Rammya Mathew: “Back to school” must be backed by a functioning covid-19 testing programmeBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3614 (Published 17 September 2020) Cite this as: BMJ 2020;370:m3614
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As a sole advocate for a change in direction from the current obsession about the ‘test, test and trace system’ as a panacea for Covid-19, I couldn’t disagree more with the author and subsequent reply.
The pandemic has moved on to a much larger scale, and spread within the community is inevitable during the winter months. Personal decisions to seek tests othe than for public health reasons are fuelling the demand aggravated by endless cries from the media, opposition, health fraternity about a debacle in testing system. Everyone is forgetting that testing is not a means to an end. Parents will seek advice for ILI (influenza like illnesses) and have done so always, and telephone triage and simple advice but at same time excluding any other sinister cause for febrile child is paramount in general practice. The downside to increasing testing capacity is more lockdowns and more disruption, whereby an asymptomatic healthy workforce will have to self-isolate. Already 13 million Brits are facing local lockdown without even mass testing. Imagine increasing testing yields even higher proportion of positive cases will eventually mean another disastrous national lockdown.
We must not sleep walk into a deadly spiral of economic downturn, joblessness, homelessness and deepening recession. The current spending on testing and tracing programmes will fail every test employed for successful treatments or interventions recommended by NICE guideline standards. Increasing the testing capacity and finding more and more healthy cases will indeed shut down the country without the need for any lockdown, which is not an intended outcome of successful pandemic handling. The focus must change to dealing with Covid-19 infections head on otherwise we risk more deaths as a result of Covid-19 in the long run, especially given the fact we still haven’t found a successful vaccine or a targeted drug.
In the absence of an effective vaccine and a safe and targeted drug treatment, we will only intentionally delay the spread of Covid-19 through the population whilst spending billions on building up testing capabilities. Whenever or whichever way this pandemic ends, its legacy built of successful mega testing capabilities will be of no use to health services for years to come.
Competing interests: No competing interests
After a trough in new Covid-19 cases in the UK over the summer, case numbers in the recent weeks have begun to rise sharply again . Either causing this or in spite of this, children have returned to schools  and the government is actively encouraging people to return to their offices for work.
As Rammya Mathew mentioned, returning to school is commonly associated with an increase in the reporting of non-specific respiratory and viral symptoms often attributed to mixing of pupils. In the SARS-CoV-2 pandemic, these symptoms are difficult to distinguish from those of Covid-19, therefore testing is increasingly important to differentiate the two. Predictably, news reports of parents desperately seeking Covid-19 testing for children with symptoms consistent with viral respiratory infections have occurred with enough frequency to have appeared in the mainstream media .
However, this problem is not confined to the general public, and may already be directly affecting workforce planning in the National Health Service. Healthcare workers around the country have been reporting self-isolation whilst awaiting testing and thereby reducing the available workforce to deliver essential care to the population. Our own department has already seen an approximate loss of 2 working days from each staff member with symptomatic children in the past week, and this situation has occurred in 5–10% of our staff members. Whilst some larger institutions such as ours may have redundancy to cope with this impact, the implications of an increasing population prevalence may have more severe ramifications particularly to smaller institutions.
At a time when elective services are being scaled up to address surgical cancellations that occurred earlier in the year , and requirements for personal protective equipment have eased , it has never been more pressing to ensure adequate testing facilities are available to healthcare workers. This will safeguard the ability of our healthcare system to deal with both Covid-19 and non-Covid-19 healthcare demands. The urgency to deliver on this need cannot be understated.
Danny J. N. Wong is an Anaesthetic Registrar at Guy’s and St Thomas' NHS Foundation Trust
Twitter handle: @dannyjnwong
Kariem El-Boghdadly is a Consultant Anaesthetist at Guy's and St Thomas' NHS Foundation Trust
Twitter handle: @elboghdadly
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Competing interests: No competing interests