Covid-19: Positive lateral flow tests will no longer require PCR confirmation, government announces

People in England who test positive for covid-19 on a lateral flow test will soon no longer need to have a polymerase chain reaction (PCR) test to confirm the result and should immediately self-isolate, the government has announced.

The temporary suspension of the confirmatory testing, which comes into effect on 11 January, coincides with a high prevalence of covid-19 in the UK and means that the chances of a false positive from a lateral flow test are very low, the government said.

People who receive a positive lateral flow result will be asked to report their result on the government website, after which they will be contacted by contact tracers.

However, people who are eligible for the £500 Test and Trace Support Payment will still be asked to do confirmatory PCR testing. Additionally, anyone who develops covid-19 symptoms should still take a PCR test, as lateral flow tests are designed for people without symptoms.

The announcement comes amid reports of lateral flow shortages across the UK,1 including in Northern Ireland where confirmatory PCR testing has also been suspended.2

A temporary suspension of confirmatory PCR testing was put in place in England from January to March last year (2021) under similar circumstances. UK Health Security Agency chief executive Jenny Harries said, “While cases of covid-19 continue to rise, this tried and tested approach means that lateral flow tests can be used confidently to indicate covid-19 infection without the need for PCR confirmation.”

The UKHSA has pointed to a report, published by the Department of Health and Social Care in July 2021, which estimated that for every 10 000 people tested, three or fewer people would be expected to receive a false positive result.3

Commenting on the change, Hayley Jones, senior lecturer in medical statistics at the University of Bristol, said, “At current high levels of infection in the population, it’s sensible to assume you’re infectious if you have a positive lateral flow test result, without a confirmatory PCR. But it’s crucial to remember that the reverse is not true: a negative lateral flow result doesn’t guarantee that you don’t have covid-19 or that you’re not infectious, so it remains important to get a PCR test if you have symptoms regardless of a negative lateral flow result.”

However, others have highlighted that the move could hinder the ability to identify new variants. NHS Confederation chief executive Matthew Taylor said, “Staff absences across the NHS are double what they would typically be at this time of year and this is on top of around 93,000 vacancies and so, at a time of extreme pressure, any measure that can enable health and care staff to safely return to work will be welcomed by health leaders.

“However, we need to understand the rationale behind this change as there is a risk it could dilute the country’s infection prevention and control response and limit our ability to both track the prevalence of coronavirus and identify potential new variants. If this is the case, then it needs to be considered as part of a wider strategy that is clearly explained and risk assessed.”