On 13 February, 83 British citizens left Arrowe Park hospital, Wirral, after 14 days of isolation, following their evacuation from Wuhan at the end of January. Two weeks was the appropriate quarantine response to potential contacts of a deadly new virus.
On the same day, a nurse in Brighton was asked to self-isolate by Public Health England. She had Covid-19 symptoms, and was astonished at PHE’s response: she was sent home wearing a facemask, in a taxi with a driver without a mask. No advice was given about how to stop the spread of the virus. When she called NHS 111, she had to wait 15 hours to get a test. As she later told the Argus newspaper: “I thought there would be a plan in place for something like this, but in my case, I know there wasn’t one.”
Six months later, in England, little has changed. People with mild cases of coronavirus and people they have contacted are told, over the phone, to self-isolate. But we have no data about whether they follow these instructions, or comply with the full 14-day period. Many of them will live with others, in crowded accommodation or multigenerational households. Some will be working in the gig economy, where 14 days without pay means a family without income.
Where South Korea and Germany offer support to those who are isolating, England offers little. Regardless of how much testing and tracing we do, without collecting data about people who are isolating, or providing support for those who need to, the virus will continue to spread. Britain should heed the example of east Asian countries. In South Korea, health authorities established a national network of community treatment centres, where people who tested positive for coronavirus and had mild or no symptoms could isolate. Patients in the treatment centres reported their symptoms twice daily, using an app, and medical staff provided video consultations to patients twice a day.
In China, people who tested positive for coronavirus remained in community medical facilities until they were Covid-free. Their contacts were asked to self-isolate at home for two weeks, where they received regular visits from community teams, and where their rental, food and bills were covered.
In Germany, meanwhile, devolved local power was key to ensuring that people isolated. Germany’s 400 local health authorities, the Gesundheitsämter, were central to the country’s public health response. They organised teams of voluntary “scouts”, mainly medical students and trained doctors, to check people who were isolating for symptoms or deterioration. Meanwhile, German state subsidies helped those who were isolating to pay rent and maintain benefits.
Aside from monitoring “complex cases”, which are managed successfully by our overworked health protection and district public health teams, England has done none of these things. Instead, cabinet ministers seem more prone to blaming individuals for failing to comply with lockdown and isolation measures. Local authorities have been disempowered and sidelined. GPs are ignored. Volunteers remain largely unused.
Sheffield has shown it is feasible to train volunteers without previous experience to undertake contact tracing effectively, but the government has not tapped into the 750,000 people who volunteered to help in March.
As Paul Nurse, director of the Crick Institute and one of the UK’s most senior scientists, recently put it, a “shroud of secrecy” has been drawn over major decisions in the coronavirus crisis. Instead of involving local volunteers and GPs, the government issued a huge central contract to Serco without a competitive tendering process, worth £108m so far (later this month, the government will decide whether to extend it, up to the maximum amount of £410m).
The results thus far have been calamitous. Of 31,323 people transferred from the testing system over nine weeks to the contact tracing system, only 51,524 contacts have been traced – fewer than two contacts per tracer. People who test positive or have come into contact with someone who tests positive are asked to isolate, but they aren’t followed up, nor offered financial support. The system’s top-down approach is inefficient. According to data seen by the Guardian provided by an employee at the company Intelling, hired through Serco, 471 contact tracers made just 135 calls in two days (around 0.14 calls per agent, per day). Multiple calls were made to the same individual; one tracer said that one person had been contacted by tracers 20 times.
Rather than handing huge contracts to Serco and Deloitte, contract tracers should have been recruited by local authorities, which could then make their own decision, empowered with localised testing, about community lockdowns. To ensure that people with even mild cases of coronavirus are able to isolate, we should have set up community centres. And central government should have focused on providing the financial support to authorities, and to individuals who need to isolate.
Getting our test-and-trace system up to scratch will require nothing short of cancelling these huge, centralised contracts and reverting to the localised approach we should have adopted from the start. Our summer lull in the number of Covid-19 cases may not last long.
Without support for and proper monitoring of people who are isolating, our testing and tracing programme will make little difference to a surge of coronavirus cases. We should have had an effective isolation policy in February, with better pandemic planning. Not to have one six months later is nothing short of public health malpractice.
• Anthony Costello is professor of global health at University College London and former director at the World Health Organization