Boris Johnson’s government has taken weeks to launch a procedure that has been used to contain a host of epidemics in the past. Camilla Royle investigates the reasons behind the latest disaster.
it seems there is a fresh example of the Tory government’s failures to deal with the Covid-19 pandemic on an almost daily basis. One of the most significant is its failure to put in place an effective and appropriate system of contact tracing early on in the pandemic.
Contact tracing has been used for a range of diseases, including pandemic flu, tuberculosis, measles and sexually transmitted diseases. It has been successfully deployed against Ebola in west Africa.
It involves interviewing people who are suspected of having an infectious disease in detail, and asking them to identify the people they have had recent contact with (their sexual partners in the case of STDs).
The corona virus that causes Covid-19 is highly infectious and it does not require close physical contact with someone in order to catch it. So, it is extremely difficult to identify everyone who a person testing positive might have passed the virus on to. But contact tracing is still useful if it can identify a high proportion of those people and get them to self-isolate.
This would help ensure that each person who has virus transmits it to less than one other person on average, therefore controlling and reducing its spread.
Obviously, the mountain of data involved would have been reduced if the UK had seriously applied this approach early on when there was a small number of cases of Covid19 in the country. If the government had put in place a lockdown much earlier — as we now know its own advisory group Sage so — this would also have helped with contact tracing by reducing each person’s potential contacts.
Instead, the government went against the views of the World Health Organisation by stopping all testing other than in hospitals on 12 March. This is thought to have contributed to the surge of cases in care homes.
People in Britain have generally followed guidelines around staying at home and observing social distancing. There is evidence that this has slowed the spread of the disease. But without a contact tracing strategy as an integral part of the policy some of the gains of lockdown have been lost.
The associated damage to jobs and the economy has not been as worthwhile as it might have been. The start of lockdown was a much more plausible opportunity to roll out a testing and contact tracing strategy than now, when people’s enthusiasm is starting to wane.
An effective contact tracing strategy is also essential before there are any further efforts to lift the lockdown; this is why the NEU teachers’ union includes “extensive arrangements” for testing and contact tracing within its five tests that must be met before it is safe for schools to open.
Contact tracing is a skilled job that requires knowledge of the disease as well as IT skills. It necessitates tactful and sympathetic conversations with people who have potentially been exposed to the virus and may be worried or upset.
Understandably, they may be resistant to being told to stay at home for two weeks, especially when this rule doesn’t seem to apply to government advisors, and when it is unclear who will pay their wages.
Public health expert John Ashton, has argued that the recruitment of contact tracing staff should be decentralised to in order to make use of the thousands of experienced public health workers with local expertise. Some furloughed civil servants could also be recruited to this task.
Instead of using people’s existing skills, however, the Tories have done the opposite, pursuing an approach based on engaging private companies and using them to recruit and train new staff who are not from health backgrounds.
People hired to do this work have described the training as chaotic and confusing. Some have complained they had been misinformed by being told they were applying for a customer service role. Others reported they had been given the same training twice and even that they were told to go to YouTube for advice on how they should speak to someone who’s relative had died of Covid-19.
Contractor Serco, a multinational run by Winston Churchill’s grandson Rupert Soames, has already messed up by accidently including the private email addresses of its recruits in a message that could be seen by all recipients.
Given its history of failings it is shocking that Serco is still given government contracts anyway. It has been found overcharging for its services, and its staff have repeatedly been accused of abusing migrants in detention centres such as Yarl’s Wood.
Another element of the Tories’ contact tracing plan is to use a mobile phone app, an early version of which was tested on the Isle of Wight in May. Such apps use the Bluetooth capacity on people’s phones to identify who they might have been in close contact with. This is an attractive idea in theory because it would make the process much quicker than using manual contact tracing. Although not everyone owns a smartphone or takes it with them when they go out, around half of Isle of Wight residents did download the app.
Part of the problem is that the app is not yet ready to be used widely. For people who report having symptoms of Covid-19, the early version of the app provides a phone number that they can call to arrange a test. But it does not allow them to input the test results once they have them.
For those whose phones detected that they had been near someone with symptoms, Isle of Wight residents report that the app simply gave them public service information that is already offered to the general public, such as advice to wash their hands and the widely ridiculed “stay alert”.
They were not offered a test for Covid-19 because this is still only available to those with symptoms. They were also left in the dark as to whether the person they came into contact with actually tested positive for the virus or not.
There were also concerns raised early on about what happens to people’s personal information gathered by this app. Security expert Ross Anderson points out that there is a legal requirement for medics to report to the authorities if someone is suspected of having Covid-19, whether or not they have actually tested positive yet (as it is classed as a notifiable disease). So there is a public health argument that people’s details should not be kept anonymously.
An app could be used to pass on the phone numbers of possible contacts of Covid-19 cases so that contact tracers can contact them. However, concerns about this are reasonable enough given the numerous past examples of government officials mishandling personal data, and Serco’s previous errors.
Questions around who gets to see the data, what format it is stored in and when it will be deleted have not been answered, and health secretary Matt Hancock has been resistant to introducing extra laws in order to ensure that the data is only used for contact tracing. It is not clear, for example, whether the police will be able to use the data to identify people who may be breaking quarantine legislation.
Security issues are likely to reduce people’s confidence to share their details in the app. Anderson says that he feels “conflicted” about this because he recognises the public health arguments for such a system but is worried about the privacy implications.
He also points to some practical limitations of the app-based approach. Bluetooth signals can travel through plasterboard so might flag up being close to someone in a different room as a contact even though there is no risk.
People might get tired of all these false positives and stop using the app. A child could potentially report themselves as symptomatic via the app and shut their school down as a practical joke.
Anderson also suggests that hackers could potentially make use of the technology, especially if it is stored in a centralised manner. He concludes that we should “not give policy makers the false hope that techno-magic might let them avoid the hard decisions”. These decisions involve spending money on testing, hiring and properly training people to work in public health and providing medical equipment such as ventilators and PPE.
At the time of writing, thousands of contact tracers are starting work. It is not yet clear how successful this approach will be and what the final version of any contact tracing app will look like. What is clear is that the Tories have missed crucial opportunities over the past few months to slow the spread of the disease.
A decade of austerity and privatisation has hollowed out the public health infrastructure needed to cope with a pandemic and has contributed to one of the highest death rates anywhere in the world.