‘Isolate, trace and support’ is the only safe way out of lockdown

Doctors in Unite believe that comprehensive, publicly coordinated and community based ‘isolate, trace and support’ procedures are vital for control of the COVID-19 pandemic as lockdown is eased.

To keep the frequency of new cases in the community manageable people must be supported to self isolate once they are identified as potentially infectious. To this end it is imperative that there is no loss of income for those who need to self isolate through having been in contact with an index case.

To control the spread of COVID-19 the government must commit to maintaining people’s income so that they are not compelled to work when they should be in isolation. The financial burden should not be directly placed on companies as many of them would simply walk away from the obligation, though of course, companies should contribute properly through corporation tax. 

We call on Unite and the Trade Union movement in general to support our demand and to actively lobby the government to ensure that it is met.

Testing times require radical solutions

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.

Contact tracing apps may have their place as part of a comprehensive testing policy. They cannot be relied upon on their own, and they should not involve the central holding of personal data.

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.

Instead the government has turned to the likes of Serco to coordinate testing – judged on their past performance, Serco should not serve this crucial role.

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”.

We demand:

  • 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.

Statement on key worker testing and contact tracing

Since the start of the lockdown we have called for contact tracing and widespread testing as the only means to establish the true prevalence of COVID-19. This is what the World Health Organisation urged all countries to do from the very beginning. 

We welcome Matt Hancock’s announcement of testing for symptomatic key workers and their families, and the promise of contact tracing. 

The fundamental principles of public health are finally being applied to the country’s most critical healthcare crisis. We congratulate the government on reaching this step. We should have been here weeks ago.

The government has acted far too slowly to change the fate of over 18,000 people who have already died. With each prevarication and each false promise an irreversible choice was made. When China, then Italy, then France were locking down, our government should have known what had to be done. But they waited.

In this ultimate test of the social contract, the livelihoods and lives of citizens depend upon the speed with which states act. Better late than never is simply inexcusable. 

The next challenge will be logistical: the rapid recruitment and training of contact tracers, and the robust and reliable collection of data. We wait in hope that the government’s response will be swift and substantial. Anything less would be another great disservice to us all.

There is no exit from the COVID-19 lockdown without population testing

It is not possible to undertake any meaningful planning for an exit strategy from the current lockdown without an understanding of COVID-19’s prevalence and our current levels of immunity.

On April 2nd Health Secretary Matt Hancock promised to test 100,000 people daily by the end of the month. On that same day the UK was testing ten times less, just 10,000 people per day. The government continues to state its desire to test. In reality are far from this target.

True prevalence is proving hard to predict. Where one study suggests 75% of people infected may be asymptomatic, another reports a very low rate of current infection – less than 1% of the tested population.

The only way out of this is to gather data and learn the truth.

Epidemiological studies of appropriately sized, randomised cohorts would determine the size of the vulnerable population. This testing would need to be repeated every few weeks in order to chart the progress of the disease.

We cannot just test those who attend hospital with symptoms. Only by widespread testing of the asymptomatic public will we learn the true spread of this virus.

Demands in response to COVID-19


The challenge of coronavirus requires a radical response. We will overcome this virus, but current legislation falls short – much more must be done. We demand:

Full PPE

This must include FFP3 masks, visors/protective spectacles, fluid resistant gowns with sleeves and gloves for all health and social care workers dealing with patients and service users who have or are suspected to be infected with COVID-19. This is vital to prevent staff going off sick en-masse leaving no one to care for patients.

Widespread testing

Whole population testing for COVID-19 is essential, with particular attention paid to health and social care workers. Isolation and follow up of identified cases with rigorous contact tracing is crucial.

Laboratories in hospitals

Full pathology laboratories should return to hospitals. Cuts and privatisation of labs have reduced the capacity for testing so that when they are needed the system cannot cope.

Public control of private hospitals

Private health care facilities must be taken under public control and made available to assist the NHS in caring for ill patients.

Public control of industry

Key industries must be taken under public control and repurposed to manufacture equipment that is essential to deal with the outbreak of COVID-19, such as PPE, ventilators and antibiotics. 

An end to needless competition

The protection of intellectual property rights for key equipment such as ventilators must end, so that companies can collaborate to produce them. There is no place for the pursuit of profit and competition between companies during a national crisis. 

Support for staff to work remotely 

Guidance on confidentiality and data security should be rapidly produced. Investment in IT should take place to enable all those who need to work from home to do so. 

Protection and recompense for retired workers returning to work

Retired workers returning to the NHS deserve the proper provision of PPE and COVID-19 testing. Older people are more vulnerable to the virus, and will need thorough protection. 

Full pay when self-isolating

All UK workers who are off sick or self isolating due to COVID-19 should be paid as if they were in work. No one should be under financial pressure to work when government advice is that they should be at home. Previous record of days off sick should not be an impediment to this principle.

Universal basic income

Universal basic income must be made available for all in line with the living wage for the period of the crisis. This would be in place of all other benefits, universal credits or employment support.

Retraining for the newly unemployed

Those who have lost their jobs should be offered free retraining in roles that support our society and infrastructure during the pandemic. This could include medication delivery, care work, and supporting the socially isolated.

Universal access to essential services

Everyone should to be able to access the essentials that they need, including food and shelter. The homeless should be accommodated in empty hotels and houses. Supermarket stocks should be centrally managed and provisions distributed so that everyone can have what they need. 

Proportionate, time limited emergency laws subject to regular review

While being clear that everyone must be able to access what they need, there is a fine balance between ensuring equity of distribution and infringements of people’s reasonable rights and liberties. All new legislation that curtails civil rights must be limited in scope, be regularly reviewed, and should include a sunset clause.

Comprehensive support for vulnerable health groups

Services for the homeless and those who suffer from substance misuse must be maintained. These are vulnerable groups who are at high risk of complications from COVID-19 infection. They are often hard to reach and should be provided with phones so that key workers can maintain contact while working remotely.

Comprehensive social care

Disabled people are vulnerable and their needs must be properly met. They are at particular risk if their carers become unwell. Those who have accepted personal budgets are particularly at risk. Services must continue for them in all circumstances. 

An end to overseas charging

NHS eligibility checks for migrants leads to them not accessing healthcare as frequently. It is vital that during a pandemic, everyone gets the care they need. Charging overseas visitors for NHS care must be stopped and the legislation that allows this abolished.

Extended rent and mortgage payment holidays

Suspend rent and mortgage payments for all NHS and social care staff. No health or social care worker should be anxious about living costs. Many are at risk of losing household income if their partner loses their job. The current three month mortgage holiday should be extended to at least six months.

Psychological support for health and social care workers

Psychological support services should be provided at no cost for NHS and social care staff caring for patients during the period of the pandemic crisis.


We the undersigned support these demands and urge their adoption by the government as quickly as possible: