Lack of guidance on PPE and test capacity hampered early testing in NHS Lothian, report shows

Community testing in NHS Lothian was subject to challenges included a limited capacity and a lack of guidance around personal protective equipment (PPE) in the early days of the coronavirus pandemic, a report shows.

The report, published by the infectious disease control journal Eurosurveillance and written by staff members within NHS Lothian, also highlights the speed community testing was mobilised and its success at meeting targets.

Details in the report show how testers were forced to develop a risk assessment of the environment they were about to conduct a test in due to a lack of Scottish Government guidance on how to put on and take off PPE.

It also states that in early February the capacity for tests at the East of Scotland laboratory which serves the Lothian area was just 100 samples per day.

That capacity has since increased to 1,200 samples per day, NHS Lothian said.

The report states that capacity reasons halted the testing of those with minor symptoms, a decision taken by the Scottish Government on 12 March.

However, the community testing team hit the target set by the Chief Medical Officer to have samples of suspected Covid-19 patients tested within 24 hours, 95 per cent of the time, the report shows.

It states: “The threat of COVID-19 has required healthcare services to react and adapt their working patterns. There was no available guidance or similar service in Scotland yet when the COVID-19 Community Testing Team was initiated.

“The COVID-19 Community Testing Team quickly identified that sampling in patients’ homes was a necessary service to ensure rapid testing and safe containment.

“Furthermore, suspected cases were able to stay within their own homes with a clear management plan and rapid sampling as well as receiving reassurance from an experienced clinical team.”

The team, featuring a dedicated ambulance car and driver as well as nurses, consultants and training grade doctors from the Regional Infectious Diseases Unit at the Western General Hospital in Edinburgh, was mobilised within three working days and was fully operational by 6 February.

Lothian MSP and shadow health minister for the Conservatives, Miles Briggs, said the report highlighted how a lack of capacity “affected the approach” to community testing.

He said: “This report from March highlighted the importance of testing in the community and how a lack of testing capacity affected the approach to community testing.

“Two months later and testing is still not being fully utilised to find out where Covid-19 is and minimise the infection rate, bringing the important R number down.

“People want to come out of lockdown as soon as safely possible and test trace and isolate is a central strategy on how to do this without Covid-19 getting out of control.

“Scotland’s economy can only survive so long under lockdown and it is in everyone’s interest to lift lockdown in a safe and controlled fashion, which testing is an essential part of.”

Professor Alison McCallum, director of public health and health policy at NHS Lothian, said: “This report highlights the extraordinary work carried out by our teams across NHS Lothian to provide vital services in the very early days of the COVID-19 pandemic, at a time when the virus was still emerging.

“Since then, our services have been bolstered and for example when once we had capacity to provide 100 tests per day, we now have the ability to provide 1,200 each day.”

A spokesman for the Scottish Government said it was “incorrect” to say there was no guidance for PPE in February.

They said: “As set out in a paper from March 2020, the Scottish Government was clear that if a point of sustained community transmission for COVID-19 was reached, we would rely less on contact tracing and focus instead on providing the best care to those who had developed the disease, delay and reduce the spread and protect those who are most vulnerable.

“It is incorrect to suggest that there was no guidance in relation to PPE in February. Infection Prevention and Control Guidance has been in place in the UK since the beginning of January which includes the correct use of PPE to prevent transmission of Covid-19 and to ensure the protection and safety of staff.”