Covid Scotland: Testing changes will take most people by surprise

At the Scottish Parliament on Wednesday, LibDem leader Alex Cole-Hamilton criticised the "paucity of detail" around the end of universal access to free lateral flow tests, while Labour's health spokeswoman Jackie Baillie warned that there was "no detailed plan for testing the immuno-compromised and their families or carers".

READ MORE: Facemask law remains until Easter Monday - but Covid wave 'peaking and stabilising'

This is not exactly true - but the Scottish Government has not gone out of its way to communicate quite how drastic the changes will be and they will almost certainly take many people by surprise.

England and Wales are already ahead of us.

As of yesterday, free Covid testing ended for the general population south of the border as community-based PCR hubs closed. In Scotland, they remain open to anyone with possible Covid symptoms until May 1.

Source: Public Health Scotland

For the majority of people, however, the most noticeable change will be the loss of lateral flow devices (LFDs).

Their usage doubled after the Omicron wave took off in December and more than 500,000 LFD results are still being reported every week in Scotland.

In England and Wales most people who want an LFD now have to pay for them, with a few exceptions.

They will remain available for asymptomatic testing in England "during periods of high prevalence" (such as the current BA.2 wave) for adult social care staff, hospice staff, patient-facing NHS staff, people working in crowded settings such as prisons and homeless shelters, and for "a small number of visitors providing personal care" to loved ones in care homes.

When virus prevalence is low (however that threshold is defined) testing will be limited to staff in "high-risk settings"such as prisons, hospitals, and care homes, but only if they have symptoms.

At all times, people with medical conditions which make them eligible for Covid antivirals should be provided with free LFD supplies to take as soon as they develop possible Covid symptoms. If positive, antivirals must be delivered to their home within 24 hours.

In Wales, the situation is largely similar, although free LFDs remain available to people with symptoms until the end of June, and to some unpaid carers via their local council.

READ MORE: Why is 'living with Covid' still wrecking the NHS - and where do we go from here?

In Scotland, universal free access to LFDs ends on April 18. 

They will be made available until the end of April for close contacts of a positive case, but pharmacies have already stopped receiving Government-funded supplies and, from May 1, very few people - with or without symptoms - will be tested for Covid, unless they buy their own kits.

The priority will be hospital-based NHS staff, patients preparing for an elective hospital admission, and care home workers based in "long-stay settings for elderly people".

Access to free LFDs for other social care staff, including unpaid carers and community-based home carers employed by councils, charities and private providers, is "subject to ongoing clinical review".

The timeline for Scotland's testing transition plan (Source: Scottish Government)

This uncertainty is causing alarm for the clinically vulnerable and their loved ones.

For months, unpaid carers have monitored themselves for infection to avoid passing it on.

Families visiting elderly grandparents or a relative immunosuppressed by cancer treatment could swab themselves for the virus first.

From April 18, this safety net evaporates.

It is all part of 'living with' Covid: accepting that infections will spread but, with vaccines and antivirals, trying to minimise the harm that they do.

Or, as the Scottish Government put it, the "primary purpose of testing is changing from population wide testing to reduce transmission to targeted testing to support clinical care".

There are potential pitfalls, however.

Firstly, effort has to be made to ensure that everyone eligible for Covid antivirals is registered as such with their health board in order to have free supplies of LFDs on standby at home.

Antivirals work best to stop infections from escalating into serious disease if taken within five days of symptom onset, so time is of the essence.

Secondly, there are concerns that the list of conditions which qualify for antivirals on the NHS - and thus free LFDs - is too restrictive.

It currently includes Down's Syndrome, various cancers, liver and kidney disease, HIV, organ and stem cell transplant recipients, some inflammatory or immune system disorders, and certain neurological conditions such as motor neurone disease and multiple sclerosis.

READ MORE: Fears for vulnerable as LFDs set to be axed for unpaid carers 

Unless they are part of the Panoramic study (a UK-wide clinical trial of Covid antivirals), over-50s will not have routine access to either antivirals or LFDs, and nor will patients with other conditions such as Alzheimer's, obesity, diabetes, or Parkinson's disease, despite these factors also being linked to a higher probability of complications from Covid infection.

The Treasury would argue that spending £2 billion a month on the UK's testing regime was no longer justified for a virus that - thanks to vaccines, natural immunity and Omicron - is now less lethal than flu, even for the over-80s.

Over-75s, elderly care home residents, and everyone aged 12 and over with a weakened immune system are also being offered second boosters to cut their risk of serious disease.

Lateral flow tests, which are taken at home and produce a result within minutes, will only be available to most people if they are willing to buy them in pharmacies and supermarkets

Arguably more could be done though, especially around ventilation.

Research from Addenbrooke's Hospital in Cambridge shows that when Hepa filter/UV steriliser devices were placed in a Covid surge wards and run continuously, the virus became undetectable in air samples.

These are portable, easy-to-use, and comparatively inexpensive machines which could make indoor environments, from care homes to schools and even pubs and restaurants significantly safer - not only from Covid, but from a whole raft of airborne respiratory bugs.

Finally, something that even the pro- and anti-maskers might agree on.