Back in July, I wrote a piece for this publication outlining my concerns about the NHS’s test and trace strategy. As was apparent then (and remains the case today), there was far too much asymptomatic disease; Covid was too widely spread in the population; and it would be impossible to find and trace the cases to any meaningful degree.
Now that children have returned to schools and winter viruses are circulating, the need to test anyone with a cough or fever renders the whole exercise impossible. As GPs, we are all too aware of the burden of respiratory diseases over winter, and their non-specific signs and symptoms.
The ‘whack a mole’ strategy could never be effective when there are likely hundreds, perhaps even thousands, of moles in every town and region. (And the moles look exactly like every other animal!)
This flawed strategy, which appears to have been accepted without question by the scientific and medical community, urgently needs to be challenged.
It would be far more effective, and achievable, to divert tests towards regularly screening healthcare workers and carers for the most clinically vulnerable and the elderly. That way we could effectively ‘cocoon’ the vulnerable members of our population from having to come into contact with the virus.
Imagine it to be akin to having a passport. You would only see a vulnerable or elderly person if you had had a negative Covid test in the past four days (or if you had isolated for 14 days). The loved ones of these groups could be offered regular testing to provide much-needed social support. If we focussed the tests where they were genuinely needed, there might be some hope of the system functioning.
However, I am certainly not advocating locking away the vulnerable and elderly. There must be a degree of freedom to choose. If a competent adult would prefer to take their chances, then fair enough. After all, an elderly person has every right to make unwise choices, and indeed to refuse medical interventions: they always have.
So, back to the test and trace system. It is inconceivable that we are diverting tests towards millions of snotty children this winter – when we know that they are at almost no risk from coronavirus.
When children have symptoms, they should be advised to avoid grandparents for a period of two weeks, and to perhaps miss a week of school. Teaching staff and other frontline workers should be stratified into low, amber, and high risk – and offered roles which are lower risk accordingly.
There is only one way this virus is headed, and that is to spread through our population. We need to focus our attention on protecting the vulnerable – as we now know that those over 80 are many times more likely to die from Covid than those under 50.
Herd immunity has become a toxic, politically unacceptable, theory – yet no one raises concerns about the UK’s strategy for managing varicella (another virus with potentially serious consequences if contracted later in life). There is an effective vaccine for varicella; yet as a country we accept that herd immunity provides adequate protection.
We know too little about Covid to be able to assert whether herd immunity is likely to effectively protect our population longer term from this virus.
But it is entirely reasonable to suppose that there are common features shared by most viruses, and some immunity would be expected after exposure. We certainly know enough to be confident that children, and young adults, could be exposed without being likely to come to significant long-term harm.
This is, after all, a game of balancing risks. At what point do we say that to make Covid the sole focus of the NHS, is to do untold harm to the health, and wealth (as these are inextricably linked), of the population? When do we reflect that more people will die early as a result of austerity, than will be affected by this virus? When do we consider that to condemn a ninety-year-old to isolation, is worse than them facing the prospect of potentially contracting Covid?
The scientists advising our Government appear to have accepted, without question, the dogma that an effective test and trace strategy is the only way we can manage the virus this winter (without a vaccine) – aside from bringing in ever more draconian lockdown measures.
But has this apporach ever been found to be effective in as large a population as ours, with a disease as widely disseminated, yet non-specific, as Covid?
I do not mean to be another armchair expert. But when it is blindingly obvious as a parent and GP that the existing test, trace and isolate system cannot possibly manage to track and suppress this virus, as a medical professional I feel I have a responsibility to speak up.
We need a broad-minded team of scientists and clinicians from a range of disciplines who are willing to challenge, question, and adapt in this fast-moving pandemic. And we need competent politicians and leaders at the helm. I am yet to be convinced that Johnson, Hancock and Dido Harding are up to this challenge.
Dr Katie Musgrave is a newly-qualified GP in Plymouth and quality improvement fellow for the South West