Written Evidence Submitted by the Earlham Institute

(C190024)

Proposal for Norwich Test, Track and Trace Pilot for COVID-19

Summary

During April, scientists and medics based at the Norwich Research Park (NRP) collaborated on a proposal for a community test, track and trace pilot for Norwich. The proposal is in line with Pillar 4 of the Government’s COVID-19 testing strategy regarding surveillance. The pilot is supported locally by stakeholders (including local government) but Government support is crucial to delivering the project. 

The proposal was sent to Ministers and senior officials in the Department of Health and Social Care, and Public Health England, including Professor John Newton, in early May.  Officials have recently indicated that whole city testing is not an immediate priority for government support, but no further explanation or engagement has been forthcoming. Whilst the NRP and its partners stand ready to continue to assist the Government in its Pillar 2 testing requirements, it would be helpful if the Science and Technology Committee can elucidate the reasons for the Government’s decision to decline support for the Norwich proposal.

Norwich Pilot Objectives

The Earlham Institute, John Innes Centre, University of East Anglia and the Norfolk and Norwich University Hospital have been working together to establish the Norwich pilot.  The proposal is developing on a daily basis, but we have secured the support of other local stakeholders who may be involved in the delivery of the pilot, such as Norfolk County Council and Norwich City Council. We have also received offers of support from local business, community groups and military reservists.

The Norwich pilot uniquely offers the Government the ability to develop a framework for local delivery of a test, track and trace infrastructure while generating vital epidemiological data.  Even with social distancing in place, the reproduction rate of SARS-CoV-2 is likely to increase again as restrictions relax. Particularly challenging is dealing with the spread through individuals who are infectious before the onset of symptoms, those who present with atypical symptoms, and those who never develop symptoms (asymptomatic carriers). Current Pillar 2 testing strategies focus on those who show symptoms and thus cannot control the continual spread caused by asymptomatic carriers. 

The Norwich pilot would trial testing a proportion of the community on a weekly basis. Cases of infection would be caught earlier and asked to self-isolate, and, additionally, asymptomatic cases would be identified. Such a strategy would enable a more rapid isolation of those who are infectious (symptomatic or not), minimising the spread of the virus whilst at the same time avoiding unnecessary isolations. It would also enable scientists and authorities to trial novel testing strategies to reduce cost and time-to-result. The information produced by this pilot would allow greater knowledge about how the virus spreads, whether specific environments or people are more at risk, and how to identify where lockdown restrictions can be relaxed or reinforced.

Why Norwich?

Norwich has several unique advantages which makes it an ideal location to trial this project:

• The city of Norwich has a relatively static population of around 140,000 people with relatively low incidence of COVID, which would make testing and contact tracing less challenging. 
• There is a large national infrastructure of bioscience facilities on a single campus at the NRP, which includes four independent research institutes, one of the UK’s largest hospitals and the University of East Anglia.
• The NRP has worked with the hospital to scale up its Pillar 2 clinical testing seven-fold in the last few weeks so already has established, trusted partnerships which will enable this project to be established quickly. A survey of the Norwich research institutes and the University shows that, collectively, we have the infrastructure and capacity to carry out the requisite level of testing in addition to the Pillar 2 testing we are conducting.

Proposed Project Plan

Some of the details of the pilot project cannot be confirmed until Government support is offered but early discussions between the research institutes, hospital and university have so far produced the following proposal:

1. Sample kits would be posted to all residents of the agreed test area in Norwich, asking them to self-test by collecting and sealing their sample. All samples would be bar-coded for individual identification. We are currently testing the reliability of saliva collection over swabbing to simplify self-testing.
2. Samples would be collected on the same day and delivered to the labs just a few miles away. We are still exploring several different options for collection.
3. The Earlham Institute currently has sufficient laboratory capacity for 5000 PCR tests a day which could be further expanded.
4. Results will be submitted to a database with the test individual’s barcode ID.
5. Ideally, individuals that test positive could be enrolled into the UK national contact tracing system and would be informed and asked to self-isolate and provide a list of contacts for tracing purposes. If this is not possible, we will explore local options for following up with these individuals to trace contacts.  
6. Infection levels and hospital admissions would be monitored to see if the strategy is effective.
7. If the strategy proves feasible and effective, further testing and tracing schemes could be replicated throughout the UK (and beyond) benefitting from the lessons learned in Norwich.
8. Our collaborators at The London School of Hygiene & Tropical Medicine and University of East Anglia would analyse data from the study to develop much more accurate epidemiological models that can inform both local and national policy and testing strategies.
9. Through the course of our pilot project, we would obtain the genetic sequence of the virus from positive samples, which would enable the identification of transmission chains and inform further areas of COVID-19 containment strategy.

Important provisos

For this pilot to be successfully trialled in Norwich, Government support is crucial. This includes funding as well as logistical and infrastructure support, particularly where it involves primary care providers. The pilot should form an important part of the Government’s COVID-19 strategy, much like the results of the Isle of Wight pilot.

Furthermore, the NRP would process the Norwich pilot samples in addition to continuing to support the current hospital-led COVID-19 testing.  It is important that the pilot does not compete for resources or distract from the current testing that is part of the Government’s Pillar 2 strategy. The pilot would therefore establish a parallel testing infrastructure using research equipment and reagents separate from clinically validated tests. We are currently working with industry and academic partners, including Oxford Nanopore Technologies, Tecan and The Francis Crick Institute to develop and benchmark faster and cheaper tests.

Conclusion

There are increasing calls for the testing and tracing strategy to be more localised and bespoke to the particular infrastructure and circumstances of each city and region. A more local approach would reduce the delays and logistical difficulties associated with the centralised regime and mobilise local expertise, including primary care networks and partners.

The Norwich pilot would limit the spread of the virus more successfully by identifying and isolating asymptomatic carriers, as well as those experiencing symptoms. The pilot would also offer the opportunity to trial other aspects of surveillance testing and tracing to inform a national roll out, such as the practice of pooling samples, exploring resource efficiencies, and focusing on specific communities, demographics and environments.

Most importantly, the Norwich pilot would save lives in Norwich whilst providing reliable epidemiological data that the government could draw upon for future policy on exiting lockdown and controlling the disease.

(21 May 2020)