September 24, 2020

expert reaction to preprint reporting on adherence to the test, trace and isolate system in the UK

A preprint, and unpublished non peer-reviewed study posted on medRxiv, looked at adherence to the test, trace and isolate system in the UK.

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“This is a useful and important contribution to the evidence base and highlights a worryingly low level of adherence to guidance around self-isolation.

“The conclusions reflect that better financial support would be one factor that can increase compliance. However, this is at odds with the governments approach where the ‘stick’ is the preferred incentive via heavy fines, rather than the ‘carrot’ of financial and practical support to encourage people to stay at home. The ‘stick’ in this case may even have the opposite effect of making people more reluctant to support their symptoms and provide the details of their close contacts.

“Decision-makers may need to rethink their strategies in the light of this new evidence.”

Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University, said:

“These are pretty robust data and the findings are not particularly surprising. The government approach to self-isolation and quarantine has always lacked sensitivity to the contingencies of everyday life to large sections of the population. This means, as the authors imply, that attempts to bully people into compliance by draconian penalties and enforcement actions are unlikely to be effective and will merely increase hardship and distress. I think we also need a better understanding of the different perceptions of risk held by professional communities and ordinary people. Professional communities tend to see extreme cases, which are also often reflected in media coverage. However, the everyday experience of Covid-19 does not mesh with this. What ordinary people are seeing are the mass of asymptomatic and mild cases, which make up the overwhelming majority of infections. It is quite understandable that they do not see transmission risks in the same light as those who only see the tip of the iceberg in deaths and ICU admissions. Given this, if compliance is difficult for other reasons, motivation is also likely to be weak. While this may mean that it is difficult to contain a new wave of infections, this research might also prompt us to ask how hard it is worth trying to achieve that.”

Prof Sheila Bird, former Programme Leader, MRC Biostatistics Unit, University of Cambridge, said

“Shortfall in those testing positive per week versus the estimated weekly numbers newly swab-test positive (including without symptoms) in ONS’s household-based Infection Survey is partly explained by only half the participants in this survey knowing the three key COVID-symptoms which should prompt test-seeking; by only about a fifth of those with symptoms actually seeking a test; and by weak adherence to self-isolation despite good intentions.

“Most worrying of all is that responses to this weekly survey had not shifted greatly during June and July and so its information has been known for weeks – including well before the Royal Statistical Society made its recommendations on how to glean intelligence about the effectiveness of Test & Trace.

“The panels from which respondent derive may not be properly representative of those whom Test & Trace quarantines and the survey questions asked did not differentiate minimal from prolonged breach of quarantine; nor whether the breach occurred because an external close contact had not been reached anyway by Test & Trace until several days of the contact’s intended 14-day quarantine period had already elapsed. Hence, respondents’ intention to adhere (70%) may yet be a better guide than self-reported actual adherence – because non-adherence may be partly due to operational failings at T&T.

“The picture painted is grim and has been for too long. Greater transparency sooner is and was required.”

Preprint available here: https://www.medrxiv.org/content/10.1101/2020.09.15.20191957v1.full.pdf

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

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.