Botched Britain or psychosomatic nation? As the broken testing system damns the country to a de facto lockdown, with runny-nosed children banned from school and sniffy Londoners pretending they live in Aberdeen to get a test, you’d be forgiven for thinking incompetence is the story of the day. But if a scandal is unfolding, it’s not that we are failing to implement the right strategy but that we have the wrong one altogether.
An alliance of blue-sky politicians and blinkered epidemiologists is determined to will a perfect universe into existence. One where we can suppress Covid-19 through aggressive nationwide testing, until a vaccine materialises. In this computer-modelled nirvana, basic obstacles are mere illusions based on negative or selfish thinking – from the slowness of medical innovation, to the need to factor in that pesky little thing known as an economy.
Such a rigidly theoretical approach to the UK’s crisis threatens to plunge us into a downward spiral of government deception, mass hypochondria and bankruptcy. It also risks a repeat of the fatal mistake we made with the first wave: failure to protect the vulnerable.
The experts are correct. Routine mass testing is the ideal way to prevent a second wave while keeping the economy going. But it is reckless to pretend that, as things stand, it is realistic. In a perfect world, the Government would have stimulated the market for Covid detection right at the start of this crisis, allowing firms to stay open provided they rapidly identified cases. At the same time, ministers would have provided juicy subsidies to private testing companies, as crowdfunding entrepreneur Matthew Cleevely has argued. This could have triggered huge investment followed by huge innovation, with tests becoming faster and more accurate. We may then have been much closer to that sweet spot of routinely mass testing the entire population every five days to keep the R number stable.
Except we don’t live in that perfect world. We live in a Red Tory state that doesn’t have enough lab technicians to process results. The PM’s Operation Moonshot is a dud. It will crowd out entrepreneurs in favour of a few mega-firms and send false positives soaring.
The latter point is crucial. Covid tests are flawed. Many are likely overdiagnosing cases as they pick up dead viral load. As testing is ramped up, so are false positives. Therefore, although hospital admissions in places like Bolton are undoubtedly on the up, the uptick of positive cases that has sent the country into fresh spasms of hysteria may be wildly overstating the true situation.
Covid testing is riddled with other complications: it does not tell us whether the viral load detected is actually infectious, for example. This means thousands of people may already be self-isolating unnecessarily. Routine testing systems that do not include second confirmatory tests for those who test positive compound the errors. Put simply we are heading for a winter of endless false alarms and institutionalised hypochondria.
Eminently sensible Prof Chris Whitty is correct in his push to prioritise testing for NHS workers. But the Government needs to go further, and ditch its disastrous population testing strategy.
Instead No 10 should put all its energies into a routine testing system for care homes and the NHS. It needs to focus the minds of its modellers on transmission among the elderly rather than among children, ignoring the Imperial College trendsetters who this week announced yet another study into how kids spread Covid-19. Ministers need to perfect infection control measures in hospitals, from PPE and Covid-friendly ventilation to techniques preventing superspreading through routine procedures like intubation. And we need better hospital and primary care surveillance systems that can tell us what is actually going on in the NHS compared with the community.
Crucially, local lockdowns also need to be urgently needs to be reassessed. If the virus is endemic then such hyper-caution may prove a deadly mistake, pushing the virus deeper into winter, with catastrophic consequences for vulnerable groups.
Perhaps No 10’s reluctance to boldly shift from a suppress to a protect strategy strikes at the Western health establishment’s most fatal mistake in the pandemic. Everyone from the EU and the British Government to Bill Gates assumed the next big pandemic would be influenza.
When Covid struck, we went with the only plan we had – a flu gameplan that overlooked the most simple lesson of previous coronavirus outbreaks, not least SARS, which ripped through Asian care homes and super spread in hospitals: protect the vulnerable. Unsurprisingly, up to a quarter of British Covid victims have caught coronavirus in hospital. Care homes account for more than half of Covid-related UK deaths. That the virus is again spiralling in nursing homes (detected in 43 and counting this month) is a scandal.
Perhaps the failure is so breathtakingly basic that the politicians can’t quite face it. Or perhaps the experts just hate to be wrong. Take Prof Neil Ferguson – who has over the last 15 years found a nice little niche modelling pandemics with data collected from historical flu outbreaks. His notorious Report 9 was based on a modified flu simulation that failed to incorporate insights from previous coronavirus pandemics. But far from recanting his doom-mongering modelling, he merely insists lockdown didn't come quickly enough. Such stupendous self-delusion at the top table doesn’t bode well for the future.