Fresh from some very mixed messaging in the United Kingdom’s mainstream media, yesterday the UK Government announced the release of their “Covid-19 recovery strategy”:
This document describes the progress the UK has made to date in tackling the coronavirus (COVID-19) outbreak, and sets out the plans for moving to the next phase of its response to the virus.
The strategy sets out a cautious roadmap to easing existing measures in a safe and measured way, subject to successfully controlling the virus and being able to monitor and react to its spread. The roadmap will be kept constantly under review as the epidemic, and the world’s understanding of it, develops.
The section of the roadmap of most interest to us is 5.6, “Testing and tracing”. There we learn that:
Mass testing and contact tracing are not, in themselves, solutions, but may allow us to relax some social restrictions faster by targeting more precisely the suppression of transmission. The UK now has capacity to carry out over 100,000 tests per day, and the Government has committed to increase capacity to 200,000 tests per day by the end of May.
The Government has appointed Baroness Harding to lead the COVID-19 Test and Trace Taskforce. This programme will ensure that, when someone develops COVID-19-like symptoms, they can rapidly have a test to find out if they have the virus – and people who they’ve had recent close contact with can be alerted and provided with advice. This will:
● identify who is infected more precisely, to reduce the number of people who are self isolating with symptoms but who are not actually infected, and to ensure those who are infected continue to take stringent self-isolation measures; and
● ensure those who have been in recent close contact with an infected person receive rapid advice and, if necessary, self-isolate, quickly breaking the transmission chain.
This cycle of testing and tracing will need to operate quickly for maximum effect, because relative to other diseases (for example SARS) a proportion of COVID-19 sufferers almost certainly become infectious to others before symptoms are displayed; and almost all sufferers are maximally infectious to others as soon as their symptoms begin even if these are initially mild.
For such a system to work, several systems need to be built and successfully integrated. These include:
● widespread swab testing with rapid turn-around time, digitally-enabled to order the test and securely receive the result certification;
● local authority public health services to bring a valuable local dimension to testing, contact tracing and support to people who need to self-isolate;
● automated, app-based contact-tracing through the new NHS COVID-19 app to (anonymously) alert users when they have been in close contact with someone identified as having been infected; and
● online and phone-based contact tracing, staffed by health professionals and call handlers and working closely with local government, both to get additional information from people reporting symptoms about their recent contacts and places they have visited, and to give appropriate advice to those contacts, working alongside the app and the testing system.
All of this begs several questions, from our perspective at least:
- Why the sole emphasis on “widespread swab testing”? Why not so called “saliva tests” for example?
- How is the “new NHS COVID-19 app” going to work? Not least because the most vulnerable people in our communities are unlikely to be the proud possessors of a recently released smartphone.
- How will the “valuable local dimension to testing, contact tracing and support” be integrated with the eventual NHS Covid-19 app?
Watch this space to discover if we ever get answers to these and other questions!