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Recovery4Life: Essential business services, supply chain and Covid-19 testing

Posted on 06 May 2020

This pandemic has caused something of a shift in terms of what is acknowledged as essential to the UK economy. The NHS and food supply chain are rightly, and unsurprisingly, considered as key. There are other, “hidden” essential business services – hidden in the sense that they attract less media coverage - that are equally essential to the running of the economy, and if were drawing a Venn diagram, we’d see a strong overlap with the NOF membership.

The team here at Recovery4Life are grateful that you do what you do to support the region and wider economy, and as fellow NOF members we see it as our duty to keep you updated on Covid-19 testing. No hyperbole or spin – just the facts as our expert clinical team see them. We hope that this is useful information and that you know we’re available to discuss, in confidence, all matters related to testing and mental health.

Covid-19 testing is complex, and to support this document we have a slide-deck that we can share with you if you would be interested – please contact us on the details, below. Finally, please note that the information here is consistent with the UK Government’s guidance.

Testing for businesses

While there are plenty of test kits available, not all tests are equal: the accuracy rating differs, as does what is being tested and how this is done. For example, one such test available to the market as a white-labelled kit, is an antibody test that has an accuracy from as low as 80% to mid-90%.  By comparison, the one we use at Recovery4Life is rated as 98.7% accuracy. You may argue that 92% accuracy is okay, but we wouldn’t use it [1]. That said, the test’s accuracy isn’t the main problem: the most important component of testing is how you use the test, and where it fits into your wider approach to managing risk in the business.

When using antibody tests, please remember that an antibody test does not tell you if you currently have the Covid-19 virus; it tells you if your body may have created antibodies as a reaction to exposure to the virus.

Two things here are key to understanding risk to the individual (and risk to others):

  1. the accuracy of the tests used
  2. understanding where in the cycle of exposure someone may be.

WHO guidelines are very clear that only a back-to-lab PCR test can be used to formally identify the virus. Antibody tests are purely a blunt tool to act as an indicator; they neither indicate whether you have had the virus nor confirm whether your body has developed long-term immunity. We are aware that both claims about antibody testing are regularly made.

The whole debate around testing is a moving feast. In order to stay abreast of developments, and understand the issues, we are working closely with:

  • Our Medical Director in terms of impact in the community,
  • A Professor of Biology at Durham University who helps us keep up to date with research – particularly European  
  • Laboratories we have long-standing relationships with
  • An Infectious Diseases Consultant, who has advised on progress on treatment and latest testing technologies being considered by the NHS and other health systems. 

Specifically, we’ve been interested in how New Zealand, South Korea, Singapore and Germany have managed the pandemic. For example, the tests we have adopted have been used in New Zealand to great effect. 

Given these vagaries around testing, the approach we have been taking with our commercial clients is one of risk management – i.e. making the best judgement on the information known at the time.  This doesn’t just rely on an individual test but on four areas:

  1. Symptoms of the employee and family members living with the employee (with start and end dates) – to limit as much as possible transmission into the workplace;
  2. Underlying health conditions of both – to limit the impact on the family/individual;
  3. Social/job factors – including identifying high risk roles of partners and individual roles – identifying other risk factors;
  4. Screening – on-going checking for symptoms including temperature checks, and testing – both antigen PCR testing (back-to-lab) and instant antibody tests (identifying IgM and IgG). We are also now able to offer back-to-lab antibody tests where there is a specific question around concerns re antibodies.

Testing is essentially a blunt tool, but by taking the above approach and using the different testing mediums at different points in time, we can – and have been able to – provide a framework for informed decision-making. This is a different approach to that taken for clinical assessment or treatment; we are trying to look for trends to assess ‘well-ness’ not prioritise ‘illness’. These are still early days and we will need to constantly review, assess and develop our approaches as things change.

Six things we do not yet know

  1. How long antibodies stay in the system and how easily triggered these could be by re-exposure to the virus.
  2. Levels of long-term immunity.
  3. Impact of asymptomatic carriers, and super-spreaders.
  4. Whether all variants of Covid-19 will respond in the same way.  CDC in Wuhan have reportedly identified over 30 different strains.
  5. The impact of demographic variables such as BMI on identifying risk etc.
  6. How many cycles/waves of the virus we are likely to experience, especially towards the end of the year in winter.  

To this end we offer both self-testing for PCR antigen testing and instant antibodies, with the option of door-to-door testing. We are also in the process of setting up on-site PCR testing, that will identify Covid-19 and offer results in 45 minutes, as well as mass screening testing for return to work.

Nine things that we do know are being affected

I would stress though that testing is a solution to just one part of the problem of getting businesses back up to speed. Other concerns we are looking at include the impact on mental health at the end of isolation and what is likely to be phases of future isolation, and the role of Mental Health Programmes, such as MHFA. This includes:

  1. At the time of writing, over 18,000 people have died in the UK from Covid-19 to date in Hospitals.  This does not include deaths in community settings/care homes and organisations such as the Welcome Trust predictions that the actual death rate will hit at least 40,000, has already been realised.  It is not known what the long-term effects on existing health conditions will be of those that survive the virus.
  2. Physical health is likely to suffer with reduced fitness and already poor diets made worse.
  3. Unsurprisingly, anxiety and depression have significantly increased in the general population
  4. Recent reports have seen up to a 28% increase in alcohol use, which over time greatly increases the chance of dependency
  5. Shortages of over-the-counter medications with codeine in them would indicate either/or/and stock-piling and increased usage – the North East already has the highest level of codeine usage in the UK and this is set to rise.  
  6. Experience from confinement following the SARS outbreak showed between 28% and 40% of people being isolated experiencing signs of PTSD, more recent studies in Wuhan have shown around 17% experiencing PTSD (though PTSD often occurs months after the event, so it will be too soon to judge).
  7. Domestic violence has increased significantly
  8. Debt and worries around debt are on the rise.
  9. Suicide and attempted suicides are on the increase according to the Police Federation.

These issues are clearly things to consider in terms of revising Health & Well-being strategies, but also have a direct impact from a behavioural health & safety perspective, as it is unlikely that things will return to exactly how they were before the pandemic. We recommend that businesses start planning for this sooner rather than later and effective testing will be key in supporting this.

Recovery4Life contact details
Call: 03333 448 288
Online: https://www.recovery4life.co.uk

[1] At the time of writing, PHE have not set what accuracy levels they will accept for antibody testing – despite considerable and on-going pressure from the testing industry - and have not approved any antibody tests to date.