There is a growing scientific consensus that successful management of the coronavirus crisis requires a comprehensive plan – combining mass testing, contact tracing, and supported isolation of potentially infected individuals. But a managed plan of action is precisely what chaotic capitalism is struggling to achieve.
Medical science was already well aware that contact tracing has to be a key part of any strategy to tackle a viral epidemic, particularly where no vaccine is yet available. It is a technique already proven to work when tackling Ebola, Sars, and Mers, for example.
The strategy is simple enough to understand. If you can quickly identify the close contacts of someone who is found to be infected, and then make sure that all these individuals are safely isolated, the onward transmission of the virus is hopefully prevented. If this is done consistently, most new cases can be identified, isolated, and the outbreak eventually brought under control, avoiding further peaks of new infections.
Of course, what works medically has a social and economic cost too. Who pays to look after the income and welfare of the isolated individuals and their dependants for what, in the case of Covid-19, might need to be at least 14 days in isolation?
Their jobs and income must be guaranteed, or the strategy will fail to operate successfully. Similarly, resources have to be in place for food deliveries and other practical support to those who need it in order to remain isolated.
How is contact tracing itself going to be carried out? Commentators place hopes in the development of tracing apps that could use smartphones to alert people that they have potentially been infected by someone who has been close to them.
But, even if they prove reliable, many, particularly the oldest and worst-off, may not own the kind of phones needed. Fears about privacy will also need to be addressed for take-up to be sufficiently high – perhaps requiring 60% of the population and 80% of smartphone owners – for such a system to work.
So, in addition to tracing apps, mass recruitment of contact tracers is going to be needed. Some of the work can be done remotely through phone interviews, some may require direct visits with adequate PPE.
A group of retired doctors and public health experts in Sheffield has set up a community contact tracing team. They train volunteers who identify contacts and then make daily phone calls to monitor symptoms, guard against mental health problems developing through isolation, and organise practical support like food delivery.
Health Secretary Matt Hancock has announced the recruitment of 18,000 tracers. But, yet again, it’s without the necessary urgency, clarity, and infrastructure. All will need to be properly trained and paid for this important role. Meanwhile, 5,000 local authority environmental health officers, who already have the necessary skills and experience, have not been mobilised for this task.
The government is even proposing that 15,000 contact-tracing call centre staff will be hired through notorious outsourcers Serco and G4S, responsible for a litany of corner-cutting and incompetence in the public sector. Once more, the inability of the Tories and capitalism to apply a clear strategy is being exposed.
For a disease like Covid-19, where some proportion of infections seem to be passed on from people without obvious symptoms, mass testing is also vital.
It’s not good enough to set up random access to headline-grabbing testing centres that take hours to get to, with the risk that some carriers may spread the virus as they travel there. We need testing properly integrated into an overall strategy, firstly to identify individuals who have the virus, and then to test their traced close contacts.
If this could be done in sufficient numbers, and with sufficiently reliable tests, this could alleviate some of the isolation requirements. It might also identify more of the individuals who actually need hospitalisation rather than just isolation.
Given the nature of the virus and uncertainty over immunity, testing will need to be regularly repeated, not just a one-off. It also requires much faster results – turnaround times can reportedly be as fast as six hours; backlogs mean processing times of several days. All of this demands an increase in capacity, certainly far greater than the 100,000 tests a day claimed by Hancock.
Having moved the goalposts multiple times, he finally announced the 100,000 target had been beaten on 1 May. The day before, there were apparently 122,347 tests. However, this only represented 73,000 new people tested, the rest being retests. And fully 39,000 of the total were counted before they had even been carried out!
As the Socialist commented in its last issue, one respected epidemiologist estimates the UK has capacity for ten million tests a day. It is only the Tories’ lack of a national plan to requisition and direct the resources, preferring to leave as much as possible to the private sector and the market, which holds this back.
A socialist government would have been in a far stronger position to manage this. Nationalisation of the healthcare and medical supply sectors, as well as big business generally, under the democratic control and management of workers, would allow a rapid and thorough democratic plan of emergency production and distribution.
Of course, identifying carriers and contacts quickly is one thing. Ensuring they then isolate themselves is another.
No ‘quick fix’
Contact tracing is not the ‘quick fix’ that some sections of big business seem to think it is. For it to work, employers need to understand that some of their workforce may well receive a message to say they need to quickly isolate themselves. Workers need to be assured they can do so without loss of income.
If, as in the case of schools, health, transport, construction, and so many other sectors, work is being carried out without adequate social distancing and PPE, the risk of being a close contact of an infected person increases significantly.
Where possible, workplaces must close to allow for deep cleans after confirmed cases. Where, as in schools, consistent physical distancing is hard to guarantee, closing altogether may even be necessary. In workplaces where this cannot happen, like transport hubs, PPE, staggered usage, hygiene provisions, and other protocols are doubly important.
The National Education Union has rightly set the following condition for schools to fully open: “Protocols to be put in place to test a whole school or college when a case occurs and for isolation to be strictly followed.”
Another problem is that it is unclear exactly how accurate these tests are, because this is a new disease. Early research in China – unconfirmed as yet – suggests the most common test could give false negatives up to 30% of the time. So workers must have a negative test and be symptom-free before returning to work.
On top of this, the government states that if you live with someone experiencing symptoms, you should self-isolate for 14 days. This rule does not extend to working with someone experiencing symptoms – but we say it must.
Workers with underlying conditions should also continue to be ‘shielded’ at home, and given full pay. And the government guidance on at-risk age groups begins at 70 – but the stats indicate it should begin at 60.
Safety v profits
Bluntly, unless workplace safety is put ahead of short-term profits, the outbreak cannot be properly managed. If the employers won’t guarantee it – and experience shows they will not – trade unions must assert control over safety with elected workplace health and safety committees.
Of course, if these necessary measures had been carried out earlier, then it wouldn’t now be so difficult to repair the damage. But on 12 March, the government stopped contact tracing.
The Cheltenham Festival went ahead that same week, and pubs and schools stayed open, all while Johnson claimed the ‘science’ didn’t prove further steps were needed. After a decade of austerity, including £500 million ‘efficiency savings’ to Public Health England, it only had 290 contact tracers in its team at that time.
In reality, the evidence from China and other countries that had already been battling the infection already showed what was needed. There, early application of contact tracing and testing was used to isolate the outbreak to more manageable hotspots. Here, the Tory government delay means it will take a lot longer for a similar strategy to work. However, it is the only realistic approach to ending the lockdown safely.