LONDON — Doctors and public health experts warn the U.K. faces significant logistical hurdles if it plans to use mass coronavirus testing and contact tracing to help ease its lockdown.
Ministers are expected to imminently set out details of how an army of contact tracers will be recruited and deployed to “test, track and trace everybody who needs it,” as Health Secretary Matt Hancock put it on Wednesday, containing the spread of the disease and helping to shut down chains of transmission.
Britain initially attempted to test those suspected of having the virus and trace their contacts early in the epidemic but then abandoned the approach, with health experts saying mass testing was “not appropriate” for the U.K.
Hancock has since pushed to rapidly increase the U.K.’s testing capacity, which currently stands at just under half of the target of 100,000 tests a day by the end of the month.
However, while welcoming the shift in strategy experts warned that the U.K. is starting from a low baseline to deliver on the plan, following a period in which public health budgets have been cut by over £700 million in real terms between 2015-17 and 2019-20.
Those drafted in will also, experts said, have to have full criminal records checks in place and require at least some training to effectively conduct the necessary telephone conversations required of a contact tracer.
“The challenge of all of this is that we’ve had a decade of cuts to public health,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “And the question is whether we can deliver this and I suspect that has been a consideration of the very beginning.”
“We shouldn’t underestimate how complicated it is,” he added. “We need to be quite careful about getting this right.”
Importance of safeguarding
Reports that officials are aiming to deploy 15,000 people are not disputed by government, with civil servants and local government officials set to be drafted in, according to the Times. The newspaper reported the government hopes to have the scheme up and running by May 7.
While much emphasis has been placed by government on the development of a new contact-tracing app by the “NHSX” tech innovation unit, experts say that simple manpower is also key to the strategy.
However, one retired public health doctor, who worked in health protection but asked not to be named, warned that the skilled environmental health officers trained to carry out such work were in short supply. “They have absolutely decimated public health in local authorities,” said the doctor.
If new recruits from the ranks of national and local government officials, or even volunteers, are to be used, they will also require training for the task of contact tracing, said Gary McFarlane, the Chartered Institute of Environmental Health’s Northern Ireland director.
“You can make this sound very simplistic, but in reality, it’s actually quite complex, he said. “The critical thing here is the answers that are actually given, because the answers need to inform where the questioning needs to go. It’s about following an investigative path.”
However, the public health doctor disagreed. “It’s not rocket science,” the doctor said, explaining that a contact tracer simply needs to take a contact through their average day, finding out who they have seen and where they went.
But that doesn’t mean the process will be straightforward, with both McKee and the public health doctor raising issues around safeguarding. This could require all contact tracers to have Disclosure and Barring Service (DBS) checks, which highlights if someone has a criminal record and usually take four weeks or more. A similar requirement is already in place for volunteers working with the most vulnerable within the NHS’s new volunteer service.
“You must not let people loose on contact tracing who have not been appropriately vetted,” the public health doctor said. “It will just open the floodgates for potential abusers to volunteer and find their way into kids’ networks and vulnerable people’s networks.”
Government officials have been contacted for comment.
‘Alternative’ to full lockdown
According to public health experts, community testing, contact tracing and isolating is one of, if not the most, effective strategy governments could deploy to control the coronavirus epidemic; a “community shield” that could avert the need for repeat lockdowns, according to Anthony Costello, a former World Health Organization director of mother, child and adolescent health.
“We allowed the epidemic to surge by stopping a national strategy for community case finding, testing, contact tracing and isolation on March 12 and still haven’t restarted it,” he told POLITICO. “This virus will come back within weeks of lifting the lockdown. Without a community shield we shall not pick up new cases and outbreaks early, and we shall be left with either repeat lockdowns, or allowing the virus to spread.”
The U.K.’s longest-serving health secretary, Jeremy Hunt, has also been an outspoken advocate of reintroducing the so-called test, trace, isolate strategy.
“If you have a system where anyone who has COVID systems can call [NHS phone line] 111, get a test immediately, we then track everyone they’ve been near and test and isolate them if necessary, you have an alternative to a lockdown,” he told POLITICO last week. “Which is why the shops, restaurants, offices are open in Korea, Taiwan, Singapore and Hong Kong.”
Hunt, who now chairs the House of Commons health committee, has highlighted World Health Organization advice that lists the ability to track and trace every single new COVID case in the community as one of six conditions for easing lockdowns.
“It’s a huge job, you’ve got to put teams in place,” he said. “The obvious thing I think would be to start in parts of the country where we have relatively low numbers of infections like Yorkshire and Cornwall and see whether you can get that mass community testing in place.”
This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email email@example.com for a complimentary trial.