Factsheet: understanding the testing landscape for COVID-19

CBI content does not constitute legal or financial advice. This factsheet is not intended to make a judgement about which testing options are best or the specific activities you should undertake.  Scientific understanding and data in this field is changing and being updated on a regular basis. Each business needs a plan unique to their own requirements. Decisions about actions to take will be different for every company and are therefore a matter for each individual business.

Testing, tracing, and isolating are a core part of the UK’s toolkit in the fight against COVID-19, and are likely to remain so until the majority of the UK population is vaccinated. Tests can identify whether someone currently has the disease, helping to pinpoint isolated cases and outbreaks. Tracing works by identifying the contacts of a confirmed case and asking them to self-isolate for ten days if necessary.

The testing landscape is fast-moving and complex to navigate. The CBI has created this factsheet to complement our guidance on NHS Test and Trace and private workplace testing, to help you understand the terms you might encounter when engaging with testing or third-party healthcare providers.

What’s the latest insight and information?

People can access tests through NHS Test and Trace if they have symptoms. Increasingly people can also access tests if they don’t have symptoms, with government recently announcing twice-weekly testing available for everyone in England (a policy the Scottish government will also introduce). Symptomatic and asymptomatic testing will be central to the UK’s COVID-19 response going forward, for detecting cases as well as introducing the possibility of unlocking the wider reopening of the economy.

There are several types of test with different pros and cons, from the gold-standard RT-PCR used by NHS Test and Trace to quick and cheap rapid antigen tests.

What types of tests are available to businesses?

There are a variety of different COVID-19 tests available, with trade-offs between accuracy, pace, cost, and usability – which may impact which scenarios or workplace settings they are most suitable for. These can often depend on whether tests are point-of-care or lab analysed:

• Lab analysed tests see samples collected and sent to labs – generally producing more accurate tests but with a longer waiting time
• Point-of-care tests are currently intended to be used outside a lab by a health professional or trained employee, with a quicker turnaround but potentially less accurate results.

Accuracy is measured against two factors:

• Specificity: The ‘true positive’ rate – i.e. how well a test detects positive results for people who actually have the disease. For employers, a test with a lower specificity rate is more likely to lead to staff having to self-isolate unnecessarily
• Sensitivity: The ‘true negative rate’ – how well a test detects negative results for people who don’t have the disease. For employers, a test with a lower sensitivity rate could risk infectious individuals continuing to enter the workplace. Employers would need to test staff more regularly to mitigate this risk.

Employers should note that no test will be completely accurate, and it will only give a result for that point in time at which a test is taken. Testing should therefore complement, not replace, other COVID-secure measures introduced by firms to stop the spread of the virus, as outlined in the CBI’s factsheet on returning to work safely.

The government advises that businesses discuss with their provider what tests are appropriate for their workplace dependent on use, case and need for accuracy and frequency. The most commonly deployed tests in use by government and some businesses, and which your firm might want to consider introducing, include:

Viral/diagnostic tests – to see if you’re currently infected

• RT-PCR: Regarded as the gold-standard in testing, RT-PCR tests are highly sensitive and specific. However, they are slightly more expensive and can have a longer turnaround time due to being lab analysed. They are performed using a nasal and throat swab and, in most cases, require a medical professional to administer. Most tests conducted by NHS Test and Trace use RT-PCR technology. In the UK these have an analytical sensitivity and specificity of greater than 95%
• Lateral flow device (LFD) antigen: With the ability to be performed in a laboratory, point of care, or home setting, these swab or saliva tests are cheaper and quicker than RT-PCR tests, with results available in 60 minutes or less. Used under the government’s free testing schemes (including for workplaces), antigen tests tend to have high specificity (making positive results highly accurate) but can have lower sensitivity (meaning there is a margin of error for negative results). The current view of LFD sensitivity is between 40-76%. A positive LFD test result should be supported by a confirmatory PCR test, to support the detection of new variants.
• RT-LAMP: A test using a swab or saliva samples. Quicker and cheaper than RT-PCR, with results that can be read by eye. The OptiGene RT-LAMP test has been approved, with a sensitivity of 79% and specificity of 100%, rising in samples with a higher viral load
• LamPORE test: A novel, lab analysed test using LAMP technology combined with nanopore sequencing, again able to process both swab and saliva samples. Analysis from Oxford University has suggested the test has a sensitivity of 99.1% and a specificity of 99.6%.

Antibody/serology test – to see if you’ve been infected in the past

• Antibody: Test that detects whether someone has had COVID-19 using a finger prick or blood test. An antibody test does not tell someone whether they currently have the virus, if they’re immune, or whether they can spread it to others.

Frequently Asked Questions

How do tests and testing providers get approved?

The UK’s approvals process requires COVID-19 tests and providers to meet a number of criteria. The Medicines and Healthcare Regulatory Agency (MHRA) regulates testing kits. Testing kits approved for use must have a valid CE mark to show that the manufacturer has met the minimum safety and performance requirements for the product.

The MHRA has also developed Target Product Profiles (TPPs), setting out how different tests work, the standards they should meet (for example the level of sensitivity and specificity), and their target scope – for example, target use, user, and use setting. PCR tests should be processed by UKAS-accredited labs. Adverse experiences with medical devices like testing kits can be reported to the MHRA using the Coronavirus Yellow Card reporting site.

The government has also set out the minimum standards testing providers must meet in its guidance for self-declaring as a private sector COVID-19 testing provider. A list of providers who have declared they meet these standards (with government performing due diligence tests) can be found here.

What are the routes available for employees to get a test?

The NHS Test & Trace programme continues to provide testing for anyone with symptoms of the virus as well as tracing their contacts. Read the government’s workplace guidance on Test & Trace. The CBI has also produced a factsheet on NHS Test & Trace and the app.

Some employers are undertaking private workplace testing, working closely with local public health authorities to share learnings. The government has produced practical guidance for employers who want to offer workplace testing for asymptomatic employees in addition to the list of approved providers mentioned above.

Businesses registered in England of any size can sign up to the government’s asymptomatic testing scheme for employees who cannot work from home. The government will provide free LFD tests to test employees twice a week in the workplace. Businesses with over 10 employees who cannot offer on-site testing can order tests for employees to collect from the workplace and use at home twice a week.

Eligible firms, including those that are yet to open, must register their interest by 12 April to receive home or on-site lateral flow tests for staff in bulk free of charge until 30 June. Companies registered with the FCA rather than Companies House should email DHSC with their name, FCA registration number, industry and email contact.

Government has also announced that everyone in England can access free, twice-weekly LFD tests from 9 April. An end date is yet to be announced. Beyond workplace testing, there are a range of routes through which individuals can access tests – such as community testing (offered by all local authorities), getting tests delivered to people’s homes, and collection from a local PCR test site.

Government continues to encourage businesses to offer workplace testing as an important channel for individuals to get tests and to provide reassurance. The CBI is engaging with government to gain further insight on the role of workplace testing within the expanded testing programme.

What is surge testing?

Since 1 February, specific areas of England have seen an increase in asymptomatic PCR testing and enhanced contact tracing known as ‘surge testing’. In areas where new mutations have been found that are unconnected to international travel, surge testing is being used in conjunction with genomic sequencing (analysing the virus to understand how it compares with other cases and whether it’s a new variant). It aims to help scientists and public health officials learn more about new variants of COVID-19 in addition to reducing spread by capturing a greater number of asymptomatic cases.

The government has published more information on surge testing and where it's taking place.

How will COVID-status certification use testing?

Government is exploring whether and how COVID-status certification (CSC) might be used to reopen our economy, reduce restrictions on social contact and improve safety. The CBI has responded to government’s Review.

CSC aims to provide reassurance that an individual is at reduced risk of transmission. Government is considering the standards that would be required for certification in domestic settings, and current expects that COVID-status could be demonstrated by using an up-to-date vaccine status, a negative LFD or PCR test taken in the past 48 hours, or proof of natural immunity (e.g. using a previous positive PCR for a time limit of 180 days from the date of the positive test and following completion of the self-isolation period). It will test approaches to CSC through pilots as part of the Events Research Programme.

Further resources

CBI resources

• Watch the CBI’s webinar with Ben Stimson, Chief Customer Officer at NHS Test and Trace, and Lisa Curlett-Harrison, Security Partner at RWE, with insight into support available to firms for workplace testing and how RWE navigated the process
• Watch the CBI’s webinar analysing the recovery roadmap, including updates and insight on workplace testing
  Watch the CBI’s webinar with Baroness Dido Harding, Executive Chair of NHS Test and Trace, and Eddie Fellowes, CEO of Smurfit Kappa, a manufacturer undertaking workplace testing
• Watch the CBI’s webinar with Baroness Dido Harding and Rebecca Weston, COO of Sellafield, to gain insight into how one firm is approaching workplace testing
• Watch the CBI’s webinar with Ben Osborn, MD and UK Country Manager of Pfizer, and Professor Devi Sridhar, Chair of Global Public Health at the University of Edinburgh, which provides insight into COVID-19 vaccination and the continued importance and potential of mass testing

Government resources

• Read the government’s practical guidance for employers who want to offer workplace testing for asymptomatic employees and the government’s list of approved private testing providers.