The lockdown alone won’t rid us of this virus – but it buys us time to develop the plan
A strategy of test, trace and isolate is crucial to winning this battle, Jon Ashworth writes
The British public can be proud of their action in staying home and suppressing coronavirus. But if we are to win this battle, a new strategy based on testing, tracing and isolating is crucial
In just four months Covid-19 has spread with speed and severity, tragically leading to well over 20,000 deaths. The daily news of tragic loss is a painful reminder of how dangerous this horrific virus is.
That is why we have always pressed the government to respond with resolute and prompt action.
We co-operated with ministers to help far reaching legislation onto the statute book. We continue to offer constructive suggestions on how our national response can be strengthened. We called for pubs to close, mass gatherings to be banned and for a ‘lockdown’ to be enforced. We support its continuation because it will save lives and ultimately help us get control of this virus reducing its spread to more manageable levels.
Now our sole aim is improving the national response to help people’s health, living standards and our economy.
But that doesn’t mean we won’t ask difficult questions, demand transparency about what comes next, or push the government to go further when we feel they are not following international best practice.
Other governments have discussed the implications and way forward with their citizens in a responsible and mature way. Jacinda Ardern’s government took swift action early on and ensured New Zealand’s citizens knew why strong measures were instigated even though their cases and deaths were far lower than ours. Angela Merkel recently spoke of the fine margins and implications of the transmission of Covid-19 in Germany and what it could mean for their health service without the right measures in place.
Keir Starmer has called for a similar grown up approach to be taken about the crucial next steps in the UK – not just about the lockdown but the next phase. We want the Government to develop and share a smart strategy drawing on what has succeeded elsewhere and one which can stand up to scrutiny. We have to get this phase right because the stakes are still so high for the country and time is against us.
After all, this lockdown has far-reaching health implications. Around two million operations have been cancelled and vital treatment delayed. Referrals for cancer are down by 75%, according to Cancer Research UK. We anticipate an explosion in mental health problems.
The economic damage caused by a lockdown will impact health outcomes too. Sir Michael Marmot’s studies explain powerfully how inequality and poverty mean the poorest become ill quicker and die sooner in life.
And a recent analysis from the Centre for Economic Policy Research suggests that if employment falls by a similar amount as it did after the financial crisis this could lead to 900,000 extra working-age adults with chronic illness. Given the poorest 10% of women and men already live eight and 10 years fewer than the wealthiest, this crisis is bound to exacerbate these health inequalities. This means we don’t just need to properly resource the efforts against Covid-19, we need to fully fund our public services for the wide scale of challenges they will face in the months and years ahead.
But just as there are awful social implications of this lockdown it remains an important tool, albeit a blunt one, in helping supress transmission.
Ministers now believe the transmission rate for this virus – the R number – is below 1. That’s a remarkable achievement on behalf of British public who can be proud of their action in staying home to save lives.
Any easing of the lockdown without an effective strategy and appropriate measures in place will only push that R number up. This in turn will lead to even more avoidable deaths in the UK, a likely return to a stricter lockdown and an even greater challenge to surmount.
Instead Labour wants in place a credible, detailed plan for how we move forward covering case finding, diagnostics with mass testing and contact tracing. It must incorporate new technology and research into antivirals, all alongside efforts on global cooperation to develop and distribute a vaccine.
As an immediate priority the fundamentals of infectious disease control, of which testing and tracing are the cornerstone, must be in place urgently. Labour has long called for more testing and earlier this month Matt Hancock promised us 100,000 tests a day by Thursday.
But with websites crashing and reports of ill people waiting days for home testing kits it is clear more must be done. This means using every lab available in the UK and ensuring key workers can access testing locally, conveniently and regularly. Any testing capacity going unused is a wasted opportunity to find and suppress this virus. It beggars belief that tests go unused each day.
Any testing capacity going unused is a wasted opportunity to find and suppress this virus. It beggars belief that tests go unused each day.
Mass testing of communities irrespective of symptoms could provide vital clues in this ongoing battle. Such a programme could shed light on how many carry the virus without symptoms and how community infection varies according to age or geography. This would allow any lifting of restrictions to be much more precise and data-driven. And crucially, it would also tell us where and when community spread is ticking up so we can act faster and more effectively in preventing a second lockdown as severe as this one.
One prime location for mass testing is hospitals and care homes. We must expand testing further beyond symptomatic carriers in hospital. All health and care workers should be the priority – protecting our nation’s heroes, reducing transmission and providing key information as to who has the virus but is asymptomatic. A recent study from Imperial, for example, suggested that weekly testing of healthcare workers “is estimated to reduce their contribution to transmission by 25-33%, on top of reductions achieved by self-isolation following symptoms.”
It’s crucial that commitments to expand testing in care homes are now implemented urgently. The New England Journal of Medicine recently warned symptoms-based screening alone in nursing homes fails to detect large numbers of infectious cases advising “testing to include asymptomatic persons residing or working in skilled nursing facilities needs to be implemented now.” We agree.
I welcome the Government’s change of strategy back towards contract tracing. It is a shame, however, this approach was abandoned six weeks ago given its success elsewhere. It means we’ve wasted precious time when we should have been building up tracing capacity, developing protocols and recruiting staff.
The South Korean government curtailed the epidemic through testing without need of strict lockdowns. The UK delay has made the task far bigger for the UK than South Korea ever faced and has left ministers weeks later scrambling to recruit 18,000 tracing staff despite experts like Azeem Majeed, Professor of Primary Care at Imperial arguing we need around 50,000 staff for tracing to succeed.
Tracing is hugely labour intensive, requiring meticulous, detailed work. Firstly it depends on a functional database with test results quickly available. This should then trigger a process where each infected person can be approached and asked to recall systematically who they recently were in contact with and then following up each contact. This is the bread and butter of local PHE Health Protection Teams across the country who do this for all other notifiable diseases day in, day out.
Local government Directors of Public Health and other key local government staff such as Environmental Health Officers will be crucial to this work and must be fully mobilised to help spearhead tracing. They would of course be in much stronger position had they not been subjected to £800 million worth of cuts in recent years.
We should quickly scale up other capacity too. Nations including Canada and the Republic of Ireland have drawn upon volunteers to help with the tracing. The UK can proudly boast of 750,000 volunteers offering to help with the national effort, yet many still haven’t been called up. Ministers should consider whether there is a role for these volunteers as well.
The Government needs to make it clear who is in charge at every level – national, regional and local
Digital app-based technology of course can play a part in helping identify contacts but it should complement local contact tracing, not replace it. There are unanswered questions about the propsoed app too: it’s not clear if ministers have a plan to ensure mass take up of the app (some have suggested the need for a 60% take up) because of course not everyone owns a smart phone. How will ministers ensure the poorest don’t lose out again?
All of this requires energetic leadership and close management at national, regional and local level. It is unfortunate that successive Tory-led administrations have demolished the regional structures, like Strategic Health Authorities and Government Offices for the Regions, that had an important co-ordination and management role at times of crisis. The Government needs to make it clear in this crucial programme who will be in charge at every level – at national level, regional level, and local level.
A strategy of test, trace and isolate is crucial to winning this battle. This lockdown isn’t the plan to rid us of this virus but it buys us time to develop a plan and urgently assemble the infrastructure we need to get control of it. Ministers must use this precious time to get ready to test, trace and isolate on mass without further delay.
Jon Ashworth is Labour and Co-operative MP for Leicester South and shadow health and social care secretary.