Sunday, March 29, 2020
Home News Covid-19: At last, a U-turn on testing

Covid-19: At last, a U-turn on testing

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THE government is U-turning on testing for Covid-19, although it won’t admit as much, and it will still struggle to catch up. While we must pull together as a society, we must also keep the government’s feet to the fire. The pandemic could be controlled within weeks, as South Korea has proved, given ready testing. Otherwise, it could last 18 months at the UK government’s latest estimate.

Testing allows us to know who is or is not infected. If infected, the subject can be treated, raising the chances of recovery. The subject can be quarantined to prevent infection. Each diagnosis can be tracked, thereby allowing the government pre-emptively to move resources to hotspots. In other words, testing allows for treating and tracking.

The UK government’s policy of self-isolation without testing does not allow for treating and tracking within pre-emptive or immediate time frames.

First, consider the personal consequences without testing. The self-isolated are left with anxieties about whether they are infected and uncertainties about how they should behave.

Second, consider that the self-isolated, if not tested, are not officially treated. They are left to treat themselves, short of taking themselves to a hospital, where the uninfected would unnecessarily expose themselves to infection and add stress to the healthcare system.

Third, consider that the untested are not officially tracked, so are contributing nothing to the wider response at the social level. Without tracking, people cannot be given local advice. Instead, they are given national advice, such as ‘avoid pubs’. These blanket advisories are more difficult for the individual to take personally, and are easier to cheat.

Testing is not difficult. The subject’s nose and throat are swabbed. The first Covid-19 specific tests were developed within two weeks of the disease being identified.

Other tests were available earlier, such as remote scanners for elevated body temperature. These are unspecific to Covid-19, but are useful for screening arrivals at a port of entry, for instance.

Testing is more important for Covid-19 than the other pathogens with which it is typically compared. The key driver in Covid-19 is its infectiousness. It has a lower death rate than MERS or SARS, but is much more infectious, which will lead to a higher casualty count in the long run. Covid-19 is more lethal than influenza, less fragile (and thus more persistent in the environment) and has a longer incubation period (which allows for more unknowing transmissions).

The good news is that the UK government has reversed its policy on testing. For weeks, it stood alone against the World Health Organisation’s advice about testing everywhere. Britain’s policy was to test only hospitalised cases, and advise everybody else to self-isolate. This has not worked. In the last couple of weeks the government has dramatically increased its testing: Britain has now achieved more tests than other European countries with similar infection levels. Boris Johnson said on Wednesday that he wants testing to reach 25,000 per day in a month from now.

The bad news is that the government, having waited so long, is still testing only hospitalised cases and those within the patient’s immediate social network, which does not contribute much to national tracking. Johnson’s aim of 25,000 tests per day may be too late, given that cases are already doubling every day. Moreover, as he says, he must prioritise health staff: the NHS employs 1.5million. Testing them at 25,000 per day would take 60 days.

One of the reasons the government was reluctant to agree with the WHO was that the government has reduced its national capacity for testing, such as laboratories, while resources were diverted to immediate care and new fashions such as gender reassignment. The Covid-19 pandemic has exposed wider material shortages. In January, in response to the first cases in Britain, the chief medical officer for England, Professor Chris Whitty, said that the NHS is ‘extremely well-prepared for managing infections’. Now we know the NHS is short of materials as simple as paper masks. Even these don’t protect the wearer from Covid-19 (they protect the subject from the wearer’s respiratory fluids). Full hazmat suits are in even shorter supply. And the government is urging private citizens to improvise ventilators for donation.

Covid-19 exposes the hypocrisy about the NHS. It is highly expensive, even by European standards (only France and Germany spending more per capita), but inadequate when tested. The government revealed this hypocrisy before the pandemic had even started by urging us not to make demands on it while reassuring us that it was ready. Incapacity encouraged a policy of self-isolation without testing, tracking or treatment, explicitly to avoid overwhelming the NHS. But without testing, tracking and treating, overwhelming the NHS becomes inevitable.

Let’s compare Germany in policy and capacity. Germany has a uniquely low death rate, despite more infections than Britain. In fact it has more infections than anywhere except China, Italy, Iran, and Spain. Yet Germany’s death rate runs at 0.2 per cent, compared with 3.5 per cent in Britain and the average country, and 7.9 per cent in Italy. More impressively, infections of the elderly are running at a lower rate in Germany than other countries.

What’s the difference? Germany immediately implemented testing everywhere. To be more exact, Germany decentralises testing, such that any doctor can perform a test for coronaviruses and knows that the national system will pay for it. The UK government centralised testing and said that tests would be administered to hospitalised cases only.

Here’s another curious contrast. Germany already has more beds equipped with both intensive care units and ventilators. The multiples are staggering, whether you make the comparison in absolute terms or units per population. Germany has 28,000 ICU beds, seven times as many as Britain. Germany has 29.2 ICU beds per 100,000 residents, 4.4 times as many as Britain.

So let’s unite around Britain, but not deny our findings:

  1. The government claims it has the best healthcare in the world but urges us not to make demands on it;
  2. The chief medical officer said in January that the NHS was prepared, but already is desperate for test kits, beds, ICUs, and ventilators;
  3. The government expects us to control the risk by voluntary withdrawal from society, but won’t deliver health services to the self-isolated;
  4. The government resisted the international consensus on testing and containment, nominally to protect the UK economy, but then was forced to urge its residents to withdraw from normal economic activity in a series of increasingly confused, sudden and draconian advisories;
  5. The government expects everybody to self-isolate but doesn’t test, track, and treat the self-isolated, so cannot directly control the risks of the vast majority of its residents;
  6. The government’s immediate policy has unnecessarily lengthened and widened this pandemic, while other countries, including China, are now in control of its spread.
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Bruce Newsome
Bruce Newsome is a lecturer in international relations at the University of California Berkeley and an expert on global security risks, international conflict and counterterrorism.

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