Test and trace is still crucial to curbing Covid, but can it cope with ‘freedom’? | Coronavirus
The £37bn test-and-trace system is described by the government as Britain’s “second line of defence” against Covid, behind the public health mantra of “Hands. Face. Space”. As England limps uncertainly into so-called freedom day on Monday, when rules around mask-wearing and social distancing will be relaxed, the programme becomes arguably even more crucial.
Yes, 69% of UK adults have now received both vaccinations. This provides a level of protection that for many was unthinkable last summer – but it is not a freedom pass. It is perfectly possible to be double-jabbed and still catch the virus – just as Sajid Javid did this weekend – and, importantly, pass it on.
This new phase of the pandemic comes as the UK is recording more daily Covid cases than almost anywhere in the world. It reported 54,674 new cases on Saturday, a higher rate per million people than anywhere except Cyprus, Fiji, Seychelles and Botswana, according to the University of Oxford’s Our World In Data project.
It is unsurprising, then, that everyone from the prime minister to your colleague, neighbour or relative is being told to self-isolate. More than half a million people were caught in the “pingdemic” in the first week of July – a 46% rise on the previous week – and that is expected to balloon as the UK heads towards an “almost inevitable” 100,000 new cases a day, and maybe even double that.
This raises troubling questions for test and trace. Its primary goal was to help break chains of transmission and allow Britain to return to normal. Since it was established, there have been two national lockdowns and more than 4.5m new cases. The blame cannot be pinned entirely on test and trace – yet, as the National Audit Office (NAO) pointed out last month, systemic problems continue to undermine this line of defence.
The first problem is compliance. Research suggests only a minority of people who have Covid symptoms come forward for testing. One explanation is that people simply cannot afford to self-isolate. This has been a gaping hole in the system since the payments were introduced in September. Dido Harding, the former head of test and trace, raised concerns about this herself, as did senior Department of Health and Social Care officials in January.
A related concern is the growing number of people deleting the test-and-trace app, which is estimated to have cost about £37m to set up and run for a year. About one in five adults of all ages – rising to one-third of people aged between 18 and 34 years – have uninstalled the app already, according to a Savanta ComRes poll published last week. Social media was awash on Sunday with people saying they had ditched it, many blaming Boris Johnson and Rishi Sunak’s initial plan to avoid isolation before their U-turn.
Work is under way to potentially limit the sensitivity of the app but this is unlikely to be done before mid-August, by which time more people may have lost patience with the system and the virus will have continued to spread exponentially.
Many public health experts remain confused about why ministers are waiting until 16 August to drop the requirement to self-isolate for those who are doubled-vaccinated or under-18 when that is already the rule in the US and most of Europe. Downing Street is understood to have been warned that ditching isolation rules from 19 July would have led to 25% more cases.
The second concern is whether fatigued local health systems will be able to shoulder the added strain of 100,000 or more cases a day. One local leader in a Covid hotspot said health experts were using phrases such as “breaking point” and “perfect storm” to described the current workload: “The worry is more and more people [are] ignoring the self-isolation period, especially those double-jabbed. [We have] no real capacity to enforce and no capacity to do spot checks on any mass scale.”
These experienced local teams were brought into the fold several months after test and trace was established, as ministers chose a centralised model where the majority of contact tracing was outsourced to inexperienced and low-paid call handlers.
The latest figures suggest that even the well-funded national system is struggling to cope with increased demand: 73.7% of close contacts of infected people were reached within 24 hours in the first week of July, down from 77.1% the previous week, when there were 80,000 fewer people to contact. Nearly one in seven potentially infectious contacts – 42,021 people – were reached after three days or more, by which time they could have spread the virus further.
As England moves into its next phase of the pandemic, when personal responsibility replaces government diktat, public compliance becomes even more important. Yet there are worrying signs that this may be waning – with little evidence that test and trace knows how to turn it around.