The many problems with test and trace
Dr Katie Musgrave
I understand you’re utterly sold on the test and trace strategy to manage the potential round two of Covid-19. The only problem I can see is that on every level it appears to have fundamental flaws.
Problem number one - The majority of Covid cases are asymptomatic, and the test and trace programme depends on testing those with symptoms and tracing their contacts. If in a room of 100 people, 20 are infected, but only four show symptoms, will it do a jot of good to trace the contacts of those four, while the other 16 continue merrily about their business? I think not.
Problem number two - If I had symptoms of Covid, would I want to divulge this to the Government? I am (soon to be) a temporary worker, outside permanent employment. I have a much-longed-for holiday coming up. Would I, truth be told, wish to ‘fess up to the test and trace army that I had a new, tickly cough?
I’d have to say goodbye to my income for the time being, and forego my upcoming holiday. ‘It’s probably not Covid anyway, I think I will just keep quiet’, says 90% of the population. Unless there is an incentive (most likely financial), the vast majority of the population will not present their symptoms to the test and trace team. So, even for those few with symptoms, it will be ineffective.
It would be nice to see some reliable data about how many infections there are out there
Therefore, we have a strategy leading us into winter, where there is the potential for a second wave of this infection (hi, Covid, we’ve missed you!); and the Government and their health advisors are pursuing a shortsighted, almost farcical strategy. Please would someone with an iota of sense give them some advice?
OK, back to me…
- You need to test frontline health workers regularly, say weekly. (Those saliva tests sound nice - do they work?). If the tests are short in number, GPs could have a restricted number of their workforce, nurses and healthcare assistants seeing patients in person. Test a few from each practice, so we can see patients safely. The other staff should carefully socially distance from one another.
- You should be doing population screening to see what the prevalence is like across the UK. Random visits to different addresses around the country would do. You have the details on the electoral roll. A screening programme of sorts shouldn’t be beyond the wit of man.
- It would be nice to see some reliable data about how many infections there are out there (see point two above), and how many people are getting seriously unwell or dying. This is fairly crucial information to guide the nation’s response.
- To be honest, I think the track and trace system is beyond redemption and should be shelved. But if you are to plough on with this nonsensical strategy - you will need to offer an incentive. If someone presents with Covid symptoms and reports their contacts, they receive a free coffee voucher. Small enough that most wouldn’t go to the bother of feigning illness, but some recognition for doing the right thing. A small thank you, perhaps?
- I agree, a further national lockdown is unlikely to be in the nation’s best interest. But, there may be a need for local lockdowns of the most vulnerable groups. More awareness of local prevalences would allow local public health teams to disseminate the message, when certain thresholds of infection were met. And the local press would be delighted to publicise these - don’t worry about that.
There you have my strategy. If each of these steps were taken, I’m certain the death toll at the end of this winter would be significantly lower.
Finally, I wrote to The Times in early March to call for regular screening of frontline health workers. We are now in August and it has not yet happened. How much longer must we wait?
Dr Katie Musgrave
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West