Test and Trace in England: a Resume of Progress

Professor Peter Bradshaw

Health policy expert

Below Professor Bradshaw explains the Government’s failings with rolling out the long awaited Test and Trace system and says it comes as no surprise why the nation is now experiencing sporadic viral resurgence as well as an overall increase in rates of infection, an increase in the R number and even with the imposition of restrictions there are some seriously notable clusters locally.

“You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected. We have a simple message for all countries: test, test, test. Test every suspected case.”

Adhanom Ghebreyesus, 2020

“These words of the Director General of the WHO on 16 March 2020 are the very logos on which this pandemic depends for containment. Yet have we in England, simply lost our way? For as the PMs stop-start, partial easing of lockdown proceeds, we learn yet again that our diagnostic and tracking measures are woefully inadequate.

Mr Hancock, (Our Man in a Muddle) has an Oxford degree in PPE - that clearly doesn’t stand for Personal Protective Equipment - has performed his latest U turn, again without using his indicators – and has scapegoated and disbanded Public Health England (PHE) for the hopeless failure of the current Test and Trace system and created a new Institute to do the job (BBC, 2020a).

Public Health England

PHE had run an overcentralised command and control Test and Trace system using inexperienced private companies Serco and Sitel, criticised by every authoritative scientific body for their ineffective slowness in testing and failure to capture adequate numbers of infected people to contain the pandemic. This latest significant volte-farce (as it is known in Oxford) came as the national testing scheme last week reached the pits. - asking to quarantine only 61% of the 12,731 contacts identified – and falling well short of the 80% target trace-rate necessary for the successful disease suppression.

Hence we see sporadic viral resurgence, an overall increase in rates of infection and an increase in the R number with some seriously notable clusters locally and with the imposition of restrictions.

A possible second wave

Worryingly therefore, researchers writing recently in The Lancet Child and Adolescent Health give dire warning that Ministers have barely one month to repair and invigorate NHS Test and Trace to avoid a second wave of the disease (Panovska-Griffiths et al, 2020). Their concern is for the spread of the virus as overall lockdown measures lessen and social distancing is relaxed and for the broader pressure on NHS Test and Trace that the reopening of Schools in September will impose.

The researchers rigorously used simulations of schools; either reopening full time or on a part time rota basis. They also assumed different levels of testing, tracing and isolation that might be achieved by NHS Test and Trace and project the likely effects of the different permutations that could lead to a second wave - with the potential to claim a further 120,000 lives.

A ‘World Class’ Service

So, notwithstanding Mr Hancock’s ‘re-disorganisation’ of PHE and the creation of his shiny new Institute, NHS Test and Trace performance remains abysmal and akin to fox hunting with a pack of three-legged tortoises. In the spring he affirmed a digital contact tracing app would be key to easing lockdown and keeping people safe. But six months on it is nowhere in sight and England is still reliant on an army of human contact tracers using semaphore messaging, an abacus, a slate and piece of chalk to find erstwhile sufferers.

A weekly diagram issued by Public Health England of UK's areas of concern in relation to the coronavirus

This image from Public Health England dated 21 August appeared in a BBC News story entitled: ‘Coronavirus in the UK: How many confirmed cases are there in your area?’.

Our Man in a Muddle

But this week after the PHE U turn – more promises exuded when Mr Hancock said he wanted to see more rapid-turnaround testing for the public saying the government is assessing the accuracy and effectiveness of new types of tests that can deliver results on the spot (Ghose, 2020b). Surely an improvement on some tests that are taking four days to report.

Yet, this latest sound bite repeats a similar Hancock promise three weeks ago that all is not so bad now we have a new 90-minute testing system – the ‘Nudgebox’. This can detect coronavirus and other seasonal illnesses and does not require laboratory facilities (BBC, 2020b). Its RNA tests will be analysed by 5000 ‘Nudgebox’ machines that can each process up to 15 nose swabs a day. Half a million on the spot tests would allegedly be available by 10 August according to Mr Hancock who described a ‘big step forward’ - adding blithely, that this testing would be widely available to schools and care homes. Alas all so far - just more repetitiously empty promises that now, ‘might take some time’!

But remember, claims for and accuracy of all of this purported new ‘magic’ technology have yet to be independently authenticated and once more, the Government has purchased testing devices based on manufacturers optimistic assertions, all reminiscent of similar past purchases that have been found by subsequent impartial verification to lack specificity and adequate performance and have been scrapped successively as an expensive waste of money.

Where are we at?

So, the Government’s costly contact tracing programme is failing to reach many of those named by infected patients in non-complex cases, including individuals living under the same roof. The outsourcing giants Serco and Sitel are being paid £192million to provide 18,500 tests for non-complex cases by their call handlers who pass complex ones to Public Health England that until this week, variously managed local outbreaks using the people who know most about containing transmission but have until now been least involved. We do not know the strategy of the new Institute but rest assured, it is the local Departments of Public Health that best know the locality of outbreaks, its people and its diverse cultures that is so important in containing transmission.

In the absence of a vaccine this disease is with us in perpetuity so it is important that we that we test, test, test, test to know precisely where we are going – but do we?

Certainly, Ministers preface all their achievements in this epidemic as ‘world beating’ and perhaps they are onto something - unless our golden success is just a mirage and our only genuine top-drawer triumph - is for ‘world beating’ incompetence?”

References:

Adhanom Ghebreyesus T (2020) Director General’s opening remarks – media briefing on COVID-19 World Health Organisation, 16 March 2020.

BBC (2020a) New public health body 'vigilant for viral threat' BBC, 18 August, 2020.

Panovska-Griffiths J, Kerr C R Stuart R M Mistry D Klein D J Viner R M Bonnell C (2020) Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling study Lancet Child & Adolescent Health 3 August 2020

Ghosh P (2020b) Coronavirus: UK to ramp up coronavirus monitoring programme BBC, 19 August, 2020

BBC (2020c) Coronavirus: New 90-minute tests for Covid-19 and flu 'hugely beneficial' BBC, 3 August, 2020