The prospect of a return to normal has wide appeal, especially at a moment Britain is about to implement a new round of social distancing measures, prompted by rising coronavirus infections.
But many public health experts are dubious. Some say the plan is not a moonshot, but a Jules Verne fantasy.
Such massive population-wide testing for disease would be unprecedented. Though some countries have deployed mass screening during this pandemic, “Operation Moonshot” would go where no public health campaign has gone before — and yet Britain doesn’t have the best track record on coronavirus testing.
Skeptics add that the sort of rapid, cheap tests the project would need are still in development, or have not yet been approved for mass screening in Britain, and could produce so many false positives and negatives as to create chaos.
The Moonshot planning documents acknowledge: “Delivering testing at the scale and level of ambition set by the prime minister is likely to mean developing, validating, procuring, and operationalizing testing technology that currently does not exist.”
Johnson, though, outlined the plan with typical brio. As he tells it, by early 2021, new “simple, quick and scalable” tests using saliva or nasal swabs would deliver results while you wait, in as little as 20 minutes.
“Theaters and sports venues could test all audience members one day and let in all those with a negative result, all those who are not infectious,” he said. “Workplaces could be opened up to all those who test negative in the morning to behave in a way that was exactly as in the world before covid.”
But some scientists and medical professionals are among the naysayers, too.
“I think it’s completely far-fetched given the state the country is in,” said Gabriel Scally, a visiting professor of public health at Bristol University. “Antibody testing? Never materialized. NHS test-and-trace that was going to be ‘world class’? Shambolic.”
He added: “The government can’t even develop a system for testing without asking people who are sick to drive hundreds of miles. I’ve heard of people in Northern Ireland given testing slots in Scotland.”
Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, said he was stunned the government was purportedly planning to spend 100 billion pounds on Moonshot — or 70 percent of the yearly budget for Britain’s National Health Service.
“I thought it was a typo,” he said.
“If it goes on much beyond March, you’re going to have a vaccine anyways, so question is: Do you actually need this? There’s so much you could do with the money,” McKee said.
He pointed to data that suggest only 1 in 5 people told to self-isolate actually do — partly because they lose money if they don’t go to work. “Why not give support for these people to self-isolate?” McKee asked. “That would make a big difference.”
Jon Deeks, a professor of biostatistics at the University of Birmingham, dismissed Moonshot as the work of bureaucrats and consultants, not scientists.
“This is not going to work,” he said. “There is no test in the world that will do what the government wants to do.”
The most accurate tests today — 99 percent accurate — rely on polymerase chain reaction machines, which require a laboratory. Fast turnaround for these tests is 24 hours, and commercial tests can cost about $50.
Lateral flow assays now being developed, which don’t require a machine but reagents and a drop of bodily fluid — blood, spit or nasal swab — are less accurate, often far less so.
There’s also a promising new antigen test by the American multinational Abbott Laboratories, which was authorized last month for emergency use by the U.S. Food and Drug Administration. The Abbott tests cost $5 a pop and give results in 15 minutes. But the tests are offered by health-care providers, not done at home. They employ nasal swabs, which many people find intrusive and might not want to endure weekly. Based on a small clinical study of 200 volunteers, which has not been published in a peer-reviewed scientific journal, Abbott reports the test is 97 to 98 percent accurate in the first seven days after the onset of symptoms. About accuracy for the asymptomatic, results are not yet known.
Deeks noted that if Britain were to test 60 million people a week, even the best tests, with 99 percent accuracy, could produce 600,000 false readings a week.
“The challenge of mass screening is that the more tests you run the more errors you get,” he said.
These errors are not negligible. “There’s a massive economic harm,” Deeks said. “There’s massive inconvenience.”
In Britain, a person who tests positive for the coronavirus is required to self-isolate for at least 10 days — and everyone in their household, adults and children, must do the same for 14 days.
Adam Finn, a professor of pediatrics at Bristol University who is studying the efficacy of current testing, said that false positives and negatives were important when diagnosing someone in the hospital but less critical in the context of mass screening.
“Clearly, you want a test that is as good as it can be, but you’re not after perfection or anything close to perfection,” Finn told the BBC. “What you’re after is something that is quick and easy to do and actually cheap, so that it’s in abundant supply and actually affordable.”
Michael Mina, a Harvard epidemiologist who has advised Downing Street on rapid testing, noted that the problem of false positives could be diminished with the introduction of a second test that seeks to verify the results of the first. If both have a false positive rate of 2 percent, then, taken together, the odds of someone falsely testing positive are slashed, he said.
Mina said it’s possible that a person participating in rapid mass testing could get a false positive every few months, but “that isn’t terrible if what you’re getting in return is you’re suppressing the whole outbreak.”
He added support for the Moonshot plan. “I think it’s a great idea,” he said. “We can’t bank on a vaccine saving us.”