Covid-19 update: 11 September

by Steve Brown

11 September 2020

The week has been dominated by the tightening of socialising rules – and the new rule of six – on the back of rising infection levels.

On Thursday, the UK recorded 2,919 cases of Covid-19, making five consecutive days above 2,000 - a sharp rise on the numbers being recorded at the end of August and early September. The seven-day rate of new cases in the UK has risen above 20 cases per 100,000 – the level at which the government considers imposing quarantine rules on foreign countries.HFMA Covid-19

With concerns that the virus is spreading again, regulations are being tightened across the UK. From Monday 14 September, in England it will be against the law to meet people you do not live with in a group larger than six. However, there are differences between different UK nations.

In England, the six rule applies indoors and outdoors, although the six can be from multiple households, and the six includes all ages. In Scotland, the six can be drawn from a maximum of two households, but does not include children under 12. In Wales, six will also be the limit for people meeting indoors, although they can be drawn from an extended household, which can bring together up to four households. But there is no change to the rules outdoors, where groups of up to 30 people are acceptable.

The Northern Ireland Executive has announced localised restrictions in certain areas including no mixing of households and a maximum of six people gathering outside from no more than two households.

While the media was full of reports of a backbench revolt among Conservative MPs and a split cabinet over the new rules, the NHS Confederation said NHS leaders would welcome the new restrictions. ‘The NHS is bracing itself for a second surge, hoping for the best that it will not happen, but already having to prepare for the worst,’ said confederation chief executive Niall Dickson (pictured). ‘The numbers of daily infections are at their highest levels since May. We must do all we can to avoid the pattern seen in France and Spain with rising infections.’Niall Dickson

With the NHS facing significant pressures this winter and staff already exhausted, he said that social distancing needed to be taken seriously and public health messages needed to be simple.

However, the government has continued to face wide-ranging criticism about its testing programme. In Prime Minister’s Questions this week, Labour leader Sir Keir Starmer asked why 75,000 coronavirus tests were not being used every day. ‘If people are being told to go hundreds of miles, something is wrong. And it has got a lot worse in the last week or two,’ he said.

Prime minister Boris Johnson defended the Test and Trace service, pointing out that capacity for testing had risen from 2,000 in the early days of the virus to 350,000 a day, with a target of 500,000 a day by the end of October. Echoing health secretary Matt Hancock, he said that the current capacity issues were a ‘function of growing demand’ and that this was exacerbated by the number of people seeking tests when they were asymptomatic.

Director of testing at NHS Test and Trace Sarah-Jane Marsh earlier in the week offered ‘heartfelt apologies’ to anyone who could not get a Covid test at the moment. ‘All of our testing sites have capacity, which is why they don’t look overcrowded. It’s our laboratory processing that is the critical pinch-point. We are doing all we can to expand quickly,’ she tweeted on Tuesday.

Further details provided to Healthcare Finance from the Department of Health and Social Care show that pillar 2 – the community testing programme – is at maximum capacity, which is defined at around 85%. There is also volatility in demand across the week, with significantly higher test volumes during the week and lower test volumes during the weekend. The Department is working to address this with increased weekend testing by care homes. The fact that laboratories are often using different equipment also means it is difficult to move capacity around the system.

The weekly report from NHS Test and Trace reports that testing capacity in the week to 2 September was just under 2.5 million tests or an average of 357,000 tests a day, with 1.3 million tests actually processed – an average of 190,000 tests per day. The report says that 436,884 people were newly tested for coronavirus in the week, a number which does not include repeat testing of individuals in high contact professions.

The week in question is before the major increase in infections seen over the last seven days. Even so the 9,864 people with a positive test result was a 43% increase on the previous week and the highest number of positive cases since Test and Trace was launched at the end of May.

Of 8,908 people transferred to the contact tracing system, 83% were reached. And of these, 82% provided details of one or more contacts. In total this amounted to 32,359 close contacts, including 25,164 non-complex and 7,195 complex (in hospitals, care homes, schools or prisons).

For non-complex cases, just over 15,000 (61%) of these contacts were reached and asked to self-isolate. Nearly all of complex cases (97%) were reached. Overall, this means that 69% of contacts across complex and non-complex cases were reached.

The target set by the government’s Scientific Advisory Group for Emergencies (Sage) for an effective contact tracing service is for 80% of contacts to be reached and asked to self-isolate. Even the 69% figure ignores the fact that the service isn’t reaching all the people testing positive in the first place. If 80% of positive testers are reached, Test and Trace would need to contact 100% of their contacts to meet the Sage target – a point made by the BBC statistics programme More or less this week.

Layla McCay, director at the NHS Confederation said the latest figures were a cause for serious alarm. ‘There has been a major increase in confirmed cases of Covid-19 week-on-week, while at the same time, taking into account all contacts identified, only 69.2% were reached and asked to self-isolate,’ she said. ‘We need to see a more effective test and trace programme, where a larger proportion of contacts are being successfully reached, to reduce the number of cases.’

 While she welcomed further increases in testing capacity, the problems with access were worrying. ‘Our members, and especially in general practice, are concerned that their staff are having to self-isolate while awaiting access to tests, as well as test results for themselves and their families, which is putting a strain on the services they can provide. We need to see concrete evidence that the promised further increases in testing capacity and faster testing are achievable, and we also need immediate action to prioritise testing for key workers.’

Health secretary Matt Hancock went for classic misdirection tactics – don’t look here, look over there – in addressing the current problems. Rather than focus on current shortcomings, he talked about plans for ‘Operation Moonshot’ to deploy mass testing using saliva and swab tests that could be turned round in as little as 20 minutes, with technology currently being verified before a national roll-out. While his statement was met with laughter in the House of Commons, he said it was the same ‘naysayers’ who doubted the government would hit its earlier 100,00 test-per-day target or its pledge to deliver tests to care homes – both of which he said had been achieved.

Reports in the BMJ suggested that the government has drawn up plans to carry out up to 10 million Covid tests a day by early next year – as part of a £100bn expansion of the national testing programme.

However in an opinion piece, also on the BMJ website, Maggie Rae and Ellis Friedman, president and treasurer of the Faculty of Public Health, warn that an effective test and trace regime is not a numbers game. ‘The government’s moonshot plan to test millions of people daily for Covid-19 risks repeating the mistakes of the early days of test and trace,’ they argue.

Instead, an effective test and trace system needs to ‘move fast, be led by local intelligence and prioritise those groups and settings where the virus can spread quickly’ with the speed of response to local outbreaks currently being ‘inhibited by excessive central control of the testing resources’.

One tool that has been conspicuous by its absence in the battle to contain spread of the virus has been a contact tracing app. However Scotland unveiled its app this week to complement its contact tracing service. Built by software developers NearForm, it uses the same technology used by the Republic of Ireland and Northern Irish proximity tracing apps. An app is due to be launched in England and Wales on 24 September, with a QR code feature enabling easy check-in at restaurants and other public venues.