Coronavirus: Inside test-and-trace – how the ‘world beater’ went wrong

News for Nick Triggle, Rachel Schreyer and Phil Kemp
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The direction of the journey soon became clear – the government called on its trading partners to set up large, centralised laboratories, which would be located outside existing medical or research facilities.

There is now a network of six major megalaboratories, called Lighthouse Laboratories, which carry out most of the testing in the UK. The swab sample sites were prepared by Deloitte management consultants.

A similar decision was taken with regard to further contacts. Sitel manages the contact centre and the national army of 18,000 contact tracers is mainly hired by Serco, an outsourced company. However, the team consists of about 3000 clinicians, some of whom come from the NHS. This point only concerns England. The rest of the United Kingdom has its own rules.

According to the government, although the contracts were concluded under extremely urgent circumstances due to unforeseen circumstances, they were nevertheless fulfilled under strict conditions.

But those who are about to make decisions will be affected. These contracts were signed and sealed in record time – many of them, according to one source, did not even include provisions for enforcement fines. The government panicked – we were in the middle of an impasse and they were under pressure from all sides. This is not the environment in which the best decisions are made.

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Centralised system Redeployment of local capacity

Currently, the government has a large testing capacity – it can carry out more than 500,000 virus tests per day. In the beginning Great Britain could only reach the year 2000. But the system has tried to shorten the time it takes for a person to take a smear and get a result.

Sir Paul Ners of the Francis Crick Institute, which set up its own local Covid testing programme, said the government had always discussed the possibilities: in principle, how many machines they had in the laboratory, but because of a logistical problem they never carried out the number of tests they claimed to be able to do.

Had we kept it at a local level, we would have been able to use these tests faster, Wilson says, referring to the existing network of hospitals, universities and public health laboratories in England. We already had the logistics.

Instead an entirely new system had to be installed to take the samples to the lighthouse laboratory and the swabs had to travel long distances – sometimes by plane from Edinburgh to Belfast – which still slows down the process today.

The value of the test decreases longer than necessary to obtain the result.

Dr. Rachael Liebmann, vice president of the Royal College of Pathologists, who works in both private and NHS labs, says you had to go beyond the NHS by default to find something new and brilliant. But we didn’t get enough information from people who understand the tests.

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According to Allan Wilson, the government went directly to the companies and told them: What can you do for us? There was no voice from the caller saying it wouldn’t work.

The companies sold test equipment to NHS laboratories that carried out tests for hospitals. This despite the fact that the kits and the chemicals needed for these machines were not sufficient and they were mainly dismantled by private laboratories in the lighthouse.

There are labs that have bought… and still can’t operate at full capacity due to a lack of chemicals [chemicals needed for testing], says Dr. Liebmann.

The representative of the Ministry of Health and Social Affairs said that the system operated in cooperation with the NHS and that joint efforts were essential to ensure the enormous capacity needed to support national efforts to combat the coronavirus pandemic.

Achieving the goal but missing the goal?

The government’s obsession with thwarting the objectives of the tests has also been strongly criticised. First 10,000 tests per day until the end of March, then 100,000 tests per day until the end of April and finally 500,000 tests per day until the end of October. However, the question is who should perform these tests and why less attention is paid to them.

Despite regular counselling, people working in hospitals were not tested for coronavirus if they had no symptoms. This is only the beginning, although there are indications of significant transmission in hospitals. But some laboratories have in fact organised regular preventive medical check-ups for medical staff on their own initiative – although according to one source they have effectively discouraged them from doing so.

Cambridge University was an example of how its research laboratory merged with nearby Addenbrook Hospital to study its staff in the midst of the first wave of the epidemic in the UK. According to Dr. Stephen Baker, who helped set up the program, by the end of June he had screened more than 10,000 people working in the hospital to identify asymptomatic carriers.

This has had a very important impact on the operation of the hospital and, he says, has helped to give NHS staff a sense of security and morale.

September– Test torque decreased by more than.

Many test problems were tackled behind the scenes. But there was a big commotion in September when the trials became almost inaccessible – just as the second wave was about to begin.

This is partly due to the fact that the children asked for tests after returning from the holiday and the children went back to school. But there were also problems with the bandwidth of the labs themselves. A volunteer from Lighthouse, a virologist who wished to remain anonymous, said supply chain issues had slowed progress: We didn’t know how many monsters were coming. We had a forecast every day, but it was never good.

Sometimes it meant that we had enough staff to process 10,000 samples and we only got 2,000, so people were in, and in other cases we got much more than we expected and were more difficult to process.

While scientists were setting up laboratories, it wasn’t necessarily people who had an idea how to deal with viruses – procedures were constantly being adapted, according to the volunteer, and there were recruitment and training problems that further slowed down the process.

Why trackers should have more than one family meeting

Testing is part of the coronavirus equation. Just as important as the ability to detect close contacts of infected people and ensure their isolation at home. For the Investigation Service, which began work at the end of May, just a week after the Prime Minister had promised that the world would not keep its promises, the challenges have manifested themselves in various ways.

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Coronavirus: Inside test-and-trace – how the ‘world beater’ went wrong

It’s very stressful – a lot of people get angry because they are often insulted.

test and follow-up manager

About 18,000 contact tracers were recruited – only 3,000 of them were of clinical origin.

It wasn’t necessarily a problem in itself. Those who work in the department say that people who do better are good communicators. The problem is that a centralised approach to call centres has so often prevented them from communicating. Contact trackers are instructed to follow strict scripting guidelines.

There was no room for caution. This meant that employees had to try to call each family member individually and fill in the same forms. This is one of the reasons why some families have started to receive a lot of calls.

A test and monitoring manager said it blew up the whole system. It’s extremely stressful. Many people are upset because they are often offended.

The government indicated that it was in the process of adapting the system after receiving feedback so that families would not receive repeated calls if the infected person confirmed that he or she had informed the rest of the family of the situation and the need for isolation.

Refusal in areas of greatest need

Overall, the figures did not meet expectations. According to government advisers, 80% of those who respond positively to a test must be registered and the details of their close contacts – mainly family, friends and colleagues – must be obtained in order to be effective. You must then contact 80% of these contacts and ask them to isolate themselves. In some regions, only half of the close contacts are reached and isolation is required. Some of them are located in areas with the highest rates, such as Bradford, Manchester, Blackburn and Nottingham.

The targets are quite ambitious. On the one hand, they ignore the fact that the test system does not detect about half of the cases on a regular basis. The government cannot be solely responsible for this situation – if so many infected people show no symptoms, the system is against it from the start. But because the goals were missed almost every week, it soon became clear that too much attention was being paid to the national system and not enough to the local system.

Was Dido Harding falsely accused?

Most criticism was directed at Baroness Dido Harding, who was hired by the NHS Test and Trace. However, this was only done after the contracts had been signed and the working model defined. By working with what she has, she appreciates the good performance of her team and regularly points out that, despite the problems, the service still works better than in many other countries.

She explains that a complex system such as Tesco, with its network of shops, distribution centres and supply chains, is built up in just a few months.

Dido Harding

You can’t expect testing and monitoring to only monitor the virus.

Baroness Harding

She says she’s getting better. But you can’t expect testing and monitoring to control the virus itself – it’s only part of a broader approach.

It is difficult to compare performance at a global level. Many of them do not publish the detailed information published by the English service. Even the data provided in the rest of the United Kingdom is more limited for comparison purposes – although this suggests that these systems have also encountered difficulties. But some countries were better, like Germany and South Korea. According to the Health Fund, it is important to pay more attention to the local teams in these countries.

City council with hospital card

The need for greater local participation was indeed recognised by the government as early as the summer. The 10th. In August, ministers announced that they would change course and that the national contact tracing team would be downsized by 6,000 people. Staff should be made available to the panels so that they can form local teams to follow up cases after the first 24 hours. It followed the success of a small number of districts that decided to set up their own local contact tracing teams.

The government’s statement was widely supported by the health directors, but then nothing happened. It was only at the end of October that ministers set an additional £1 billion for the winter. It was a source of great disappointment. The Councils have insisted on greater participation from the outset.

And because local systems have evolved – more than half of them are now operational – they have encountered difficulties due to the centralised nature of the system. About the problems that have been reported:

delays in the transfer of the national team’s files.
Transferred files do not contain important contact information or duplicate files that have already been processed, wasting valuable time.
Lack of access to the central computer system used by the NHS Test and Trace, which means that Tips must write the collected information in spreadsheets.
The Soviets can only keep an eye on one infected case, so they are powerless against family members, even if they are at the door.

It’s a complete nightmare, says a health consultant who created the service. They gave us a hospital ticket. They never thought of using local controls, so there’s no infrastructure.

Insulation – Forgotten part of the test and tracking system

Although £10 billion has been set aside for testing and research to help people find them, not much attention seems to have been paid to how people should be helped to isolate them. A number that is measured both after a positive test and because they are in close contact is not measured in the normal order. Some research has shown that this is one in five cases, but the NHS Test and Trace has reduced this number by almost half. Anyway, this is an outrageous problem. Some say the period of isolation is too long.

In some other countries, close contact only lasts seven days in isolation, says Professor Tim Spector, who has a popular application for monitoring C-19 symptoms. According to him we now need more realism and pragmatism to separate people.

In addition, there are questions about financial support for people who cannot work in seclusion at home. Until the end of September, there was nothing other than the statutory sickness benefit. There is now a one-off payment of £500 for those entitled to benefits. People who are asked to be isolated by a request can’t even do that. Contact the trackers who said there were problems. If we make a breakthrough, people often refuse to cooperate. They have a life to live and work to get paid.

Professor Robert West of the Department of Public Health at University College London believes that this is one of the main problems in the system.

We need to do much more to help – then we can create strong social standards whose violation would be unthinkable.

But the problem is, he says we missed the connection. When the number of infections is high, the window to do it right is gone. If a late lock in the first wave was our biggest mistake, in the second wave it was a waste of time to get an efficient test and traceability system with this lock.

Analysis of Wesley Stevenson’s data

Update : For editorial reasons, this article has been revised to remove certain elements related to the production of Randox test machines.

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