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Local public health leaders in England are demanding greater control over the Covid-19 testing system after circulating a list of complaints about the way it is working and accusing ministers of giving mixed messages about the availability of the tests. tests.
The complaints, seen by The Guardian, have been prompted by fears that a capacity shortage is hampering attempts to quell local outbreaks.
Public health directors want local testing units to be dedicated to the local population rather than available nationally, in some cases to people who live hundreds of miles away.
On Wednesday, Health Secretary Matt Hancock appeared to partly blame the public for the paucity of tests, saying some people were using it in a way that was “inappropriate.”
He said the centralized system, which often suggests the closest testing center is more than 100 miles away, was being overwhelmed by people trying to book tests when they had no symptoms, which he said was contrary to advice. of the government. He said that about 25% of the people who showed up were not eligible for a test.
“I’ve even heard stories of people saying, ‘I’m going on vacation next week, so I’m going to get tested,'” he said. “No, that’s not what the test system is for. We have to be more assertive, I’m afraid, with the rules on eligibility for testing. “
Shadow health secretary John Ashworth accused ministers of “seeking to blame people for simply doing what they were advised to do.” On July 21, Hancock had said: “If in doubt, get tested for coronavirus” and that “anyone who needs a test can get tested.”
Ashworth said: “With the children returning to school and thousands returning to the office, it is obvious that additional testing capacity would be needed. The fact that the ministers did not plan is even more astonishing incompetence. “
In recent days, the UK has seen a sharp spike in the number of Covid-19 infections, raising fears that a second wave of cases is starting.
Infectious disease epidemics behave in different ways, but the 1918 influenza pandemic that killed more than 50 million people is considered a key example of a pandemic that occurred in multiple waves, the latter being more severe than the former . It has replicated, albeit in a milder way, in subsequent flu pandemics. So far that was what was expected of Covid-19.
How and why multi-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modeling and pandemic preparedness studies, which have examined everything from behavioral social and health policy until vaccination and the accumulation of community immunity. , also known as herd immunity.
Is there evidence that the coronavirus returns in a second wave?
This is being watched closely. Without a vaccine and without widespread immunity to the new disease, an alarm is sounding for the experience of Singapore, which has seen a sudden resurgence of infections despite being praised for its early handling of the outbreak.
While Singapore instituted a robust contact tracing system for its general population, the disease reappeared in the crowded dormitories of thousands of foreign workers with inadequate hygiene facilities and shared dining rooms.
The Singapore experience, while highly specific, has demonstrated the disease’s ability to reappear with force in places where people are in close proximity and its ability to exploit any weaknesses in established public health regimes to counter it.
In June 2020, Beijing suffered a new cluster of coronavirus cases that prompted authorities to re-implement restrictions that China had previously been able to lift. In the UK, the city of Leicester was unable to get out of lockdown due to the development of a new spike in coronavirus cases. Groupings also emerged in Melbourne, requiring a reimposition of the lockdown conditions.
What are experts worried about?
Conventional wisdom among scientists suggests that second waves of resistant infections occur after treatment and isolation capacity is exhausted. In this case, the concern is that the social and political consensus that supports the blockades is being overcome by public frustration and the urgent need to reopen the economies.
However, Linda Bauld, professor of public health at the University of Edinburgh, says that “’Second wave’ is not a term that we would use at this time, as the virus has not disappeared, it is in our population, it has spread to 188 countries so far, and what we’re seeing now is essentially localized spikes or a localized return of a large number of cases. ”
The overall threat decreases when the population’s susceptibility to the disease falls below a certain threshold or when widespread vaccination is available.
Generally speaking, the proportion of susceptible and immune individuals in a population at the end of a wave determines the potential magnitude of a later wave. The concern is that with a vaccine still many months away, and the actual rate of infection can only be guessed, populations around the world remain highly vulnerable to both resurgence and subsequent waves.
Peter Beaumont, Emma Graham-Harrison and Martin Belam
Extraordinary examples of delays and anecdotes about people being sent to testing centers far from their homes continued to emerge. On Wednesday morning, people who logged into the NHS Test and Trace website were again faced with the message: “This service is currently very busy. More evidence should be available later. “
There were many more complaints from the public about the shortage of tests. The family of a five-year-old boy with symptoms was told there were no test appointments available until Sept. 17 and that there were no home test kits left, the boy’s grandfather told The Guardian. They have been told that the whole house must be isolated and that the child cannot go to school for 14 days.
In Walthamstow, east London, residents were offered tests in Newport, south Wales, a 320-mile round trip.
The daily struggle for community testing has also raised concerns on the NHS about additional pressures on their services, with many callers giving up the dedicated 119 helpline number to obtain a test and calling the general number 111 NHS. In other cases, people have gone to their GPs.
There is also evidence that some test stations may have been providing tests to asymptomatic people. A father from East London reported that he took his symptomatic son to a test drive site and the site staff strongly urged him and his other son, who was also in the car, to take a test despite the fact that they had no symptoms.
Sarah-Jane Marsh, director of testing at NHS Test and Trace, apologized Tuesday for the situation, saying lab processing was “the tipping point.” But frustration is mounting among local health officials.
“I’m not interested in an apology,” said a senior director of public health. “I want you to stick your finger out and solve this mess or hand it over to us and get out of the way. The testability problem was completely avoidable. Hancock was the one who said to go and get tested, there are many tests. It’s getting more and more chaotic. “
Ian Ashworth, director of public health for Cheshire West and Chester, told The Guardian that he had been contacted this week by a symptomatic resident who had been offered a test in Telford or London within five days. There is a walk-through test center in Chester city center, but because it is on the national reservation system, spaces are available to people everywhere.
“We can’t handle outbreaks like that,” he said. “It’s like having one hand tied behind your back. We have been asked to develop outbreak plans and testing plans go with that. But if the national system is exhausting our local testing capacity, there is no way we can control local outbreaks. “
Dr. Jeanelle de Gruchy, president of the Association of Public Health Directors, said: “It is crucial not only that the amount of testing is sufficient, but that that testing capacity is targeted and utilized in such a way that those with symptoms can Access tests close to where you live and receive your results immediately. Clear and concise communication from the government about who is eligible for testing is vital. “
