March 10, 2021

expert reaction to House of Commons Public Accounts Committee report on test, track and trace

The first examination of the test, track & trace programme and its performance has been published by the House of Commons Public Accounts Committee.

Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, University of Leicester, said:

“Unfortunately the very costly UK test, track and trace system has not been very effective.

“There several reasons for this, but perhaps the most obvious one is that there was no effective enforcement of isolation/quarantine of those testing positive.

“Other countries in which this approach has been very effective have used security tags or tracking apps with financial support but also severe penalties if such isolation/quarantine is breached, e.g. as described in this BMJ Editorial on the approach used in South Korea (of similar population size/development to the UK):

‘Another lesson is the need to enforce isolation for people with covid-19. In South Korea, isolation is monitored through the compulsory use of a mobile phone app and includes financial support for families.13 Violation of quarantine regulations is a criminal offence and can result in a fine of up to 10 million won (£6600; €7400; $8100) or a year in prison. Enforcement of isolation helped South Korea avoid full lockdown, and society is now starting to return to normal, although the recent outbreak linked to night clubs suggests such venues may need to remain closed.’

https://www.bmj.com/content/369/bmj.m2084

“In fact this Editorial also points out other weaknesses in the UK system – particularly a lack of community testing, which led to the unidentified spread of the virus in the community to an extent that when the UK track and trace system was finally rolled out, it could not cope with so many new cases per day arising in the community – another quote from this Editorial sums it up very succinctly:

‘The key difference between the two countries was that South Korea rapidly adopted a “test, trace, isolate, and treat” strategy. People with suspected disease were tested, contacts identified, strict isolation enforced, and free treatment given to those infected, with compensation for people who had to self-isolate.3 The UK put in place limited testing early on in the pandemic and then abandoned contact tracing and community testing in March. This policy probably contributed to the rapid increase in the number of covid-19 cases and deaths. South Korea expanded its testing capacity more quickly than the UK in the early part of its outbreak, ensuring it had sufficient tests to implement its testing and tracing policy.’

“There are multiple other inefficiency issues with the UK track and trace programme, as pointed out by the report, but these two issues are the main ones.

“If you do not test/identify the community cases and isolate them together and  quarantine any contacts, immediately and effectively, they will then create more cases that may not be identified and the track and trace programme will fail – because of this lack of detection of new cases.

“Of course, the deprivation of civil liberties with enforced isolation/quarantine in the UK has been a concern, but without this, any track and trace programme will be ineffective.

“After several million cases, over 100,000 deaths, the multiple businesses that have collapsed in the past year in the UK, now the British public may be more willing to accept some degree of enforcement in a smaller number of cases, to avoid a repeat of the past catastrophic year – to reduce the overall numbers COVID-19 cases and deaths – and the massive impact on the economy.

“A final quote from this Editorial puts this in some perspective – from the earlier part of the pandemic:

‘By mid-May, despite several weeks of “lockdown” and a decline in numbers since the peak in April 2020, the UK was still recording over 3000 cases each day; this compared with fewer than 30 cases a day in South Korea. Furthermore, the UK has so far recorded over 36 000 deaths from covid-19 compared with under 300 in South Korea.2 Why has the impact of covid-19 in the two countries varied so much?’

“The UK has done well with COVID-19 vaccine development, therapeutic clinical trials, SARS-COV-2 genome sequencing because they have done all of this before and already have well-established trained, skilled personnel/ systems/ infrastructure in place for this – including the vaccine rollout, which to some extent is done also for seasonal flu each year.

“The track/trace/isolate/quarantine on a national scale of a fast moving pandemic virus like SARS-COV-2 – which requires a restriction of civil liberties for some (though this has been done on a much smaller scale for MDR/XDR TB), is something quite different – and more thoughtful planning rather than hollow rhetoric is needed – to avoid the tragic deaths and the destruction of the livelihoods of so many people in the UK.”

Dr Alexander Edwards, Associate Professor in Biomedical Technology, Reading School of Pharmacy, University of Reading, said:

“It is vital we remember that the underlying principles of testing, contact tracing, and isolating remains one of the most important tools for managing infections and for public health. Many past examples have proven that these principles, effectively applied, can and do control many deadly diseases. There are decades of data and the approach is based on very strong evidence. Multiple Ebola outbreaks have been contained without vaccines; in 2003 SARS was contained by test-trace-isolate. Diagnostic testing remains a fundamental foundation of modern healthcare; testing and monitoring to control spread is in all the infectious disease textbooks. However, integrating different public health measures is essential for success (e.g. vaccines were combined with epidemiology to eliminate smallpox). But this makes it harder to measure the direct benefits of each intervention.

“We do need to measure how well any new diagnostic program works in the real world- ideally using similar methods to clinical trials for medicines such as vaccines. Clinical trials take time- Covid-19 vaccine trials took from March to November. It’s not made easier by the complex and sometimes counterintuitive language used to measure diagnostics. This is illustrated powerfully by the report- I quote “NHS T&T told the committee that a negative test result means that an individual is around 77% likely to be negative for Covid-19”: this doesn’t make sense, because it implies that someone with a negative test result is around 23% likely to be infected, yet ONS data for 4 March suggests ~0.5% of the whole population was infected, implying an untested person was around 99.5% likely to be negative for Covid-19. The quote appears to scramble terms used to measure accuracy, mixing “negative predictive value” with “sensitivity”. Negative predictive value does depend on sensitivity – but it also changes when infection levels vary. Just because the terminology can be confusing doesn’t mean the underlying science isn’t sound. But it is vital that we do translate the science (and language) into practice effectively.”

The Forty-Seventh Report of Session 2019–21 on COVID-19: Test, track and trace (part 1) by the House of Commons Public Accounts Committee was published at 00:01 UK time Wednesday 10^th March.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.