Award-winning GP and former deputy chair of the British Medical Association Dr Kailash Chnd says, “We need mass testing before we lift the lockdown!”
The UK started its lock-down late, when even just a week earlier would have saved up to 60,000 lives across the course of the pandemic. To avoid even more needless deaths, the Tory government led by the invisible Boris Johnson now needs to look beyond short-term gains and produce a comprehensive strategy for the long haul. The present lock-down will expire on 7 May.
Current data indicate that the national lock-down is slowing down the transmission and most scientists agree that the real-time effective reproductive number – the so-called ‘R’ – which shows how many people a COVID-19 sufferer can infect on average, has declined , indicating a flattening of the curve of the spread of the epidemic.
But is flattening the curve the right metric to measure the success of the UK’s coronavirus strategy?
It is essential to have appropriate benchmarks to measure the success of the government’s response to the pandemic- and merely flattening the curve will simply mean allowing huge numbers of people to die over a longer period.
It is an amended ‘herd immunity‘ strategy – and lifting the lock-down at the wrong time will shorten the time-frame of the mass deaths again. Getting it wrong will mean that the speed at which cases double may decrease (or the ‘Rt’ increase) as people interact more and provide more opportunities for the infection to spread — maybe even more rapidly than we saw before the lock-down.
The benefits of the lock-down, which were gained at huge economic and social cost, could easily be lost if the government gets it wrong. Reopening without triggering a new acceleration depends on our ability to transition from population-wide mitigation – which is what social distancing does – to individual-level containment.
And that means that ending the lock-down must be linked to an ability to conduct the World Health Organisation’s test-and-trace plan on a massive scale – allowing each infected individual to be quickly identified and their contacts rapidly traced, tested and where necessary isolated, breaking the chains of transmission and starting to contain the virus, not merely mitigate its spread.
In addition, one of the government’s conditions for re-opening the country is a downward trend in infections. But we can’t know that the numbers are going down unless we have an accurate daily count, which can only be obtained through widespread testing.
Mass testing will also provide the reassurance that many need to resume normal activities. Having enough tests to regularly check employees, students and teachers would help provide confidence that we can resume work and school.
And imagine if all patients receive a test before they enter the hospital, and those who test negative can then receive care in a separate ward from those who test positive.
Patients would not be so frightened to seek care for ongoing medical issues such as cancer, pregnancy or heart disease, preventing the virus-linked deaths from other illnesses that experts believe have already occurred in the tens of thousands. Hospital staff could also optimise the use of personal protective equipment that is in such short supply.
But we are very, very far from being in a position to take this essential step. Matt Hancock said last week that we have too many cases for test-and-trace to be realistic – a damning indictment of the government’s performance and strategy so far – but we have to start from where we are, not where we should be. There is no other route out that will not cost huge numbers of lives.
In addition, the government’s long-standing failure to provide enough PPE to health staff not only inspires no confidence in government assurances that a test-and-trace scheme will be ready when the UK reviews its lock-down next month, but also leaves huge holes in the lock-down’s effects, allowing the virus to continue spreading more than it should.
Currently, the UK government has no capacity, no credible strategy and neither the ability nor the willingness to implement the watertight ‘test, trace and isolate’ plan that is vital for a successfully-concluded lock-down.
Sadly, the government has instead adopted a stop-gap strategy in place of a sustainable, robust public health strategy and this will cost us in the long run. It has already cost us.
The past two months were an opening gambit. Now the UK needs to handle the middle- and end-game well. The delays so far have made this task far larger than it needed to be.
But there is no alternative. Any attempt to lift the lock-down without such a system ready to go is doomed to failure — a failure that will kill people. The responsibility for those deaths, like many of the lives already lost, will be at Boris Johnson’s door.
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