AAfter a summer of social gatherings, “eating out to help out” and urging commuters to “get back to the office,” the government appears to be losing control of the pandemic. Nearly 3,000 new cases were reported in the UK over the weekend and hundreds of pupils went into solitary confinement after cases were discovered in more than 90 schools. Gatherings of more than six people will now be banned in England from Monday in an attempt to curb this increase in the number of cases. But although the government is right to reinforce social distances, this alone will not solve the problem of the increase in cases. To do this, he urgently needs to restructure England’s failed test and tracking program.
Indeed, England’s testing and tracking program has always been unconvinced. It was supposed to be “the world beating”, but now it feels more like a national shame. On March 12, the government stopped community testing altogether on the advice of its scientists and doctors. By that time, South Korea had already mobilized its pharmaceutical and state labs to ramp up mass testing. In Wuhan, where the Covid-19 pandemic originated, authorities have deployed 9,000 community health workers and volunteers to find cases, trace contacts and ensure their isolation among 11 million residents, a ratio of one worker for every 1,220. people.
On the contrary, England did not mobilize anything. We only tested through the few public health labs in existence and ignored the capacity of our 44 NHS molecular virology labs. None of the 750,000 volunteers who signed up to help the NHS, including thousands of retired nurses and doctors, were used. No attempt was made to engage communities with contact tracing.
In April, the government finally realized it was calling for a national test and traceability program. He then bypassed the NHS, ignored community volunteers, and sought inexperienced solutions in the private sector. While Germany and South Korea had sent skilled health workers to administer swab tests, the UK turned to accounting firm Deloitte to manage parking tests, where untrained testers handed out nasal swabs for people. to take in their vehicles. Private Lighthouse Laboratories, also run by Deloitte, provided centralized testing but were not subject to the same stringent quality controls as their NHS counterparts. Test results were not shared with local public health centers or primary care physicians, people who could have worked to prevent transmission in their local communities. And despite the government having weeks to prepare for a second wave, the test system continues to fail. Many people have to travel hundreds of miles from home to receive a swab test.
When it comes to tracing contacts, England has fared no better. The government outsourced the service to Serco and Sitel, who then subcontracted the work to 29 other companies to provide centralized contact tracking for the call center. Reports found that many contact trackers only made a handful of calls per month, instead occupying their time with barbecues and quizzes, while research showed that in the first few weeks of its inception, the system failed to reach thousands of people. For months, no financial support has been offered to those who have been asked to isolate themselves; even now those who have to isolate and give up their wages only receive 13 pounds a day. A survey of people who were asked to self-isolate in the UK showed that 75% had left home in the previous 24 hours.
With the reopening of the economy and schools, an increase in cases was always likely. According to the Academy of Medical Science, a second wave could lead to 120,000 hospital deaths between September and June next year, while the London School of Hygiene and Tropical Medicine predicts between 170,000 and 480,000 deaths by the end of 2021, with only repeat national blocks. capable of stopping the carnage. But we should be wary of these apocalyptic estimates. Populations are not homogeneous in their vulnerability to Covid-19 and many things have changed since the beginning of the pandemic.
More people who are vulnerable are protecting now than they were in the beginning. There may be increasing levels of immunity in people who have produced T cells against the virus, even if antibodies are absent. And the risk of transmission is not uniform among infected people: some are “super speakers”, but others do not transmit it at all. British neuroscientist and mathematical modeler Karl Friston estimates that Britain could see a much lower death rate than some predictions suggest and that we could suppress the epidemic by November if we ensured that only 25% of infected people without symptoms were actually isolated. Currently that figure is around 5%, and given England’s current testing, tracking and isolation capability, it seems overly optimistic that this can easily be achieved.
But that doesn’t let the government off the hook. There is no room for complacency: the size of the second wave will largely depend on the effectiveness of the testing and tracking program. Improving this system would include the launch of many more nasal swab tests, administered by qualified nursing staff in primary care centers. It would mean completely reallocating funds and contact tracing staff to local public health teams, assisted by England’s experienced national health protection teams. We would have local public health review committees monitoring the number of tests and the effectiveness of the system, while community volunteers would be involved in contact tracing where needed and also remind people of the availability of tests and the positive test rate for 100,000 in their area.
The government would cut the stupid money it wasted on private contracts, instead investing it in local public health and a generous support program for people who need to isolate themselves. The spread of the coronavirus and the success of our economy are intertwined. It is only with a drastically reformed test and tracking system that we have a chance to restore our livelihoods and economy this winter.
• Anthony Costello is Professor of Global Health and Sustainable Development at University College London