With the new Covid variant everywhere, it’s not enough to just wait for the vaccine

Stephen Reicher

Guardian December 28th 2020

New UK-wide restrictions are now essential. At Independent Sage, we’ve come up with a five-point emergency plan

• Stephen Reicher is a member of Independent Sage

The new variants of Covid-19 have changed the nature of the pandemic. We are no longer facing the same situation as in March or even November. Our response must change accordingly.

It is now clear that variant B117 of Covid-19 is already established in all parts of the UK. Being an estimated 56% more transmissible than pre-existing variants, it is likely to constitute 90% of all cases by mid-January. According to UK government briefings, even current tier 4 restrictions are insufficient to deal with its spread. Indeed, no single measure is likely to be sufficient to bring the pandemic back under control. Rather we need an integrated response that brings together all the instruments we have to deal with the infection.

How do we do this? My colleagues and I on Independent Sage are proposing a five-point emergency plan, which would allow the UK to start 2021 with a comprehensive strategy in place to deal with the crisis. All five parts of the plan must happen in concert and they need to be accompanied by a comprehensive communications campaign.

First, there’s the question of vaccination. The rollout of vaccines is a key part of the strategy to combat Covid-19 and must be accelerated as a matter of urgency. This should be organised through the over 8,000 GP practices in the UK, supported through additional staff and resources, and coordinated via local public health structures.

However, vaccination cannot be the entire strategy. This is because of the time taken to complete it (that’s even if we reach the target of 2 million vaccinations a week called for by members of the government’s influenza modelling group), uncertainties over its duration of immunity and impact on transmission, and restrictions on its use in some populations (eg children, pregnant women and breastfeeding mothers).

All this is exacerbated by the fact that, due to the increased infectiousness of the new variant, a higher proportion of people need to be vaccinated in order to achieve population immunity. In the medium term there will be pockets of the population in which the infection continues to circulate, with periodic outbreaks inevitable. Vaccination can complement but not supplant other interventions.

This takes us to the second point: national control measures are essential. Further restrictions are necessary in two main areas. The first of these is personal travel, especially international travel. This must be monitored and regulated effectively, with advance application for travel to and from the UK, a negative PCR test prior to travel and managed isolation on arrival. The second area is education. Schools should remain closed until buildings are made as safe as possible for pupils and staff. This includes smaller class sizes (achieved through hiring extra teachers and teaching rooms), adequate ventilation and free masks for all pupils.

Universities should move to online teaching as the default until Easter at least. This will allow students to study from home, avoiding issues arising from travel and crowded campus accommodation. For school, college and university students, there should be universal provision of computers and wifi connections to ensure everyone can study remotely. Schoolchildren without space for home study should be taught along with vulnerable children and children of key workers.

Our third point in the plan is about the UK’s test, trace and isolate regime. Throughout the pandemic, the government has reduced the issue of a testing system to the numbers of people who are tested. However, testing is only the first step in the process. It must be part of a strategy designed to trace contacts as quickly as possible so as to isolate them before they can infect others. This requires not only forwards tracing (identifying who you might have given the infection to) but also backwards tracing (where you got it from).

The government’s contracting out of the test and trace system has shown the private sector is not up to the job – and nor can it be. Effective tracing and supported isolation depend upon local public health staff who know their patch and are trusted by the community. The need for a “public health reset” of the testing system remains urgent.

Practical support is necessary in order to enable people to self-isolate. The continued failure to address this issue in the UK has led to continued low adherence (less than 20% for those with symptoms) and contrasts markedly with the 90-95% rates achieved in places like New York, which supports isolation with everything from financial assistance and hotel accommodation to pet care.

Next, workplaces. When the government relaxed restrictions in July, they handed over responsibility to employers and owners of facilities to make their premises safe but with limited guidance, minimal support, and virtually no formal regulation. While many enterprises have worked assiduously to ensure that adequate Covid mitigations are implemented, this is not true of all. It is now critical to ensure that we have robust systems to prevent the spread of infection. This should include funds for necessary changes, inspection of all premises and certification of those meeting the required standards. This would have the added advantage of increasing public confidence in using certified premises (shops, hospitality etc).

Finally, financial support for the public is crucial. Inequalities are playing a central role in this pandemic. The disease impacts more on vulnerable populations as do the measures used to control it. People on low incomes are more likely to lose jobs and suffer financially than the more affluent, many of whom have profited from this pandemic. The firm measures we propose here are both morally and practically untenable without enhanced support for individuals and local businesses that will be affected most.

At a time when the UK (population 67 million, Covid deaths 70,752) has been experiencing more than 30,000 new cases a day and prevaricating about what measures are needed, Australia (population 25 million, Covid deaths 909) instituted immediate and far-reaching restrictions in Sydney after an “outbreak” of 38 cases. One local person responded by saying: “Let’s go early, let’s go hard and let’s get this baby.” This makes a good mantra for the pandemic as a whole. Our plan is a minimum for what needs to be implemented – without delay.

• Stephen Reicher is a professor of psychology at the University of St Andrews and a member of Independent Sage. This piece was written after discussion and detailed input from other members of the group.

Plans for 30-minute Covid testing in England halted amid accuracy fears

Guardian December 22 2020

Exclusive: government shelves Christmas rollout of lateral flow test centres

The government has shelved plans to open rapid-turnaround coronavirus test centres across England over Christmas amid concerns from public health experts about the accuracy of their results, the Guardian has learned.

Ministers had planned to convert a number of existing testing sites into centres for lateral flow tests, which provide results in 30 minutes, to help cope with an anticipated surge in demand.

However, the scheme was halted last week after concerns were raised by directors of public health about the accuracy of the tests and the potential false reassurance given to people who test negative. A government source said the planned rollout “proved unnecessary”.

The development is a blow to the UK government’s £100bn “Operation Moonshot” mass-testing plan, which aims to increase the number of tests carried out each day from 430,000 to 10m by early next year.

It also raises questions about the plan to rapidly test lorry drivers taking goods across the Channel, which is one of the UK government’s proposed solutions to bring an end to the disruption at Britain’s ports.

The Guardian has learned that the Department of Health and Social Care (DHSC) invited local health directors to convert their existing coronavirus testing sites into lateral flow test centres to help ease a possible surge in demand over Christmas.

But the plans were shelved within days of a phone call last week between the government and directors of public health, who raised concerns over accuracy.

It is understood that the government is instead planning to convert one testing centre and analyse the results before potentially expanding the scheme more widely. This process is not expected to conclude before the end of January.

Government figures from the mass testing programme in Liverpool revealed earlier this month that the tests missed 30% of cases with a high viral load and half of positive cases that were detected by standard coronavirus tests.

Lateral flow devices were used to mass-test university students across the UK before they returned home for Christmas earlier this month. However, a study of the results of more than 7,000 students at the University of Birmingham suggested about 60 positive cases were missed.

Jon Deeks, a professor of biostatistics and the head of the test evaluation research group at the University of Birmingham, said the tests were “not fit for purpose” unless they were used on highly infectious people and that even then, a follow-up test was required using a swab.

“There’s a big risk this test will give a lot of false reassurance which will inevitably lead to more Covid disease,” he said.

Deeks said the best thing the government could do with the 20m tests it had ordered was donate them to a poor country that did not have laboratory capacity to carry out the gold-standard swab tests. Their use as proposed by the government was “dangerous” and an “enormous waste of time and money”, he said.

A DHSC spokeswoman said the tests were “accurate, reliable and successfully identify those with Covid-19 who don’t show symptoms and could pass on the virus without realising”.

She added: “The country’s leading scientists rigorously evaluated the lateral flow test and confirmed the accuracy of the tests using a sample of over 8,500. Latest figures for similar settings showing sensitivity of 57.5% generally and 84.3% in people with high viral loads.

“With up to a third of individuals with Covid-19 not displaying symptoms, broadening testing to identify those showing no symptoms will mean finding positive cases more quickly and break chains of transmission. Anyone who tested positive with a lateral flow test during the university testing earlier this month would have been asked to get a confirmatory PCR test.”

The government must not be allowed to rewrite history on its failure to protect the NHS

HSJ Dec 23 2020
By Alastair McLellan 23 December 2020

Let us lay to rest the assertion that the government acted quickly to stave off the threat from the new coronavirus variant.

The facts are these. On 9 December, HSJ reported admissions of covid patients had begun to rise from 4 December. It is really important to remember and stress this was not meant to be happening. The plan was that restrictions were meant to be dampening down infections ahead of the Christmas lockdown. 

HSJ was simply reporting a trend apparent from publicly available data which refers to the position three days previously (in this case 6 December). The senior NHS executives and government representatives attending the daily national incident response board had known, discussed and expressed concern about the trend since at least the start of the month. Two senior figures who are participants in these calls have both told HSJ that even if the government did not know the exact cause of the problem, it certainly knew there was a big one.

Yet still the tiered restrictions and Christmas plans remained unchanged and shoppers thronged the streets and stores. The cautionary principle observed by other European states seeing upticks in infections was seen as pure pessimism.

On 11 December, HSJ reported “36 trusts had seen covid admissions rise by 20 per cent plus in a week”. On 14 December, we reported covid admissions were again on the rise slowly in the North, and explosively in the South.

Later that Monday, the health and social care secretary Matt Hancock first publicly mentioned the new variant and fears that it could spread faster. It later became clear the variant had been first identified in September.

On 15 December, HSJ and the British Medical Journal called for the government to respond to the worsening situation by cancelling its plans to allow house-hold mixing over Christmas and tightening the tiered restrictions immediately.

On 16 December, Boris Johnson said such a move would be inhuman. Matt Hancock speaking privately to colleagues railed against mischief-making “newspapers” who knew it was too late for the government to change tack and whose opinion on this matter was worthless in any case.

The U-turn which followed on Saturday sent thousands of people onto crowded trains, exporting the new variant far and wide.

Speaking to HSJ after the decision, an exasperated senior Tory politician bemoaned his government’s chronic delay “on every single decision” that mattered to controlling the pandemic.

The end result — as forecast in HSJ’s 15 December editorial — is that, in the words of a national NHS leader speaking to HSJ this week: “The most likely scenario is that we’ll have more covid patients in our beds on 1 January than we did at the height of the first peak.”

Thank heaven the government did finally see the sense in changing its Christmas plans. But it should not be allowed to get away with claiming they were forced to do by a previously undetected threat — or that the situation facing the health service is anything other than an unmitigated and avoidable disaster.

The prime minister talked about “changing his mind” because the “facts have changed”. Well, as we have seen, the “facts” changed long before the government acted.

The vaccination programme

Truth be told, HSJ receives many reports of Mr Hancock being an energetic promoter of the NHS’ cause with Whitehall and Westminster. He and the senior medical/scientific advisers have usually managed to eventually persuade No 10 to take the right course of action.

Where Mr Hancock has undermined his reputation with the NHS (and, it should be noted, within his own party) is with his constant over promising and under-delivering.

This has been particularly brought to the fore in his predictions of how successful Test and Trace would prove to be. One senior T&T executive said dealing with expectations created by his constant boasts was “100 per cent the biggest issue in my working life”. When HSJ suggested to one of the programme’s leaders that they might ask the health secretary to be more cautious, they laughed hollowly and rolled their eyes.

Compare that scenario with the one surrounding the covid vaccination programme, led by NHS England.

In sharp contrast to Test & Trace, the approach has been strictly to boast of successes only once they have been achieved.

From a standing start at the start of the month, more than 500,000 people have received their first shot of the Pfizer vaccine. This has been achieved despite having to involve hundreds of NHS organisations, thousands of independent GP contractors and a myriad of IT systems.

The programme has not been without its teething troubles or its critics, but it has got off to a strong start and, crucially, seems to have established the public trust vital for all vaccination initiatives.

Of course, the programme must successfully accelerate in both scale and intensity if it is to hit Sir Simon’s ambition to have every at-risk person vaccinated by Easter. There will likely be pressure to go even faster. People’s relief that vaccination has begun will also soon start to be replaced by impatience that they have not yet had their shot.

It is also the case that when and in what quantity vaccine supplies arrive is out of NHSE’s hands. As is the approval of new vaccines, including the all-important one from AstraZenca/Oxford University. These are two other good reasons why NHSE has been very careful about what it has promised.

Finally, for the reasons explained in the first half of this editorial, some systems will have to deliver the vaccination programme while being overwhelmed by covid. Finding the staff and facilities needed to significantly increase and maintain the pace of vaccination in these areas will be a nightmare.

Merry Christmas and a better new year to all HSJ subscribers.

Can Warwickshire District and Borough Councillors follow this example of Oxford City Council’s vote for Local Contact Tracing?

On December 1st, SWKONP email:

Yesterday, in nearby Oxford a meeting of Oxford City Council carried unanimously a cross-party motion: ‘Improving coronavirus testing and tracing’ (scroll down to 16a).

We need our local Warwickshire District & Borough Councillors to follow this neighbouring example.

In brief, the Oxford motion says:

This Council believes the only way to fully rectify the situation is for full control to be passed to local authorities, with the necessary funding to do the job properly, with national input providing any support necessary to ensure effective co-ordination.

We believe a local scheme will:

· Improve traceability

· Enable increased and targeted testing, including asymptomatic testing

· Be better integrated into existing Council COVID support services

· Be a more cost-effective solution

· Achieve greater community engagement

· Allow for the engagement of local volunteers

Pressure is building on the Government both to use local authorities more and to cease contracting out ‘NHS’ Test and Trace’ to private companies.

This Council agrees to add its voice to those challenging the current, failed system by asking the Leader to:

· Call on our Director of Public Health and the leader of the County Council to support more local authority engagement in testing and tracing.

· Write to our MPs asking them for their support.

This is a fine example of City councillor pressure on MPs and County Council (responsible for Public Health & Covid 19 contact tracing) for local control of Covid contact tracing. Their example can be adopted by District & Borough councillors here too.

KONP, as well as We Own It and Independent SAGE have been pressing for local contact tracing for months. The mass media remains silent on the disaster of Dido Harding-led national and privatised contact tracing – and sticks to the ‘lockdown’ / ‘economy’ narrative.

We need to raise the local contact tracing issue again. Can you contact your councillor, send them this Oxford City motion and ask them to put a similar motion locally? You can find your local councillors at WritetoThem.

Warwick District Councillors could organise a cross-party motion similar to Oxford City Council’s.

Numbers in Warwick District Council could allow for a cross-party initiative (Conservatives have 19 councillors, the Liberal Democrats have 9 councillors, the Green Party 8 councillors, Labour 5 Councillors with the remaining 3 councillors are part of the Whitnash Residents Association).

Warwickshire County Council Director of Public Health and the Leader of WCC must be pressed – again! – to demand to have local control of testing and tracing.

Covid-19: Innova lateral flow test is not fit for “test and release” strategy, say experts

BMJ November 17th 2020

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4469 (Published 17 November 2020)Cite this as: BMJ 2020;371:m4469

The government has claimed that rapid lateral flow covid-19 tests, which are being used in mass testing pilots in England and can provide results in 30 minutes, are “accurate and sensitive enough to be used in the community,” after evaluation results were published.1

However, experts warn that the tests may miss as many as half of covid-19 cases, depending on who is using them—making them unsuitable for a “test and release” strategy to enable people to leave lockdown or to allow students to go home from university.

The ongoing assessment, carried out by Public Health England’s Porton Down laboratory and the University of Oxford, tested a number of lateral flow devices in different settings including hospitals, schools, and universities.

The Innova SARS-CoV-2 Antigen Rapid Qualitative Test, which has been used in the Liverpool mass testing pilot to detect infections,2 is the first test to near completion of the four stage evaluation process. A report reviewed 8774 Innova tests carried out across a number of groups including outpatients with SARS-CoV-2, healthcare staff, armed forces personnel, and school students aged 11-18.

It found an overall sensitivity of 76.8%, but this rose to over 95% in individuals with high viral loads. The overall specificity of the test was reported as 99.68%, meaning a false positive rate of 0.32% (22/6967 tests.)

The evaluation found that the test performed best when used by laboratory scientists when the sensitivity was 79% (156/197 positive: 79.2% (95% confidence interval 72.8% to 84.6%)).

Sensitivity dropped to 73% when used by trained healthcare staff (92/126 positive: 73.0% (64.3% to 80.5%)) and to 58% with self-trained members of the public (214/372 positive: 57.5% (52.3% to 62.6%)).

Sensitivity

Jonathan Ball, professor of molecular virology at the University of Nottingham, said that these tests could offer some use in terms of community surveillance.

“Even though it won’t detect as many infected individuals as the PCR [polymerase chain reaction] test, it will identify those with the highest viral loads, and it’s those people who are most likely to go on to infect others,” he said. “It won’t replace other tests like PCR, but it is a useful additional tool for coronavirus control.”

Meanwhile, Jon Deeks, professor of biostatistics at the University of Birmingham and leader of the Cochrane Collaboration’s covid-19 test evaluation activities, highlighted concerns about the findings from the testing centre evaluation, where people self-administered the test. The report said that the test’s sensitivity was 58% when used by the public and that the false positive rate was 0.38% (0.16% to 0.88%).

He said that, while 0.4% (400 in 100 000) was a very low rate, with a sensitivity of 58% and specificity of 99.6%, this would mean that 100 000 people being tested would find 630 positives—of which only 230 would actually have covid-19, while 400 would be false positives.

“The poor detection rate of the test makes it entirely unsuitable for the government’s claim that it will allow safe ‘test and release’ of people from lockdown and students from university,” he warned. “As the test may miss up to half of covid-19 cases, a negative test result indicates a reduced risk of infection but does not exclude covid-19.

“Independent evaluations for the World Health Organization have shown that other lateral flow antigen tests are likely to outperform Innova, but even those do not have high enough sensitivity to rule out covid-19. The Innova test is certainly not fit for use for this purpose.”

Deeks added that it was of “immense concern that the [UK government’s] Moonshot plans have not undergone any scientific scrutiny by experts such as our National Screening Committee.”

The leaked Operation Moonshot documents, revealed by The BMJ,3 showed that the government was planning to implement a testing for access scheme, which would use rapid turnaround testing to “give people assurance that, at least for a limited time, they are unlikely to have the virus and are at low risk of transmitting it to others.”