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
I found this really difficult to read. I agree that test and trace isn’t the way forward, but to say “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”, we don’t know this and the evidence is that maybe 1:10 seem to be suffering lasting problems no matter how old or badly affected. We have no idea of the long term consequences. By not testing people we dilute the significance of the illness and potential for the NHS to become overwhelmed. The Cummings effect has had a significant reduction in the compliance with the Laws and diluted how important people feel it is.
It’s difficult enough convincing people they have COVID symptoms now, ‘I know it’s not COVID coz I’ve not got a temperature’. If you say, you don’t need a test, just guess and don’t see granny for two weeks, well the kids can go back to school after a week, so a weeks probably ok to go see Granny, and if I don’t need a test, well no one can prove I’ve had it and therefore I can’t get in trouble for going on the train back to Scotland from my job in the House of Commons….
What we need is a better test with easier access, rules and acknowledgment from the government that Covid doesn’t always present with one of the 3, it’s just the cough means you’re more likely to land you in hospital, I’ve seen so many patients with GI symptoms who keep working and spreading it. If you could get a same day test and result we could get people testing for any symptoms, educate the population and keep the economy and nhs going. I hate to admit it but I think the moon shot is our best chance.
Heard immunity is an unknown, other coronaviruses that have had significant outbreaks in previous centuries and still affect us know with much milder symptoms, so infect you again after a year but you are infected as an assymptomatic spreader. This is the worse case scenario for Covid (other than mutation for the worst or having no immunity), that’s why a moon shot is worth a go…
Stephen Robertson, I’ve no idea where you plucked that 1:10 figure for those suffering long term problems from? I think you missed several zero’s from that. Did you mean only 1:10 cases are being picked up by test and trace? Even for that I suspect it’s more like only 1:100, most people don’t get a test because they don’t want to have to self isolate for 2 weeks. This virus is now widespread and has been in our community for more almost a year. It’s blindingly obvious that the young and healthy overwhelmingly do not get significantly ill from this virus.
The NHS was never overwhelmed and only in London and one or two other centres was there any major pressure on beds, the nightingale wards were never used anywhere other than a few beds in London, and despite the latest panic, current admissions and deaths remain very low.
So if you don’t agree with letting the virus spread through the population naturally and develop immunity, what is your end point in all of this? Despite the best efforts of the politicians and their “Sage” scientists (what a classic misnomer that is) to lock everyone up indefinitely the virus continues to spread, inevitably, as that’s what viruses do.
There is no prospect of a safe and effective virus in the next 18 months at the least (don’t forget we been looking for a coronavirus vaccine for decades) so lockdown will continue. By the end this country will be bankrupt, the death toll from all other causes will be catastrophic and the virus will still be circulating.
The only logical option now is to lift all restrictions, forget about test and trace which still is and never likely to be fit for purpose, shield the vulnerable who want to be shielded and support them financially, and let the rest of us move on and start to repair the wholesale damage and death caused by lockdown which far outweighs the death toll from covid . Nobody even blinked during the last ‘flu epidemic recently with circa 50k deaths.
Can I add a few points :
1) 10 million Covid tests per day are available from 1st October, according to Government /DoH, so there is plenty of testing capacity;
2) Coronavirus vaccines have been availabke for several years, just not for Covid-19 and not for humans, because we thought they were not dangerous to humans;
3) the elderly and vulnerable are being forgotten, locked away, scared to death of social contact, because we have prioritised summer holidays and eating out and going to the pub over safety and mental health of our communities;
4) we still could eradicate Covid from Britian and return to near-enough normal domestically in about 3 months, according to estimates
John Mackay, see the BMJ article on long covid (doi:10.1136/bmj.m3026) where it states approximately 10% of people experience prolonged illness after covid-19. I suspect I am one of those more mildly affected but I may never know because routine testing wasn’t done in March when it all started.
Absolutely correct, Dr. Musgrave and, I would add, that all the relevant information concerning ‘Basic Virology’ was known from the beginning but ignored.
When all is said and done, the future Annals of Medicine will weep over the total mismanagement of SARS-2.
I actually don’t know personally what to do, apart from emigrate to New Zealand or parts of Australia. Perhaps rather than a penal colony the UK can negotiate a post brexit agreement for the vulnerable and aged for a few years in the new world?
The rest of the UK population can then get on and mix developing the inevitable herd immunity.
Hey this beats sending refugees to the middle of the Atlantic!
I have to disagree with the basic tenet of the arguement that because winter viruses are circulation that you can not test for covid.
The reality is that there are very very few winter viruses circulating, except covid.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/927142/Weekly_Flu_and_COVID-19_report_w42.pdf
There is some rhinovirus in kids, but even that is going down, and rhinovirus rarely gives flu like illness in adults.
Indeed even serious infections like meningitis, scarlet fever, measles, mump, and even malaria are at a small fraction of their usual prevalance.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/926795/NOIDS-weekly-report-week41-2020.pdf
The biggest problem with testing is that there isn’t enough of it and it is only 70% effective at picking up positive cases. This means patients with covid symptoms should really be tested twice.
But with so little of anything else going around all flu like illnesses should be treated and managed as covid even with a negative covid test. The fact that those and their contacts can stop self isolating is probably as significant reason for the failure to control covid in this country.
I would suggest people listen to independent sage. Surprisingly their weekly presentation of data and advise on covid has only been viewed 6000 since it was steamed yesterday. When you have people such as Prof. Gabriel Scally, President of Epidemiology and Public Health, Royal Society of Medicine, more people should listen to what they have to say, and examine the evidence for themselves.
https://www.youtube.com/watch?v=c5XjUcwBoKk