As deaths pass 20,000, testing and tracing are finally back at the heart of government policy – but it’s taken too long and has been poorly planned. A series of delays and U-turns cost time – and the country could pay a price for months to come

The pay-and-display sign still marks the entrance to the Milton Keynes coronavirus testing hub – a cluster of tents in a car park across from a shuttered Toys R Us shop – that is the heart of the UK’s drive to contain and control the disease.

On Friday afternoon a queue of about 20 cars had formed up on the road outside, carrying key workers from schools, hospitals and care homes.

Men in high-vis jackets working for the accountancy giant Deloitte, which runs the centre, patrolled the street and tried to clear it of anyone not coming to be tested, even though they admitted they had no legal authority to do so.

Those who had arrived had been given the postcode to put into their satnavs but there were almost no signposts to the hub on nearby ring roads or streets, perhaps to keep it a secret from curious locals or passersby.

Less than 24 hours earlier, the health secretary, Matt Hancock – desperate to “ramp up” testing (and then contact tracing) in the hope of getting somewhere near his target of 100,000 tests a day by the end of April – had announced that all key workers with symptoms could apply to be checked for coronavirus.

Huge pent-up demand from people would defeat the system within hours of it going live. On Friday morning the testing website could not cope and it told applicants that there were no more tests available, an administrative hitch for which the government swiftly apologised.

Those in the queue on the outskirts of Milton Keynes had, however, logged on before the crash. Several told the Observer they wanted tests as much for their patients, or the people they worked and lived with, as for themselves. Many had signed up in the small hours, including a school key worker who had gone online at 2am to register.

“I work around Covid patients, although we wear full PPE,” said one nurse who asked not to be named. “This is the first opportunity we’ve had to get tested. It’s for my patients as well as myself, so I don’t risk infecting them.” She had travelled with her sister who works in care, and her parents who are isolating with them. Their father’s diabetes makes him a high risk if he contracts Covid-19.

Once inside the car park the symptom carriers were directed into one of five bays, and greeted by a worker in full protective equipment, holding up a mobile phone number to ring from inside the car. The person on the phone explained how to take the test, and then provided a kit.

“You had to get a swab and rub it along the back of your throat and tonsils, and then use the same swab up your nose,” said Charlie Dawkins, a pre-school worker who signed up for a test after coming down with a fever and sore chest. “I’m quite glad we got to do it ourselves, I feel that if someone else did it I would have been sick. We had to keep stopping.”

Dawkins had driven for around half an hour with her mother, a key worker in a school who received an email saying she was eligible for tests the previous day. She too registered in the middle of the night.

Facebook Twitter Pinterest The health secretary, Matt Hancock, during a media briefing in Downing Street on Thursday, where he opened up testing to all key workers with symptoms. Photograph: Pippa Fowles/Crown Copyright/PA

Dawkins said she found the experience as smooth as testing for a terrifying disease could be ever be. “The people were really nice, everyone was so friendly.” She has been told to expect results by text or email within 48 hours, linked to a QR code she was given on registration, and scanned when collecting the test kits.

Across the country key workers and their families and friends, some who had worried about their exposure and health for weeks, were going through this extraordinary, novel and anxiety-inducing procedure.

Nic Mitchell, a property and financial services adviser, began developing symptoms a few days ago, which forced her partner, the head engineer at a food processing factory, to go into isolation with her. She has a complex underlying medical condition. “A test would help me manage my other underlying conditions better,” she said. “The symptoms may be related to something else – this would help me rule it in or rule it out.” Mitchell’s partner is considered to be an essential worker, so they managed to book a test online.

The nearest centre for her was in Worcester, 22 miles from her home in Cheltenham. Before attending, she said it would be “very scary” because she hadn’t left the house since 4 January when she got back from holiday incredibly ill. “Actually, going into the outside world is something that gives me a high level of anxiety, so going 22 miles makes it worse,” she added.

When Mitchell arrived at the testing site at Worcester Warriors rugby club just before 3pm on Saturday, she was told that there would be a two and a half hour wait – but the centre would shut at 5pm regardless. The only option was to attempt to rebook. “They told me they couldn’t cope,” she said. “It was very disappointing.”

Play Video 5:58 Coronavirus tests: how they work and what they show

The tents of the Milton Keynes test centre are visible from nearby roads, normally busy with shoppers and office workers, and now emptied by coronavirus. The silent streets, with the test queue the only sign of life, were a reminder of the abrupt distortion of normality.

Quick guide Official list of key workers in England Show Hide The UK government has expanded the criteria for who qualifies for a free test for coronavirus to all essential workers and their families in England – up to 10 million people. The list of essential workers is the same as the one used to allow the children of key workers to carry on going to school during the lockdown: Health and social care

Frontline health and social care staff such as doctors, nurses, midwives, paramedics, as well as support and specialist staff in the health and social care sector. In addition it includes those working in supply chains including producers and distributors of medicines and personal protective equipment. Education and childcare

Nursery, teaching staff and social workers. Key public services

Those required to run the justice system, religious staff, as well as those responsible for managing the deceased, and journalists providing public service broadcasting. Local and national government

Administrative occupations essential to the effective delivery of the Covid-19 response or delivering essential public services. Food and other necessary goods

Those involved in the production, processing, distribution, sale and delivery of food. Public safety and national security

Police, support staff, Ministry of Defence civilian staff and armed forces personnel, fire and rescue staff, and those responsible for border security, prisons and probation. Transport

Those who will keep air, water, road and rail passenger and freight transport modes operating. Utilities, communication and financial services

Staff required to keep oil, gas, electricity, water and sewerage operations running. Staff in the civil nuclear, chemical and telecommunications sectors. Those in postal services and those working to provide essential financial services.

The swabs are not tested on site, because they need sophisticated laboratory processing. Milton Keynes has one of the biggest labs in the country, based at the UK Biocentre, just a few miles from the car park test centre, which handles swabs sent from at least 20 testing centres across the country.

The labs are largely manned by scientists who volunteered to step away from their usual research to carry out testing, which is labour-intensive work.

At Milton Keynes, the scientists operate in pairs working 12-hour shifts, and together can handle around 400 to 500 swabs a day. The lab’s daily capacity, at full stretch, is around 8,000 tests.

Inside the lab there are three work stations, the first of which is protected by a biosecurity hood, where samples are treated with a solution to kill everything inside. In the second, the virus’s genetic material (or the material of anything picked up by the sample) is extracted. In the third, that genetic material is put through a machine that multiplies it, so that there is enough for the test to detect, then checked for coronavirus. The biggest challenge, experts say, is not the science but the logistics of getting the tests in, then scaling up and bringing in robots.

The Milton Keynes lab is part of a centralised approach to testing in the UK that has puzzled many scientists and may have been a key contributor to the slowincrease of testing capacity.

Other countries that have rolled out more rapid testing programmes have relied at least in part on letting existing labs become testing centres with their own teams and equipment, who are able to start testing almost immediately on site.

Facebook Twitter Pinterest Technicians carry out a sample transfer during the opening of the new Covid-19 testing lab at Queen Elizabeth University Hospital, Glasgow last week. Photograph: WPA/Getty

In the UK, by contrast, authorities have chosen to bring equipment and scientists together in government-established centres, which are slower to get going because logistics and supply issues need to be worked out.

Prof Allyson Pollock, of Newcastle University, says one of the many reasons the UK’s reaction has been late and, until now at least, fairly ineffective is that it can no longer respond to local need, because of endless reorganisations and years of austerity. She also says the government is treating this pandemic as a national one, when actually it is a series of local ones, requiring dedicated local responses.

But what angers scientists, health workers, experts and others more is why it was left until so recently – when Hancock was already admitting the peak was near – for this mass process of testing and contact tracing to be ordered across the country. And why has it all seemed so chaotic and poorly planned?

The criticism of ministers and their advisers is all the greater because they know the UK started on the right road only to halt, change course, then resume when the virus had spread and all that could be achieved was damage limitation.

In early March, during the “containment phase”, Public Health England (PHE) began testing and contact tracing of the few cases identified. Just under 300 staff were hired at that time. The team, working around the clock, traced 3,500 people and supported the 3% of contacts found to be infected to self-isolate. But tracing was then scaled back when the UK moved to the “delay phase”.

Governments that have contained larger scale outbreaks once they are under way, perhaps most notably South Korea, which at one point was the worst affected country outside China, have done it through large-scale testing and rigorous tracing of the contacts of infected people.

“The fact is that the UK was not able to operate a testing and tracing campaign like the one used in South Korea,’ says Prof James Naismith, of Edinburgh University. “We, like many countries, did not have the infrastructure in place to maintain a testing programme in the first wave. South Korea - and Germany - did. However, as with being on the Titanic after it hit the iceberg, there is no time for recriminations, we need to act now to save lives. While we have lagged behind in testing and tracing, if we focus we can catch up.”

After the UK stopped its testing and contact tracing, the World Health Organization ordered all countries to “test, test, test”. But in a vital period last month, the UK resisted. Only recently, as pressure to limit the lockdown has grown from businesses, Conservative MPs and a frustrated public, and as Hancock’s testing target looked in danger, has the government completely changed course.

Facebook Twitter Pinterest Workers direct cars at a coronavirus testing site in a car park at Chessington World of Adventures, south-west London. Photograph: Jonathan Brady/PA

There is dismay among health workers who see daily the effects of Covid-19, that early efforts to “ramp up” testing (before key workers were included from last Thursday) were suboptimal to say the least.

Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, said: “There has been a lot of zig-zagging and veering on what is the policy, who is responsible for mobilising it, what is the plan.” When Hancock first announced his target of 100,000 tests a day she says no one really knew how it would work. “In our view it was not clear. It was just a number that was put out there.” Cordery says it is not clear who the 100,000 should be initially, nor who would be involved in the testing. Should those to be tested include NHS staff, patients, who?

This lack of action was irksome for scientists, who last week pointed to the UK’s massive but ignored capacity for carrying out genetic testing. Medical virology, molecular cancer and regional genetic laboratories as well as other academic centres around the country routinely use PCR [polymerase chain reaction] technology, which could easily have been turned to Covid-19 work a long time ago, they say.

“Only the US has a greater capacity to do testing,” said ProfGerome Breen, of King’s College London. “But the NHS has refused to reply to many offers of help from research centres to supply tests.” One of these offers came from Breen, a geneticist whose department already carries out PCR testing on a large scale. “A month ago we offered to turn our laboratory over to Covid-19 work and test medical staff at King’s College Hospital to find out who might have been infected with the virus. We could have started within a fortnight and would have been doing thousands of tests a day by now. We had a couple of emails from the department but heard nothing from them after that. It was intensely frustrating.”

Prof Martin Marshall, the chairman of the Royal College of GPs, suggested GPs should have been able to play a bigger role in referring patients for testing and helping the testing process. This admittedly would have required them to have the correct PPE, which has proved another challenge altogether.

“Have they been a bit slow in getting to general practice, understanding the needs of general practice, understanding the PPE needs, for example, which took a time, understanding the role of general practice in identifying vulnerable patients understanding the testing needs for general practice? I think all of that has been slower than we would have liked to see.”

Asked if the government knew who it ought to be testing, he said: “I think the testing programme has been influenced more by the politics of the availability of testing than it has by the epidemiology of what’s required.

“You can have a good policy on testing, but you can only deliver it if you’ve actually got the kit.”

Play Video 'Test, test, test': WHO calls for more coronavirus testing – video

This weekend, with the UK passing 20,000 hospital deaths from Covid-19 , and the WHO insisting that testing and contact tracing is essential before life can go back to normal, both are suddenly back at the heart of government policy.

But have the U-turns and the delays cost? And what if the lockdown has to continue for months more because effective testing and contact tracing has not been put in place?

Already business leaders and Conservative MPs are beginning to warn that without an easing of the lockdown based on testing and contact tracing, the economy faces ruin. Last week, the crisis facing small businesses and the need for a balance to be struck between saving lives and saving the economy was raised in a heated, virtual meeting of the 1922 Committee of Tory backbenchers.

The former cabinet minister, David Davis, said: “There is deep concern among backbenchers about the fate of the vast numbers of small businesses, which will determine how fast we come out of this economic slump. Unless we are very quick and very effective at bringing as many as possible back into work in a few weeks’ time, the scars of this problem will go on for a decade.”

Graham Brady, the chairman of the 1922 Committee, said: “All members of parliament must be receiving representations from businesses large and small needing further assistance or some sense of when they can start to plan for at least a partial release from these measures.”

Charles Walker, the committee’s vice-chair, added: “Our inboxes are full of desperate people who own small businesses, some of which are their lives’ work, who now risk losing everything. We need to have a cabinet minister put in charge of small business.”

Q&A Coronavirus: should everyone be wearing face masks? Show Hide Some countries and states have been recommending that everybody wears face masks in indoor settings where social distancing is difficult or impossible. They have been made mandatory on public transport or in shops in many countries. According to guidance from the World Health Organization, people over 60 or with health issues should wear a medical-grade mask when they are out and cannot socially distance, while all others should wear a three-layer fabric mask. The WHO guidance, announced on 5 June, is a result of research commissioned by the organisation. It is still unknown whether the wearers of masks are protected, say its experts, but the new design it advocates does give protection to other people if properly used. The WHO says masks should be made of three layers – with cotton closest to the face, followed by a polypropylene layer and then a synthetic layer that is fluid-resistant. These are no substitute for physical distancing and hand hygiene, it says, but should be worn in situations where distancing is difficult, such as on public transport and at mass demonstrations. The WHO has been reluctant to commit to recommending face coverings, firstly because the evidence on whether they offer any protection to the public is limited and – more importantly – because it was afraid it would lead to shortages of medical-grade masks for health workers. Sarah Boseley Health editor

There is another, even more pressing need to start testing in increasing numbers, says Prof Charles Swanton, of the Francis Crick Institute in London, who is an oncologist and the chief clinician at Cancer Research UK. He said studies of infected hospital patients in Wuhan, in China, where Covid-19 first emerged, indicated that around 40% had contracted the disease inside the hospital. “Hospital transmission is a very likely source of ongoing Covid-19 infection in the middle of a lockdown,” he said.

For some patients – for instance, those with life-threatening cancers – this is a very serious issue. “Patients are avoiding going to their GPs and GPs are making fewer hospital referrals. There are also 200,000 fewer cancer screenings taking place each week in the UK, due to the Covid-19 pandemic. That, in turn, means there are approximately 2,000 to 2,500 cancer diagnoses being missed each week.”

Many scientists now believe reliable testing on a large scale really does offer the UK a route out of its Covid-19 crisis. However, merely reaching a figure of 100,000 tests a day on its own is not enough, warned Naismith.

“It won’t matter if we can test numbers of that order if we cannot then rapidly trace the contacts of those who are found to be positive and then isolate them. Once a person is found to be positive we will have to trace their contacts very, very quickly – within a day – and then test them.”

Such tracing will inevitably require technological aids – mainly by using mobile phones to track a person’s movements, said Naismith. “Inevitably, that will have privacy issues,” he added. “However, these will have to be dealt with because testing and tracing offers us the best chance we have for dealing with Covid-19 at the moment.”

• This article was amended on 26 April 2020 to correct a quote from James Naismith.