Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.
Forget how much the data justified the new lockdown. The real question is what living with the virus will look and feel like in the months ahead. It is clear that lockdowns are ruinously for the economy, and that another in a few months’ time would lack political legitimacy.
It is also clear that NHS capacity is limited. Much of the opposition to the new national lockdown was because it will only provide temporary respite from the virus, and many MPs see no sign of the strategic thinking that would avoid a third lockdown.
National briefings have become mistrusted for their partial presentation of data. SAGE says NHS England has conducted modelling which shows hospitals will run out of beds in weeks, but why was this model not already published, as it was so central to the Government’s case for the lockdown? The use of leaks, briefings and the partial publication of official data is no substitute for proper data transparency.
The Office for National Statistics estimates that the virus was infecting about 50,000 people per day last week, and it is reasonable to assume that this will lead to unsustainable hospitalisation rates. By far the most affordable and politically sustainable response is to mount an operation to contain the spread of the virus by identifying spreaders via mass testing, and by persuading those testing positive, and their contacts, to self-isolate.
That is why NHS Test and Trace is the vital capability to get us out of the crisis. But, as a public campaign aimed at changing behaviour, NHS Test and Trace is still a long way from commanding public confidence.
The present level of infection overwhelms any capacity to track and trace. The hope must be that the latest restrictions will suppress the spread of the virus. Last summer, we were down to a few thousand cases per day. A return to that level would leave a manageable number of positive tests and their contacts to follow up. Supported by the arrival of quick turnaround mass testing being trialled in Liverpool, this would deliver a system capable of containing the virus indefinitely, pending improvements in treatments and the arrival of vaccines.
The challenge is to persuade the public (and Conservative MPs) that we are all playing a part in delivering a coherent national plan that will succeed in containing the virus. The failure to achieve this is frustrating, when the Government is broadly trying to do the right things. The key is to persuade the ‘spreaders’ to self-isolate.
Imperial College published a model in August that claimed an effective contact tracing system could bring the R rate down by 24 per cent. It rested on three core assumptions: that 80 per cent of symptomatic cases are tested, that 80 per cent of close contacts are contacted, and all data from testing is processed in 24 hours.
All three of these assumptions are, at present, unachievable. But come within reach once the infection rate is brought down: to around 2-5,000 new cases per day. Yesterday, there were 20,582 new positive tests.
In Japan, successful contact tracing has avoided the need for new lockdowns. The country uses a technique called “retrospective” tracing. Regardless of the severity of their illness, 80 per cent of patients who contracted the disease do not infect others, but there are also “super-spreaders” – individuals infecting many others, creating a cluster.
The Japanese tracers are like detectives. They document the chain of transmission to trace clusters of multiple cases to a common source. Their system has been described as “very analogue”, relying on local, person-to-person communication, which engenders more trust than remote contact, relying on national data bases and centralised call centres.
The UK already has its own cluster hunters. We have NHS board health protection teams (HPTs), based in regions and sub-regions. They receive information from local contact tracing staff when a ‘complex setting’ is identified. This might be a care home, a hospital, a homeless shelter or a school. The weekly statistics for NHS Test and Trace show local is by far the most effective: 97.4 per cent of close contacts are reached and asked to self-isolate, compared to 59.5 per cent for the national system.
The Government therefore needs to shift the emphasis of operations from national to local. National databases and call centres neglect two key groups of potential spreaders.
First, there is no way of knowing whether positive cases who are successfully contacted are actually isolating. Local government teams should offer them support via the ‘community hubs’ that were so effective at supporting those shielding in the first lockdown. Your friends and neighbours would have far more influence over compliance.
Second, NHS Test and Trace fails completely to contact some 35-40 per cent of those tested positive. Local councils should be given the job of following up ‘non-responders’.
Engendering public support is vital – something which NHS Test and Trace has been unable so far to think through. Cambridge, not Liverpool, was the first mass testing trial, conducted by the University itself. Since the start of term, students from different colleges have sent in swabs every fortnight. Results are pooled with members of their bubble. If a bubble tests positive, then it is locked down until they can get re-tested to identify who is infected.
The key lesson from the Cambridge scheme is the importance of public support. Eighty per cent of students volunteered to take part, and because they are in college all can easily be followed up.
People and families on low incomes who are told to self-isolate are entitled to a payment of £500 from their local authority under the Test and Trace Support Payment scheme, but many are still struggling to claim what they are entitled to. You cannot expect people to self-isolate if there is an unreasonable financial penalty. It would also help if the period of isolation was shortened; the chances of being infectious after seven days without symptoms is very low.
500,000 tests per day is a great achievement, but ministers hailing these achievements answers instils little public confidence. How will these tests be used? Who will be tested? How is the test data analysed and how fast? In consequence, where is the effort to trace and isolate best targeted?
The constant promotion of what seem like silver bullets – Operation Moonshot, the Oxford/AstraZeneca vaccine, the mass testing of the whole population – make for good-looking headlines, but they risk ending in disappointment, unless they are presented as part of a coherent plan.
The new lockdown is intended to reduce the prevalence of the virus. NHS Test and Trace has breathing space until the virus rate falls to manageable levels to get its act together. There is now an opportunity to get the public back on side.