Lack of Covid-19 testing means no swift end to lockdown, says Dr Miriam Stoppard

By | April 17, 2020

Even now, when we don’t have nearly enough information on the Covid-19 pandemic to start theorising about an exit strategy, people are asking when lockdown can be relaxed.

Not for some time in my opinion because we’re not getting the right information that would allow us to relax it.

The key to removing lockdown is knowing we can control the spread of Covid and we don’t even know how many people are asymptomatic carriers.

As long ago as February 24 the World Health Organisation recommended countries outside China beset with Covid outbreaks to “prioritise active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts”, says Allyson M Pollock and colleagues in the BMJ.

These are classic tools used by public health to control infectious diseases. WHO says they’ve been meticulously adopted in China, Singapore, Vietnam and South Korea.

Rigorous contact tracing combined with community testing were vital in containing the disease. The model used by the UK Government clearly shows that such rigorous contact tracing and case finding is effective.

Contact tracing started in the UK but stopped early in the epidemic. Why? This, coupled with the lack of testing of people in care homes and the wider community, suggests our figures of the number of cases who’ve contracted the virus are an underestimate.

The reasons why tracing was dropped, against WHO recommendations, aren’t known but could be a consequence of the Government changing its strategy from “contain” to “delay”.

One reason seems to be a lack of tests and testing facilities. However, contact tracing is essential and testing is a support, not a substitute, for tracing.

So what now? The WHO’s mantra of “trace, test and treat” must be followed. It is not too late and could avert a second and third wave of the epidemic if lockdown is relaxed too early. Contact tracing must recommence.

This means immediately starting a massive, centrally coordinated, locally based programme of case finding, contact tracing
and testing.

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It requires large teams of people, including volunteers, using traditional methods as well as social media and mobile phones. We should also adapt the manuals and guidance published by China.

It has seemed to me from the very beginning that Government strategy was being driven by lack of testing and equipment, and unpreparedness rather than science.


Mirror – Health