Covid-19 testing: Where did England go wrong?

Amelia Schofield of We Own It draws on lessons from contact tracing success stories around the world.

Pennsylvania Public Health Laboratory in Exton tests for Covid-19
Tom Wolf/Flickr

From Taiwan to Germany, Wales to South Korea, publicly owned contact-tracing systems are helping to track Covid-19 and keep it under control. Meanwhile in England, the government’s centralized and outsourced system is already a disaster.

The World Health Organization warned against the lifting of lockdown measures in England until a more ‘robust’ system was put in place, yet restrictions are already being eased. In order to exit lockdown safely, to see and hug our loved ones again, we need an effective test, track and trace system. We were promised ‘world beating’, but so far contact tracing in England has proven to be an international embarrassment.

The botched system – where private companies didn’t mandate the passing on of testing data to public health teams, where companies like Serco have been training their tracers for as little as one hour – has to end. The government must urgently learn from publicly owned systems abroad and end the practice of haphazard, minimally accountable outsourcing now.

Taiwan’s comprehensive approach and its publicly owned contact-tracing scheme has kept rates of infection remarkably low. Since early July, there have been seven deaths due to Covid-19 in total since the start of the pandemic.

The private sector is getting the cash, the public sector is delivering the goods

Where new infections have emerged from international arrivals, effective contact tracing has enabled the Taiwanese government to react quickly and stop the virus in its tracks. This success in tracking and tracing the virus meant that Taiwan was able to avoid going into full lockdown as cases remained low.

Unlike England, Germany chose to keep its contact-tracing system in-house. By bolstering existing public health networks, the German contact-tracing system has been able to make use of local expertise and adapt to regional circumstances.

Along with widespread testing, the publicly owned and locally-run German contact-tracing scheme has helped to monitor infections as national restrictions have eased. Recent localized outbreaks in Germany show the fight against the virus is not over yet. However, these cases also highlight how important it is for local authorities to be given the resources and power they need to respond quickly to regional outbreaks and track contacts effectively.

And effective testing systems are already paying off in Wales, where the contact-tracing system was also kept in-house. In the coastal area of Ceredigion, the local councils publicly owned contact-tracing scheme helped to keep rates of infection low.

The government’s own SAGE (Scientific Advisory Group for Emergencies) committee has said that in order to stop the virus from spreading further, 80 per cent of the contacts of all symptomatic cases need to be identified and isolated. Across Wales, the publicly run system has ensured that 90 per cent of contacts have been reached and advised. By contrast, in Blackburn, where health teams are battling a major outbreak, the privatized national tracing service is reaching just 52 per cent of all close contacts. The Welsh case shows us how important it is for local public health experts to have control over protecting our communities.

The initial results of publicly owned contact-tracing systems elsewhere in the world are encouraging. South Korea’s national contact-tracing scheme was key to the country’s early reduction in the number of daily reported cases of Covid-19. In Australia, local contact-tracing teams remain the most effective line of defence in responding to localized outbreaks.

Contact tracing in Vietnam is yet another publicly owned success story. At the time of writing, eight deaths due to Covid-19 had been recorded in a country of over 97 million people. Extensive testing and contact-tracing measures helped to reduce community transmission and get control over the virus. Vietnam’s low number of cases has also been praised as a factor in allowing the country’s top clinicians to focus on a small number of critical care cases, such as in the remarkable recent recovery of a Scottish pilot who had fallen ill with Covid-19 while in Vietnam.

Where did England go wrong?

Well, outsourcing much of our contact-tracing system to Serco was a bad start. NHS doctors have criticized England’s approach, pointing out how the many layers of outsourcing in the Test and Trace service led by Serco have created a fragmented and chaotic system.

Multiple Independent SAGE reports have echoed this damning assessment of England’s privatized contact tracing scheme. According to one report, 'The key components of this system are themselves based on outsourced services, are fragmented, suffer from poor data linkage, and do not provide an integrated system based on the existing public health and NHS infrastructure.'

According to Independent SAGE, the key to successful contact tracing is local expertise and public ownership. Instead, we’re getting national incompetence and a bonanza for private companies. The government must scrap the Serco contract and instead make use of existing public health structures and contact tracers already in our NHS. These are the people who already have the expertise and the experience to deliver effective tracing. Tim Riordan – who until recently worked on the national test, track and trace scheme - has made clear that it is essential to fund local authorities and public health teams to do this, as the local knowledge and connection is important.

We’ve already seen just how true this is from the test, track and trace statistics for England at the start of July. Local public health teams identified over 80 per cent of the people needing to isolate. By contrast, the nationally co-ordinated system managed by Serco and Sitel has identified only around 20 per cent of these cases. That’s in spite of much of the government’s £10 billion splurge on test and trace going on these private contracts. The private sector is getting the cash, the public sector is delivering the goods.

In light of this, council leaders across England have also been pleading with the government to give them the resources and powers they need to respond more quickly in order to control the virus. They understand that the current system is putting their communities at risk, and that the solution is to localize test, track and trace, as well as to take it out of the hands of the private sector. And the public understands this too – just 15 per cent of us think that private companies like Serco should be in charge, compared to 67 per cent who think it should be local public health teams.

It is time the government listened. It’s time they ditched their wrong-headed, ill-fated and ideological obsession with privatization. It’s time they learnt from the more successful systems abroad. We need a publicly owned and locally run contact-tracing system that we can have faith in now.