This updated COVID -19 testing strategy sets out our testing priorities and the use of testing technology.
Higher prevalence of COVID-19 and the emergence of the new variant has required alert level 4 restrictions in Wales.
Testing continues to play a pivotal role in our overall approach to preventing the transmission of COVID-19 across Wales alongside other measures including the impact of safe and effective vaccines. In time it could mean that restrictions are eased and we can move step by step towards a return to more normal day-to-day life.
However, effective suppression of COVID-19 transmission will continue to be vital to manage the virus even as vaccines are rolled out, including for those who cannot be vaccinated.
We know that up to a third of individuals who test positive for coronavirus have no symptoms at all and can therefore spread it unknowingly. The revised Testing Strategy for Wales sets out how we plan to deliver on our priorities during 2021, including a range of approaches to test asymptomatic people. This includes those working in the NHS and in social care, in other high-risk settings and delivering key services.
The strategy recognises under its ‘Test to Find’ approach that identifying and isolating COVID-19 cases in the community reduces the transmission of infection, supports contact tracing, protects vulnerable individuals and helps to slow or stop the spread of the disease.
Given that a third of the population testing positive show no symptoms and uptake for testing in some communities is low there are certain contexts in which we need to deploy more active case finding approaches within communities.
The learning from the testing trialled in Merthyr and Lower Cynon during late November and December 2020 and from other areas such as Liverpool has identified in our revised Testing Strategy the potential of locally led community testing that targets active case finding based on local intelligence and knowledge.
This document sets out the Welsh Government framework and offer of support for community testing and invites local health boards and local authorities to work with other Test Trace and Protect (TTP) partners to develop locally led proposals.
Community testing programme
This section provides an overview of the Community Testing Programme for Wales, including its key benefits.
Community testing – key benefits:
- Supports ‘Test to Find’ and also links to ‘Test to Maintain’ approaches set out in our revised Testing Strategy for Wales
- It provides a locally led public health risk based approach using area intelligence and knowledge to reduce the spread of the virus
- Provides additional asymptomatic testing capacity within communities
- Removes barriers and incentivises people to take up testing and self‑isolation
- It identifies active cases from individuals showing no symptoms and unaware they are potentially infecting others
- Enhances local surveillance in the community to aid further actions by partners
- Provides additional reassurances and support for communities when restrictions start to ease.
Our revised Testing Strategy sets out the priorities to reduce the harm of the virus and how new testing technology will work alongside our existing testing infrastructure to support delivery. As we begin 2021 our approach will continue to evolve to meet the challenges we face including how our testing programme will continue to play an important role in supporting us to save lives and livelihoods alongside vaccination.
Testing makes it possible to identify people who have the virus and to target support to help those who are positive and their contacts to isolate so chains of transmission of the virus can be broken. We now have a number of channels through which people with symptoms can access testing including a network of testing centres with more planned for 2021. This makes testing for COVID-19 more accessible for those with symptoms than ever before.
Our testing sites include:
- Regional Testing Sites (RTS) – that provide drive through facilities
- Local Testing Sites (LTS) – that provide walk in facilities
- Mobile Testing Units MTUs) – that can provide flexible facilities to increase accessibility and to focus in areas of need
- Home testing – for people to have tests posted to them to take at home. But given that people may have mild or no symptoms there are certain contexts in which we need to deploy more active case finding approaches such as those trialled in Merthyr and Lower Cynon where whole area testing was undertaken during late November and December 2020.
Case study: locally-led community testing in Merthyr Tydfil and the Lower Cynon Valley
Merthyr Tydfil County Borough was identified as an area community leaders wanted to explore the potential for community testing due to the high prevalence of COVID-19. Between 21 November and 18 December everyone who lived, worked or studied in the area was offered repeat testing with a rapid lateral flow device. Test sites were set up in the community and tests were also offered to staff and pupils at secondary schools.
Between 5 and 22 December the pilot was extended to the Lower Cynon area of Rhondda Cynon Taf County Borough.
In total, almost 50,000 tests were carried out with 1,135 returning positive results. People who tested positive and their contacts were supported to self‑isolate.
The interim findings concluded there is a role for targeted community testing using lateral flow tests in more deprived communities, with local businesses and periods and places of temporal increases in incidence.
The capacity and rapid test technology now available to us provides us with an additional tool to reach out further, working in partnership with local leaders and areas to deliver locally led targeted community testing for areas with high prevalence or significant risk factors. This framework outlines the support available for local areas to set out plans for how they will ‘Test to Find’ people who are infected and potentially infectious but asymptomatic and unaware that they might be spreading the disease, so that we can trace their contacts, support them to isolate and prevent transmission to others. It is aimed at supporting local health boards and local authorities working with TTP partners to develop proposals that use local intelligence and engage the
communities they are targeting.
Locally led community testing
This section sets out, based on our learning to date, aspects of community testing that are most likely to contribute to its effectiveness in reducing transmission and support communities as we potentially ease lockdown restrictions:
- Community testing will be locally led by health boards and local authorities delivered in partnership with other TTP partners, the voluntary and community sector and local businesses. It is for local areas to determine the best way to target testing, maximise the reduction in prevalence, and roll out participation incentives for their communities.
- It will use evidence and work alongside resources available under the NHS Test Trace Protect service including PHW data, use of the App and close working with the local tracing and protect teams. Learning from Merthyr and Lower Cynon has highlighted community testing should be based on a risk based targeted approach. This will involve assessing areas that have higher positivity rates, lower up take of testing, industries/activity that have higher exposure to risks or do not allow people to work from home and periods and places of temporal increases of incidences. This risk based assessment should enable smarter more focused testing plans and support.
- The risk based approach and assessment will also require proposals to fully consider the needs and impact on vulnerable hard to reach groups and those identified as having low engagement with testing. This will need to include accessibility of testing, communications and importantly how you incentivise people to take part including innovative approaches to encourage take up and self-isolation. Welsh Government will work with local partners on ideas and potential opportunities for incentives and enhanced support.
- Key to success of community testing is ensuring local engagement that result in high levels of both turnout and compliance with self-isolation. The more people tested, and the more positive cases and their contacts isolated, the greater the reduction in prevalence.
- Set out funding and support requirements to deliver testing over and above that available in existing programmes and which is proportionate to the scale and ambition of the proposal.
- Based on an initial 4-week programme delivered in partnership with an agreed assessment of impact and exit strategy.
- Considered duties as specified under equalities and Welsh language legislation and other statutory requirements. Sit alongside other TTP provision and not duplicate funding and services that are already being provided.
While a guiding principle should be that local areas can tailor incentives to their local needs, a number of non-negotiable principles apply:
- testing cannot be mandatory
- all incentive packages and other measures designed to drive turn out or compliance with self-isolation will need to be modelled to ensure safety and signed off by both the local Director of Public Health and the Chief Executive of the local authority.
Support available for community testing
Welsh Government Support under the programme will include:
- On-going guidance and support from officials from initial design phase to delivery including planning, logistics, set-up, waste management and communications that draws on the learning from Merthyr and Lower Cynon.
- Provide lateral flow devices (LFDs), PPE required and the clinical protocols that have been developed in accordance with the scientific validation of lateral flow devices. This includes a clinical standard operating procedure (SOP) and a lateral flow testing guidebook which includes:
- the citizen testing journey. Proposed citizen journeys, both digitally and nondigitally enabled. Aspects of the nondigital journeys can be tailored to suit local need
- the end-to-end testing process. Guidance on how to conduct the testing process, including the required quality assurance and clinical governance processes
- digital support for the testing processes. Digital software solutions for user registration, results capture and delivery guidance on how to identify, select and set up new test sites. Local areas will be able to select venues based on their suitability and proximity to targeted groups. Local workforce will be responsible for setting up and running test sites
- training: online training covering all aspects of the skills and knowledge required to deliver lateral flow testing. Materials will also be available to enable delivery of the training through other channels
Wastewater sampling – we are working under the programme we have in place to understand if it can assist the community testing programme.
PCR Testing – we can consider supporting proposals from our testing infrastructure via Mobile Testing Units.
Other testing technology – we are also looking at the opportunities to provide other mobile testing technology, for example LAMP, to support our community testing programme.
Funding - funding available will be estimated based on the number of lateral flow tests local areas project they will deliver. Initial proposals submitted should work on the parameter of total funding per test set at £14.00, for example, plans aiming to deliver 10,000 tests would plan on a budget of £140,000. The funding per test is expected to cover all reasonable costs associated with the programme including site costs, workforce costs, local communications and marketing, logistic and other delivery costs. A local area will only be reimbursed for actual costs incurred. Welsh Government officials are happy to engage with partners on funding estimates to ensure costs are covered to deliver plans and achieve the expected outcomes.
Partnership proposals – what they need to include?
We fully understand the broader pressures on local systems at the moment and are therefore asking for ‘light’ proposals which succinctly set out:
Details of your partnership (including the lead partner) and the community testing proposal for your area setting out your aims and objectives and the local impact you expect to achieve in the proposed communities. This will need to include the rationale for prioritisation based on a risk based approach, such as stubbornly high levels of prevalence (such as 7 day positivity rate per 100,000) and/or other factors.
Whether there are groups within the community prioritised who may not currently engage with the testing programme and who should be targeted as part of this intervention.
Timeline for implementation including planning and delivery phase.
Resourcing plan including resources local partners will be providing to support delivery and the resources, support required from Welsh Government as outlined above and anticipated budget requirements.
Communications and engagement – setting out how you will engage with communities that you are targeting including the incentives that you are planning to offer and expected behaviours and implications on results both positive and negative.
How you are working with the contact tracing and protect teams to provide an end to end service and wraparound package within the community, including promotion of isolation support and encouraging adherence to the measures in place. This could include suggested incentives to support self-isolation.
Evaluation - your plans for evaluation and impact assessment including consideration of achieving your aims, successfully engaging with your targeted communities and finding cases that are then supported to self-isolate to reduce transmission.
Additional costs above the £14 per test will be available for evaluation work.
Timeline for proposals
We are asking for initial proposals to be submitted by 15 February with the expectation that local partners would be in a position to start delivery early March. Welsh Government will engage with partners on the development of plans to aid logistics and lead in time for implementation to start in early March and will hold webinars and provide further guidance in early February. Proposals will need to be submitted to: Covid19.CommunityTesting@gov.wales