Lateral flow tests are limited, says Professor Denis Kinane, chief medical officer of Cignpost ExpressTest
Travel and tourism have been among the worst-affected industries by Covid-19.
In addition to the headline redundancy figures reported by major airlines and airports, recent Abta analysis found 195,000 of 526,000 people usually employed in the sector had either lost their jobs, or were on the brink of redundancy.
More than half of small businesses in the sector reported they would not survive another three months without trading. Millions have also been unable to travel, not just for holidays or business but to see families cut adrift abroad.
The picture is bleak, and it is unsurprising the UK’s traffic light system – coding countries as either red, amber or green depending on their level of Covid-19 risk – is coming under scrutiny.
While people understand that countries on the high-risk red list require special measures, there is less acceptance of the restrictions for the amber list.
Anyone taking a trip to a country on the amber list faces up to four Covid-19 tests and having to quarantine for up to 10 days on their return.
That makes travelling abroad, whether for holiday, business or to meet family, impossible for millions of people.
The government is considering allowing fully-vaccinated Britons to travel from amber list countries without restrictions.
Understandably, this suggestion has been met with some scepticism as, once again, it seems to favour a certain group. What about those unable to be vaccinated for medical reasons? How do children play into this?
Most importantly, vaccines do not provide 100% protection, especially when faced with new variants that can be more contagious and capable of evading vaccine-induced antibodies.
Clearly, the current system needs a rethink.
Currently, for travellers to return to the UK, they must take a pre-departure test which can be a lateral flow test.
Lateral flow devices are significantly less costly than their gold-standard PCR counterparts and are, understandably, the preferred choice of test for the majority of travellers.
Yet they are low cost for a reason. Lateral flow tests have been shown to miss up to half of asymptomatic carriers of Covid-19. That means someone with a negative result may still be infectious.
In addition, any test conducted by an individual with no training on how to swab themselves will be less thorough.
Ever since the pandemic began, we have picked up significant numbers of travellers coming into the UK with a negative lateral flow test result who have subsequently tested positive by PCR.
This high level of inaccuracy for the lateral flow tests is a major factor that necessitates returning travellers to take two further PCR tests on their return and to quarantine for 10 days.
But there is a better option available, one which removes the need for those damaging red and amber lists and which could allow people to travel once again over the summer.
Those travelling back to the UK should be required to take a pre-departure PCR test.
Most importantly, this would significantly reduce the risk of bringing new variants into the UK.
It could also eliminate the current amber list requirement for a second PCR test on day eight and, critically, the need to quarantine beyond day three.
Such a regime could also encourage the government to move more countries from red to amber, or amber to green, with all the benefits that would bring.
This would reduce the financial impact of the amber list regime and encourage more people to travel.
If lateral flow tests continue to be used, the accuracy and reliability of the technology must be improved. Until accuracy levels are far higher, it will only ever be a tool of limited utility.
There are also new technologies which we are exploring that could remove the variability in reading these tests.
We are also developing a way to connect the lateral flow device to a smartphone, so we can guarantee that the person taking the test is the one intending to travel.
The travel sector needs saving, for both the businesses that have suffered financially and for those wishing to travel for holiday, business or family reasons.
A better testing regime could help save it.