Covid-19 reader: 29 October

MPs slam Test and Trace service

Public Accounts Committee, report

NHS Test and Trace has not achieved its main objective to help break chains of Covid-19 transmission and enable people to return to a more normal way of life, the Public Accounts Committee concluded this week in a critical report.

In fact, since the end of October 2020, the committee highlighted the fact that the country had had two national lockdowns and case numbers had risen dramatically. This was despite having an ‘eye-watering’ budget of £37bn over two years – and not managing to spend £8.7bn of the first year’s allocation.

The committee acknowledged that it was not clear how much of this was NHS Test and Trace’s fault. ‘It may never have been an achievable goal for a testing and tracing service, but it was a goal set by NHS Test and Trace in its own business case,’ the committee said in its Test and trace update report this week. It added that gaps in data meant the tracing service was unable to demonstrate its effectiveness at reducing transmission – only routinely monitoring in-person PCR tests. The committee called on the organisation to publish a performance management framework by the end of December, including specific published targets and metrics for each major area of activity.

The cross-party MPs also pointed at the variable uptake of test and trace services, with some vulnerable groups less likely to engage with it. Only between 18% and 33% of people with Covid-19 symptoms report getting a test, with some groups such as men, older people and certain ethnic minorities much less likely to request tests.

The committee also accused the national service of being focused on getting programmes up and running, but paying less attention to ensuring the programmes delivered the promised benefits. For example, while the service has distributed 691 million lateral flow tests, only 96 million of these have been registered. This represents just 14% of the total and it is not clear what benefit the remaining 595 million tests have secured. There was also criticism for the programme’s continued use of expensive consultants.

‘The national Test and Trace programme … set out bold ambitions but has failed to achieve them despite the vast sums thrown at it,’ said committee chair Meg Hillier (pictured). ‘For this huge amount of money, we need to see a legacy system ready to deliver when needed, but it’s just not clear what there will be to show in the long term.’

Did the roadmap work?

Imperial College Covid-19 response team, research

The roadmap out of lockdown in England was successful in balancing increased transmission with population immunity, according to new analysis by Imperial College’s Covid-19 response team.

England went through four incremental steps in moving out of lockdown earlier this year starting on 8 March and finishing with all restrictions lifted in mid-July. Cases, hospitalisations and deaths had been falling spring the spring with the country in full lockdown. The analysis, published in The Lancet, said this continued following step one, when schools and educational institutions reopened.

Step two involved the re-opening of outdoor hospitality and non-essential retail from 12 April.  Following this, the R number (the number of people that one infected person will pass the virus on to) continued to be below 1 for the Alpha variant, due to increasing population immunity from the vaccination programme. Researchers estimate the R number stayed below 1 through to July.

The Delta variant, which was detected in April, led to an increase in cases and hospitalisations that was ‘not entirely counterbalanced by the vaccination programme’, the research found. This was due to the variant’s higher transmissibility and vaccines being less able to deal with it.

In step three in May, indoor hospitality also reopened, increasing contact rates further. But this continued to be partially offset by the increasing immunity in the population from the ongoing vaccination programme. However, there was again a split between the Alpha variant, with the effective R below 1, and Delta, where the reproduction number was above 1.

The researchers said that, had the Delta variant not emerged, lifting all restrictions as planned on 21 June would not have led to a substantial third wave.

Increasing concern about Delta led to a one-month delay to step four – the lifting of all remaining restrictions. Before this arrived, here was a sharp increase in transmission in early July followed by a rapid fall. The researchers said this was mostly likely associated with the Euro football tournament and not as a result of step 3 of the roadmap.

Meanwhile, the delay of step 4 enabled 2.8 million more people to receive a first dose of vaccine and 3.8 million more second doses. The research team suggested the delay was likely to have reduced the risk of a large autumn/winter peak in hospital admissions and reduced deaths in the following 12 months by around 20%

Since step 4 (looking at trends up to mid-August), cases, hospitalisations and deaths have increased gradually. And looking ahead to the autumn and winter, the research team predicted an autumn wave of transmission, but with large uncertainty around the peak in hospitalisations and deaths.

‘Timing the gradual relaxation of Covid restrictions to track the roll-out of vaccination was largely successful at limiting infection levels,’ said Neil Ferguson, a professor in the school of public health, although he added that the Delta variant had posed additional challenges. ‘While hospitalisations and deaths are still a fraction of what they were in January, Delta means that infections are currently higher than we would have hoped for. Rapid roll-out of booster doses and second doses in teenagers is likely to be key to maintaining control of transmission in the next few months.’

International comparisons

World Health Organization and The BMJ, weekly update and article

In the week to 24 October, there were 2.9 million new cases of Covid-19 recorded across the globe, representing a small 4% increase compared to the previous week, according to the latest epidemiological update from the World Health Organization. More than half of these cases (57%) were in Europe and Europe was the only region to report an increase (18%). Some regions reported significant decreases including the African region (21%) and the Western Pacific region (17%).

The European region’s increase in cases was accompanied by a 14% increase in deaths, and this continued a trend of rising cases and deaths seen since the end of September. Two-thirds of the countries in the region reported an increase in cases, although the UK, with 330,465 new cases or 486.8 new cases per 100,000, reported the highest number – representing a 16% increase.

A feature in The British Medical Journal looked into the UK’s apparent poorer performance compared to continental neighbours. The article, by freelance journalist Chris Stokel Walker, acknowledged that the ‘data indubitably show that the UK is currently facing a bigger wave of infections than the rest of western Europe’.

However, according to Paul Hunter, professor in medicine at the University of East Anglia, who is quoted in the article, the situation may not be quite as bad as it looks from the data. ‘Comparing case number graphs between ourselves and our neighbours gives a slightly distorted picture, in part because we’re doing a lot of testing of children that many of our European neighbours are not doing,’ he said.

According to the BMJ, at around 14 tests for every 1,000 people, the UK is testing twice or three times as many people as many European countries including France and Italy. And more testing is likely to mean more detected cases. Professor Hunter suggested the rest of Europe would soon be seeing similar numbers to the UK.