Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.
Government’s roadmap is a detailed 68-page document – but little of the news reporting has covered much beyond the hopes for loosening restrictions and the encouraging data on vaccine efficacy.
But tucked away from page 47 onwards, the paper heralds a real challenge: keeping the virus under control relying substantially on the less accurate lateral flow tests, leading, in the long-term, to “Living with the Virus”. It’s certainly not Zero Covid, but it’s not quite what the CRG asked for. It’s… well… the 22nd of February roadmap. It is worth interrogating the assumptions behind this compromise strategy.
NHS Test and Trace has quietly come on leaps and bounds. Accurate polymerase chain reaction (PCR) tests are turned around quickly; more contacts are reached. The national call centres now support the local public health teams. Only the latter can focus on local outbreaks in complex settings – such as around a place of worship, a care home or factory – using boots on the ground.
Such contact tracing has worked wonders in South Korea, Japan and Taiwan. Sudden local outbreaks in infection have been brought under control without the need for lockdowns, but they depend upon much lower general prevalence than the government is seeking to achieve here.
Last year, the benchmark for loosening restrictions, in Germany, was set 35-50 per 100,000 and that was before B117. This is broadly what the zero Covid advocates want. Will the UK be anywhere near that on 8th March, when the schools go back? The answer is no
The roadmap contains welcome developments. The funding made available for local authorities to make discretionary support payments will be increased to £20 million per month. The Test and Trace Support Payment scheme is now being extended to cover parents who are unable to work because they are caring for a child who is self-isolating. But it does not go as far as the £500 payment for all those self-isolating floated by Ministers a couple of weeks agom or the £75 a day compensation for other civic duties such as jury service.
The main thrust of the government strategy relies on mass Lateral Flow Tests (LFTs), not contact tracing. The logic is simple. They are cheap and give a result in 30 minutes. Asymptomatic cases are now thought to be a significant driver of transmission, but it is not necessary to reduce prevalence levels seen in East Asia, because everyone here at risk of infection will now get a regular test.
The trial data in support of the tests is patchy. There have been several pilots, but too few of the results have been published. The Birmingham University pilot looked terrible. The use of LFTs at Jaguar Land Rover in Halewood did not prevent an outbreak. What has been learned from these pilots?
The usefulness of LFTs has been challenged by Mike Gill and Jon Deeks. The government data shows 0.4 per cent of LFTs gives false positives (the current rate of positive results in all LFT tests, suggesting a high false positive rate). Around 30 per cent of true positives result in a negative result. As prevalence drops, the false positives begin to outnumber the real ones. But, it is argued that LFTs are still better than no test, if a positive test is checked by a confirmatory PCR test, or even if with just another LFT.
However, when LFTs are given to those with low viral loads, the test might produce more false negatives. Getting a negative test may result in a negative behavioural impact, because a negative test encourages an individual to socialise more freely, however clear the messaging. School children, in particular, who want to see their friends, might spoil the test by completing an imperfect swab.
When more pupils and students return to face-to-face education in schools and colleges on 8th March, the Government will introduce twice weekly testing of secondary school and college pupils, starting with testing on site in the first two weeks and then home testing. This could prove very useful. It may be better than no testing, but it must be admitted that there is yet little data to support it in practice.
The Government should publish the full data for the LFT pilots. Public Health England have been sitting on them for months. PHE should be exploring the behavioural response of getting a false negative, and the likelihood of different categories of people, such as school pupils, wanting to spoil the test. This should inform a new testing document. Government should issue detailed instructions on when to use PCRs or LFTs. It must be ready to adapt the strategy in the light of events and experience.