The social life of COVID-19 testing
A summary of Dr Alice Street’s talk at Edinburgh Responds webinar series
The coronavirus pandemic has raised public awareness of the important role of diagnostics in public health.
Demands for more tests for COVID-19 continue to be at the centre of political debate and criticism of governments’ handling of the pandemic, particularly in the UK and the US. The political messaging around testing has underplayed the complexity of diagnostics, particularly in relation to the emergency response.
Political leveraging of diagnostics has placed enormous expectations on COVID-19 tests. They are expected to provide certainty on the pandemic situation the country. They are expected to reassure that the measures taken by the government and health authorities are appropriate for controlling the spread of the pandemic. They are expected to provide a guarantee for people to come out of the lockdown and get back their freedom of movement. Perhaps above all, they are expected to set countries on to the path of economic recovery.
Experiences from DiaDev's (Investigating the design and use of diagnostic devices in global health) research in Sierra Leone in the West Africa Ebola response in 2014-2016, and ongoing COVID-19 related research in India and the UK, show that there are multiple kinds of diagnostic technologies with varying usages and benefits. Different kinds of tests are best operated in different places – triaging patients, for making decisions on clinical care of individual patients and for surveillance purposes.
The focus on getting more and better tests has also diverted attention from building capacity of national laboratory systems, particularly in the low and middle income countries.
Reflecting on these experiences, it is evident that even in a country like the UK, there are weaknesses with the supply chain and the manufacturing system for diagnostics. The focus on point of care diagnostics may be distracting concerned authorities from considering the comprehensive ‘diagnostic system’, from production to marketing, distribution, maintenance and waste management.