We believe that the failure of the UK government to properly coordinate testing for COVID-19 has contributed to the UK suffering the highest death toll in Europe.
Countries that have had lower mortality adopted robust testing strategies early on.
Testing centres are not local to where most people live. A common stipulation is that they must be driven to. If someone is unwell or doesn’t own a car this makes the testing centres inaccessible.
Reliable testing is dependent on when, in the course of the illness, the test is taken. There is a false negative rate of around 30%. To be meaningful, testing must be frequently repeated.
Countries that were early adopters of the fundamental public health principles test, trace, isolate, support and integrate have had much lower mortality from COVID-19.
If lock down is to be relaxed and there is the possibility that schools may fully re-open, it is imperative that robust, locally run testing and contact tracing takes place. Failure to do this could let the virus tear through a community and cause another surge in cases and deaths, something that the NHS and social care services are ill equipped to cope with.
The danger in schools is not so much children becoming unwell, as the virus being shared and spread back into the community. Although schools have re-opened in Denmark, they were one of the first countries to close schools. On March 15th Denmark had no deaths from the virus and just 137 people in hospital for treatment.
The modelling in Denmark used to inform policy was based on the assumption that children spread the infection at the same rate as adults, and had no ability to social distance. The government’s openness and cooperation with the teaching unions led to a situation of mutual trust. Denmark and the UK are very different. While lessons should be learned, they must be the right lessons.
The government and Public Health England failed to act in February while it was clear the pandemic was spreading globally. There was an opportunity to set up robust testing which was missed, even though local councils already have the infrastructure to test and contact trace – they already do this for tuberculosis, STIs and outbreaks of food poisoning.
Primary care services have adapted very quickly and risen to the challenges of COVID-19. Local GP ‘hot clinics’ could be used as testing sites. Many areas have set up home support services for those who are unwell, but not ill enough to warrant hospital admission.
Support workers deliver pulse oximeters to measure oxygen saturation levels and contact unwell people with a daily phone call. This could easily be adapted to test, trace, isolate, support and integrate.
We support the pilot lead by retired doctors in Sheffield and believe that, in the absence of a coherent plan from the government, local councils should invest in and roll out similar initiatives.
The infrastructure to test and analyse is available in NHS hospital laboratories – but the government has chosen not to use these in England. Instead, this is outsourced to private laboratories, which do not integrate with general practices as NHS hospital labs do. Test results are not communicated to GPs who could act on them to limit the local spread of coronavirus. A key public health resource is being squandered.
Awarding contracts to the private sector is familiar pattern by this government. It is an ideological strategy rather than one based on what is best for the public, when evidence suggests that outsourcing can lead to chaos and a loss of life. The government is using a public health crisis to accelerate an agenda of privatisation – in the context of the continuing talks of trade deals with the US where we are told, but do not believe, that the NHS is “off the table”.
- Locally coordinated and robust testing, tracing, isolation, support and integration.
- The use of existing local authority infrastructure upscaled with the necessary government investment.
- The use of NHS hospital labs for local testing and effective transmission of results to GPs.
- Repeated testing due to high false negative rates.
- The use of retired health workers to provide clinical support, and furloughed workers to help to administer the community systems.