Wednesday 29 April 2020

Why we must have 'find, test, isolate and care' in place to safely end the lockdown

There is a growing scientific consensus that successful management of the Covid-19 crisis requires a comprehensive plan combining mass testing, contact tracing and supported isolation of potentially infected individuals. But a managed plan of action is precisely what chaotic capitalism is struggling to achieve.

Medical science was already well aware that contact tracing has to be a key part of any strategy to tackle a viral epidemic, particularly where no vaccine is yet available. It is a technique already proven to work when tackling Ebola, MERS and SARS for example.

The strategy is simple enough to understand. If you can quickly identify the close contacts of someone who is found to be infected, and then make sure that all these individuals are safely isolated, onward transmission of the virus is hopefully prevented. If this is done consistently, most new cases can be identified, isolated and the outbreak eventually brought under control.
Proceedings of the National Academy of Sciences of the USA

Of course, what works medically also has a social and economic cost too. Who pays to look after the income and welfare of the isolated individuals and their dependants for, in the case of Covid-19, what might need to be at least 14 days in isolation? Their jobs and income must be guaranteed, or the strategy will fail to operate successfully. Similarly, resources have to be in place for food deliveries and other practical support to those who need it in order to remain isolated.

How is contact tracing itself going to be carried out? Hopes are being placed in the development of tracing apps that could use smartphones to alert people that they have potentially been infected by someone who has been close to them. But, even if they prove reliable, many, particularly the eldest and worse off, may not own the kind of phones needed. Fears about privacy will also need to be addressed for take-up to be sufficiently high - perhaps requiring 60% of the population - for such a system to work.

So, in addition to tracing apps, mass recruitment of contact tracers is going to be needed. Some of the work can be done remotely though ‘phone interviews, some may require direct visits with adequate PPE. All will need to be properly trained and paid for this important role. Matt Hancock announced the recruitment of 18,000 tracers but, once again, without the necessary urgency and clarity. Once again, the inability of the Tories and capitalism to apply a clear strategy is being exposed.

For an infection like Covid-19, where some proportion of infections, if not yet one reliably known, are passed on from people without obvious symptoms, mass testing is also vital.

It’s not good enough to set up random access to headline-grabbing testing centres that take hours to get to, with the risk that carriers spread the virus as they travel there. We need community testing properly integrated into an overall strategy, firstly to identify individuals who have the virus and then to test their traced close contacts. If this could be done in sufficient numbers, and with sufficiently reliable tests, this could alleviate some of the isolation requirements. Of course, it might also identify individuals who actually needs hospitalisation rather than just isolation.

Given the nature of the virus and uncertainty over immunity, testing will need to be regularly repeated, not just a one-off. That requires an increase in capacity certainly far greater than the UK’s present 25,000 tests a day, but also far more than the 100,000 tests promised by Hancock.

Of course, identifying carriers and contacts quickly is one thing, ensuring they then isolate themselves is another. Contact tracing is not the ‘quick-fix’ that some sections of big business seem to think it is. For it to work, employers need to understand that some of their workforce may well receive a message to say that they need to quickly isolate themselves. They need to be assured they can do so without loss of income.

World Health Organization advice 140420
If, as in the case of schools, health, transport, construction and so many other sectors, work is being carried out without adequate social distancing and PPE, the risk of being a close contact of an infected person increases significantly.

Workplaces may have to close altogether. Bluntly, unless workplace safety is put ahead of short-term profits, the outbreak cannot be properly managed.

Of course, if these necessary measures had been carried out earlier, then it wouldn’t now be so difficult to repair the damage. In mid-March (see video below), the Cheltenham festival went ahead and pubs and schools stayed open, all while Johnson claimed the ‘science’ didn’t prove further steps were needed.

In reality, the evidence from China and other countries that had already been battling the infection, already showed what was needed. There, early application of contact tracing and testing was used to isolate the outbreak to more manageable hotspots. Here, Tory delay means that it will take a lot longer for a similar strategy to work. However, it is the only realistic approach to ending the lockdown safely.

Update 3/5/20:

The Five Tests 'twitterstorm' tonight helped raise the profile of the NEU's demands - but I did get comeback from someone who thought we were trying to just stop schools re-opening altogether. When I explained our demands further, he supported what we were saying - but just thought it was impossible to get the testing done on that scale.

We have to explain that, it IS possible, and it's also necessary - and urgently so.
As this article explains, written by a former GP, "a national plan is needed, drawn up by NHS, university, biotechnology and other workers through their trade unions, to mobilise all the resources needed for a huge increase in testing".

I was also pleased to get a chance on LBC last night to make the case for 'find, test, isolate and care'  - and for the NEU's 'five tests' (which are very much in line with that WHO advice). You can hear what I had to say here:

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