Universal weekly testing as the UK COVID-19 lockdown exit strategy

Peto, Julian, Alwan, Nisreen, Godfrey, Keith, Burgess, Rochelle A., Hunter, David J., Riboli, Elio and Romer, Paul (2020) Universal weekly testing as the UK COVID-19 lockdown exit strategy. The Lancet, 395 (10234), 1420-1421. (doi:10.1016/S0140-6736(20)30936-3).

Abstract

he British public have been offered alternating periods of lockdown and relaxation of restrictions as part of the coronavirus disease 2019 (COVID-19) lockdown exit strategy.
Extended periods of lockdown will increase economic and social damage, and each relaxation will almost certainly trigger a further epidemic wave of deaths. These cycles will kill tens of thousands, perhaps hundreds of thousands, of people before a vaccine becomes available, with the most disadvantaged groups experiencing the greatest suffering.

There is an alternative strategy: universal repeated testing. We recommend evaluation of weekly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen testing of the whole population in an entire city as a demonstration site (preferably several towns and cities, if possible), with strict household quarantine after a positive test. Quarantine would end when all residents of the household test negative at the same time; everyone else in the city can resume normal life, if they choose to. This testing programme should be assessed for feasibility in one or more cities with 200 000–300 000 people. Such a feasibility study should begin as soon as possible and continue after the current lockdown ends, when the infection rate will be fairly low but rising. The rate at which the number of infections then rises or falls, compared with the rest of the UK, will be apparent within a few weeks. A decision to proceed with national roll-out can then be made, beginning in high-risk areas and limited only by reagent supplies. If the epidemic is controlled, hundreds of thousands of lives could be saved, intensive care units will no longer be overloaded, and the adverse effects of lockdown on mental ill health and unemployment will end.

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Contributors

Author: Nisreen Alwan

Author: Keith Godfrey

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