Will Test and Trace be ready by June 1st?

On 9 am Thursday this week the UK government launched the new test and trace service in England.[1] This programme aims to control the spread of COVID-19 within the community so that outbreaks do not spread rapidly undetected. The Government’s test and trace programme, implemented differently across the four nations, plan for 25,000 contact tracers to interview individuals infected with COVID-19.[2] Contact tracers then develop a full list of individuals that have potentially been in contact with COVID-19 positive patients. It is then the job of contact tracers to identify all contacts at high-risk from being infected. Advising such individuals to isolate at home for 14 days to prevent further spread of COVID-19.[1–3]

However, upon the launch of the new system, many scientists are uneased by the rushed roll-out of the scheme. With many specifying the UK government are yet to meet 3 out of 5 self-imposed tests.[4] Key scientists have addressed their concerns publicly that the new test and trace system needs weeks to become fit-for-purpose; to effectively control the spread of COVID-19. Therefore, the mood amongst scientists is that the government should reconsider reopening schools, for “fear that infections will rise”.[5]

Chris Hopson, Chief Executive of NHS Providers, spoke to Newsnight on Wednesday [6]; where he was asked if the new tracing system was ready? The Chief Executive explained, that while it is important to have a contact tracing programme in place. There are “two very clear examples” where the system needs further development.[6]

Chris Hopson said “that we first absolutely need very rapid test turn around. The international standard is that we should get tests results back in 24 hours”.[6] A cause for attention as many hospitals and care homes receive patient results in 3–5 days, on average. Secondly, Mr Hopson said to have a good contact tracing system in place; we need to “mobilise local tests resources”, ensuring those “who need to isolate have the support to do so”.[6] A worry, as local health experts expect this task to take 3–5 weeks to develop; despite local authorities only being asked to begin finding these resources a week ago.

The test and trace service is based on two parts.[7] Patients displaying symptoms of COVID-19 (high temperature, continuous coughing lasting longer than an hour or 3 coughing episodes in a day, and loss of taste and smell) must first self-isolate; and order a test on the NHS website, or by calling 119.[7] Patients who test positive will then be contacted by the NHS test and trace service to conduct a contact tracing interview either online or by telephone.

Contact tracers will then alert at high-risk people who have recently been in close contact to an individual infected with COVID-19. Advising those who have been in contact with infected individuals to self-isolate for 14 days.[7] Whole households are no longer required to self-quarantine with people who have been in close contact with infected individuals. But it is advised that members of these households should stay alert and continue frequent handwashing.[7] Should a person who has been in proximity to an infected individual develop symptoms, every member of their household must then self-isolate for 14 days. Symptomatic individuals must then request a COVID-19 test; where the test and trace cycle would then restart.[7]

While the concept of the test and trace service is welcomed by scientists. Many fear that as the test and trace system is still in its infancy; its introduction cannot prevent further spread of COVID-19 alone. To begin with, many scientists are puzzled by the government’s decision to relax lockdown restrictions next week. Especially since the UK has still not yet met all 5 of the self-imposed tests required to exit lockdown.[4] Currently, the rate of infection (RØ) for COVID-19 varies greatly, from an estimated 0.4 to 1, across the UK.[4] This goes against the third test to decrease RØ to manageable levels across the country.

Secondly, the UK managed to perform just 131,000 tests on Thursday.[8] Showing minimal progression on increasing the number of tests per day, since ‘achieving’ 100,000 tests on April 30th. This is further worrying, as the UK government’s website no longer provides data on the number of people tested each day.[3, 8] This comes amid concerns from doctors that they must retest 30% of patients, due to high false-negative rates.[9] Therefore, suggesting that less than 100,000 UK citizens are being tested daily.

Alongside the high false-negative rates, tests are coming back to patients and GPs 3–5 days after being tested.[6] Much slower than our international neighbours who have a test turn-around of 24hrs. Further proving that the UK’s testing capacity is still not yet fit-for-purpose. Therefore, with doubts cast over matching the criteria to pass tests 3 and 4; the UK has also failed to fulfil the criteria to pass test 5. As adjustments to current measures increase the risk of a second wave.

In addition to the concerns that the government may be too reliant on the introduction of the test and trace service before it is safe to begin to exit lockdown.[10] Local health workers and politicians have scrutinised the poor roll-out of the programme.[2] Of particular concern was that local councils were only aware of their role in the delivery of the test and trace service last minute.

This was addressed by Dr Allyson Pollock, Clinical Professor of Public Health at Newcastle University. On Thursday’s Newsnight, Dr Pollock expressed her apprehension regarding the organisation of the new contact tracing programme.[4] She said, “the government are bypassing the established system for contact tracing that has been in operation for decades. And it is putting a very new kind of system, a centralised and partly privatised system, that is completely bypassing GPs”.[4]

In addition to the lack of local integration required for the delivery of the test and trace service, many are concerned that not having a contact tracing app may increase the risk of a second outbreak.[3, 5, 11] While Matt Hancock has explained that the NHSX app will become available “once the system has been bedded in”.[3, 11] Scientists have questioned if the NHS test and trace service may require extra tracing resources, without a functional contact tracing app.

The new contact tracing system was reviewed by the Royal Society for the Scientific Advisory Group for Emergencies (SAGE), to advise the government on the effectiveness of the programme before its launch. Among the key points made in the Royal Society report; reducing the time between confirmation of infection and the initiation of contact tracing is vital to suppress COVID-19.[12] Stating that beginning tracing procedures 3 days after identification, instead of 5, can reduce the RØ by up to 60%.[12]

The Royal Society also reported that local health authority involvement is crucial to flag potential local outbreaks before they occur.[12] A concern as some deems this may have been overlooked presently. Similarly, the Royal Society believes that as asymptomatic individuals are: 1) not being tested and 2) not having their contacts traced and interviewed; there is a real risk that COVID-19 could spread undetected.[12] Therefore, the Royal Society concludes that the number of new confirmed cases will only drop by 5–15% based on the current service.

Based on the Royal Society report, SAGE advised the UK government that it is still not safe to reopen schools on June 1st.[5] SAGE recommended that the government must first structure contact tracing coherently across the country. Suggesting that local public health and health care facilities should have more of an intrinsic role in data collection.[5] Additionally, SAGE recommended that the current testing programme must deliver results to patients and their GPs within 24hrs. Furthermore, SAGE considers the NHSX app is an important factor required; if we are to allow schools to reopen. Fearing a rise of infections without a contact tracing app.[5]

Many scientists agree that it is still too early to reopen schools and local businesses tomorrow morning. While the UK is finally beginning to get disease control measures in place, it is popularly believed that until all measures are aligned, the government should not rush the ending of lockdown. As public trust in the policy and the policymakers taking a significant hit over the last week. The government must show the public that scientists are being listened to. It is important that as the UK transition out of lockdown, all policies introduced are fully backed by scientists across the board.

References:

[1] Gye, Hugo. “NHS Test And Trace Scheme Launches On Thursday In Bid To Track Covid-19 Spread”. Inews.Co.Uk, 2020, https://inews.co.uk/news/test-and-trace-coronavirus-nhs-track-scheme-launch-england-app-explained-2866450. Accessed 28 May 2020.

[2] Boseley, Sarah, and Heather Stewart. “Hancock: It Is Public’s ‘Civic Duty’ To Follow Test-And-Trace Instructions In England”. The Guardian, 2020, https://www.theguardian.com/world/2020/may/27/government-unveils-covid-19-test-and-trace-strategy-for-england#maincontent. Accessed 28 May 2020.

[3] Locke, Tim. “UK COVID-19 Update: England’s ‘Test & Trace’ Starts Tomorrow”. Medscape, 2020, https://www.medscape.com/viewarticle/931184#vp_1. Accessed 28 May 2020.

[4] BBC. Newsnight 28/05/2020. 2020, https://www.bbc.co.uk/iplayer/episode/m000jjqq/newsnight-28052020. Accessed 28 May 2020.

[5] The Independent Scientific Advisory Group for Emergencies (SAGE). When Should A School Reopen? Final Report.. 2020, http://www.independentsage.org/wp-content/uploads/2020/05/Independent-Sage-Brief-Report-on-Schools-5.pdf. Accessed 28 May 2020.

[6] BBC. Newsnight 27/05/2020. 2020, https://www.bbc.co.uk/iplayer/episode/m000jjsy/newsnight-27052020. Accessed 27 May 2020.

[7] “NHS Test And Trace: How It Works”. GOV.UK, 2020, https://www.gov.uk/guidance/nhs-test-and-trace-how-it-works. Accessed 28 May 2020.

[8] “Number Of Coronavirus (COVID-19) Cases And Risk In The UK”. GOV.UK, 2020, https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public. Accessed 28 May 2020.

[9] Brooks, Michael. “How Accurate Are The Results From Self-Testing For Covid-19 At Home?”. New Scientist, 2020, https://www.newscientist.com/article/mg24632823-200-how-accurate-are-the-results-from-self-testing-for-covid-19-at-home/. Accessed 28 May 2020.

[10] Neville, Sarah et al. “Head Of UK ‘Test And Trace’ System Warns It Won’t Be ‘World-Class’ At Start”. Ft.Com, 2020, https://www.ft.com/content/342ef0fe-a686-4bc9-9f64-9653855fa7cb. Accessed 28 May 2020.

[11] Hughes, David. “Everything You Need To Know About The UK’s Track And Trace Coronavirus Plan”. Inews.Co.Uk, 2020, https://inews.co.uk/news/politics/track-and-trace-uk-coronavirus-test-covid-19-what-explained-nhs-app-how-work-2861195. Accessed 28 May 2020.

[12] The Royal Society. Test, Trace, Isolate. 2020, https://rs-delve.github.io/reports/2020/05/27/test-trace-isolate.html. Accessed 28 May 2020.

[13] “Success Of Test, Trace And Isolate Programmes Depends On Speed, Compliance And Monitoring | Royal Society”. Royalsociety.Org, 2020, https://royalsociety.org/news/2020/05/success-of-test-trace-and-isolate-programmes-depends-on-speed-compliance-and-monitoring/. Accessed 28 May 2020.