Test and Trace is a disaster and doctors should voice outrage, not remain silent.
We must stop being polite about the national Test and Trace service. Its privatised design by politicians is a lethal mistake. Yet the media is awash with statements implying that we should “allow” time for it to be improved. It cannot improve in its present state. Both the media and our profession appear complicit in allowing systematic misinformation, egregious miscalculation, delay, and diversion of public funds, to benefit private companies. We all want to pull together in a collective effort and we are wary of rocking the boat. But there comes a point when being silent (and being polite is a kind of silence) becomes part of the problem.
A year ago Richard Horton of The Lancet urged doctors to consider non-violent direct action over our collective failure to address the environmental crisis. The government is failing to manage both the environmental crisis and the pandemic. This means that the covid-19 crisis is a likely precursor of environmental collapse. Horton’s exasperation is caused by the profession’s acquiescence. Our silence at the ineptitude of our government’s handling of covid-19 is as serious as our silence over the environment.
The national Test and Trace is a disaster. Its design means that it cannot possibly contain outbreaks of covid-19. It is obsessed with testing at the expense of all the other necessary links in the chain of actions needed to control outbreaks. It fails to detect asymptomatic people and those who are unwilling or unable to be tested and it ignores false negatives. This means that before it starts, it has potentially missed up to 80% of those who are infectious. It then loses cases at each of the stages of informing the index case, collecting information on contacts, reaching those contacts, and then persuading them to self-isolate. Probably less than 20% of those advised will effectively self-isolate. The national Test and Trace fails dismally to find cases at the start of the process and then fails dismally at the other end of the process in supporting people through the difficulties encountered in trying to effectively self-isolate. It is likely that less than 5% of the contacts of those who are currently infectious with covid-19 self-isolate effectively. We as tax payers are paying billions of pounds for this failure.
During this second lockdown the country is paying a massive economic price, people are enduring enormous social disruption, and more lives are being lost. When the numbers of cases are reduced again by this second lockdown, unless there are root and branch changes, the national Test and Trace is likely to fail to prevent a third or even a fourth lockdown. Yet the government continues to expand the single link of testing while neglecting the other links in the long chain of find, test, trace, isolate, and support as described by Independent Sage. Surely, doctors should be standing up at every opportunity and on every platform to object vociferously to a massive failure of public health management? Instead, we are embarrassed to watch senior doctors be bullied by politicians who are out of their depth.
The mistakes the government has made in managing the pandemic are legion, but the national Test and Trace service is the single biggest and most persistent mistake. Plans for massive expansion of testing have some merit, but will be ineffective without each of the other links in the chain being properly organised. A big testing programme will not identify people who are unwilling to be tested because they just cannot afford to be found positive.
We have learnt many things about covid-19 this year. For example, it is spread more by aerosol than by touch, masks are helpful in decreasing spread and treatment with dexamethasone is effective for seriously ill patients. Most important of all however, is that track and trace services that are properly organised, generously funded, and locally run, can control and eliminate the virus from a population, as has happened in New Zealand and other countries.
Should we not listen to our own emotional responses? Societal problems are not caused only by bad people, but by good people remaining silent. It’s time for the medical profession to pull together and show nothing less than moral outrage. The privatised national Test and Trace system must be brought back under the control of the NHS and local public health experts with support from general practice as outlined by Independent Sage. Assessment of patients prior to and after testing by professionals, must be put in place. Primary care is best placed to provide this. There must also be meaningful financial and social support for those self-isolating, some of whom will need hostel or hotel accommodation to be able to do this. Full independent audit of every stage of this chain of interventions is required. We must show our outrage now to enable effective isolation of cases and contacts during November and December. Without this we will be stuck in a cycle of repeated lockdowns.
Bing Jones, former Associate Specialist in Haematology, Sheffield.
Jack Czauderna, former GP Sheffield.
Paul Redgrave, former Director of Public Health, Sheffield.
On behalf of Sheffield Community Contact Tracers
*This is a reprint of an article that appeared in the British Medical Journal. Dr Jack Czauderna is a member of Doctors in Unite.