May 27, 2020

expert reaction to government launch of the NHS Test and Trace service

The government has announced today that the NHS Test and Trace service will launch tomorrow on Thursday 28th May.

Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:

“’Test, Track and Isolate’ and ‘Test and Protect’ refer to strategies to suppress transmission of COVID-19 infections using contact tracing. Contact tracing is one of the few tools we have available – apart from social distancing – to try to reduce the reproduction rate, the R number.

“The DELVE report by the Royal Society provides an exceptionally clear account of the way that contact tracing suppresses the transmission rate and the challenges that must be overcome to make contact tracing an effective tool for combatting COVID-19.

“The key element of the strategy is to increase the proportion of exposed people who self-quarantine before they show symptoms. At present, self-quarantine applies mainly to people sharing a household with a case. Contact tracing can extend this to other types of ‘contacts’, such as co-workers or fellow attendees at social gatherings.

“Contact tracing is designed to identify people who have been exposed to infection and ask them to self-quarantine, at least until they can be tested to determine whether they have the virus or not. It is especially important in reducing rates of transmission during the pre-symptomatic phase of infection. To do this effectively it is vital that contacts are identified and informed of their status quickly; they may become infectious just a few days after exposure so speed is all important.

“Testing plays two roles in the strategy. Firstly, contact tracing is not triggered until the index case is confirmed to be positive. This is to avoid expending effort seeking contacts of suspected cases that turn out not to have COVID-19. There could be very large numbers of these as the symptoms of COVID-19 are not very specific. Second, the contacts are tested to establish whether they need to remain in quarantine. This is to avoid very large numbers of people being quarantined unnecessarily as the great majority of contacts are expected to be uninfected.

“A successful contact tracing programme should contribute to reducing R. However, as the Royal Society report notes, it is unlikely to be enough by itself, at least while the incidence of new infections remains high. Other countries have combined contact tracing with social distancing and it is difficult to determine the relative contributions of those two measures to reducing R.”

Prof Sir Simon Wessely, Regius Professor of Psychiatry, King’s College London & Director, Health Protection Research Unit in Emergency Preparedness and Response, KCL, said:

“Most people who develop symptoms suggestive of COVID-19 won’t have it. At moment it is still less than one in ten, and that figure will get even lower. So we need to test people very rapidly, to identify those who don’t have it just as much as those that do, or the system will fall into disrepute. There won’t be much problem getting the cooperation of someone who has tested positive, but it will be harder with their contacts, especially when we don’t have an App in widespread use. People will have different views on how a contact should be approached – some will prefer to do it themselves, others will want the opposite. If we don’t respect that, they might not tell you. Those most likely to get infected and their contacts are more likely to the delivery drivers, transport workers, care home workers, shop assistants, the self-employed and so on.  So at the point of notification there needs to be provision to support those in need – financially, medically and even accommodation if necessary.

“When this all started most people cooperated amazingly well out of a sense of altruism (“Save the NHS”) and then fear, which remains very high.  But for younger generation altruism may decline as they realise that they are going to be the generation most affected by the recession and restrictions, and fear will also decline as they realise they are the least vulnerable to the virus. Convincing them to cooperate with Test and Treat over a long period will be its greatest test.”

Dr Robert Shorten, Chair, Microbiology Professional Committee, Association for Clinical Biochemistry and Laboratory Medicine, said:

“‘Test, trace & isolate’, or contact tracing is a well-established way to help control infectious diseases. In the context of COVID-19, a person who has symptoms would be asked to self-isolate, and would be tested for the presence of the virus with a swab test as soon as possible. The test should be performed using a well-taken swab from the nose or throat to minimise the risk of a false negative result. This should then be transported to a laboratory for testing as soon as possible.

“Results must be rapidly passed on to those performing the tracing for ‘test, track & isolate’ to have maximum impact. If the test shows a positive result, rapidly passing on this information will help decrease onward spread of COVID-19 infection as those in contact with the symptomatic person will also be asked to self-isolate and monitor for symptoms. If the test shows a negative result, rapidly passing on this information will help limit the time individuals are in isolation.

“Central to this whole process is the end-to-end quality of the test – from taking the swab, transportation, testing, interpretation, and reporting of the result. For a rapid response it is vital that each component is joined up. Strong links across each part of the process also provides the high quality testing needed to inform effective public health action. NHS and Public Health laboratories in partnership with Public Health colleagues are well practiced in these principles of controlling infectious diseases. Replicating this well-established process is the best way to carry out the large scale ‘test, track & isolate’ programme, regardless of where the sample is taken and the test is performed.”

Prof Linda Bauld, Professor of Public Health, University of Edinburgh, said:

“International experience shows us that a test, track and isolate system is central to containing Covid-19 as we gradually move out of lock down. Other countries implemented this early and have kept doing it since the start of the pandemic but the UK abandoned it at an early stage and is now playing catch up.

“The success of the programme will rely on a number of things. First, that our testing capacity is at the level needed and that people with symptoms can be tested quickly by travelling to a testing centre or being tested at home. Secondly, that test results can be returned quickly. Thirdly that people who are positive feel sufficiently confident in the security of the system to report their contacts and pass on their details and in turn that contacts are comfortable taking calls from contact tracers. Fourthly, contacts then need to be willing to self-isolate for 14 days. This is going to be very challenging for some and that means that the ‘support’ element of test and trace (statutory sick pay and access to food and medicines if needed) will have to work well, and be put in place quickly. Given all these steps, we shouldn’t expect that this will work perfectly and there could be several points of failure.

“A further key element is the message that social distancing measures need to remain in place for some time to come.  If we continue to follow this guidance, we reduce the chance that we develop Covid-19, pass it on to others or indeed become a contact ourselves, with all that involves. For some groups, continued social distancing is going to be extremely difficult – including for young people and for couples who don’t live together and have been separated for weeks. As part of rolling out test and trace we need to be preparing detailed guidance for these groups and others. Only if everyone understand how the system works, why it is needed and how it applies to their individual circumstances will people be willing to comply.”

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:

“An effective test and trace programme is absolutely essential to be able to safely lift the lockdown.  As the authorities implement this, it will be interesting to see how it will be enforced.  With a lack of local, ‘on the ground’ workers to monitor compliance, anyone who wants to flout the instruction to stay at home could be free to do so and if they don’t have symptoms, nobody will be any the wiser.  When challenged at today’s Liaison Committee, the Prime Minister said ‘we will be asking people to stay at home’; the UK system will rely heavily on the willingness of people to participate properly and accept a bit more tracking of their movements, in exchange for more freedoms.

“The highly successful South Korean system is much more draconian; it removes anyone diagnosed with the coronavirus from their household, reducing the risk of infecting people who are mixing amongst the general population and it is much more forensic in tracing people’s movements.  In addition to using GPS phone tracking, surveillance camera records and credit card transactions are monitored.  It remains to be seen how effective this system will be in breaking the chain of infections.

“This new initiative can only work if the government reinforces the message that the rules must apply to everyone, and are not interpreted to suit individual circumstances.  Given recent revelations, they now face an uphill battle to show the public that we really are all in this together.”

Aisling Burnand MBE, CEO of the Association of Medical Research Charities, said:

“The NHS test and trace service could bring significant benefits to all of us but only if it is launched and managed in the right way.  Data driven technologies can save lives during the COVID-19 crisis and potentially support our route out of lockdown as part of a track and trace strategy.

“But that success will be dependent on sustaining widespread public trust and confidence in the use of our data, for which transparency and open communication from the government are absolutely vital. How it will work, who will have access to data, and why test and trace is important must be clear if this is to become a tool which helps unlock our route out of the crisis.”

Prof James Naismith, Director of the Rosalind Franklin Institute, & Professor of Structural Biology, University of Oxford, said:

“It is welcome news the Government is building a test and trace system. The challenges of operating such a system must not be underestimated however and there are bound to teething problems. Although mobiles phones can help, there is no simple technology shortcut, contact tracing relies on manual work and crucially the public’s full cooperation. Along with other steps, this approach is the best way we have available of avoiding a calamitous second wave in the autumn.

“As the DELVE group from the Royal Society has emphasised, speed is a key factor. To be most effective, individuals who have been in contact with confirmed cases need to be isolating within three days. I would hope to see the increase in testing capacity that will permit rapid automatic follow up testing of contacts rather than waiting for them to make a request. The key people to identify and isolate are those who are otherwise well but have the virus.

“As the Royal Society report recognises incentivising people, especially those who are otherwise well to do the right thing, is important for success. Measures to support people who are required to isolate will be helpful in two ways. Firstly, the people concerned will isolate effectively if they are supported and secondly people testing positive will more willing cooperate with tracing if they feel the isolation of their contacts is not unduly burdensome. The scientific justification in continuing to require the self-isolation of people who test negative and have no symptoms is unclear. I believe we have the time if we remain laser focussed to build a rapid, effective and user friendly test, trace and isolate system.”

Professor Eivor Oborn, an expert on health technology at Warwick Business School, said:

“The fact that the trace, track, and isolate system is being launched ahead of the delayed NHS app is a problematic sign.

“The government had already admitted the app would not be ready to launch on June 1. That implies there have been issues, e.g. getting the technology to work correctly without draining the phone battery.

“If the Bluetooth signals do not transmit as predicted, then even those who are using the app cannot make the intended progress in terms of decreasing transmission.

“It is imperative the technology actually works. Manual tracing alone is too slow, and if there is a second spike it would be very difficult, if not impossible, to locate contacts fast enough.

“Without an app, the rapid transmission of the virus between people, will be faster than the time it takes to do the needed detective work and phone calls to alert all exposed individuals.

“The decentralised approach being taken by many other countries, including devolved nations such as Scotland and Northern Ireland, does nothing to reinforce confidence in the government’s position on a centralised app. It will also make travelling between countries much harder, in terms of minimising the spread of the virus.”

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.