Prof Allyson Pollock is director of the Newcastle University Centre for Excellence in Regulatory Science https://www.allysonpollock.com/?page_...
To tackle this virus, local public health teams need to take back control A massive increase in testing and tracing should be the next phase, but decades of cuts and reorganisations have whittled away the necessary regional expertise https://www.theguardian.com/world/202...
Allyson M Pollock and Peter Roderick Sun 26 Apr 2020
Perhaps, the most surprising aspect of the British Covid-19 crisis is the extent to which the Scottish, Welsh and Northern Irish governments, and the English regions, have allowed strategy to be decided by Westminster.
Health and social care are devolved, and this national epidemic is not homogenous. It is made up of hundreds, if not thousands, of outbreaks around the country, each at a different stage . England had its first confirmed case on 30 January, Wales on 28 February and Scotland on 1 March. Some areas â such as Rutland, Hartlepool, Blackpool, Isle of Wight, Tyneside, Durham, Orkney, Western Isles â had no reported cases until late March, and some even now have relatively few cases.
Contact tracing and testing, case finding, isolation and quarantine are classic public health measures for controlling communicable diseases. They require local teams on the ground, meticulously tracking cases and contacts to eliminate the reservoirs of infection. This approach is recommended by the WHO at all stages of the epidemic. It was painstakingly adopted in China, Singapore and Taiwan, with a high percentage of close contacts identified and many housed in hotels. Germany has traced contacts throughout. The leaked UK national risk register proposes it.
Yet Public Health England, the agency responsible for communicable disease control in England, stopped contact tracing on 12 March, having reportedly only contacted 3,500 people, of whom about 105 were found to be positive. Itâs now about to resume. But why was it stopped, and how will it be resumed?
Weâve not seen an official explanation for its stopping. But lack of both resources and effectiveness are usually mentioned. Resources are essential, just as they have been for increasing acute care capacity, and the potential pool of contact tracers is vast. There are thousands of environmental health officers in local authorities and other sectors who have the necessary skills and experience. Singapore used its army. Teachers and barristers have volunteered in Ireland. Centralising control and management of the pandemic through NHS 111 has also left 7,500 GP practices underused, and the potential for real-time knowledge of new cases, results of swab tests and insight into the geography of spread has been lost. Yes, itâs true that contact tracing is insufficient, but thatâs not the same as ineffective. It should have been supplemented, not replaced. Look at Germany.
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