage with smaller businesses:

[Small] businesses have no social media, there’s high digital poverty so you need a grass roots local, hyper local approach. This needs time and is about building relationships.

Feedback from these businesses regarding asymptomatic testing was mixed, with some viewing it positively but not knowing how to engage from the outset, while others viewed it negatively on account of distrusting authority (as discussed previously).

One main barrier for smaller businesses was the potential impact of a positive result. Smaller local businesses would have limited financial cover if they were forced to close after a positive result in their workforce. Some, such as barbers and hairdressers, were less keen to take part having recently opened after lockdown.

Conclusions

The positivity rate of tests taken as part of this pilot was 0.7%. This was much higher than ONS estimates of positivity in the general population at that time (0.05%) but slightly lower than the positivity rate of asymptomatic tests in the home testing channel (0.8%). But given the low uptake of the testing offer, and those that chose to be tested were a self-selecting sample, we cannot draw conclusions about how the positivity rate of this group compared with that of the wider population.

The qualitative element of the pilot generated useful insights into employees’ motivations for and barriers to testing. We learned that employees weigh up risk in their decision-making – including the risk of catching COVID-19 and the risk of a positive test and how that could affect their lives.

Personal responsibility and civic duty acted in some cases as motivators and in some as barriers. They acted as motivators in the sense that people understood the importance of tracking the spread of the virus and halting its progress. But, at a time when testing capacity was constrained, some questioned whether they were the most worth recipients.

Clear, neutral communication was found to be effective in dispelling some people’s doubts about testing. And they also said that encouragement to get tested by their organisation’s senior leadership was acceptable.

Follow-on from this review

Discussion from the ministerial roundtable focused on generating further insight into the interim findings of the pilot. When the pilot was conducted, asymptomatic testing in the workplace was not widely available, and testing was largely limited to key workers and those who were asymptomatic. Understanding the complexity around these different situations continued to be a priority. Asymptomatic testing in workplaces continued to scale up to reduce the risk of them becoming vectors for infection.