Research and analysis

Liverpool COVID-19 community testing pilot: interim evaluation report summary

Published 14 January 2021

Applies to England

The pilot

On 6 November 2020, Liverpool City Council, NHS Test and Trace, NHS Liverpool Clinical Commissioning Group, Cheshire and Merseyside Health and Care Partnership, and the University of Liverpool embarked on a national pilot of community open-access testing for the COVID-19 virus among people without symptoms.

The purpose of the pilot was to reduce or contain transmission of the virus while tackling the mounting harms to health, social and economic wellbeing from COVID-19 restrictions.

This report

This is an interim report from an evaluation led by the University of Liverpool into the Liverpool pilot of community open-access testing for the COVID-19 virus among those without symptoms. The evaluation was invited by the joint local and national command of the pilot and sponsored by the Department of Health and Social Care (DHSC).

The report evaluates the data on the biological, behavioural and systems aspects of the pilot and its early public health impacts. It presents early findings to help policymakers with similar approaches to COVID-19 testing. A more detailed report will follow in early in 2021.

The report was led by the University of Liverpool, alongside researchers from NHS Test and Trace, Joint Biosecurity Centre, Public Health England and the Office for National Statistics.

The report was published on the University of Liverpool website on 23 December 2020.

Main findings

In the first phase of the pilot, from 6 November to 9 December 2020, 25% of 498,000 residents took up lateral flow tests (LFTs) and 36% took up LFT or polymerase chain reaction (PCR) tests. 897 individuals were identified as positive via LFT and 2,902 via PCR.

The pilot team developed SMART (systematic, meaningful, asymptomatic, repeated testing), an alternative approach to mass testing. The elements of SMART are:

• test-to-protect (vulnerable individuals and settings)
• test-to-release (sooner from quarantine, when appropriate and combined with other measures)
• test-to-enable (safer return to key activities for social fabric and the economy, when appropriate and combined with other measures)

Large-scale, intelligence-led, targeted and locally driven community testing for SARS-Cov-2, in concert with other control measures and vaccination, can support COVID-19 resilience and recovery.

Biology

The sensitivity of Innova lateral flow devices in this context was lower than expected (based on the preceding validation studies) at 40%. But they identified two-thirds of cases where people had higher viral loads.

In addition, the time and scale gained from a low-cost, no-lab test provided a useful additional COVID-19 control measure with targeted and clearly explained use.

Behaviours

Awareness of the pilot was high and attitudes towards it were generally positive. Collective identity and social responsibility were key motivators of testing uptake.

Fear of not having adequate support to isolate was a major barrier to taking up testing.

No firm conclusions can yet be drawn about the effects of a negative test on risk behaviours but there were no alarming indicators in survey results.

Systems

The speed of design and implementation of the pilot was challenging. It drew upon, and further strengthened, the local networks and collaborations delivering Liverpool's COVID-19 responses.

Military involvement was well received by the public and by local operational teams.

A combined NHS, local authority, and public health intelligence system underpinned communications and testing operations.

Local knowledge and targeted communications, including tackling misinformation, were essential.

Public health

Given the complexities of the interventions in the pilot and nationally, alongside falling COVID-19 prevalence in Liverpool over the initial evaluation period reported here, it was not possible to disentangle the potential effects of testing on case or hospitalisation rates.

Yet over a third of Liverpool's identification of infected individuals throughout December 2020 was via community testing for people without symptoms – people who would not have previously been eligible for testing. And asymptomatic case and contact identification rose in Liverpool during the pilot period while the corresponding rates in neighbouring Manchester fell.

Longer term impacts will be reported in the final report.

Community testing uptake in the most deprived fifth of areas was half that in the least deprived fifth of areas – 16.8% vs 33.4% – and test positivity was double in these most vs least deprived areas (1.0% vs 0.5%).

Digital exclusion was a substantial barrier to testing uptake, more than deprivation alone.

Younger people, particularly males, were harder to reach than older people. However, since 9 December there was a large increase in young adults seeking testing, which will be reported in the full evaluation.