While a testing and traceability system that quickly detects the coronavirus and prevents further transmission cannot eliminate the risk of new cases emerging, it can minimize the impact of the virus. New Zealand has only seen 22 coronavirus deaths, compared to more than 46,000 in the UK. And as summer approaches New Zealand, the country can reasonably expect more coronavirus-free days in the future.There is no such optimism In England. Unlike New Zealand, England’s approach is not to completely eliminate Covid-19, but to minimize its impact. Instead, there are good reasons to be concerned about the approach of winter, when the transmissibility of the virus is greater and schools are expected to reopen. Importantly, the country’s overly centralized, fragmented and semi-privatized testing and traceability system has been costly and inefficient; despite Boris Johnson’s claims, a system based on outsourcing centralized contracts to Serco, which then outsourced contact tracing tasks to call center agents, was never going to “beat the world.” While the recent government decision to outsource these call handlers to local teams may help improve the system as a whole, using remote call handlers with minimal experience and training was bad. approach from the start. Meanwhile, Serco and Sitel continue to siphon scarce resources that should be invested in local public health teams.
Fortunately, we seem to be moving towards a more decentralized system with greater recognition of the importance of local action plans and local leadership in public health. But there is still a long way to go if England is to be ready for a potential second wave of coronavirus cases this winter. The capacity for testing must continue to develop. It also needs to be fast, nimble, and linked to frontline health and social workers, as well as community members, such as teachers, who are key to identifying new clusters of viruses.
A real-time information system covering local health centers, regional public health teams and national levels of government will be crucial in identifying clusters and ‘super-spread’ events (there is evidence that only 10 % of infected people can be responsible for almost 80% of transmission). The government must also ensure that people who test positive for the coronavirus actually isolate themselves. No data is currently available as to whether people who are asked to self-isolate are respecting the 14-day quarantine period, and no financial support is available to isolate them from the consequences of this quarantine.
No one can say for sure what will happen in the fall and winter. There are so many variables, and our models are still compromised by an incomplete understanding of the behavior of the virus. We are not sure what role children and adolescents play in the spread of the coronavirus. We do not know exactly what proportion of the population is vulnerable to infection, nor what proportion of this population is vulnerable to clinically significant disease.
What we do know is that England will come in autumn and winter under different circumstances. The country will be a quieter and less crowded place than at the beginning of March; there will be no densely packed football trains and stadiums, no indoor choir practices, no office Christmas parties. There won’t be thousands of people returning from high transmission vacation destinations, and we shouldn’t be making the mistakes that have led hospital patients to be sent to nursing homes, where they unwittingly spread the virus. .
Health officials may not be able to stop the embers of the outbreak from continuing to flash, but they should be able to prevent the real conflagration we experienced in March and April. We have seen the detrimental effects of indiscriminate and prolonged lockdowns on young people and vulnerable people, and on the economy as a whole. To avoid imposing drastic measures, the government must help people behave responsibly and safely – not just giving orders from above.
The first requires a well-informed public; rather than asking people to “stay vigilant”, which could mean a number of things – and therefore say nothing – the government should provide them with clear direction. Restoring public confidence will be an integral part of preventing future outbreaks. To a large extent, we are all in the same boat – but we cannot ignore the fact that some people are affected much more than others and that the trade-offs inherent in any set of policies chosen are fundamentally political and ethical. nature.
Ultimately, the government will not be judged solely by the health effects of the coronavirus. The fallout from the pandemic will be felt socially and economically, entrenching the inequalities that already exist in our society. We must do all we can to prevent a surge in coronavirus deaths this winter. It won’t be easy, but if we are to live with the virus, we will have to deal with it alongside other risks and threats to our health and well-being.
• David McCoy is Professor of Global Public Health and Director of the Center for Public Health at Queen Mary University in London