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AAfter a summer of social gatherings, “eating out to help” and urging travelers 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 isolation 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 stem this increase in the number of cases. But while the government is right to tighten social distancing, this alone will not solve the problem of increasing cases. To do that, it urgently needs to restructure England’s failed test-and-trace program.
In reality, England’s test and trace program has always been half-hearted. It was supposed to be a “global beating”, but now it looks more like a national disgrace. On March 12, the government completely suspended testing in the community on the advice of its scientists and doctors. By then, South Korea had already mobilized its state and pharmaceutical laboratories to expand mass testing. In Wuhan, where the Covid-19 pandemic originated, authorities 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 test through the few existing public health labs and ignore the capacity of our 44 NHS molecular virology labs. None of the 750,000 volunteers who signed up were used to help the NHS, including thousands of retired nurses and doctors. No attempt was made to engage the communities with contact tracing.
In April, the government finally realized that it needed a national testing and tracing program. He then bypassed the NHS, ignored community volunteers, and sought inexperienced solutions from the private sector. While Germany and South Korea had dispatched trained healthcare workers to administer the swab tests, the UK turned to the accounting firm Deloitte to administer the tests in parking lots, where the untrained testers handed out nasal swabs for the tests. people will take them in their vehicles. Lighthouse’s private laboratories, also managed by Deloitte, provided centralized testing but were not subject to the same stringent quality controls as their NHS counterparts. The test results were not shared with local public health centers or GPs, the people who might have worked to prevent transmission in their local communities. And even though the government has weeks to prepare for a second wave, the testing system continues to fail. Many people have to travel hundreds of miles from home to have a swab test.
When it comes to contact tracing, England has fared no better. The government outsourced the service to Serco and Sitel, who then outsourced the work to 29 other companies to provide centralized contact tracing in the call center. Reports found that many contact trackers were making only a handful of calls a month, rather than occupying their time with barbecues and contests, while research showed that in the first weeks of its inception, the system did not reach thousands of calls. persons. For months, no financial support was offered to those who were asked to isolate themselves; even now, those who must isolate and forego wages receive just £ 13 a day. A survey of people who were asked to self-isolate in the UK showed that 75% had left home in the last 24 hours.
With the economy and schools reopening, cases were always likely to increase. According to the Academy of Medical Sciences, a second wave could cause 120,000 deaths in hospitals between September and June next year, while the London School of Hygiene and Tropical Medicine forecasts between 170,000 and 480,000 deaths by the end of 2021, with only national closures. repeated. able to stop the carnage. But we must be careful with these apocalyptic estimates. Populations are not homogeneous in their vulnerability to Covid-19, and many things have changed since the start of the pandemic.
More vulnerable people are protecting themselves now than at the beginning. There may be increasing levels of immunity in people who have produced T cells against the virus, even if there are no antibodies. And the risk of transmission is uneven among infected people: some are “super-spreaders”, but others do not transmit it at all. British neuroscientist and mathematical modeler Karl Friston estimates that Britain may see a much lower death rate than some forecasts suggest, and that we could quell the epidemic for November if we made sure that only 25% of infected people did not symptoms were effectively isolated. Currently that figure is around 5%, and given the current state of England’s testing, tracking and isolation capabilities, it seems overly optimistic that this can be easily achieved.
But this does not liberate the government. There is no room for complacency – the size of the second wave will largely depend on the effectiveness of the test and trace program. Improving this system would include the implementation of many more nasal swab tests, administered by trained nurses in primary care settings. It would mean completely reallocating funds and contact tracing staff to local public health teams, with the help of England’s national expert health protection teams.. We would have local public health review committees that monitor the number of tests and the effectiveness of the system, while volunteers from the community will participate in contact tracing when necessary, and will also remind people about the availability of tests and the positive test rate per 100,000 in your area.
The government would cut back on the silly money it has wasted on private contracts, investing it instead in local public health and a generous support plan for people who need isolation. The spread of the coronavirus and the success of our economy are intertwined. It is only with a drastically overhauled test and trace system that we will 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
