Watch the webinar
Today's webinar took the form of a conversation between our own Deputy Director-General, Josh Hardie, and Baroness Dido Harding, the chair of NHS Improvement and the person running the government’s Test & Trace efforts. Here are the main topics they discussed:
- The three parts of the Test & Trace service
- What will the app do? And when will it arrive?
- The barriers to success…
- …including concerns about sick pay
- The situation with Spain.
The three parts of the Test & Trace service
Dido began the discussion by helpfully explaining the “three different business lines” that define the Test & Trace service. These explain the work being done by Test & Trace officials now, but also where they are heading in future.
The first is the “core citizens service”. This is what most of us understand as Test & Trace at the moment – identifying people who may have Covid-19; diagnosing them; reaching out to their contacts in the case of a positive test; and then encouraging affected individuals to self-isolate. This entire system explained Dido, is designed to “break the chains of transmission, one person at a time”.
The second is “local outbreak management”. This is what we have witnessed in the case of Leicester – although the process is now better defined thanks to the publication of the “Contain Framework” about ten days ago. This system kicks in, said Dido, “if you can’t contain [an outbreak] one person at a time,” but it nevertheless aims to contain any outbreaks to “as small a geography as possible”.
The third line is what Dido described as the “most nascent”. It involves a “flip from curtailing people’s freedom to giving people more personalised insights into the risk they’re taking – so they can manage their own risk”.
Dido gave a few hypothetical examples, including that of an older man who lives in Northumberland, is healthy and doesn’t see many people – until now, this man might have been advised to isolate, but he is actually “low risk” and should be able to act accordingly. By contrast, a younger man with diabetes and living in Leicester is actually “very high risk; we want you to isolate today and to get a test”.
How will people get their own personal risk-based assessments? “That’s where the app very much sits,” said Dido.
What will the app do? And when will it arrive?
We shouldn’t get carried away with the possibilities of a Test & Trace app, warned Dido: “Everyone wants to believe that, with more granular data, this will get easy – unfortunately, the virus doesn’t follow those rules. We can’t use data to force the virus to change.”
However, what the forthcoming app will be able to do is “provide more clinically driven advice to individuals”. Dido revealed that the public health authorities are currently working on “individual risk-based assessments” that can be used to tailor the advice given to people in future.
So when will we get the app? Dido wouldn’t be drawn on a specific release data, but she did quote the Prime Minister saying that the target is the second half of this year. “We intend to have an app ready for the winter.”
Alongside the app, said Dido, other technological innovations will help the Test & Trace effort – including faster tests. There are already “encouraging signs” around new tests that take only half an hour to deliver a result. “None of those tests are yet fully validated and available at scale, but I think we can all be optimistic that newer testing technology is arriving later in the year.”
The barriers to success…
Dido explained that “finding the people who are infectious is the hardest part of the Test & Trace service”. This is, in part, because of the nature of Covid-19: “Only between one and two per cent of those getting tested turn out to have the virus. A lot of people who think they have it don’t have it. Between 40 per cent and 60 per cent of those who do have it don’t have any symptoms.”
But it’s also because of structural, economic or other reasons. Dido emphasised that individuals with Covid-19 symptoms shouldn’t be “stigmatised” nor “demonised” – and the same goes for businesses. “However much we try to make a workplace Covid-secure, sometime the virus is better than that.” No one should feel as though they have to cover anything up.
To some extent, this will require a broader cultural change: “We’ve got to make [testing] a normal part of everyday life…. If we have a temperature, we don’t just take a Lemsip and go to work…. we dial up a Covid test.”
…including concerns about sick pay
Is it possible that people won’t report symptoms or won’t self-isolate because they are concerned about losing income, due to the current provisions around statutory sick pay? “We are starting to see evidence,” revealed Dido, “that that is a challenge for individuals, when we ask them why they might not follow the guidelines.”
“I would be lying to say that I’m not worried about that,” continued Dido. “I am worried about that.” She emphasised that, when it comes to further financial support for those affected by a coronavirus outbreak, “I’m not a government minister and this is above my paygrade”. But she added: “I continue to make the case about how we continue to support those in the lowest-paid roles and the self-employed.”
Josh re-emphasised this message – and, indeed, said that both he and the CBI’s Director-General, Carolyn Fairbairn, will be making the case for extra support in a meeting with the Prime Minister today.
The situation with Spain
Since our last webinar, Spain has been removed from the government’s “travel corridor” list – meaning that people travelling from the country now have to self-isolate for 14 days if they enter the UK.
Dido explained why this period is so long, even with a Test & Trace programme in place: “I would love it for people to arrive [in the UK] and we test them and it’s negative…. [But] all the test can tell me is that you don’t have sufficient symptoms to trigger the test on the day you were tested.” Because Covid-19 has a 14-day incubation period, any of the subsequent days could represent a contagion risk for other people.
She continued: “We will learn more about the decay curve of the virus, so we might be able to shorten that period” – but it’s unlikely that people coming from “an area with high prevalence” will ever be able to just take a test on their arrival and then immediately be sent on their way.
Josh added that the “main lesson from Spain” is “the speed at which things move…. Even a week ago, we didn’t think that we were going to get into this position.” What’s important from now on, from a business perspective, is having “clear criteria” for when similar situations may occur in future.
Key questions we answered:
- Dido, could you give us an update on the Test and Trace scheme?
- The purpose is to break the chains of transmission, which enables more people to get back to a more normal way of life.
- We are building this service through three service lines:
- Core citizens – We aim to break the transmission one person at a time. We find people who have got the disease, and anyone they have been in close contact with, and ask those contacts to self-isolate
- Containing local outbreaks – If we cannot contain the virus one person at a time, we want to contain it in a smaller area, with a smaller number of people having their freedoms restricted
- Giving people personalised insight into the risks they are taking – We want to equip people with the information necessary to minimise their personal risk based on their own personal circumstances.
- Data definitely helps us, but we cannot use it to force the virus to change.
- When the app is launched, it will be able to provide you with more personalised information on your risks.
- We are making progress on testing. The quicker testing produces a result, you can start to take tests to double-check that you are still negative, as opposed to taking them with the expectation of finding out that you are positive.
- Dido, where is Test and Trace working well and where is it not working so well?
- We are pretty good at contacting people who have contracted Covid-19 and getting their contacts quickly.
- The area I worry about is people coming into the funnel. We don’t reach everyone who has symptoms. Part of that is because the virus is not simple to measure.
- A lot of people think they have the virus, and then turn out not to. And of those who do have it, somewhere between 40-70% don’t show any symptoms.
- Finding the people who are infectious is the hardest part.
- We have to make this a normal part of everyday life. If we have a temperature, we don’t just take a Lemsip and go into work – we get a test instead. This is how you ensure you don’t have an outbreak in your premises, and how we break the transmission of the disease.
- Josh and Dido, how do we ensure that the service works for business?
- Josh – There are challenges for businesses with this service. Who do you inform and when? It feels as though the advice isn’t clear enough.
- Dido – If one of your staff tests positive, contact your local health protection teams via your local authority. They will help you decide what needs to happen next. If you have an outbreak, the growth is exponential. The way to break that growth is to act hard and quickly. What you shouldn’t do is panic. Don’t make those individuals feel stigmatised because they got sick. If we stigmatise outbreaks, we disincentivise reporting. We need to think carefully about how we support people in the lowest-paid roles and the self-employed.
- Dido, how do we get to those hard-to-reach communities where response rates are low?
- The response rate does vary across the country.
- This is a genuine national-local partnership.
- The way we will reach these communities is by doing it together. In Leicester and Blackburn, we are doing this by working with the local authorities to knock on doors.
- Dido, is enough of the contact tracing being carried out on the ground?
- All local authorities have built their local action plan and all of them involve plans to surge contact tracing and testing if they need it.
- In the areas where you are seeing the disease start to grow, that is exactly what local authorities are doing. They are getting people out, knocking on doors.
- The prevalence of the virus across the country is, currently, quite low. But we must be quite obsessive when we start to see cases rise and stamp on them when we see them, at a local level.
- Dido, is there going to be international testing at airports? And what do you think about the news regarding people coming back from Spain?
- I would like to test people as they arrive. But the disease doesn’t work like that. All the test can tell me is whether the person has the disease at that point in time. Because the incubation period is quite long, you could test positive the next day, or day after that.
- Globally, everyone is standing by a 14-day quarantine as a means of ensuring that you don’t have the virus. Over time we will learn more about the decay curve of that incubation period.
- I would like to believe we will be able to shorten that quarantine time. I do, however, think it is highly unlikely that we will be able to say, if you are coming from a part of the world with a very high prevalence of the disease, that you can be tested on day one of your return and then proceed back to normal.
- Dido, what have you learned since you started your job?
- The biggest thing I would say we have learned is that technology isn’t a magic solution to this.
- We have learned a huge amount about the virus since February and March. We didn’t know how dangerous asymptomatic transmission was. We do now.
- Testing to find asymptomatic carriers is so important in containing outbreaks.
- All of us have to change our behaviour a little bit.
- The more we can utilise a locally led response to address any outbreaks where they may occur, the less likely we will need to use a national lockdown again.