To mark four years since Liverpool led the world’s first voluntary mass testing for Covid-19, The Pandemic Institute has collaborated with Professor Iain Buchan to produce a short film exploring the city’s response, and how we can use data-driven community testing in future pandemics.

In November 2020, during the COVID-19 pandemic, large-scale community testing with lateral flow devices was piloted first in Liverpool to save lives and livelihoods. The hope of this testing was that it would slow the spread of the virus and allow the city to move to a lower level of restrictions, enabling vital parts of the Liverpool’s economy to reopen and relieve pressures on hard hit families living in poverty.

Around 2,000 army personnel were drafted in and helped to facilitate over 200,000 tests at almost 50 testing centres. The Army worked as one team with Liverpool City Council, the University of Liverpool, NHS and charity and voluntary sector organisations. A quarter of the population came forward to be tested in a month. Residents took swabs themselves while they were observed by soldiers, who processed the samples on lateral flow devices. Evaluation found that mass testing was associated with an overall reduction in COVID-19 related hospital admissions by a quarter, and cases by a fifth.

A pilot study using daily testing as an alternative to quarantine saved 8,292 key worker workdays. At the time there was a risk of critical services (e.g. a fire crew) being out of action in quarantine.

The short film we released today explores people’s experiences of taking part in the testing and summarises a recent review we carried out for the UK Health Security Agency (UKHSA) on how to best use community-driven testing in future pandemics.

Community testing is a complex intervention that needs data, real-time intelligence and strong involvement of local communities to achieve maximum value. During the COVID-19 pandemic, large-scale testing enabled us to:

• Protect vulnerable individuals and settings
• Release people from quarantine or isolation promptly and safely
• Recover the economy, public services and social activities important for wellbeing

In a recent review, we convened a panel of experts involved in COVID-19 testing to reflect on the recent pandemic and identify data and evaluation requirements for intelligence-led community testing in future pandemic scenarios. The review identified areas for developments, including science communication and access to national data, and set out recommendations for future community testing schemes such as prompt, well-governed access to nationwide data and defined strategies for entering and exiting testing promptly for maximum value. You can find full details of the review here.

Professor Iain Buchan from the University of Liverpool said: “There is a lot to learn from how Liverpool’s people responded to the offer of new testing tools to take back control of their own lives, and to save lives and livelihoods in the COVID-19 pandemic. Quarter of a city coming forward in November rain to be tested, despite media doubts over the value of doing this, showed the power of community at the heart of public health.” 

“Testing is as much a social as a biological intervention – one person testing in a family may affect the whole family’s behaviours around the risks of spreading a respiratory virus. Our evaluation of the Liverpool pilot brought members of the community together with a broad range of professionals and researchers, considering biological, environmental and social aspects as an integrated public health taskforce.” 

“The Scientific Advisory Group for Emergencies (SAGE) received the stop-go evidence for making a national community testing policy within five weeks of the first testing centres opening in Liverpool. The original evaluation team has published many subsequent articles and continues to help scientific, policy and public audiences prepare for future pandemics – including the current purpose-led, data-responsive testing framework produced for UKHSA and fed into the COVID-19 Inquiry”. 

“Importantly, through this film, we want to thank the people of Liverpool for helping the world to understand how to respond to COVID-19 with community-driven testing.”