On 16th March, Dr. Adhanom, the Director-General of the World Health Organisation (WHO) said that the key to defeating COVID-19 was to “test, test, test.” After all, “you cannot fight a fire blindfolded.” But, “fighting it blindfolded” is exactly what we are doing.
Our testing figures are shocking: as of the 3rd of April, only 13,000 people a day are being tested despite a target of 25,000. Germany, by comparison is testing over 100,000 people a day whilst boasting a very low mortality rate. Even scarier, of the half a million NHS staff working to deal with this pandemic, only 2,800 have been reportedly tested. This means that staff continue working whilst they are ill, exhausting themselves and putting the lives of their colleagues at risk. On the other hand, six out of seven self-isolating staff tested were found not to have COVID-19. At a time where our NHS is under immense stress, we need as many people serving in the front-line as possible.
Of the half a million NHS staff, only 2,800 have been reportedly tested.
Perhaps the greatest cause for Britain’s shortcomings in testing is uneducated policy amid a lack of communication. Until late March, the government’s policy was to implement a ‘herd immunity’ approach, which would have allowed the disease to spread freely among the population. The logic was that if enough people were infected and subsequently gained immunity, the vulnerable (who should isolate during this period) will be protected. This is because once an individual has become immune, they would no longer be carriers hence spreaders of the disease. Whilst this approach can be successful, it’s not suitable for COVID-19.
According to Dr Richard Horton, the editor of The Lancet, trying to achieve herd immunity was highly flawed due to the virulence of COVID-19. He said that the government failed to realise that “20% of people infected would end up with severe critical illness.” This is despite “the evidence (being) there at the end of January.” Dr Horton blamed the policy failure on the dominant voices in the Scientific Advisory Group for Emergencies (Sage), which were mathematical modellers and behavioural scientists rather than public health experts and doctors. As a result, basic public health interventions such as testing, isolation and quarantine were barely on the agenda.
There is a significant discourse between the government and Public Health England (PHE). According to Deenan Pillay, a professor of virology at University College London, the two are working “in parallel” rather than together – “they just don’t talk to each other.” This couldn’t be more evident when Professor Peacock, the director of infections PHE announced that millions of home testing kits would be available within days. Following the announcement, Chris Whitty quashed the idea, saying tests needed proper evaluation before they can be released.
Basic public health interventions such as testing, isolation and quarantine were barely on the agenda.
Another issue limiting testing is the centralised running of a dozen laboratories by Downing Street. The additional bureaucracy and heavy regulation has slowed progress and stifled innovation at a time when creativity and speed are of the essence. The UK’s centralised approach contrasts heavily with Germany, which has remained completely decentralised whilst encouraging small start-ups to develop unique testing techniques.
So, where do we go from here? At least partial decentralisation is needed: the UK is blessed to have many small but successful biotech companies, such as Oxford Nanopore and Medisense. The government must work with these companies but not deter their innovation through constant regulation. We must follow the lead of Germany and let the free market encourage creativity.
We must continue to purchase tests whenever they become available. So far, the UK has ordered 3.5 million antibody tests, which is a brilliant start. Front-line staff and patients should be tested first, followed by fair distribution of the remaining tests. With current plans to sell the tests through Amazon, there is fear that tests will only be available to the richest: the government must find a way to ensure distribution is based on need rather than wealth.
Going forward, it is evident that doctors and medical officers must play a bigger role in policy-making. Communication between 10 Downing Street and PHE needs to improve to allow this to happen, or else resources and lives will be wasted.
Image source: Tom Wolf
