The media is full of the story about the latest fiasco over test and trace, with the government's system having misplaced thousands of positive test results. The opposition, and those that have been pressing the government to implement even harsher lockdowns with the attendant evisceration of civil liberties, and devastating effects on the economy and workers' livelihoods, have seen another opportunity to attack the government opportunistically, whilst diverting attention away from the devastating effects their own promotion of lockdowns have had, and the fact that, in terms of stopping the virus, they have been completely useless if not counter-productive. But, all of this emphasis on the failure of the government's test and trace scheme, and implication that all would be well if only the government could implement such a scheme effectively, is a complete diversion. It simply repeats the errors of the lockdown but in a different way.
The emphasis in the criticism of the government scheme has been the way it was implemented incompetently, leaving several thousand people who had tested positive out of statistics, and failing to pass on this information for the purpose of tracing those they had been in contact with. This amounted to about 15,000 people. But, in the grand scheme of things, this is chicken feed. The reality is that only a small minority of people are ever tested for COVID to begin with. Take out those that have to be tested several times, and the actual number of people tested is even smaller. Of those tested, even setting aside the current problems, about 30% of people who are positive show up as negative, because they do not have the virus in their nasal cavity or throat, which is where the samples are taken. But, even this is only a small part of the number of people who have the virus, but who never get into the actual figure of infections.
Around 80% of people who are infected are asymptomatic, or have only mild cold-like symptoms. In other words, this is the same 80% of the population that are not at serious risk from the virus, essentially those under 60. So, if you are in this group, why would you ever get tested, unless you have to. But, more than that. Even amongst the 20% of the population at serious risk, i.e. those over 60, only a very small proportion of them, who contract the virus, actually develop serious symptoms, and even smaller proportion require intensive care, with many of those who do also dying. So, even of those in this 20% who become infected, only a small proportion will become ill enough to seek out testing. In short, the number of people who are tested and found to be positive, comprise around only 10% of the actual number of people who, at any one time, have been infected. If the official figures for new infections are around 10,000, the actual number of new infections is around 100,000, and 90,000 of those new infections are never detected or recorded, and so all of those individuals then spread the virus amongst the population.
That is why test and trace is never going to work. It would require that you test every single person, and even then it would miss people, because someone who is tested, may contract the virus an hour after they have been tested. So, to cover that you would have to test every single person, every single day, which is an impossibility. The only time that test and trace worked was in small countries with easily managed borders, where they could catch an initial small number of infected people, and prevent them spreading the virus. But, they too couldn't maintain that regime indefinitely, any more than lockdowns can be maintained indefinitely, and so, as with lockdowns, wherever, the test and trace regulations were relaxed, the virus once again began to flare up. And that is necessarily the case, because neither test and trace nor lockdowns do anything to kill the virus or to build up the required herd immunity that would effectively prevent its spread, and so kill it. In fact, they slow the development of herd immunity and so make matters worse.
Once again, this shows the extent to which concentration on the number of infections, which is a meaningless metric, has got in the way of concentrating on the real issue, which is the number of hospital admissions and deaths. The latter can only be reduced by ensuring that those actually at serious risk from the virus are isolated from it, but that is precisely the course of action that governments and others have resisted in favour of lockdowns, test and trace and other such ineffective measures.
The consequence is that a hullabaloo is made over things that really are unimportant. SNP MP Margaret Ferrier has run into a storm, because she caught a train, and went into parliament having tested positive for COVID. The Tories have been somewhat constrained in their outrage, because its little different to what Dominic Cummings did. Ferrier should not have been surprised at the furore, which shows a particular lack of political awareness, unless, of course, she wanted to provoke such a response. Yet, the actions of Ferrier, in a rational world would have provoked no such response. Ferrier is not one of those in the at risk category. She was not ill, and so there was no reason why she should restrict her activities any more than if she had, any other year had a cold. The argument against her is that she risked transmitting the virus to others. But, so what? Every year, millions of people transmit the coronavirus or the flu virus to others via such action, when they are suffering from a cold or flu.
Significant numbers of people who contract the flu or the common cold, also die each year, but we do not insist that those with colds and flu confine themselves, we do not close down the economy to prevent transmission of these viruses. With coronavirus, we know that it almost exclusively targets the elderly – those over 80 specifically, but also those over 60 – so the obvious course of action, rather than closing down society, or implementing ineffective and costly test and trace systems, is simply to protect/shield those elderly people against the virus, and thereby allow everyone else to get on with life as normal. If that approach was followed, there would have been no elderly or otherwise at risk people on the train that Ferrier took, nor in parliament etc. There would have been absolutely no issue, and anyone who then contracted the virus would have developed antibodies to it, helping to quickly develop herd immunity so that the virus could not spread, and reducing the time that the vulnerable in society needed to be shielded from it.
If that approach had been followed then we would not have had tens of thousands of deaths of old people, most of whom were residents in care homes, or in hospital, because those institutions would have concentrated on ensuring that staff and visitors had proper PPE, that there were adequate isolation and contact protocols in place to prevent transmission of the virus to the old and vulnerable. But, a crazy concentration on preventing widespread infections amongst the majority of the population who were at no serious risk from the virus, meant that this necessary focus on shielding the elderly and vulnerable was not undertaken, and so care homes which should have been sanctuaries instead became killing fields.
And, the truth is that, for the reasons set out above, every day, thousands of people, who have the virus, but who are asymptomatic, are travelling on trains, and in the process they already are passing on the virus to thousands of other people who are similarly asymptomatic, without anyone batting an eye, because they all remain blissfully unaware that this is happening. Its why the actual number of people who have had the virus, and now have antibodies or other forms of immunity is much larger than the official figures suggest is the case, which will only become obvious when we get large scale antibody testing, which is the only form of testing that has any useful purpose.
9 comments:
Doesn't Japan show the best way to make test and trace work?
They know that most Covid infections are caused by a small minority of super-spreaders (far more than with flu, for example) and endeavour (once someone tests positive) to trace backwards to discover who likely infected them, so that they can encourage anyone who contacted that spreader to also be tested as soon as possible. This allows testing capacity to be used far more efficiently than testing the infected person's onward contacts, most of whom are have relatively little likelihood of being infected themselves.
Also, have you seen the Great Barrington Declaration yet? You could find it interesting...
It assumes that everyone has the same kinds of conditions that Japan has. It also assumes that all those infected are tested, so as to trace their contacts, but 90% of people who are infected are not tested, because they have no or only minor systems, so have no need to be tested.
Weren't all those people who died in Britain's care homes essentially victims of Tory austerity policies, as one of the consequences of those policies (in the UK as well as in most other Western European countries) was that stockpiles of PPE were no longer being maintained, in the belief that it would be easy to acquire PPE at the time if necessary: a belief that turned out to be false, because China was secretly buying up the world's production of PPE while still covering up how infectious the new virus was?
In part, but not entirely. The fact is that the whole emphasis was on preventing infections, rather than protecting the vulnerable, so the effort was dispersed and ineffective. If the effort had been to create isolation hospitals or wings, to put in place contact protocols and so on that would have gone a long way to protecting the elderly and vulnerable. What PPE existed then only needed to be focused on those that were actually going to come in contact with the vulnerable, whereas the attempt has been to provide at least some PPE to everyone and their dog.
There still seems to be a complete lack of rational thinking about how to organise contact protocols. Its quite possible for people in care homes to see members of their family for example in the grounds of care homes though that's getting more problematic as we move into Winter. However, rotas to allow such visits of small numbers in the large lounges that all care homes have is possible, and that can be done without visitors needing to be totally togged up - unless they are also in a vulnerable category, in which case, such contacts are better done by Skye etc.
There is no reason for vulnerable people in my category to require particularly extravagant measures. Millions of us over 60 are very healthy and fit. We can isolate perfectly well. All that is required is that we can continue to get our groceries and other such shopping delivered online securely to our door, so that we can then take it in. The problem with that has been that lockdowns at the beginning caused physical shortages, and they seem to be reemerging again. Also some stores like Sainsbury's had inadequate resources to make the required online deliveries so it became impossible to get delivery slots. Fortunately, TESCO have employed an additional 16,000 workers to increase their capacity.
A bigger problem with that is now going to be the looming threat of Brexit. With or without a deal, its likely that availability of food and other goods will be hit. We may even see power supplies go down so even frozen foods may be a problem. I'm restocking already accordingly to cover the disappearance of food and other necessities in coming weeks.
A lot of PPE did exist, but was in the wrong places. Some was not used because it was past its use by date, though in large part this may be a bit of bloody mindedness, bureaucracy and arse protecting, because its hard to see how some of these things would not have been usable. At the very least a pair of rubber gloves or a mask that is past a use by date is better than none at all!
You claim that test-and-trace cannot work because a majority of those infected are asymptomatic, but South Korea, Japan and Germany made it work because you got one of your critical assumptions wrong about those asymptomatic carriers.
Respiratory viruses spread primarily through their symptoms (coughs and sneezes) and asymptomatic people can therefore only pass on the virus in very special circumstances: usually through shouting or singing as with the case back in February of the Skagit Valley Chorale.
This means that test-and-trade can work provided that asymptomatic spread is stopped by other means: by eliminating the kind of activities that lead to a lot of shouting. This for example means banning large public gatherings, closing nightclubs and banning pubs from playing loud music: all measures which (IIRC) Sweden introduces even while eschewing more onerous restrictions.
George,
I don't accept that. The places you mention got on top of it early on, before the virus spread widely. Some have favourable positions such as NZ, S. Korea, Japan as islands where it was also possible to close borders in a way that isn't possible elsewhere. But, even in these places, as soon as the regime was relaxed, cases materialised once more.
I also don't accept your premise about asymptomatic infection. People don't just cough or sneeze as a result of having some infection. Even close proximity on a bus or in a workplace is likely to spread the virus as people simply breathe. Exhaling by defintion involves expellation of air from the lungs. Coughing or sneezing simply expels it a greater distance, making transmission more likely. But, in addition to the things you mention there is kissing, there is the potential of transmission by hand contacts, and so on.
And, the reality is that we don't know whether in Germany et al the actual level of infections was reduced precisely because of the level of asymptomatic infection. There could be millions of people in these countries that have been infected without anyone knowing, simply because they are asymptomatic - that seems likely in Sweden certainly, which is why deaths have virtually ceased. We would only know if we got reliable antibody tests, and they were conducted on a wide basis.
Could another reason why test-and-trace has failed so dismally in Britain (and perhaps in many other Western countries) and would continue to fail even if the testing and tracing were competently implemented, is because the full system should be "test, trace and isolate" and Britons are chronically unwilling to self-isolate when told to?
Perhaps there's a reason why the more obedient cultures of East Asia have tended to have more success with test-and-trace? I can now see the attraction of lockdowns in that sense as a kind of scorched-earth strategy: stop people leaving their homes by ensuring that everywhere where they might wish to go has been closed.
No that's not the reason. On Peston I had heard David King say the way to deal with things is not lockdown but effective test and trace and isolate. If we were dealing with Ebola or some such similar disease, which has a very high mortality rate, but which does not spread easily, and without symptoms that would be absolutely correct. Its why when the Ebola outbreak occurred a few years ago, I thought it would be acceptable to close borders for a very short period for that purpose. But, this virus is completely different. It has to be treated more like flu or the common cold, because that is what its like. Indeed, the coronavirus is what causes the common cold, and is responsible for around 14% of all "flu-like symptoms" every year.
Test and trace will never work, because 90% of infections are asymptomatic, or cause symptoms not serious enough for anyone to seek medical assistance. So, during all the Summer period, when people were saying that the lockdwon had succeeded in preventing the spread of the virus it was bunk. It simply slowed the spread of the virus to people in the 20% who were likely to fall ill with it. In other words, in a very cackhanded, sledgehammer to crack a nut way, it did do what was required, which was to isolate the vulnerable, but did it by trying to isolate everyone. Meanwhile tens of thousands of younger people contracted the virus without being ill, and without anyone knowing, or it being recorded in official data, because they are asymptomatic. On council estates across the North, I have heard a first account of it from Bury, during that time, young people organised their own Shabeens as pubs and other venues were closed. They didn't fall ill, any more than the thousands who turned up on the beach at Eastbourne or the thousands that turned up to BLM protests fell ill, for the simple reason that COVID is a virus that almost exclusively attacks the elderly. 92% of deaths are those over 60, a further 7% those with underlying conditions.
Cont'd
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The reason that everywhere across the globe that lockdowns or test and trace has been relaxed has seen an upsurge in infections is down purely to the fact that as those restrictions were relaxed, all the old people who had been isolated by it, came out, and started to go shopping, go to the pub, to restaurants again. They went to see their kids, or vice versa, and so the virus which had been spreading quietly during the Summer simply manifested itself amongst all these older people as they again fell ill. It shows once again that because the emphasis has been on infections rather than who is infected, and who is going to be ill, the measures required to protect the latter were not put in place, which is precisely what focused protection says should have been done.
Opponents of focused protection say you can't identify who requires the protection. That is nonsense. We know exactly who needs that protection, and they can easily be protected by simple measures. The same people say instead we need effective test and trace, but that is where the real problem of identification resides, because there are no such databases of people as there are for the elderly and sick! The 20% amounts to around 13 million known individuals, but test and trace requires knowing the identity, movement and whereabouts of the other 50 million people, 50 million people whose identities and condition is wholly unknown. All the media and reports talk about the success of test and trace only in terms of the tiny number of people who are actually tested. But, the vast majority of people are never tested, they have no need to be tested because they are not ill.
But, also because the testing is only if you currently have the virus - not whether you had it previously, and now don't, but in the meantime you passed it on to another 100 people - the current tests can never even enable effective tracing. Nor do the tests detect whether you are going to be infected an hour after being tested, so unless you test everyone every day, its pointless.
At this rate, the virus will actually have infected a large enough proportion of the population silently and undetected, and have created herd immunity, long before any vaccine is available next year, at the earliest.
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