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How should we treat risks from Sars-CoV-2 and influenza viruses in future?

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The Ham

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Something which needs remembering with the future is that isn't something which is used for other illnesses is that they are testing in sewerage systems for Covid.

As such is possible to undertake surge testing in advance of it becoming noticeable through hospitalisations.

Whilst that's not going to stop all cases it's likely that in effect that our ability to limit the spread of it within the community is increased, which should mean that small gaps in the numbers being vaccinated should be less of an issue.

The other thing which comes into play is the testing required to enter the UK as well as the likely requirement for vaccination for international travel, again that's likely to limit transmission (unlike, for example, flu).

It's likely that such testing could change in nature, for example moving from PCR to lateral flow for travel to those countries with high vaccination levels, which would result in cheaper testing.

Whilst there may still be random PCR testing to confirm (much like there's random additional security checks for some), such tests should then be free (well covered by a couple of quid on the ticket price of everyone, for instance if 1:30 were tested then that's likely to be £2/ticket).

Which leads to the question, could similar steps be taken for other things to reduce their impact (such as flu).

Ah Mr Bond, we've been expecting you, here's your entry to the UK results. As you'll see you are clear for Covid, but we've identified that you do have the flu. Can you therefore limit your interaction with others for 7 days. We recommend that you practice good hands washing, limiting your interactions with people who are closer than 2m, especially inside, and when you do we recommend that you wear a face covering.
 
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yorkie

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Something which needs remembering with the future is that isn't something which is used for other illnesses is that they are testing in sewerage systems for Covid.

As such is possible to undertake surge testing in advance of it becoming noticeable through hospitalisations.
I don't understand what you are trying to say, but I think you fundamentally misunderstand what is going to happen in future.

Do you have any evidence that, once we have achieved high levels of immunity, this will be any different to other viruses that are endemic in this country?
Whilst that's not going to stop all cases it's likely that in effect that our ability to limit the spread of it within the community is increased, which should mean that small gaps in the numbers being vaccinated should be less of an issue.
I don't understand what you are proposing here. Once we have high levels of population immunity against Sars-CoV-2, why would we need to worry about it any more than we would worry about any other virus to which we have good immunity?

The other thing which comes into play is the testing required to enter the UK as well as the likely requirement for vaccination for international travel, again that's likely to limit transmission (unlike, for example, flu).

It's likely that such testing could change in nature, for example moving from PCR to lateral flow for travel to those countries with high vaccination levels, which would result in cheaper testing.

Why would we need to carry out tests once we have achieved mass vaccination?

Which leads to the question, could similar steps be taken for other things to reduce their impact (such as flu).
Why would we do that?

Ah Mr Bond, we've been expecting you, here's your entry to the UK results. As you'll see you are clear for Covid, but we've identified that you do have the flu. Can you therefore limit your interaction with others for 7 days. We recommend that you practice good hands washing, limiting your interactions with people who are closer than 2m, especially inside, and when you do we recommend that you wear a face covering.
If we really wanted to reduce the impact of 'flu even further, we would vaccinate more people against 'flu.
 

Yew

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Which leads to the question, could similar steps be taken for other things to reduce their impact (such as flu).
That's a very concerning idea, that some people might put their myopic quest to 'beat' flu above the collateral damage of restrictions. If people wish to virtue signal wear masks and take tests, they're more than welcome to it; but I think we've seen quite clearly that such people soon start screaming for the force of law to be brought down on others who don't subscribe to their pseudoscientific self-flagellation.
 
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yorkie

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That's a very concerning idea, that some people might put their myopic quest to 'beat' flu above the collateral damage of restrictions.
Some authoritarians may not want to give up power easily, so I agree this is a concern.
 

The Ham

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I don't understand what you are trying to say, but I think you fundamentally misunderstand what is going to happen in future.

Do you have any evidence that, once we have achieved high levels of immunity, this will be any different to other viruses that are endemic in this country?

I don't understand what you are proposing here. Once we have high levels of population immunity against Sars-CoV-2, why would we need to worry about it any more than we would worry about any other virus to which we have good immunity?



Why would we need to carry out tests once we have achieved mass vaccination?


Why would we do that?


If we really wanted to reduce the impact of 'flu even further, we would vaccinate more people against 'flu.

I was thinking more medium term whilst there could still be high risks from imported new variants. Especially if it was unknown as to how those variants would play out in a vaccinated population.

However, given that public health bodies have identified a way of determining if there's a problem in a given area without needing to know who lives in that area (so no personal freedoms are impacted as all that they know is that there's an issue in a locality not who's there, as people move in and out of areas for work and leisure purposes as well as those who live there) I could see that they could be keen to try and use this for other purposes.

I'm using flu as something which we all understand as something which impacts us, but could be anything.

For instance, they could identify of there's significant cases of flu in an area before it starts to cause the NHS issues. That would allow them to prepare for more cases whilst also highlighting to the local area that it could be beneficial to take steps to reduce their risk of infection.

In doing so it might then help the NHS not be overloaded and even when cars numbers are high there's been preparations made to limit risks.

As an example, you were booked to have surgery and could be told a few weeks in advance that due to an increase in infections locally that either your surgery (in this case critical due to, day, cancer) could be moved forwards or (due to it being elective and less of an issue if it were delayed) was going to be delayed by a few weeks.
 

DustyBin

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Some authoritarians may not want to give up power easily, so I agree this is a concern.

Agreed. Some of the suggestions I’ve seen from people are frighteningly close to what we ordinarily view as conspiracy theories. For example, the idea of a daily health check, presumably technology based. Imagine waking up each morning and being ‘scanned’ for a range of infections before being permitted to leave the house. How anybody can’t see what’s wrong with that I’ve no idea. I saw another person suggesting that everybody’s medical records should be made publicly available so that you “can check people out”. I’d like to think these lunatics are a very small minority but it’s unsettling to see people actively calling for this kind of thing. Too much Blade Runner and Nineteen Eighty Four I suspect!
 

LAX54

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I am assuming as soon as we have mass vaccination, to say 85% of the population, then PCR tests, if not all tests should stop, otherwise are we not just chasing our tails ?
 

brad465

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If we end up mass testing for covid just to be able to do what we were doing before, despite a successful vaccine rollout, then forget Johnson's "we'll beat this" rhetoric, Covid's won.
 

Lloyds siding

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Agreed. Some of the suggestions I’ve seen from people are frighteningly close to what we ordinarily view as conspiracy theories. For example, the idea of a daily health check, presumably technology based. Imagine waking up each morning and being ‘scanned’ for a range of infections before being permitted to leave the house. How anybody can’t see what’s wrong with that I’ve no idea. I saw another person suggesting that everybody’s medical records should be made publicly available so that you “can check people out”. I’d like to think these lunatics are a very small minority but it’s unsettling to see people actively calling for this kind of thing. Too much Blade Runner and Nineteen Eighty Four I suspect!
You do realise that this already happens. Many people are checking their blood pressure/pulse 24/7 with gadgets to alert you if it becomes concerning.
Those with diabetes have to do a glucose test before they can drive a car, the gadget records the result with a time stamp...if you had an accident then the insurance company would cover you.
Numerous airports and seaports around the world have infra-red monitors checking passengers...if it shows raised temperature then public health officials will pull you aside and carry out further checks before you are allowed entry, or put in quarantine.
A daily health check is a really good idea, it means that you can detect when you are becoming ill, or your existing condition is deteriorating. This would help hugely in treating people, who tend to present at the docs when they are already seriously ill, if caught early, treatment would be easier and cheaper. (I speak as someone who had a chronic condition, which despite attending the dos/hospital outpatients, was only treated when I became seriously ill, the docs having failed to diagnose it...I only had tests when I went to the outpatients, whereas regular testing would have showed that I was deteriorating ..and not a 'slacker' as many of the health 'professionals' believed.)
 

philosopher

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Those who have symptoms should stay home. Only those unlucky enough to be hospitalised should be tested, merely to help diagnose their illness to determine the best course of treatment.

Perhaps those who live with those with symptoms perhaps should minimise contact with those outside their household, for example by working from home. However this should not extend to kids missing school if their dad is ill or those in non office jobs not going to work if their partner has a cough.

Obviously people should wash their hands and catch their coughs and sneezes.
 

Yew

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Perhaps those who live with those with symptoms perhaps should minimise contact with those outside their household, for example by working from home. However this should not extend to kids missing school if their dad is ill or those in non office jobs not going to work if their partner has a cough.
.
I wouldn't mind ending 'presenteeism' where employees come in when sick to appear diligent. However this should be in the realm of 'should' rather than 'must, on threat of fines of many thousands of pounds worth of fines'
 

DustyBin

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You do realise that this already happens. Many people are checking their blood pressure/pulse 24/7 with gadgets to alert you if it becomes concerning.
Those with diabetes have to do a glucose test before they can drive a car, the gadget records the result with a time stamp...if you had an accident then the insurance company would cover you.
Numerous airports and seaports around the world have infra-red monitors checking passengers...if it shows raised temperature then public health officials will pull you aside and carry out further checks before you are allowed entry, or put in quarantine.
A daily health check is a really good idea, it means that you can detect when you are becoming ill, or your existing condition is deteriorating. This would help hugely in treating people, who tend to present at the docs when they are already seriously ill, if caught early, treatment would be easier and cheaper. (I speak as someone who had a chronic condition, which despite attending the dos/hospital outpatients, was only treated when I became seriously ill, the docs having failed to diagnose it...I only had tests when I went to the outpatients, whereas regular testing would have showed that I was deteriorating ..and not a 'slacker' as many of the health 'professionals' believed.)

The examples you’ve provided are completely different though. If somebody wants to monitor themselves because they suffer from a particular condition that’s fine, in fact it’s probably a good idea. The diabetes example addresses a very specific risk with serious consequences. Entering a foreign country isn’t something most people do on a daily basis (and it makes sense not to import diseases that may have originated thousands of miles away). Would you really advocate removing a persons liberty because they’ve contracted an endemic virus though? To what end? I’ve heard people say that we could rid ourselves of the common cold and flu if we really tried. Even if this was possible, what would replace them? These viruses have lived alongside us for thousands of years or more, we coexist relatively happily and the thought of creating a ‘vacuum’ that could be filled by who knows what doesn’t seem like a great idea to me. It may sound a little philosophical, abstract or maybe plain daft, but trying to ‘defeat’ nature in this way makes me nervous, I honestly don’t believe it’s within our gift.
 

Lloyds siding

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The examples you’ve provided are completely different though. If somebody wants to monitor themselves because they suffer from a particular condition that’s fine, in fact it’s probably a good idea. The diabetes example addresses a very specific risk with serious consequences. Entering a foreign country isn’t something most people do on a daily basis (and it makes sense not to import diseases that may have originated thousands of miles away). Would you really advocate removing a persons liberty because they’ve contracted an endemic virus though? To what end? I’ve heard people say that we could rid ourselves of the common cold and flu if we really tried. Even if this was possible, what would replace them? These viruses have lived alongside us for thousands of years or more, we coexist relatively happily and the thought of creating a ‘vacuum’ that could be filled by who knows what doesn’t seem like a great idea to me. It may sound a little philosophical, abstract or maybe plain daft, but trying to ‘defeat’ nature in this way makes me nervous, I honestly don’t believe it’s within our gift.
I don't advocate removing people's liberty (with the possible exception of quarantine), and didn't say so. I'm not speaking up for lunatics (with the exception of Howard Hughes who looks to have been right all along). I merely pointed out that the 'daily health check' already exists for some people.
You express concern about tackling, maybe eliminating common viruses such as the common cold.
We 'play God' all the time, whether building sea defences to prevent inundation, applying savlon to a wound to prevent infection setting in, fly around in heavier than air machines, etc.
In the 1930s we had infant death rates that would be horrifying now. Thanks to improved public health, clean drinking water and vaccinations we have hugely improved our chance of surviving into old age. Polio and smallpox are now things of the past. You are concerned at what would replace them...well COVID is one, and due to our laziness and 'modern' diets, obesity and associated conditions are coming to be more significant health problems.
I wouldn't worry about trying to 'defeat' nature...nature's having a go at us all the time: storms, floods, earthquakes, diseases, plagues of mice, rat infestations, sunburn, Japanese knotweed, etc, etc!

Something which needs remembering with the future is that isn't something which is used for other illnesses is that they are testing in sewerage systems for Covid.

As such is possible to undertake surge testing in advance of it becoming noticeable through hospitalisations.

Whilst that's not going to stop all cases it's likely that in effect that our ability to limit the spread of it within the community is increased, which should mean that small gaps in the numbers being vaccinated should be less of an issue.

The other thing which comes into play is the testing required to enter the UK as well as the likely requirement for vaccination for international travel, again that's likely to limit transmission (unlike, for example, flu).

It's likely that such testing could change in nature, for example moving from PCR to lateral flow for travel to those countries with high vaccination levels, which would result in cheaper testing.

Whilst there may still be random PCR testing to confirm (much like there's random additional security checks for some), such tests should then be free (well covered by a couple of quid on the ticket price of everyone, for instance if 1:30 were tested then that's likely to be £2/ticket).

Which leads to the question, could similar steps be taken for other things to reduce their impact (such as flu).

Ah Mr Bond, we've been expecting you, here's your entry to the UK results. As you'll see you are clear for Covid, but we've identified that you do have the flu. Can you therefore limit your interaction with others for 7 days. We recommend that you practice good hands washing, limiting your interactions with people who are closer than 2m, especially inside, and when you do we recommend that you wear a face covering.
You say that it is only COVID that is being tested for in sewage. This is not true...the idea of doing sewage testing is that we already do it for other diseases. It's been used for years to test for salmonella, polio and others. I used to do simple tests for E coli just to check for sewage pollution in water courses and the sea However, alongside me were university researchers who were doing DNA genetic testing to characterise whether that E coli came from animals, birds, humans (and in those days) a limited indication of which human populations (i.e, which towns)...this was 15 years ago! The differnce with COVID is that people (governments) are throwing money at it!
 
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DustyBin

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If what you're saying is that you think it's fine to make people quarantine because they test positive for something like the common cold or flu then we'll have to agree to disagree (I'm not sure that is what you're saying incidentally, it's not clear). I'm a big believer in common sense (sadly lacking in a lot of people admittedly) and would far rather people stayed at home when ill, used a tissue etc. when out and about voluntarily as it's the right thing to do.

We do play god in some respects, but we understand things like gravity and have developed the technology to overcome it. These are things we fully understand. The problem with viruses is that we don't fully understand them. Polio and Smallpox are (or were) particularly nasty and it's great that we have more or less eliminated them. In my opinion that's different to trying to eliminate relatively stable endemic viruses (yes I realise there are multiple flu strains and it mutates quite quickly). I often wonder how many viruses go undiscovered as they can't compete with the likes of endemic Coronaviruses and Rhinoviruses; in that respect they may actually be protecting us. They certainly offer us protection by keeping our immune systems active if nothing else.

I totally agree with your point regarding the man-made health problems we face, and they are things we can and should be combatting. I also agree that nature throws a lot at us, but some things we should accept and live with. It's a case of picking our battles, in my opinion at least.

Edit: In response to @Lloyds siding, probably obvious but quote hasn't copied across!
 

Lloyds siding

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If what you're saying is that you think it's fine to make people quarantine because they test positive for something like the common cold or flu then we'll have to agree to disagree (I'm not sure that is what you're saying incidentally, it's not clear). I'm a big believer in common sense (sadly lacking in a lot of people admittedly) and would far rather people stayed at home when ill, used a tissue etc. when out and about voluntarily as it's the right thing to do.

We do play god in some respects, but we understand things like gravity and have developed the technology to overcome it. These are things we fully understand. The problem with viruses is that we don't fully understand them. Polio and Smallpox are (or were) particularly nasty and it's great that we have more or less eliminated them. In my opinion that's different to trying to eliminate relatively stable endemic viruses (yes I realise there are multiple flu strains and it mutates quite quickly). I often wonder how many viruses go undiscovered as they can't compete with the likes of endemic Coronaviruses and Rhinoviruses; in that respect they may actually be protecting us. They certainly offer us protection by keeping our immune systems active if nothing else.

I totally agree with your point regarding the man-made health problems we face, and they are things we can and should be combatting. I also agree that nature throws a lot at us, but some things we should accept and live with. It's a case of picking our battles, in my opinion at least.

Edit: In response to @Lloyds siding, probably obvious but quote hasn't copied across!
Not, perhaps, quarantine for the common cold...but the nastier flu viruses, something like Spanish flu or some of the bird flu types that we've had, then, yes, I think quarantine is not unreasonable.
'We understand things like gravity' ....well, yes, it's predictable enough to allow us to calculate how to fly, hold buildings and bridges up, and work out orbits of planets, satellites and how to get there....but understand it? I really struggle with gravity being due to the curvature of spacetime, and gravitational waves altering the curvature, etc.

The endemic virus that interests me from a public health perspective is the human papillomavirus, which affects virtually everybody at some time in their lives, as usual, there's lots of different types. HPV can cause warts, plantar warts (verrucas), papillomas, genital warts and cervical cancer. HPV vaccines have been developed in recent years and these are now part of national vaccination programmes in many countries (including the UK) to target cervical cancers and, to a lesser extent, genital warts. These are preventive vaccines, research continues for therapeutic vaccines, for those who may have established infections or cancers.

The figures that always astounded me about viruses was that there are about 50 million virus particles in a teaspoon of sea water, of which about 90% are unknown/unidentifiable! They probably do help us in that we'd be knee deep in bacteria if bacteriophages (bacteria consuming viruses) didn't dispose of them. Someone I know (his daughter used to work with me) discovered what was then the world's largest virus in slime from a cooling tower in Bradford. They were so weird (and unknown) that a whole new taxanomic virus family had to be created to describe them. The Mimiviruses (as they are now known) are found all over the place, including seawater. They are now suspected of causing some pneumonias (the original discovery was when looking for Legionella in the coooling tower) So, yes, you are right: there's still many viruses to be discovered!

COVID's 'benefit' is that there's now lots more interest and money being targeted on these topics than just two years ago.
 

DustyBin

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Not, perhaps, quarantine for the common cold...but the nastier flu viruses, something like Spanish flu or some of the bird flu types that we've had, then, yes, I think quarantine is not unreasonable.
'We understand things like gravity' ....well, yes, it's predictable enough to allow us to calculate how to fly, hold buildings and bridges up, and work out orbits of planets, satellites and how to get there....but understand it? I really struggle with gravity being due to the curvature of spacetime, and gravitational waves altering the curvature, etc.

The endemic virus that interests me from a public health perspective is the human papillomavirus, which affects virtually everybody at some time in their lives, as usual, there's lots of different types. HPV can cause warts, plantar warts (verrucas), papillomas, genital warts and cervical cancer. HPV vaccines have been developed in recent years and these are now part of national vaccination programmes in many countries (including the UK) to target cervical cancers and, to a lesser extent, genital warts. These are preventive vaccines, research continues for therapeutic vaccines, for those who may have established infections or cancers.

The figures that always astounded me about viruses was that there are about 50 million virus particles in a teaspoon of sea water, of which about 90% are unknown/unidentifiable! They probably do help us in that we'd be knee deep in bacteria if bacteriophages (bacteria consuming viruses) didn't dispose of them. Someone I know (his daughter used to work with me) discovered what was then the world's largest virus in slime from a cooling tower in Bradford. They were so weird (and unknown) that a whole new taxanomic virus family had to be created to describe them. The Mimiviruses (as they are now known) are found all over the place, including seawater. They are now suspected of causing some pneumonias (the original discovery was when looking for Legionella in the coooling tower) So, yes, you are right: there's still many viruses to be discovered!

COVID's 'benefit' is that there's now lots more interest and money being targeted on these topics than just two years ago.

I suspect your knowledge in this area exceeds my own! Personally I find viruses mind boggling, there appears to be some debate as to whether they are living organisms even, which in itself I find incredible.... The same probably goes for gravity now you mention it, I know (or knew - I'd need to dust the text books off!) how to do the calcs to overcome it when designing structures, I'll admit to having never thought about what it actually is though. Again, mind boggling stuff!
 

The Ham

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You say that it is only COVID that is being tested for in sewage. This is not true...the idea of doing sewage testing is that we already do it for other diseases. It's been used for years to test for salmonella, polio and others. I used to do simple tests for E coli just to check for sewage pollution in water courses and the sea However, alongside me were university researchers who were doing DNA genetic testing to characterise whether that E coli came from animals, birds, humans (and in those days) a limited indication of which human populations (i.e, which towns)...this was 15 years ago! The differnce with COVID is that people (governments) are throwing money at it!

That's interesting to know, and certainly highlights that it could be broadened if there was funding (which could likely be fairly small compared to other costs if it allowed steps to be taken sooner).

If what you're saying is that you think it's fine to make people quarantine because they test positive for something like the common cold or flu then we'll have to agree to disagree (I'm not sure that is what you're saying incidentally, it's not clear). I'm a big believer in common sense (sadly lacking in a lot of people admittedly) and would far rather people stayed at home when ill, used a tissue etc. when out and about voluntarily as it's the right thing to do.

We do play god in some respects, but we understand things like gravity and have developed the technology to overcome it. These are things we fully understand. The problem with viruses is that we don't fully understand them. Polio and Smallpox are (or were) particularly nasty and it's great that we have more or less eliminated them. In my opinion that's different to trying to eliminate relatively stable endemic viruses (yes I realise there are multiple flu strains and it mutates quite quickly). I often wonder how many viruses go undiscovered as they can't compete with the likes of endemic Coronaviruses and Rhinoviruses; in that respect they may actually be protecting us. They certainly offer us protection by keeping our immune systems active if nothing else.

I totally agree with your point regarding the man-made health problems we face, and they are things we can and should be combatting. I also agree that nature throws a lot at us, but some things we should accept and live with. It's a case of picking our battles, in my opinion at least.

Edit: In response to @Lloyds siding, probably obvious but quote hasn't copied across!

In my opening post I want suggesting daily testing of individuals, nor was I suggesting quarantining them.

I suggested that testing of sewerage systems (which wouldn't know who was where) and at entry to a new country (which for many would be a couple of times a year). However, even then my level of response was to advise to limit your close contact interactions with others for a period of time rather than full quarantine (which although I was talking about flu, could also apply to Covid on a world where the vast majority of the population have been vaccinated).

It wouldn't stop all infections, and trying to would cause issues which few would be willing to live with, however it could reduce the impact of them by reducing the numbers who get infected from the person entering the country.

For instance, you return from holiday and get told you need to quarantine for 10 days, well few bosses are going to be happy with that is you only went away for the weekend. Conversely, you get rid to limit your interactions for 10 days and practice good hands hygiene, well although that may still cause issues for the boss, they would probably take steps to assist (although many will still exist) as it means that they are less likely to have half their staff off sick over the next few weeks.

That's a very different level of personal impact. Yes there could be times when full quarantine could be useful, however only really if there was something which was likely to cause significant concern (i.e. Ebola) however such infections should be rare.

Depending on what was tested for, it could be that more comprehensive tests could pick up early stages of other illnesses. Although those more wide ranging tests would be optional, however there would be some who opted for them from time to time, so that they could seek treatment much earlier than would otherwise be the case. This would reduce the cost to the NHS whilst also limiting the risk of harm to the individual. However that's a different matter and would remain very much optional.
 
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