As the government twists and turns in order to avoid the blame for its incompetent handling of the coronavirus pandemic, it now hopes it has found a way out: forcing local authorities to take responsibility for managing outbreaks in the future, and virtually ruling out a second national lockdown even in the event of a winter spike. As we go to press, Britain still has the highest death toll per head of population among the G7 countries whichever way it is counted, with 65,200 excess deaths according to the ONS, and 45,000 according to the Department of Health. Far from being as Boris Johnson claims a ‘world-beating’ test-and-tracing system it has been one of the deadliest. CHARLES CHINWEIZU reports.
The key to the disaster lies in the government’s complete lack of preparedness to create an effective test and trace programme. It ignored the World Health Organization’s (WHO) advice on 16 March to ‘test, test, test’ and even now the programme it has set up is completely inadequate, reliant as it is on private companies which have no experience of public health campaigns. This failure threatens a second wave of coronavirus infections which, according to the Academy of Medical Sciences (AMS), could kill 120,000 people in hospitals alone.
Late on everything
If the 23 March ‘lockdown’ had been implemented just two weeks earlier, according to the AMS, ‘perhaps most of the Covid-19 deaths to date…might have been prevented’, and even a week earlier could have reduced the final death toll by half. However, lockdowns are not the only solution. Implementation of rapid tracing and isolation of all contacts of positive cases; population-wide targeted, regular and accessible testing with rapid turnaround of results; and mandatory use of face masks in public places, could all help suppress the epidemic. The AMS has urged ‘intense preparation’ throughout the summer to reduce the risk of the NHS being overwhelmed in winter by ensuring ‘there is adequate PPE, testing and system-wide infection-control measures… Increasing capacity of the test, trace and isolate programme to cope with the overlapping symptoms of Covid-19, flu and other winter infections, and establishing a comprehensive, near-real-time, population-wide surveillance system…’.
The government’s testing strategy rested on the extension of ‘Pillar 2’ community- and home-based swab testing and nationally-driven contact tracing – both privatised services. Locally, there has been NHS-led ‘Pillar 1’ swab testing of patients in hospitals, and fitful testing of health and care workers. Deloitte, Serco, G4S, and Levy provide facilities management for Pillar 2 testing. Randox provides home testing kits, the logistics for which are provided by Amazon. Pillar 2 samples are analysed by the four new ‘lighthouse labs,’ which involve AstraZeneca and GlaxoSmithKline even though both state that ‘diagnostic testing is not part of either company’s core business.’
Wasting money
The government also ordered antibody home test kits based on the mistaken belief that having a positive test result gives immunity. This is the so-called ‘Pillar 3’ serological testing. The antibody kits are highly inaccurate; they have not been properly validated; there is no data on their performance in elderly, BAME and immune-compromised people; and there is no evidence that having antibodies actually gives immunity or how long that immunity would last for. The government ignored WHO advice on 8 April that these kits ‘may miss patients with active infection or falsely categorise patients as having the disease when they do not, further hampering disease control efforts.’ Only on 29 May did the Medicines and Healthcare Products Regulatory Agency stop suppliers from selling these tests. The government had wasted millions of pounds by this time.
Late on testing
It is now clear that the entire testing system (and the data it has produced) remains a shambles. As we go to press, the number of people tested is 1.9 million – the numbers who have had Covid-19 can only be guessed at. The testing fiasco began on 12 March when the British government stopped all testing except for symptomatic hospital patients. The SAGE scientific advisory group had already heard on 5 March that community transmission was underway, and five days later, that there were likely to be ‘thousands of cases – as many as 5,000 to 10,000 – which are geographically spread nationally.’ Reuters estimates that, based on subsequent death rates, by that time Britain had only detected about 3% of all Covid-19 infections, and 18% of those with symptoms; Germany was detecting 43%.
Even such testing used a narrower definition (only a sharp new cough, fever or shortness of breath) of Covid-19 symptoms than the WHO, which listed eight symptoms in February. Other countries were testing asymptomatic and mildly symptomatic patients. On 18 May after about 34,800 deaths, a loss of taste and smell was added to the symptom list, and the next day everyone over five years old (with symptoms) could in theory be tested. About 36% of Covid-19 cases have neurological symptoms; many UK cases therefore went unnoticed and infections spread unchecked.
All hospital testing was controlled by the Department of Health and Social Care (DHSC) through Public Health England (PHE). PHE refused to use any labs outside their control; some labs were told to ‘back off’. Samples for test that did not meet the official definition were rejected. Testing was also restricted to symptomatic patients or contacts of positive cases from Wuhan, then the rest of China (on 1 February), then other parts of Asia (7 February), and then only parts of Italy and Iran (25 February). A study later showed most UK infections had come from Europe, not Asia. Anthony Costello, Professor of Global Health at UCL, said early on that 44 molecular virology labs were ignored and that ‘if they were doing 400 tests a day, we would be up to Germany’s levels of testing’, which at the time was 400,000 tests a month.
No data
Since 23 May, NHS Test and Trace has had no credible cumulative testing figures from when the outbreak began. According to Sir David Norgrove, the chair of the UK Statistics Authority, the figures on testing that have been published are incomplete and incomprehensible, and their aim is ‘to show the largest possible number of tests, even at the expense of understanding’. Without a quick and credible testing programme Britain will be unable to respond to any future outbreaks or implement local lockdowns.
As an example of the meaninglessness of government data, four million home test kits have been posted out since late April, but only 2.9 million have been processed. Yet the headline total of tests misleadingly adds together tests carried out with tests posted out; and adds viral swab tests with antibody tests. There is no date for when tests were carried out. Tests on a single patient are counted as multiple tests, and test results sometimes do not include key information such as NHS number, types of employment, age, gender and location. Independent SAGE has pointed out there are no figures for suspected cases or how many of them later test positive. The onus remains on the individual to get a test.
Embedding the private sector
Rather than develop and extend the existing system of public health laboratories, facilities and staff, the government chose to rely on the private sector which had no laboratories, facilities or staff. The local testing centres that were established were run by the army, but required people to administer their own tests. They had to:
- read a dense instruction booklet;
- take the sample correctly;
- avoid contaminating the swab;
- correctly attach a barcode to the vial and package it.
If they were doing the test from home, they had to post it to a Lighthouse Lab so that the tests arrived within 48 hours or the results could be worthless. Many vials arrive leaking, mislabelled or unlabelled and already contaminated. At the testing centres, the vials could be dropped, or further contaminated and may need reprocessing. People waited up to 12 days for their results if they received them at all. Even now only 87% get their results within 24 hours.
With so many private corporations involved, there are multiple testing formats, multiple data outputs, multiple different barcodes, with different testing labs and hospitals each operating on different types of barcode systems. Rather than use existing networks of local GPs and public health and environmental health officials with local knowledge, and hospital and academic labs to ramp up testing and contact tracing, the British government chose to set up this complicated chaotic system overnight in the middle of a global pandemic. The data then became the commercially-sensitive private property of private companies.
Leicester fiasco
Leicester provides a glimpse of what is at stake: local public health officials complained they did not get Pillar 2 data in a timely manner, and the data did not detail who tested positive, where they lived or worked, or their age or ethnicities. A rapid response was stymied by a lack of information-sharing as the Department of Health and Social Care refused to release the full data. Instead an increase in testing capacity, including mobile testing units run by the army, was introduced to Leicester, which was ‘ineffective in the absence of a locally directed coordinated response, leading to lockdown measures being reintroduced’. The government blustered, repeatedly claiming that all the necessary data had been passed to local officials. It was a succession of lies, exposed on 18 July when the government U-turned and made some named-patient data available, and added the data to its daily local authority breakdown of testing information.
Contact tracing
Having suspended contact tracing on 12 March, the government waited until 28 May to restart it. But rather than using ‘old-fashioned things like telephones or going door to door…local teams because they need to understand the local communities’, as Allyson Pollock, Professor of Public Health at Newcastle University, advises, the government sidelined thousands of public health specialists and environmental health officers and contracted contact tracing out to Serco, the same private company in charge of Pillar 2 testing. The 25,000 ‘contact-tracers’ that were then employed work from home for a plethora of sub-contractors such as Capita, on a ‘call centre’ model. They earn a miserable £8.72 per hour, having received just one hour online ‘training’.
The record for this system is dreadful: thousands who test positive cannot be reached to provide details of people they have come into contact with; only 80% of those reached then even provided a contact; and only 56% were contacted within 24 hours of being referred for contact tracing. Large numbers of infected people and their contacts are not being reached and isolated. It was evident by mid-July that this system would not work, and that there had to be locally-based tracers to ensure that infections did not get out of control.
The government’s plans had been to keep tight control over the pandemic response at whatever the human cost. Leicester exposed this for the disaster it could become if repeated across the country. Hence a further U-turn: on 18 July, the government gave local authorities new powers to manage local outbreaks. There is no indication that they will receive extra money. But Prime Minister Johnson wants to ensure that the Tories are not blamed for any resurgence of coronavirus, knowing that any new outbreaks will most likely happen in the poorest areas – that is, in local authorities run by Labour. His description of a second national lockdown as a ‘nuclear deterrent’ is not so much a warning as a statement that he will not countenance such a step. In the meantime the government will avoid any official enquiry into the handling of the pandemic, and equally avoid any serious planning against the eventuality of a second wave in the winter.
FIGHT RACISM! FIGHT IMPERIALISM! 277 August/September 2020
