Intended for healthcare professionals

Rapid response to:

Editor's Choice Editor’s choice

The burning building

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1101 (Published 19 March 2020) Cite this as: BMJ 2020;368:m1101

Rapid Response:

Re: The burning building: "Fire, Fire"- We need to start to put out the fires: "Test, Test, Test"

Dear Editor,

To quote Dr Tedros Ghebreyesus, WHO Director-General, "you can not fight a fire blindfolded" (1).

On the 11th March the World Health Organisation declared COVID-19 a pandemic, but it was still possible to turn the tide by the standard techniques of detect, test, treat, isolate and trace (2). The following day the UK government announced that it was going to stop its containment strategy and move to a delay phase but still allow the virus to spread through the population to develop "herd immunity" (3). The plan being to implement social distancing strategies to "flatten the curve" to allow the NHS to cope.

The only country in the world to propose such a plan. Though Matt Hancock later stated that this was not "stated policy" (4).

Over the past week the implications of such a strategy have become increasingly apparent especially follow the paper from Imperial, that even under the most optimistic scenarios the likely numbers of deaths would exceed 250,000 and the intensive care capacity of the NHS would be completely overwhelmed. (5)

Since then the government has announced a series of social distancing proposals but has not restarted any form of community testing and contact tracing. Testing is to be increased but to allow increased testing in hospital, and hospital staff, it seems.

While this is to be welcomed, we should also be testing in the community. Testing at least those in the community with, or have had classic symptoms of covid-19; fever and dry cough should start now. Assays are now becoming available that can deliver "millions of tests a month", on standard hospital analysers (6).

We need to "test, test, test" and contact trace as advised by the WHO (1).

We need to stop running into fires to save people, but to start putting them out.

(1)https://www.youtube.com/watch?time_continue=178&v=CHHCJFiDoR4&feature=em...
(2)https://www.who.int/docs/default-source/coronaviruse/transcripts/who-aud...
(3) https://www.youtube.com/watch?v=xRadMzCKnCU
(4)https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-...
(5)https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-...
(6) https://www.roche.com/media/releases/med-cor-2020-03-13.htm

Competing interests: No competing interests

20 March 2020
john ashcroft
GP
john ashcroft
Derby