Jeremy HUNT
Our track and trace system is working well from a standing start but we need to reach all new infections
So July 4 will indeed be independence day – with a collective sigh of relief from the nation after yesterday’s announcement by the Prime Minister. But if we are to avoid losing our liberty in another lockdown, we will need to resolve some serious issues in the way our test and trace programme is working.
We should recognise the enormous achievement in getting this system up and running from a standing start. Dido Harding and her team have set up a system of considerable complexity which has so far persuaded 87,639 people at risk of developing coronavirus to self-isolate. Seventythree per cent of newly diagnosed corona cases are being contacted and 90 per cent of their contacts are being reached and asked to self-isolate.
Our approach is modelled on track and trace systems that have had spectacular success in South Korea, China, Taiwan, Hong Kong and Singapore. But in nearly every case they were introduced at a much earlier stage of the pandemic. The result is that although we are tracing the contacts of around 700 people a day, the Office for National Statistics estimates about 2,500 people are being newly infected daily. That means that while we are reaching the vast majority of new cases we know about, we are only reaching a third of likely new infections. This is why Tony Blair, William Hague and many others have called for the introduction of mass testing: until we know we are catching the vast majority of new infections, we will not be able to contain spikes.
This requires a massive further ramp-up of capacity. Beijing, with a population one third of the UK, has put in place the capability to test 400,000 people a day in order to deal with its latest outbreak. Such testing need not be for the entire population initially – it makes sense to concentrate on groups where prevalence may be higher, such as taxi drivers or people working in hotels. Used at airports it could even replace the need for quarantine. But there is one area where it must be an absolute priority: frontline NHS and care staff.
We do not know the precise proportion of new infections in healthcare settings, but it is likely to be around one third. The people there are either the most vulnerable or in constant contact with the most vulnerable. Until we minimise the risk of asymptomatic transmission by introducing weekly testing for all NHS and care staff, we are failing in a basic duty of care to the people most likely to die if they get the virus.
Some may argue that because the swab test is not 100 per cent reliable, people may be told wrongly they are Covid-free. That is just another reason why testing should be regular – if someone is not picked up the first time, hopefully they will be the next. Another risk is “false positives” – people being told to isolate when they turn out not to have the virus. Taking a doctor or nurse unnecessarily off their job carries big risks, so the solution is surely to conduct a second confirmatory test immediately.
Testing NHS frontline staff weekly means an extra 200,000 tests a day. Add in social care staff and you can double that number again. But the costs are small compared to the cost of a second wave this would prevent.
There is another reason why we must go down this path with more urgency than to date. Waiting lists, according to evidence seen by the Health Select Committee, are likely to double. The Royal College of Surgeons says there will be a “mountain-sized” waiting list for surgery that could take five years to clear. But because of the need for social distancing and PPE, many hospitals can only work at 60 per cent capacity. One of the quickest ways to increase that capacity is to create “Covid-light” units where weekly testing of staff minimises the risk of Covid infections.
In other words, mass routine testing helps the NHS to get back to its normal capacity by making it safer for patients and staff. It will also help the care home sector where financial problems are now emerging as infection worries keep potential new residents away.
The Prime Minister has described test and trace as “whack a mole”. It is time to whack the Covid moles in our health and care system by committing to weekly testing of all staff to keep them and their patients safe.