Test, Trace, Isolate and Support

Originally written as a comment piece in November 2020

The importance of identifying infected patients, finding their close contacts and, most importantly, isolating them before they can pass on the virus, is the basis of managing any epidemic and is demonstrated across the world, including by countries with fewer health resources than the UK. Unfortunately, the UK Government’s focus has mostly been on headline-grabbing test numbers rather than ensuring they are part of a fast and efficient system to Test and Trace anyone who could be carrying the virus, and provide support to ensure they Isolate until no longer infectious. 

With cases and deaths rising, and despite the Prime Minister’s scorn for the idea, England has been forced back into a full national lockdown. The question now is how the time will be utilised to avoid endless repeats. While there are many criticisms of the UK Government’s handling of the pandemic, including handing out jobs and contracts to people with little relevant expertise, the most critical is the failure to establish an effective Test, Trace and Isolate system, after almost 10 months.

When faced with the challenge of establishing testing for Covid, the UK Government decided to create a commercial network of Lighthouse labs from scratch instead of providing funding to expand NHS lab capacity. The latter would have delivered quicker in-hospital testing for patients and staff as well as providing leadership on data handling, quality and safety to any research and academic laboratories involved. The commercial approach also meant there was no specific funding provided for the Devolved Governments to develop testing services integrated with their NHS systems or suited to their demographic and geographical needs.

After testing, the next step is to reach all those who have tested positive with Covid, and any of their close contacts, before they can pass on the infection. While Public Health England’s regional teams tackle outbreaks in hospitals and care homes, and despite misleadingly being called ‘NHS’ Test & Trace, community cases in England are mostly traced by commercial companies with no public health experience, like Serco and Sitel.

Time is of the essence and the World Health Organisation (WHO) recommends that 80% of all close contacts should be reached within 72 hours. Since their public health based contact tracing systems were established in June, Scotland has reached 94% of positive cases (with 88% of those being interviewed within 24 hours) and 96% of close contacts while Wales has reached 98% and 93% respectively. In contrast, the most recent government data for England shows less than 60% of close contacts were reached and asked to self-isolate by the Serco led system. In addition, due to a technical issue, the supposedly ‘world-beating’ English Covid App sent hardly any alerts during its first few weeks.

Involving local public health teams, who know their local communities, is critical to improving the final and most important part of the system; isolating those who are infected or may be carrying the virus. Testing and Tracing identify those who need to isolate but it is Isolation which actually stops the spread of the virus. Disappointingly, though many surveys suggested over 80% of people would be willing to isolate, research from Kings College, London has shown that less than a quarter are actually doing so. This is why I support the campaign, run by ‘We Own It’, to have the Westminster Government change their approach so there is locally led, public effective testing and contact tracing all across the UK. 

A key problem is that workers are unlikely to isolate at home if it means they will not be paid or may even lose their job. It has taken many months to get the Government to accept the need to provide financial support and, while the new isolation payment of £500 for low paid workers is welcome, many are struggling to actually access it.

While news of a potential vaccine is incredibly welcome, we will be living with Covid for some considerable time. With England back in full Lockdown, it’s vital the Westminster Government uses the time to suppress the virus.  This involves managing the external borders and supporting businesses to invest in better indoor ventilation systems. However, the most critical is to get the Test and Trace system working effectively, with financial support to help people Isolate and stop the spread of Covid.