Early lessons from the Liverpool, city wide, covid testing pilot

More on covid pandemic 2020

Early lessons from the Liverpool, city wide, covid testing pilot

Friday 6th November 2020 was the first day of the all city wide, no symptoms testing pilot (as of the eveing of 13th November – there’s now no need to book a test – which makes some of the comments below redundant but asks the question why this way of testing was changed) in the chosen city of Liverpool. As the country enters the eighth month of so-called ‘pandemic measures’ this is the first time in the country something has been introduced that displays a modicum of imagination and approximates what might be considered a strategic approach to dealing with the virus. Everything tried so far has merely been a reaction to events, often resembling a panic, or just a plain and simple knee jerk, reaction to events or various pressures.

This Liverpool testing pilot might lead to a way out of what is becoming a cycle of lock downs (of various intensity) with the same tactics – and slogans – being used in November as were used in March. Society, not just in Britain, hasn’t learnt a great deal from historic plagues of the past 700 years and it was probably asking too much for anything to have been learnt in the last seven months.

But will this new approach make any difference? Obviously it’s too soon to say but at least it is different and has the feel of attacking the virus rather than just running from it in the hope a miracle vaccine will arrive in the not too distant future.

For that reason – and as this is supposed to be a pilot where lessons, both positive and negative are learnt – I thought it would be useful to document the experience surrounding a test taken on the first day to see how it did work, with both a few pluses as well as a number of negatives. How those lessons are evaluated by those concerned for running the test in the early days will be even more crucial than the testing itself, especially as success in Liverpool could entail such an approach being applied throughout the country.

Accessing the Government’s test booking site the day before the test was due to begin didn’t bode too well when there was a line saying that test slots ‘would be available soon’. With the memory of failed testing ‘experiments’ in the last seven months (whether they be the actual testing itself or the use of the test-trace-track mobile phone app) not to be able to book a test less than 24 hours before the programme was due to begin didn’t inspire confidence. That was a bad thing.

Although an earlier visit to that website showed the test centres opening between 09.00 and 19.00 on the Friday 6th November by late on the 5th the opening time had been shifted to 12.00. This seemed to indicate that the announcement had been made before the actual logistics had been fully worked out. This was reminiscent of the wild and woolly promises by the Buffoon earlier in the year about the numbers of tests that would take place each day as well as the speed of the return of the results. So that was another bad thing.

However, by 09.30 on the morning of the 6th November (when I again went online) it was possible to book a slot for the same day. I thought the official site was overly complicated. There was a lot of personal information that had to be entered before there was any chance of choosing an actual time slot. Wouldn’t it be better for people to first pick the test centre and time slot best for them and only then enter the information needed to be able to process the test results?

This is not least because the system considers you are applying for a same day appointment but if you are late in the day, when appointments are starting to run out, then you are possibly offered a test in another, more distant centre, or the option of a test sent to your home. If that’s not what you want to do you have to start from the beginning. There may be a logic in the way the questions are ordered but I can’t quite see it.

(Here I’m describing the booking of a walk in test – those with vehicles are probably slightly different and the request for a home test would, obviously, follow another route.)

So you have to put in quite a bit of information about yourself, some of it quite personal – such as an NHS Number – and this should be ringing some alarm bells for those in authority as hackers would love to get hold of such information and the NHS doesn’t have a great record in being able to defend itself against outside attacks.

You don’t get a designated time, as I expected, but a 30 minutes time slot when you should arrive at the centre. Whether this will change is another matter. On the first day there would have been some question as to how many people would arrive and as we are dealing with a whole city (of about 500,000 people) a certain amount of flexibility would be necessary, at least at the beginning. This made sense on thinking about it but didn’t when you consider how the process played out.

There is a logic of having a more exact time for arrival. The naysayers are already complaining that the process means many people are standing together for a longer time than is desirable. That might be true but the answer to that is not to ditch the pilot but to speed people through the process so that they are together for as short a time as possible. As a recent example of how a more specific time slot works an appointment for the annual flu jab at a nearby general practice a couple of weeks ago meant that no big queues developed whereas a 30 minutes slot means that everyone in that section of time arrives at the beginning of the slot.

After going through the process of entering all the personal information you are sent (depending upon what information you had supplied) a confirmation via text to a mobile and/or an email. You were asked to show the text message (or printout) as proof you had made a booking and would be able to present the QR code on arrival. I was able to print out the email but when I tried to go to the Print page on the Government’s website (at the end of entering all the information) the page didn’t have the necessary link – just an empty page with an official heading. That issue should be addressed – why have a website with broken links – especially in such circumstances as a pandemic? But then again, this is a pilot so, hopefully, these matters will be continually monitored to see what is working and what is not.

On the print out it asked that you arrive at the test centre with a face mask and also a photo ID, such as a passport.

So I’m down for the first time slot of the first day (12.00-12.30). I arrive at the centre (the sports centre in Liverpool 8) exactly at 12.00. But I’m far from being the first in the queue. There are a lot of people (which is a good thing) but it seemed that some had booked but others had not as there were two queues, one inside the perimeter and one outside, those with a booking being allowed through the gate first. However, those standing outside started to get somewhat annoyed seeing those people ‘jump the queue’ – or so they thought – and soon the two queues became one.

But it must have been about 30 minutes before there was any movement at all with people entering the building. The delayed start from 09.00 to 12.00 therefore seemed to have a reason – and that seems to have been because they were not fully prepared, which is a bad thing.

Now an aside, but possibly an important one. The 6th November in Liverpool was a bright and sunny, but cool, autumn day. The rest of the days of this pilot are unlikely to be be the same pleasant experience as people wait out in a queue that isn’t moving. To help make this pilot a success there will need to be shelter from the elements provided, especially the rain, if the number of covid deaths are not replaced by pneumonia caused by standing and getting soaked and frozen. Just putting some temporary protection in place to make it as ‘inviting’ as possible is all that’s needed, especially if the aim is to get people making regular visits to a test centre as we go through the winter. If the process gets speeded up (which it should do) then there will be less need for this temporary shelter but the pilot could fail if people are asked to stand for an hour subject to the elements.

At about 12.55 I reach the entrance, staffed by a young soldier in uniform. This is where the system started to fall down. There was no request for the form with the QR code you are told to bring and which connects you to the information already entered on the Government’s website when making the appointment. Neither was I asked for any photo identification. So why were we told to bring photo ID?

Instead every one was given a card with it’s own QR code – plus 4 bar codes stickers with an identical number. This small card is professionally produced and it is hoped that they exist (under normal circumstances) for those occasions when people don’t bring what they have been told to bring. There was not a sign of a QR reader on site at the test centre – was that the reason for the issuing of yet another QR code?

Everyone was told that they should scan the QR code on the card with their Smartphones and then fill in the details asked for – which were the very same details that were asked for and which took some time to enter in the comfort of your own home. Now if you don’t have a Smartphone you are snookered. The young soldier at the entrance, when informed of this, stated that someone at the end of the corridor (just before going into the room where the tests actually take place) would have an iPad and the necessary information could be entered there.

That turned out not to be the case. At the end of the corridor was another young squadie who wasn’t expecting this sort of request and certainly didn’t have an issued iPad to hand. The ubiquity of Smartphones meant it took some time for the first people without one to arrive. So a lack of communication here between the soldiers staffing the centre, a lack of initiative from their officers or City Council in not foreseeing such a situation and a lack of provision of the hardware necessary to deal with such a circumstance.

This young squadie then used his own Smartphone to take a picture of both the QR and the bar code followed by entering all personal details – as I said, the very ones that were already in the system. So the whole process that everyone had to go through to book a slot was just a waste of time – and when you want to get people on board with something like the Liverpool pilot you don’t want that. And it should not be for some young soldier whose task is just to process people through the system, to have to use his own personal phone for something that should have been foreseen once it was decided that the registration cards were to be given to everyone entering the centre.

So something that should be looked at there. It would obviously be better to be accessing this information which is already on the system by providing those at the entrance with a QR reader. Was this one of the things that were not in place on the 6th November in L8 and the card was a fall back? This is something that should be rectified soon (if it has not already been so). Apart from anything else a reader would speed up the processing of people.

Then it was in to a room (one of the gyms) where a number of temporary booths had been constructed – about 12, I think, although not all being used. Again why? Was it because there was a doubt of the ability to process more people? Was it just getting into the swing of things? Shouldn’t the process have been tested somewhere, at some time before the centres were even opened? All questions which should now, into the fourth day of the pilot, have been answered with a positive resolution.

At the entrance to the gym you are given a long, thin swab in a sealed bag and directed to one of the booths where you carry out the test yourself. There’s an instruction leaflet attached to the wall. You carry out the test and then poke your head and hand through a cut out window into the centre of the room and a soldier will take the swab – and one of the bar codes – and that’s it.

The card is not taken off you – it’s yours as a souvenir, together with two of the bar code strips – so why give out four? Then its out through the back door.

The test itself took just three or four minutes but I had been on site for one hour and a quarter, leaving the building at 13.15.

Given that the 6th was the first day then a little bit of leeway can be allowed. I would hope, however, that the system in the next few days gets more streamlined and processes people much quicker. For the length of the time it took to take the test the people should have been going through that centre much quicker.

So what about the result? A number of times 40-45 minutes was mentioned as the time that would lapse before receiving a text message on the mobile phone (an email is also sent at the same time if supplied) However, my result didn’t arrive until 15.23. Much quicker than we have heard about with tests taking place in the last few months but still a lot longer than the 40 minutes ‘promised’. If we have learnt nothing from the Buffoon in the last eight months is that you don’t promise what you can’t deliver.

So some minor problems on the first day. Not perfect – and not really needing much to make it so. Just connecting together the information already entered and the individual – and perhaps making the process faster and providing some sort of shelter if the queues are going tp develop outside in the bad weather.

Just a few more thoughts.

I wasn’t aware of anyone, either from the Army or the Council, who seemed to be monitoring what was going on or how easy matters were processed. All the people in the centre seemed to be there to move people through the system and not looking to see what could be improved.

There is no method where (as far as I can see) those attending the test centres can give ‘feedback’. It’s possible to make a comment about the gov.uk site but not the experience of the individual test centres. Wouldn’t it be a good idea to understand if some centres are managing better than others. After all they are all very distinctly different buildings and will have their own peculiarities.

There’s no information about the process of a repeat test. When the Liverpool pilot was first announced it was suggested that people would go for a retest after a period to make sure they hadn’t been infected in the meantime. Is that the case? Will people be called back as a matter of course. After all, the system now has the contact details (mobile number and/or email address) of an increasing proportion of the city’s population. Would it also be an idea for the Council to use the paperless system that is related to Council tax to send out a general email to encourage those who have not taken the test to do so?

More on covid pandemic 2020