COVID-19 Test & Trace Goes Live

Peter Russell

May 28, 2020

A programme to test new COVID-19 cases and trace their contacts began today in England.

Prime Minister Boris Johnson predicted that it would "change people's lives".

NHS Test and Trace would form a central part of the Government's coronavirus recovery strategy and "help return life more to normal", the Government said.

However, the service went live without a contact tracing app, which had been scheduled for a launch in mid-May.

Scotland's 'test and protect' system has also been launched today, while Northern Ireland's programme is already in place. Wales plans to start its 'test, trace, protect' programme in June.

A 'Civic Duty'

From today, anyone in England who tests positive for coronavirus will be contacted by tracers who will ask for details about their recent contacts. This could include household members, people with whom they have had direct contact, or those who have come within 2 metres for more than 15 minutes.

Close contacts of anyone testing positive will be told to stay at home for 14 days, even if they are asymptomatic.

Matt Hancock, England's Secretary of State for Health and Social Care, told Wednesday's Downing Street briefing that the new system "must become a new way of life", and that an instruction to self-isolate would be a "civic duty".

He warned: "This will be voluntary at first because we trust everyone to do the right thing. But we can quickly make it mandatory if that's what it takes."

In April the scheme was announced as 'test, track, and trace'. However, the word 'track' has since been dropped.

Prof John Newton, leader of the Government's COVID-19 testing programme, said that because infection levels were falling "we're able to start considering releasing some of the lockdown restrictions".

Isabel Oliver, interim director of the National Infection Service at Public Health England, said developing an online tool had been a "huge undertaking" on a scale not previously seen but that "absolutely, we are ready to start".

Baroness Dido Harding, who is leading the test and trace programme, said NHS Test and Trace would mean that "instead of 60 million people being in national lockdown, a much smaller number of us will be told that we need to stay at home".

Asked at a briefing convened by the Science Media Centre, Baroness Harding said she expected the public would comply with the new rules because during lockdown "the vast majority of people have complied with guidance". She added: "I think it's really important that we don't stigmatise people who get ill, or who have been close to someone who was ill."

What Happened to the NHS COVID-19 App?

She confirmed that the CV19 app, developed by NHSX, the digital arm of the health service, and currently undergoing trials on the Isle of Wight, was not yet being rolled out nationally.

"I see the app as the cherry on the cake, not the cake itself," she said. "Launching the national NHS Test and Trace scheme needs to come first."

Concerns have been raised over whether people will comply with the new measures, particularly when their livelihoods were at risk, or because they had concerns over privacy and data security.

Prof Newton said that contact testing, such as in cases of tuberculosis, was "a tried and tested process", and that this system would be "focused on the interest of not just the people involved but of course, the public".

Prof Sir Simon Wessely, director of the Health Protection Research Unit in Emergency Preparedness and Response at King's College London, said: "Those most likely to get infected and their contacts are more likely to be delivery drivers, transport workers, care home workers, shop assistants, the self-employed, and so on.  So, at the point of notification there needs to be provision to support those in need – financially, medically, and even accommodation if necessary."

Linda Bauld, professor of public health at the University of Edinburgh, said other countries implemented similar test, trace, and isolate programmes earlier in the pandemic and the UK was now "playing catch up". She said people would need to "feel sufficiently confident in the security of the system to report their contacts and pass on their details, and in turn that contacts are comfortable taking calls from contact tracers".

'Little Trust' in the Government 

Dr Simon Clarke, associate professor in cellular microbiology at the University of Reading, warned that the widely publicised behaviour of Dominic Cummings, the PM's senior adviser who travelled across the country despite lockdown rules, might jeopardise the programme. "This new initiative can only work if the Government reinforces the message that the rules must apply to everyone, and are not interpreted to suit individual circumstances.

"Given recent revelations, they now face an uphill battle to show the public that we really are all in this together."

Prof Karol Sikora, an oncologist who comments on cancer issues for Medscape UK, said there was "little trust" left for Government policy. "Test and trace are essential public health tools but there are far too many loose ends," he told us.

He asked: "What really happened to the NHSX app on the Isle of Wight? And do cancer patients have to stop treatment to isolate if they are contacted? And as it’s anonymous, how do we prevent malicious reporting?"

Prof Sikora added: "This all seems poorly thought through – too little – too late. And branding it an NHS service seems a convenient way to get closure from last weekend’s disturbing events."

Speed of the System 'Will Be Crucial'

James Naismith, director of the Rosalind Franklin Institute, and professor of structural biology at the University of Oxford, said speed of testing and tracing would be crucial to the success or failure of the programme. "The challenges of operating such a system must not be underestimated however and there are bound to be teething problems. Although mobile phones can help, there is no simple technology shortcut. Contact tracing relies on manual work and crucially the public’s full cooperation.

"Along with other steps, this approach is the best way we have available of avoiding a calamitous second wave in the autumn."

A report published by the Data Evaluation and Learning for Viral Epidemics (DELVE) group convened by the Royal Society said on Wednesday that the speed at which  tests can be completed, results delivered, and contacts traced, high levels of public compliance, and the ability to identify a large proportion of cases would all be crucial to the scheme working.

Adding contact tracing of confirmed cases to a broader package of measures, including social distancing and hand hygiene, could reduce the number of new infections otherwise occurring by 5-15%, it said.

Baroness Harding said they were prepared to learn from experience now the test and trace programme had gone live. "I fully expect that there will be things that we can do better," she said. "As we aim to build an NHS Test and Trace service that is world class, it's not going to be world class on day one."

Prof Andrew Goddard, president of the Royal College of Physicians, welcomed the launch of NHS Test and Trace. However, he warned that self-isolation could impact on NHS staffing levels.

"The Government must ensure that there is capacity to undertake rapid and regular testing of NHS staff until antibody testing is widely available," he said.

Dr Penelope Toff, BMA public health medicine committee member and past chair said: "There is a very real concern that as funding has only now been made available at local level, and as much of the local contact tracing will need to be done in person, there is the potential for some of these systems to become overwhelmed with the sudden surge in demand. It is vital that adequate support is on hand, to enable all directors of public health and Public Health England consultants leading these local systems, to deliver this effectively. 

"The safety of the public and key workers is paramount and given the limits of the test itself, self-isolation of those with symptoms and their contacts is even more vital.

"This will require good communication with the public at a national level."

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