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Thu 29 October 2020
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Dr John Ashton, a former director of public health, provides his regular update on the Government’s Coronavirus response and the need for real local testing and tracing.

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It has been a hectic week in COVID-19 crisis.

The shortcomings and obfuscations of the ironically named SAGE committee have led to the establishment of a credible alternative witness and commentator under the chairmanship of the highly respected former Chief Scientist Sir Dave King.

The desperate attempts by the Government to massage its way out of a commitment to conduct 100,000 tests per day by the end of April have been exposed as a PR sham, aiming low and missing on subsequent days.

The UK has reached the unenviable achievement of having the highest number of Coronavirus-related deaths in Europe (however you count them), with a rebound in the numbers of daily cases.

The much-vaunted Imperial College modeller, Professor Neil Ferguson, has been hung out to dry in a vain attempt to distract attention from our abysmal efforts to get on top of the public health emergency.

The latest wheeze is the testing of a contract tracing App that is claimed to be the key to easing off the COVID-19 lockdown.

So what is the reality?


The ‘Little England’ Contract Tracing App

From the earliest days of the virus pandemic the incitement from the World Health Organisation to ‘Test, Test, Test’ has been and remains the lynchpin of any effort to protect the public from disease and death.

We now have it on the admission of Deputy Chief Medical Officer, Dr Jennie Harries, that the real reason for discontinuing testing and tracing in mid-March was not some coherent strategy for containment, or even the half-baked notion of letting the virus run free to achieve herd immunity but the lack of local capacity, of feet on the ground, in the diminished local and regional public health system since the establishment of the obsessively centralising and controlling Public Health England in 2013. 

Everything since then has been about playing catch up and backfilling the narrative in an attempt to explain away the mess. This latest initiative is a further international outlier, an idiosyncratic Little England App, apparently conjured up by commercial cronies of the Government. This is claimed to provide the intelligence to sit alongside the elusive testing and tracing and allow the economy to resume. Sadly, this seems unlikely.

The theory behind this App, which depends on the collection of centralised data from individual smartphones, is that it will require phone holders to input personal symptom data, enabling contacts of cases to be notified electronically and to self isolate. It differs from the de-centralised model developed by Google and Apple and being adopted in most other countries, including the Republic of Ireland ( more exquisite cross-border issues in the pipeline) in its potential to compromise personal data security either now or at some future time, in the absence of an exit strategy in which all data will be destroyed.

The development of the App has taken place without any formal input of ethical expertise or public consultation and is now being trialled on the Isle of Wight, hardly a community typical of the urban heterogeneity of the country at large.

Apart from ethical and confidentiality concerns, there are major practical reasons why we should not expect too much from the Government’s latest flight of fancy.

In Singapore, which has tried a similar approach the bald facts are as follows: whilst 95% of adults have a mobile phone, only 80% of these are the smartphones which are needed for the App; it is estimated that whilst three-quarters of these (60% of the population) are needed for the system to produce meaningful data, in reality, less than 20% have downloaded the App.

In view of the storm of concern that the Government initiative has faced and the obscure clunkiness of the App’s operating systems, this may turn out to be yet another example of the Government over-promising and under-delivering. In these circumstances perhaps the best we might hope for would be some broad-brush intelligence on the distribution of the virus and its relative levels across the country, rather than the detailed, fine grain intel that would enable us to target local outbreaks and recrudescence of the epidemic after we get past the first wave.


The Testing Fiasco

Meanwhile the saga of achieving the essential and effective levels of testing, tracing and isolating continues. After this weeks farce of the failure to sustain even 100,000 delivered daily tests using the private consultants Deloitte, local Directors of Public Health and General Practitioners, who should be in the driving seat of delivery, are getting restless. 

Hundreds of thousands of tests by Deloitte have still to be shared with this local frontline who have no idea where any clusters of infection might be found – the very essence of an effective public health response.

This has led to an apology from the Chief Medical Officer together with a first from PHE Testing Co-ordinator, John Newton, who has finally owned up to not sharing data. According to Blackburn with Darwen Director of Public Health, Dominic Harrison, quoted in the Guardian:

“The Deloitte screening programme has now been running for a number of weeks and we have seen no data from that. So I have no idea whether 10, 100 or 1000 residents have tested positive. I certainly hope they sort this out very, very quickly because it is critical for case finding and contact tracing”.

A glimmer of hope in this dire situation is that the Directors of Public Health are finally removing the gags imposed on them from above.

Which brings us to the nub of the the App wheeze. Without a proper, robust large scale programme of hundreds of thousands of daily tests and an effective local workforce of testers and tracers led by local public health teams, the App is likely to be as much use as a chocolate teapot.

With the latest statistics showing increases in new infections and the likelihood that these are coming from viral spread from hospital, care home, and maybe prison staff, it should go without saying that yet again the mantra should be ‘Test, Test, Test’ and ‘PPE, PPE, PPE’.

Dr John Ashton is a leading international authority on public health and a member of the Crown Prince of Bahrain’s Corona Task Force.


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