Now that pubs are ordered to close, extended families are forced to stop reuniting, and intensive care beds are filling up quickly, government science advisers Sage have concluded that the NHS test and trace did not work.
Too few people get tested, results come back too slowly, and not enough people are sticking to instructions to self-isolate, they say.
The system “has a marginal impact on transmission”, therefore, and unless it grows as fast as the epidemic, this impact will only diminish.
So what is wrong?
Too centralized from the start …
Tasked in the spring with deploying millions of coronavirus tests, Secretary of Health Matt Hancock opted for a centralized system using private companies. The consulting firm, Deloitte, was awarded a contract to help run tests at local, walk-in testing sites, with swabs being sent for analysis at a network of national laboratories, many of which are also contracted out. Serco also has an agreement to manage contact tracing and outsource work to other companies.
The stakes for their success were high. An Imperial College study found that if testing and tracing worked quickly and efficiently, the R-number could potentially be reduced by up to 26%.
Local public health directors knew this from experience dealing with sexually transmitted diseases and food poisoning epidemics, but their role was limited, making many exasperated at being excluded.
As the system became operational over the summer, ONS surveys into the prevalence of the virus suggested that the NHS test and trace could only detect a quarter of actual cases.
In July, one of the system’s top officials, Alex Cooper, privately admitted that the system only identified 37% of the people “we really should find.” The clamor of mayors and local public health officials for a greater role has grown.
Finally, this week the government admitted that cities and regions should receive help to do more.
“We always knew that there was a need for a local element of testing and traceability, as a centralized system lacks local expertise and is not able to cut through the most communities. hard to reach, ”Andy Street, the conservative mayor of the West Midlands, told The Guardian this week.
The pressure on a centralized system has been clear. Sarah-Jane Marsh, director of tests at the NHS test and trace tweeted last month: “The test team works 18 hours a day, 7 days a week. We recognize that the country depends on us. She is about to resign after less than six months in her post.
Warnings from the website that no tests were available exposed the testing crisis to the British public almost daily this summer, particularly in September when schools returned.
System manager Dido Harding said last month that the number of people wanting testing was three to four times the number available. The “flagship” national laboratories of Milton Keynes, Cheshire, Glasgow and Cambridge had reached their capacity.
More than a quarter of people attending 500 local testing centers after coming into contact with someone who had tested positive were simply turned away because they did not show symptoms.
The scale of the task was shown when Harding told MPs that around half of the tests available were used by NHS patients, social services and NHS staff.
Such was the tension that tens of thousands of tests had to be sent for processing abroad.
And the need for testing will only increase.
Johnson has pledged a daily testing capacity of 500,000 by the end of the month. As of Tuesday, it was 309,000 people.
Already very far from the target, the system will come under increased pressure in the coming weeks. On Tuesday, the government finally said visitors to care homes could be tested regularly in an attempt to end the isolation caused by banning their visits to loved ones. There are 400,000 nursing home residents.
New labs in Newcastle, Bracknell, Newport and Charnwood are expected to open within a few weeks and they cannot arrive soon enough. As early as May, Sage experts said the speed of the results had a significant impact on the virus’ reproduction rate. Turnaround times should be 24 hours or less and it was “critical” that this capacity be achieved in the fall / winter.
Johnson pledged on June 3 to “get it all [non-postal] the tests took place in 24 hours at the end of June ”.
But for the last week of September, the percentage of test results returned within 24 hours to the testing community was no more than a third. Almost nine out of 10 Covid-19 tests performed under the system used by nursing homes in England were returned after 48 hours in September. Kathy Roberts, president of the Care Providers Alliance, told MPs on Tuesday she did not trust the government’s testing and traceability strategy.
“The percentage of returns is still too low,” she said. “It got better for the people on the way out but not for the workforce.”
Last month, Congressman Greg Clarke, chair of the Commons Science and Technology Committee, asked Harding whether the failure of the testing system was “the cause of the increase in the pandemic.”
“I firmly deny that the system is failing,” she replied.
The data error that left nearly 16,000 coronavirus cases unreported in England last month when they disappeared from a spreadsheet, was not an isolated computer glitch. The government’s first attempt to create an app to track infections was scrapped in June after months of development.
A new approach costs around £ 36million in development and running costs in the first year. The app allows users to check in at locations and receive alerts if they’ve been near an infected person, provided the infected person tells their app. But he hasn’t found his marks yet.
For a while, people tested in the NHS and PHE settings couldn’t enter their results, which meant thousands were missed. A feature that’s supposed to alert people when they are in a place where there has been an outbreak has only been used a few times, despite the app being downloaded by more than 16 million people.
Some employers have also asked workers to deactivate the app.
The figures suggest that contact tracers working in the national system performed less well than officials in local councils. The percentage of people reached and asked to provide details of recent close contacts hit its lowest level since June through late September, with performance steadily deteriorating over the month. This means that around 25% of contacts are not reached at all.
There have been embarrassing reports that contact tracers don’t make any calls for days, with some catching up to Netflix while being paid for doing nothing.
In contrast, local public health officials, some setting up their own call centers and redeploying environmental health workers and sexual health experts with local knowledge and properly trained for the job, believe they trace nearly 100% of contacts.
The difference was particularly significant in the north-west of England, where the virus took hold this summer and communities of South Asian origin have proven more difficult to reach. Ministers finally agreed to share real-time data with local authorities in August, but only after several councils threatened to break ranks and set up their own locally managed system.
Local health officials have complained that the centralized system has failed to join the dots on related infections. For example, it might spot 40 cases in a zip code – but wouldn’t quickly understand that the cluster was tied to a specific workplace, event, or pub.
“Local residents recognize and can identify with their local council, which is not always possible with a national system,” said Ian Hudspeth, chair of the Association of Local Governments Community Welfare Council. “Council staff can go to people’s homes to make sure they know what to do.”
People struggle to isolate oneself
Sage estimates that at least 80% of the contacts in a case must self-isolate for the system to work.
Last month, however, he found that rates of total self-isolation were below 20% and particularly low among the youngest and poorest.
A study from March to August found that only 18% of 1,939 people with symptoms stayed at home, and those facing greater difficulties were less adherent.
The ability to self-isolate was three times lower among people with incomes below £ 20,000 or savings below £ 100, according to a third study.
Additional reports: Josh Halliday