At the moment, they’re free, at least for users. The Government will provide them, in packs of seven, to anyone who asks. But is that going to stop? There was confusion over the weekend after one “senior Whitehall source” told the Sunday Times that it would — before the education minister, Nadhim Zahawi, informed Sky that there were no such plans.

Maybe it’ll happen soon, maybe it won’t. But we are moving towards a world in which we need to think differently about testing for Covid; the current scenario — free tests for anyone who wants them, followed by automatic isolation if you have a positive result — cannot continue forever.

The question now is: what should replace it? Will it soon be time to start using tests in new ways – to let people decide whether they ought to stay home, rather than ordering them to via restrictions? And will we start doing the same for diseases other than Covid?

First, let’s be clear about something: the cost of LFTs has been low. The figure usually quoted is £6 billion — which seems tiny when compared to the £315 billion spent on Covid measures (as of December 2021), not to mention the vast economic damage inflicted since March 2020. Economists often talk about “Treasury brain”, the desire to cut any and all spending without asking whether that spending is actually saving money elsewhere. I suspect the call to stop giving away LFTs is an extreme case of Treasury brain: lateral flows don’t have to stop all that many infections to pay for themselves many times over.

And they probably do stop a lot of infections. LFTs are less sensitive than the standard PCR tests, but they are much quicker — minutes rather than hours — and, unlike PCRs, will not detect dead virus in the system of someone who has been recovered for days or weeks. “I’ve always been a big advocate,” says Prof Alan McNally, a microbiologist at the University of Birmingham. In particular, they are more likely to return a positive result when you have a high viral load and, therefore, are more likely to be infectious. He points to various studies, including this modelling paper in the Lancet Public Health journal, which seem to find that LFTs followed by self-isolation lead to significant drops in transmission.

That said, we should still be wary. LFTs definitely miss some non-trivial fraction of cases, including some which are infectious. Alexander Edwards, a professor of biomedical technology at the University of Reading, notes that one recent preprint followed 30 people who had tested positive for Covid on PCR while doing LFTs at the same time. It found, as expected, that PCRs tended to pick up the infection earlier and more reliably. But it also found, through contact tracing, that four people passed on the virus in between negative LFTs. It’s a tiny study, and we have no way of knowing how common events like that are. But they do happen: you can’t 100% rely on LFTs telling you whether you’re infectious or not.

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What Covid tests can we trust?

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But LFTs have always been in a bit of a strange situation. On the one hand, there is a tendency to assume that they are outranked by PCRs. I know at least one person who had a positive LFT followed by a negative PCR, and assumed that meant the LFT was wrong and they could go back to work. But that’s wrong. “I’m always astonished by this,” says McNally. “If you have symptoms, and you take an LFT and it’s positive, then you have Covid. The idea that PCRs trump LFTs is baffling.”

There have been calls recently to drop PCRs altogether — for Test & Trace to rely entirely on LFTs — and that makes sense to me: even if PCRs are somewhat more sensitive, they’re much more expensive and they take two days to give you a result. An imperfect result now is better than a somewhat more accurate one after you’ve been spreading the virus (or needlessly locked at home) for two days.

On the other hand, there’s a contradictory tendency: to think of LFTs as definitive. I notice this in myself: I’ll say things like “Ah, good thing I don’t have Covid!” when I test negative, rather than virtuously thinking “Well, this new evidence supports my hypothesis that I do not have Covid.” No medical tests are 100% accurate — some number of negatives (and positives, although that’s rarer with Covid) will be false. “I’ve always been nervous that people will think that if they have a negative PCR it’s fine to go and see their family,” says Edwards. “And that’s not true.” He worries that overenthusiastic supporters of LFTs “overemphasise how good they are”, and potentially undermine trust in them when false negatives happen.

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It's time to end mandatory isolation

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But we are moving into a new phase of the pandemic, and trying to return to as normal a life as possible. At the moment, Covid is a “notifiable disease”: that is, if you are diagnosed with it, the Government must be informed. But if we are to “live with the virus”, then at some point that will change; we don’t inform the government when we have a cold, or the flu. Likewise, we’ll need to stop informing the Government of every asymptomatic infection or mild case of Covid-caused sniffles.

It’s unclear when that will be, although my own feeling is that it should be relatively soon: a few months’ time, at most, assuming future variants aren’t much more dangerous. Certainly, we should be thinking about reducing the isolation period for positive tests, and letting people make their own judgments about isolating. (We implicitly do this already, since the whole thing runs on an honour system: if you want to fake a negative LFT test, it is trivially easy to do. We’re relying on people’s honesty as it stands.)

But once we do move away from notifying the Government about Covid cases, LFTs are still going to be a vital part of the world. We will need to think of them neither as PCRs’ inadequate cousins nor as golden tickets allowing us to enter our elderly relatives’ nursing homes free of danger, but as useful tools in our risk assessment.

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If you’re going to visit your elderly parents, and you’re all triple-vaccinated, and you have no reason to think you have Covid, then you might feel pretty safe already and use an LFT to add an extra layer of reassurance. Likewise, shops, pubs and theatres might also want to call for customers to show a negative LFT result in order to reduce the number of Covid infections among their patrons and staff — it won’t remove every one, but it will reduce the risk.

What’s going to be really interesting, though, is how Covid changes our attitudes to diagnostic testing in general. “It has democratised it,” says McNally. Before now, infectious-disease testing was something done in labs, by doctors and scientists. But now we’re all extremely capable of sticking a simple cotton swab up our nose and using that to test for Covid, at home.

But we don’t have to do that just for Covid. I recently spoke to Pantelis Georgiou, a professor of electrical engineering at Imperial College London. He’s developing what seems to be the natural successor to LFTs: “lab on a chip” technology that can test for a variety of pathogens, whether viral, bacterial or other, as quickly as LFTs. It has been used to detect malaria in Ghana, and, he told me, has been shown to work for TB, aspergillus and dengue, among other other things.

The most interesting thing to me, though, is that it doesn’t need to be specific to a single disease. “We are working to roll out a version that looks for the top five respiratory or fever-causing pathogens,” he told me. So you could do a simple swab test, and it will tell you in minutes whether the cold symptoms you have are Covid, or the flu, or a rhinovirus.

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“I think it could really change how people regard having symptoms,” says McNally. For instance, imagine you often get snotty, and you’re not sure whether it’s just allergies or a virus. In future, you might be able to test, and use the result of that test to help you decide what to do — you might feel comfortable going into the office with a confirmed cold or a negative result, but not with an influenza virus or Covid, for instance.

That’s for the future. For now, LFTs do a good job, as long as we see them as risk-reduction tools rather than infallible oracles. “The actual cost of producing one is pennies,” says McNally — most of the £5-or-so price tag at the moment represents the cost of building factories, and logistical issues like boxing and transport, costs which will fall. “You could see a situation where you can buy a pack of seven for £10, and that would really change things.” In future, maybe they’ll be like paracetamol, just something that everyone has in their cupboards.

For now, I suspect that keeping them free is the best option, contrary to the Treasury-brain instinct — although perhaps some nominal cost would stop people stockpiling them when demand is high. Rather, the next change should not be to how we provide them — it should be to how we react to them. And that is to rely on the results, rather than double-checking them with PCR. Meanwhile, with a 90% vaccinated population, we can surely put an end mandatory isolation, and start trusting people to make their own decisions about risk.

Later today, I’ll give evidence to Parliament’s Public Administration Committee on the operations of Number 10. It will focus on the usual controversies and challenges faced in that poky building. But as I reflect on my five years there I can’t help but conclude that the worst thing about Downing Street is its addictive power.

Politics and elections are bad enough: I was once told by a campaign organiser that blisters on my feet weren’t a reason to sit down. I should only stop delivering leaflets if they started to bleed, and only then in order to apply plasters. But once you’re working for the Prime Minister, fatigue becomes a badge of honour.

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How I learned the Tories weren't evil

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You don’t need to look far to see leaders boasting about their inhuman resilience. Margaret Thatcher claimed to only need four hours sleep. Donald Trump has done the same. When Dominic Cummings advertised for new special advisers, he made clear they’d not see their friends or daylight if they took the job. Boris Johnson claimed for two weeks he was working through his Covid symptoms, because sickness — like sleep — is for wimps. It was only once he was admitted to intensive care that they admitted someone else might need to take the tiller of government for a couple of days.

Did they learn from that? Of course not. A couple of weeks ago,  minister Nadhim Zahawi was challenged on Sky News about the performance of Dido Harding, the beleaguered boss of the beleaguered test and trace system. He leapt to her defence and claimed she is working 19 hours a day, seven days a week. We can only hope he’s mistaken, because if this is true she might as well be running the place drunk.

The impact of chronic sleep deprivation on cognitive performance is profound. The scientific literature shows people think slower, and — if pressed for time — make more mistakes. Their memory gets foggier. They learn less easily. And they have “difficulty determining the scope of a problem due to changing or distracting information”, a phrase which sounds like it came from a public inquiry report into the Test and Trace shambles.

The AA estimates that up to 25% of fatal accidents are caused by motorists falling asleep at the wheel. If you’re driving an organisation, rather than a car, you’re running the same risk. “Working 19 hours a day” is a sure fire way to make yourself worse at your job. But what’s madder: doing it, or seeing someone else do it and being impressed? Zahawi clearly thought he was complimenting his fellow minister for her dedication and self-discipline. He — and most of the nation, it seems — has fallen prey to a collective delusion that working yourself to exhaustion is the way to look tough. It’s a rotten mix of machismo and masochism.

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It’s not just politics. Step into the swamp of LinkedIn and you’ll find endless “hack your body” mentors instructing you to get up at 4am. This is wakefulness inflation: 20 years ago Robin Sharma created the “5am club”, advocating people get up at this ungodly hour for 20 minutes learning, 20 minutes planning, and 20 minutes exercise before anyone else woke up. But once 5am was popular, you had to be in the 4.30am club to be special. And then 4am. Soon you’ll have to get up before you go to bed in order to keep up with the business influencers.

The absurdity of this is that it’s not about what you’re achieving. It’s about showing that you’re working more than other people. You want to be the first in the office and the last to leave because it looks good. The most depressing part is that it often works to help individuals get ahead. So many bosses are rubbish at measuring performance, so they measure who’s there instead. Men end up working more hours than women, because they’re less likely to have caring responsibilities. They’re more likely to be able to put their hands up for the overtime. And that drives the gender pay gap even wider.

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But if our work addiction is toxic when it comes to overtime, it’s even worse when it comes to sick leave. If you want proof of our cultish delusion, spend half an hour watching adverts for cold and flu remedies on YouTube.

You know the routine. Person feels ill. Person drinks medicine. Person gives a brilliant presentation / performs brilliantly on stage / plays enthusiastically with their children at a crowded activity centre. The message is obvious: take our pills and you can carry on with your life, regardless of how far you spread your disease by doing so. There was even a postie coughing all over the letters and parcels before he delivered them. After all, nothing says hard work like pushing disease vectors through people’s front doors.

In fact, a decade ago when Benylin launched an advert encouraging people to stay at home when sick the Federation of Small Businesses reacted with horror and disgust. “These terms make a mockery of how serious it is not to turn up to work,” said the boss of the FSB. “If people have real flu then of course they should take the day off, but if it is just a cold then they should not.”

Are they stupid? It’s completely counterproductive to tell people to come to work while infectious, even with a cold: you’ll just end up with the whole team falling ill. And yet the official representative body of small business says that’s precisely what we should do.

The work-til-you-drop culture is reflected in our ludicrous sick pay system, which only requires your employer to pay you if you’ve been off for more than three days. Even then, it’s less than £100 a week. So — unless your employer is more generous — you basically have to show up for work unless you physically can’t. Which means people trek their viruses and bacteria to work and we end up losing more — instead of fewer — days to ill health. And that’s before you even count the productivity loss of wooly-headed snifflers trying and failing to do their jobs when they should be at home with Netflix and a duvet.

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If Covid-19 has taught us anything, surely it has taught us to change these rules? And change the culture that underpins them. When you’re sick, you should stay at home. When you’re tired, you should sleep. Sick people and exhausted people are bad managers, they’re bad leaders, and they’re bad colleagues.

In the early days of the pandemic, the money guru Martin Lewis was presenting a live TV show about how to manage your finances during the crisis. At one point, he had to cough. He shocked his audience by observing that it was suddenly less socially acceptable to cough on live TV public than to fart. But I’ve realised this is a social stigma we should stick with. I’m no particular fan of flatulence, but what harm does it do? It’s coughs that spread disease. We shouldn’t be shaming people for staying in bed to cough and sneeze. We should be shaming them for taking their coughs and sneezes out with them to the office, the shop, the factory, and the bus. Freedom for farts. Stigma for sneezes. It’s the way forward.

It’s been more than 200 years since Welsh mill owner and labour rights activist Robert Owen argued that what we need each day is simple: eight hours labour, eight hours recreation and eight hours rest. Those 200 years haven’t changed human nature. If you’re working more than Owen prescribed, chances are you’re not being a strong and powerful leader. You’re taking work away from others who need it and undermining your own performance.

Being at work is not a virtue in and of itself. Being productive is what matters. When we see a crisis of bad management like Test, Trace and Isolate, we shouldn’t ask why the team aren’t working harder. We should ask why they are working so much. You cannot run a marathon at a sprinter’s pace. Whether it’s senior management or a junior worker, in public services or private enterprise, we will get more from our people if we ask them for a little less.