Read on Twitter
This is a good (and positive!) piece, if a little too rosy on test (and trace) in my view. https://twitter.com/bealelab/status/1334958302657208321
A few thoughts to expand (bearing in mind it says public health amateur in my bio for a reason - I’m not an expert, I just work with some and try to learn from them)...
As far as I know, there’s been no published evaluation of the mass testing pilot in Liverpool, so too early to tell whether it has made a difference or not. But it feels notable that the incidence rate was on a downward trajectory before the pilot started, and...
we see a bump in the incidence rate when testing starts (more identification of cases, including asymptomatic, which is good!) followed by a return to the same trend, which doesn’t indicate a large impact. Also notable that other areas not in the pilot aren’t doing much worse... https://twitter.com/rowlsmanthorpe/status/1333834754395877376
Logistics also relevant - Liverpool have had 2000 troops on the streets to support the effort, and it’s far from clear that other places will be offered the same should mass testing be rolled out further. If the army doesn’t help out, that resource will have to come from...
somewhere, which means taking it away from other, also important work. Local services have been hammered by a decade of austerity and are working at the limit to keep their populations safe already; we can’t do much more without more resources.
Beyond that, take up of mass testing in Liverpool has been disappointing. As I understand, the aim was to test the whole population regularly, and they have got nowhere near that (which is not to denigrate the effort - it’s a mammoth task and to do what they have is amazing)...
but it does point to a critical issue: take up of tests skews towards more affluent areas. Why would this be? My hypothesis is that for those on lower incomes the incidence implications of a positive test and the resulting need to self isolate is A Big Deal...
Which is where we come to one of the major problems with the government’s approach. There is not much point to testing and tracing by itself. It gives you good surveillance of the disease, but without isolation you don’t actually break the chain of transmission. IMO the...
failure of the government to put genuine support in place for those who have to isolate is one of the MAJOR shortcomings of their approach. It is a significant disincentive for people to get tested and id contacts if they have the slightest doubt about symptoms...
and spending significant sums on unproven technology over getting this right seems to me a major error. Going back to the Test and Trace programme, it seems to me self evident that T&T has made a difference: the question is, has it done as much as it could have?
To that I can only note that where local authority contact tracing programmes have been set up to deal with cases that the national set up has *failed to reach*, they have delivered a success rate that would have been excellent for the programme as a whole, never mind the...
hardest cases. I think it’s fair to say that governments failure to work with local government and their knowledge of their places will eventually be seen as another major failure.
In sum: NHS Test and Trace has made a difference, but not enough. It should have been (and still could be if govt chose) locally led. And putting £billions into mass testing represents a major opportunity cost for investing in supporting people to self isolate.
(I meant to say too: there is significant doubt about the accuracy of LFTs in real world contexts, esp when not administered by trained clinician. False negatives are a major risk) https://twitter.com/deeksj/status/1334426403425685504
