Category: Covid-19

The Francis Crick have successfully built a process for Covid PCR testing for patients and NHS Staff. The Crick have also validated a reverse transcription loop-mediated thermal amplification (RT-LAMP) method for 25-minute coronavirus testing. The best way to realise Operation Moonshot is to bring the two processes together and deliver across 200+ NHS trusts.

The following is a costed break-down of all of the necessary components within a solution architecture. I try to provide costed reasoning for all of my assumptions and to use fixed cost points and recent precedent. The costs are broken down into 5 areas: equipment, self-swabbing (as drive thru won’t scale), RT-LAMP testing, IT & processes and rollout. I believe that Operation Moonshot could be delivered for half the UK Government’s initial assessment.

1. Testing Equipment: The UK Government has already invested in the novel RT-LAMP test capability. The highest throughput machine is the Oxford Nanopore PromethION 48 which can process 15000 RT-LAMP tests a day. Each machine costs just under half a million pounds meaning that handling 10million tests a day would require 667 machines at a non-discounted prices of a third of a billion pounds.

machine list price	£476,145
tests per machine	15,000
tests a day	10,000,000
nhs trusts	220
number of machines	666.67
cost of machines	£317,430,000
cost per trust	£1,442,864

2. Testing Capacity Increase & Self-Swabbing Costs: The UK already has an appointment booking process for the national pillar 2 swab testing. These tests are carried out in car and involve bagging the swabs with pre-registered barcodes. There are 50 test sites in the UK which provide the majority of the UK’s capacity of 350k a day. Increasing the testing capacity to 10m a day would require nearly 1500 sites and tens of thousands of more testers.

current test capacity	350,000
number of test sites	50
site processing capacity	7000
number of sites required	1,429

The other testing approaches would be either localised testing making use of any medically trained personnel or through self-testing through posted self-test kits. We will examine the self-test model: Based on 10m test a day the whole UK population will be tested each week meaning that everybody in the UK should be receiving a number of tests through the post. Self-testing would have a lower rate of accuracy but this would be mitigated by the sheer size of the testing quorum. The collection of self-tests will need to be within 24-48 hours for the test to be valid and testing centres will be reliant on the immediate return of tests.

tests a day	10,000,000
unit cost per kit	£0.50
daily cost	£5,000,000
kit test cost for 1 year	£1,825,000,000
courier costs per kit	£2.50
daily courier costs	£25,000,000
courier cost for 1 year	£9,125,000,000
total	£10,950,000,000

The kit and courier costs of 10m tests a day would be in excess of a £10bn a year even with the lower possible unit prices for kits and couriers. To be cost effective the self-test model would need a local drop-off and collection area to lower the total courier costs. Based on a drop-off model of £10 per 100 tests the yearly cost would decrease to 2bn a year.

tests a day	10,000,000
unit cost per kit	£0.50
daily cost	£5,000,000
kit test cost for 1 year	£1,825,000,000
drop-off courier costs per 100	£10.00
daily courier costs	£1,000,000
courier cost for 1 year	£365,000,000
total	£2,190,000,000

3. RT-LAMP Testing & Results Process: RT-LAMP testing will unpack all self-swab packs and run each sample through the testing lifecycle producing a result within 25 minutes. Test results will need to be validated by medical professionals and positive tests need to be recorded against the summary care record and notified to the relevant Public Health Authority. If each NHS trust would have between 3-6 RT-LAMP machines handling tests and each machine would require a minimum staff of 6 people to continually operate and validate the test results. At an average cost of £40k per FTE this would cost more than £200m per year.

tests a day	10,000,000
nhs trusts	220
RT-LAMP machines per trust	4
trust daily throughput	45,455
daily FTE requirement	24
extra staff requirement	5280
staff costs	£211,200,000

4. Central IT Costs, Notifications and Mobile App: The national roll-out of a 10 million a day testing service would be vastly complex, far more complex than mere rocket science! Achieving such a service would require both centralised common processes and local variations to succeed. A good example of local variances would be the designing of the self-swap collection locations. A successful would also need the IT and process functions to be right first time, including the mobile app launch. The IT functions could be realised within a multi-tenanted ITIL compliant solution (e.g. ServiceNow) which would allow centralisation and local variances. Such a solution would also allow for stock and asset management. All test records could be centralised from the RT-LAMP machines and then fed to the relevant PHA’s by integration with the final notifications going to the public via a mobile app. Staffing would manage the end to end processes and the criticality of the data demands a security overhead. It is not unreasonable to include a 30% contingency on the total.

centralised IT process	£5,000,000
localisations budget	£10,000,000
staffing	£2,500,000
mobile app	£2,000,000
PHA integrations	£2,000,000
security	£3,000,000
contingency	£7,350,000
total	£31,850,000

5. Rollout Process: Rollout costs should be viewed separately as deployments would take time to bed in and would need a degree of local stock and asset management. Precedent suggests that getting to 100k daily tests would have more easily achieved with a lot of small ships rather than following a centralised model. It is therefore not unreasonable to suggest a £10m budget per trust for rollout processes. If the rollout were to include many more smaller GPs then that budget would have to be increased, for this reason I’ve included a 30% contingency.

number of trusts	220
cost per roll-out	£10,000,000
contingency 30%	£660,000,000
total	£2,860,000,000

• Total: The total cost assessment is for one year only but is approximately half of the UK Government’s assessment of £10bn. The most accurate costs are for the Testing Equipment based on the capacity and list prices of the Oxford Nanopore equipment. The self-swabbing approach is based on a collective drop-off solution as otherwise another £8bn could be spent on individual collection of swabs. The RT-LAMP costs as predominantly staff costs for 5000 new staff. The IT costs include a 30% contingency and are based on the UK Government getting its IT right first time. The rollout costs are the the highest individual costs but should be a year one only cost and do not include any economy of scale across multiple NHS trusts who may be able to work together.

Testing Equipment	£317,430,000
Testing Capacity Increase & Self-Swabbing Costs	£2,190,000,000
RT-LAMP testing	£211,200,000
Central IT Costs, Notifications and Mobile App	£31,850,000
Rollout	£2,860,000,000
Total	£5,610,480,000

Operation Moonshot has not published any assumptions, cost validation or time period for its £10 billion total cost. The above costs are all based on my recent previous experience of Covid-19 PCR testing. It is not unfeasible that Operation Moonshot could be achieved for half the costs currently being claimed.