New entry requirements to UK - logic fail?

[zico]

Returned from France via Eurotunnel on Monday evening, and encountered the just-introduced "Lateral Flow Test" system. You must complete a "Passenger Locator Form" and in order to do this, you must book a lateral flow test through a private company (£28 each in our case). You're allowed 2 days to take a lateral flow test, and then you post it to (in our case) Expert Medicals (a company that was removed from recommended testers back in early September after lots of complaints).

This all seems nuts, but perhaps I am missing something here?

Let's suppose for a moment my wife and I picked up Covid (perhaps a new strain) while in France. The UK's just-introduced system forces us to pay £28 each to take a lateral-flow test, but we don't have to take it for 2 days, and during that time, it's perfectly legal for us to visit nightclubs, crowded restaurants, care homes, anything we want.

If we did pick up Covid abroad, we won't know we are spreading it until we get the results back from Expert Medicals - which is likely to be at least 4 days after entry (and probably more, given their dismal record on handling tests to date).
If we do have a new variant, the lateral-flow test won't detect that. We'd need to take a PCR test to find out if that was the case.

Alternatively, we could have been told the following at the border.

You need to travel directly to your home, and avoid all unnecessary contact with others (perhaps even wear a mask until you get home!). When you arrive, take one of the free NHS lateral-flow tests that you have in your cupboard, and take the test to immediately find out whether you have Covid or not.
(Or - even more radical, if the government was concerned that people wouldn't take the test at home, why not insist that travellers take a lateral flow test (with immediate results) at the border - and if it shows positive, then either refuse entry, or require people to go to a quarantine hotel until they produce a negative test?)

Can anyone explain the logic of the government requirements from a public health perspective?

Incidentally, the declaration to enter France is surprisingly laid-back, relying simply on you filling out a "declaration of honour" that you've had 2 jabs, and no recent contact with anyone you know has Covid. Of course, once you've entered France, if you can't prove you've been double-jabbed, you can't book a hotel or get served in a restaurant.

Note - Expert Medicals describe themselves on their website as follows "We work with the medico-legal industry to deliver more efficient ways of managing and delivering medical reporting, screening, rehabilitation and diagnostic service in relation to personal injury claims".

[redsturgeon]

I don't think that Expert Medicals are on the government approved list that only includes 37 companies at the moment!

John

[Lootman]

Incidentally, the declaration to enter France is surprisingly laid-back, relying simply on you filling out a "declaration of honour" that you've had 2 jabs, and no recent contact with anyone you know has Covid. Of course, once you've entered France, if you can't prove you've been double-jabbed, you can't book a hotel or get served in a restaurant.

The US is similar. As of November 4th, US nationals and permanent residents returning to the US only have to show proof of vaccination, with no test at all either before or after the flight. And proof of vaccination is required in any hotel, restaurant or bar. Foreigners still need a test to enter, plus proof of vaccination.

So a round trip to the US now requires 2 tests, whereas until recently it required 4 tests and 10 days self-quarantine. I presume that with travel returning, it was not workable or cost-effective to keep the previous regime, which it seems is what you are arguing for.

[servodude]

Can anyone explain the logic of the government requirements from a public health perspective?

Partly theatre - they want to be seen to be doing "something"
But also if people are "only" out and about for two days before returning a test and isolating then that's better than nothing?

So it's not going to prevent COVID being brought in but it might slow it down a bit and it's more popular than suggesting people quarantine at home on return?

So what's the polite term for half-arsed?

-sd

[Julian]

...
(Or - even more radical, if the government was concerned that people wouldn't take the test at home, why not insist that travellers take a lateral flow test (with immediate results) at the border - and if it shows positive, then either refuse entry, or require people to go to a quarantine hotel until they produce a negative test?)

Can anyone explain the logic of the government requirements from a public health perspective?
...

I'm not an expert but I'll throw out a guess for those who are experts to comment on.

From a health perspective I am wondering how long after infection it takes for a positive test result to be triggered. Looking just at Europe for instance their infection rates are lower than ours in almost all major EU countries so perhaps the point of maximum risk of becoming infected is at the airports where one is mixing with all sorts of passengers from all sorts of countries. Perhaps a border test on return would be too early to catch an infection only acquired hours or even a day or two beforehand.

One could of course require both, a border test and a 2-day-after test, but the border test would I suspect create massive logistical nightmares (and increase the cost to travellers if they are also having to pad for a day 2 test as well) and if my hunches about points of maximum risk and of delays before testing positive are right then maybe the government feels that the most valuable test in terms of being most likely to catch something caught during the journey back is the 2-day-after test. If one was to only do one test and it was the border test that might well be likely to catch fewer incoming infections, again if my hunches are correct which of course they might not be. I await some expert input.

- Julian

[Lootman]

...(Or - even more radical, if the government was concerned that people wouldn't take the test at home, why not insist that travellers take a lateral flow test (with immediate results) at the border - and if it shows positive, then either refuse entry, or require people to go to a quarantine hotel until they produce a negative test?)

Can anyone explain the logic of the government requirements from a public health perspective?

I'm not an expert but I'll throw out a guess for those who are experts to comment on.

From a health perspective I am wondering how long after infection it takes for a positive test result to be triggered. Looking just at Europe for instance their infection rates are lower than ours in almost all major EU countries so perhaps the point of maximum risk of becoming infected is at the airports where one is mixing with all sorts of passengers from all sorts of countries. Perhaps a border test on return would be too early to catch an infection only acquired hours or even a day or two beforehand.

One could of course require both, a border test and a 2-day-after test, but the border test would I suspect create massive logistical nightmares (and increase the cost to travellers if they are also having to pad for a day 2 test as well) and if my hunches about points of maximum risk and of delays before testing positive are right then maybe the government feels that the most valuable test in terms of being most likely to catch something caught during the journey back is the 2-day-after test. If one was to only do one test and it was the border test that might well be likely to catch fewer incoming infections, again if my hunches are correct which of course they might not be. I await some expert input.

I am not one of those experts on the science, but I go through Heathrow a lot and the idea of every single incoming passenger having to be tested before being processed by Border Control would be a logistical nightmare.

Even as it was before this week, there could be horrific delays at immigration with the spot checks of Passenger Locator Forms. On some days passengers were forced to stay on the plane for an hour or two because the immigration hall was so packed. And of course people being packed like that is a bigger problem than the risk that a few passengers might be infected.

Heathrow isn't designed to hold thousands of people in the inbound sterile zone. The terminals were designed in a way that presumed that people keep moving and are processed quickly. Most other airports are similar, but less busy of course.

[Julian]

...(Or - even more radical, if the government was concerned that people wouldn't take the test at home, why not insist that travellers take a lateral flow test (with immediate results) at the border - and if it shows positive, then either refuse entry, or require people to go to a quarantine hotel until they produce a negative test?)

Can anyone explain the logic of the government requirements from a public health perspective?

I'm not an expert but I'll throw out a guess for those who are experts to comment on.

From a health perspective I am wondering how long after infection it takes for a positive test result to be triggered. Looking just at Europe for instance their infection rates are lower than ours in almost all major EU countries so perhaps the point of maximum risk of becoming infected is at the airports where one is mixing with all sorts of passengers from all sorts of countries. Perhaps a border test on return would be too early to catch an infection only acquired hours or even a day or two beforehand.

One could of course require both, a border test and a 2-day-after test, but the border test would I suspect create massive logistical nightmares (and increase the cost to travellers if they are also having to pad for a day 2 test as well) and if my hunches about points of maximum risk and of delays before testing positive are right then maybe the government feels that the most valuable test in terms of being most likely to catch something caught during the journey back is the 2-day-after test. If one was to only do one test and it was the border test that might well be likely to catch fewer incoming infections, again if my hunches are correct which of course they might not be. I await some expert input.

I am not one of those experts on the science, but I go through Heathrow a lot and the idea of every single incoming passenger having to be tested before being processed by Border Control would be a logistical nightmare.

Even as it was before this week, there could be horrific delays at immigration with the spot checks of Passenger Locator Forms. On some days passengers were forced to stay on the plane for an hour or two because the immigration hall was so packed. And of course people being packed like that is a bigger problem than the risk that a few passengers might be infected.

Heathrow isn't designed to hold thousands of people in the inbound sterile zone. The terminals were designed in a way that presumed that people keep moving and are processed quickly. Most other airports are similar, but less busy of course.

I completely agree. The only reason I didn’t mention any of that in my answer, apart from one reference to “massive logistical nightmares”, was because zico specifically asked about the “public health perspective”. I suppose though that you could include that congestion as a public health issue. If my hunch about airports being a relatively high risk area is correct then increasing congestion and lengthening transit times significantly, which I agree at-border swabs would likely do, could actively promote more infections at the airports that, to make matters worse, would be so recent that they almost certainly wouldn’t be caught by the at-border check.

- Julian

[dealtn]

Incidentally, the declaration to enter France is surprisingly laid-back, relying simply on you filling out a "declaration of honour" that you've had 2 jabs, and no recent contact with anyone you know has Covid. Of course, once you've entered France, if you can't prove you've been double-jabbed, you can't book a hotel or get served in a restaurant.

Incidentally I wonder if on the "idiot de citron" site there are threads started highlighting the surprisingly laid back french approach to international travel and the propensity to bring it into the country from that well known Covid hot spot, the UK, where even they at least insist on a Lateral Flow Test within 48 hours.

[chas49]

...
(Or - even more radical, if the government was concerned that people wouldn't take the test at home, why not insist that travellers take a lateral flow test (with immediate results) at the border - and if it shows positive, then either refuse entry, or require people to go to a quarantine hotel until they produce a negative test?)

Can anyone explain the logic of the government requirements from a public health perspective?
...

I'm not an expert but I'll throw out a guess for those who are experts to comment on.

From a health perspective I am wondering how long after infection it takes for a positive test result to be triggered. Looking just at Europe for instance their infection rates are lower than ours in almost all major EU countries so perhaps the point of maximum risk of becoming infected is at the airports where one is mixing with all sorts of passengers from all sorts of countries. Perhaps a border test on return would be too early to catch an infection only acquired hours or even a day or two beforehand.

(Also not an expert)

You are (IMHO) right in the observation that a border test might be too soon. Unfortunately, the so-called 2-day test is a slightly misleading name. You have to get a test within 2 days of arrival. There are companies which allow you to do this on arrival and get the result before you leave the airport. Requiring a 2-day incubation period would require the rules to say something like 'between 2 and 4 days after arrival'. And the public health message that it's OK (even legally required) to wait for a while before testing would be difficult to explain.

[Julian]

...
(Or - even more radical, if the government was concerned that people wouldn't take the test at home, why not insist that travellers take a lateral flow test (with immediate results) at the border - and if it shows positive, then either refuse entry, or require people to go to a quarantine hotel until they produce a negative test?)

Can anyone explain the logic of the government requirements from a public health perspective?
...

I'm not an expert but I'll throw out a guess for those who are experts to comment on.

From a health perspective I am wondering how long after infection it takes for a positive test result to be triggered. Looking just at Europe for instance their infection rates are lower than ours in almost all major EU countries so perhaps the point of maximum risk of becoming infected is at the airports where one is mixing with all sorts of passengers from all sorts of countries. Perhaps a border test on return would be too early to catch an infection only acquired hours or even a day or two beforehand.

(Also not an expert)

You are (IMHO) right in the observation that a border test might be too soon. Unfortunately, the so-called 2-day test is a slightly misleading name. You have to get a test within 2 days of arrival. There are companies which allow you to do this on arrival and get the result before you leave the airport. Requiring a 2-day incubation period would require the rules to say something like 'between 2 and 4 days after arrival'. And the public health message that it's OK (even legally required) to wait for a while before testing would be difficult to explain.

The whole thing if fraught with compromises. On the "within 2 days issue" people who do it much earlier, potentially even at the airport, play to my concern that a test too early might not catch an infection caught on the journey home but then again those "early testers" do reduce the effect that zico originally raised, i.e. that people only testing on day 2 could potentially be out in the community in the time before they test positive. It's all swings and roundabouts.

My tentative suggestion for a scheme that might tread the line between overly-disruptive but rock solid and not so disruptive while at least minimising leakage would be to keep the same scheme of requiring proof of a booked at-home lateral flow test in order to get back into the country but for the instructions for returning passengers to be to quarantine at home for 2 days after arrival and on the second day they would get a text or phone call (possibly automated) to tell them to do the test within a certain number of hours and report the result by a certain time that day or be subject to some level of fine. By definition the reasonably precise and aggressive instructions on when to do the test & report the results shouldn't be an issue because they should be at home and hence able to do the test virtually at the drop of a hat or they are already breaching the rules. The locator forms should have the required phone numbers and the IT systems to time the texts & phone calls and to monitor whether a particular test result was submitted within the specified time window should be relatively straightforward to implement, or at least a £37 billion budget should be able to cover it somehow. The "leakage" of course is on the journey home from the airport to the traveller's home but that's at least an improvement on people spreading the virus by going about normal life for 2 days as zico described in his/her (don't want to make assumptions) original post and also reduces the chances of testing too early and missing a "travelling back" infections completely. Had something like this been planned ahead and the pieces put in place this would, I would have thought, been practical and not felt too onerous by many people. Travellers returning on a Friday wouldn't even have any work or school time disrupted.

- Julian

[Lootman]

The whole thing if fraught with compromises. On the "within 2 days issue" people who do it much earlier, potentially even at the airport, play to my concern that a test too early might not catch an infection caught on the journey home but then again those "early testers" do reduce the effect that zico originally raised, i.e. that people only testing on day 2 could potentially be out in the community in the time before they test positive. It's all swings and roundabouts.

It depends. Just because you get your test at the airport (or at Paddington immediately after taking the Heathrow Express, which is what I do), doesn't mean you get the results then. You might if you choose the more expensive test where you get the result within 15 minutes. But otherwise it might be 24 or 48 hours until you get the result.

So then it is the worst of both worlds. The test is "too soon", but the results don't come until it is "too late".

As for people quarantining at home for 48 hours, I don't think that can happen now. It was only ever on the honour system, but now people are used to going as they please immediately upon returning to the UK. It would be very hard to get people to comply with any new restriction like that.

Prudent or not, travel is now getting back to normal. Daily air passenger volume in the US went from 3 million a day to 300,000 a day at the height of the pandemic. It is now back to 2 million a day. Heathrow is getting busier all the time, with BA overflowing T5 again, and it is resuming some flights from T3.