14 August 2020

How to fill the gaps in the UK’s covid defence and prevent a second wave


This week, the Government announced a significant rejigging of the Track and Trace regime, to better integrate the national scheme with local public health teams.

The change comes after months of criticism that the contact tracing system was excessively centralised: dependent on outsourced call centre operators who could barely reach more than half the close contacts of confirmed cases, while council-based public health teams were given inadequate data to track and prevent local outbreaks.

The new approach, which has been successfully used in Luton, Leicester and Blackburn with Darwen, will see local areas given dedicated callers from the national scheme, and data given to local health officials to follow up – including even visiting non-contactable people at home.

This change comes with the bonus of some savings for taxpayers as 6,000 of the national call centre operators are made redundant, reducing their numbers down to 12,000. Many of these people reported having nothing to do during their shifts other than watch Netflix and do exercise classes on YouTube.

Decentralising contact tracing is immensely sensible. It is a disgrace the Government did not learn from the earlier failure of Public Health England’s highly centralised approach to testing and has persisted with a highly centralised Track and Trace system for so long.

Local public health officials should not have been left twiddling their thumbs while a Whitehall-directed system failed to stop outbreaks in their area. After all, those local officials have previous experience in contact tracing and better knowledge of their local circumstances. It’s no surprise that the world’s most effective tracing systems are highly localised.

People are more likely to pick up a call from a local number and listen and understand when someone knocks on their door to have a one-on-one conversation. These local officials have already proven extremely effective in dealing with “complex” cluster outbreaks in schools and workplaces: tracing 98% of contacts compared to 54% among the national call centre cases.

Some have complained about privacy infringement of the state coming to your door. But while it is not ideal to have a state official at your door asking you to isolate for fourteen days, it is even less ideal for you to spread a potentially deadly virus in your community. What’s more, new lockdowns – which the public will demand if cases significantly expand – are a rather more significant infringement on liberty.

These changes will not mark the perfection of our testing and tracing regime. There remain serious holes that need to be plugged if we are going to stop a second outbreak when the weather turns cold.

Firstly, we have no idea whether people are actually isolating for 14 days when asked. We are depending on the good will of the public. It is not a criminal offence to break quarantine – you cannot be fined for failing to isolate and there are no spot checks by the police. Nor do we incentive people to isolate by providing payments like many other countries – particularly unfair for low income individuals with hourly paid jobs that are being asked to sacrifice income for the greater good.

We know from Melbourne, Australia that even when police have been doing random checks, and there are serious criminal penalties for breaching quarantine orders, compliance is not particularly high. The police found that more than 800 of the 3,000 people they checked were not at home isolating. Non-compliance is likely to be much higher in the United Kingdom. Introducing legally mandated stay-at-home orders, along with payments to make it practically possible, may be the only way to achieve the compliance necessary to prevent a second wave.

From a liberal perspective it would be ideal if this were not necessary, but we should remember: your liberty to swing your arm stops at the moment it hits my face. You have no “right” to harm others by spreading a deadly virus.

The other issue is testing. We may have a high level of testing capacity – well over 300,000 per a day – but the actual number of people coming forward each day to be tested is much lower and we are still catching just a small fraction of cases in the community. Getting a test processed also takes far too long, as Jethro Elsden has pointed out on CapX.

The Government has announced new rapid testing from LamPORE and DnaNudge but this simply is not enough. We are not focusing on the best kind of test. LamPORE is not the same as the RT-LAMP: LamPORE, like the current PCR tests, requires an expensive machine to process. RT-LAMP is a standalone one-step saliva or swab test that can be taken at-home involving a small tube and viral RNA amplification technology.

Imagine being able to spit into a tube and it telling you, by the colour it turns, whether you have Covid-19. We could all be regularly and rapidly tested to identify when and who should isolate to stop the spread. RT-LAMP was successfully used to tackle Ebola. This could end the pandemic and allow life to more or less get back to normal straight away.

There are already open access RT-LAMP test designs for Covid-19 that have proven just as accurate as the much more costly lab-based PCR. Both Oxford University and Francis Crick Institute have verified RT-LAMP tests. The Government’s number one priority should be taking away regulatory barriers that would prevent this test from being used for diagnosis in the United Kingdom.

Testing and tracing is getting there – we are slowly embracing a decentralised and innovative approach. But now is not the time to declare mission accomplished.

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Matthew Lesh is Head of Research at the Adam Smith Institute.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.