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Rapid response to:


Covid-19: England’s test and trace system records worst weekly performance since launch

BMJ 2020; 371 doi: (Published 15 October 2020) Cite this as: BMJ 2020;371:m4027

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Rapid Response:

Covid-19 test and trace: localised approach urgently needed.

Dear Editor

We are grateful to Iacobucci for drawing our attention again to some of the issues with England’s test and trace system.(1,2) In our earlier rapid response we stated that we did not think that testing was being given the priority it deserves.(3) We are saddened that over 6 months later there are still major problems.(1)

Accurate data is essential for effective public health practice and can be used for:
1) Highlighting current and new issues
2) Planning
3) Monitoring
4) Evaluation
5) Raising awareness and encouraging action with members of the public, health professionals and policy makers.

A high-quality coronavirus testing scheme would help us to know precisely the size of the current problem and accurately pinpoint outbreaks. This information would support local communities and national government, planning interventions, as well as informing them if their past work had been successful. Importantly with a trusted scheme like this the public are more likely to back interventions and change their behaviour so that transmission could be reduced.

Crucially, any testing scheme needs to be carefully thought through and be part of a Test, Trace, Isolate and Support system. Moreover, this needs to be part of an overarching public health strategy. The emphasis should not just be on aiming for high testing numbers, as this on its own will not tackle the virus and will not improve the health of the country.

The DPH leadership role is pivotal to the health of our communities.(4) The DPH and their multidisciplinary teams have detailed knowledge of their communities and significantly they have long standing relationships with key individuals and organisations.(5,6) Positive local relationships often lead to trust, which is very important in this area. We recommend that local DsPH are put in the driving seat of the Test, Trace, Isolate and Support system. However, critically they also need to be given the resources to enable them to make it a success. Funds need to be re-directed from a national level.

At a local level we would like to see far more involvement of general practitioners, environmental health officers, health visitors, and other health professionals who are working in the community. Together they have considerable knowledge, skills and experience to offer a local Test, Trace, Isolate and Support system. Although primary care is the cornerstone of the NHS it has been much underused in this pandemic and it should have been at the forefront of efforts to control the pandemic.(7,8)

In relation to the national level there is still a need for coordination and support of local public health professionals. One key role is that data needs to be collected, analysed and disseminated in a timely manner. We feel there is a need for a new national body to undertake this which is led by elite public health professionals who are qualified and have extensive experience in public health.(9) Primary care should also be represented at this strategic level.(7)

In the current situation we are having blanket lockdowns and many individuals are being restricted even though they are not ill. Significantly, there are already reports of non-covid adverse health effects. In addition, there are negative economic effects on individuals, families, businesses and the country. We believe that with a locally driven well-funded Test, Trace, Isolate and Support system more precise information will be gathered, a higher proportion of people can be isolated and supported, and there will not be a need for blanket lockdowns.

1) Iacobucci G. Covid-19: England’s test and trace system records worst weekly performance since launch. BMJ 2020;371:m4027

2) Iacobucci G. Covid-19: What is the UK’s testing strategy? BMJ 2020;368:m1222

3) Watson M C and Lloyd J. Covid-19: we need to give testing the priority it deserves. British Medical Journal Rapid Response 29 March 2020.

4) Watson M C and Lloyd J. BMJ briefing: meet the new masters of public health. British Medical Journal Rapid Response 8 July 2013.

5) Woolliscroft T, Kelly S, Ramirez R, et al. Covid-19: Better contact tracing could help save lives and the economy. Insights on how to improve contact tracing from a community pilot project. BMJ Opinion, October 12, 2020.
[Accessed 13/10/20]

6) Iacobucci G. Covid-19: Is local contact tracing the answer? BMJ 2020;370:m3248.

7) Park S, Elliot J, Berlin A, et al. Strengthening the UK primary care response to covid-19. BMJ 2020;370:m3691

8) Smeeth L. A Martian's view. British Medical Journal Rapid Response 13 October 2020.

9) Watson M C and Tilford S. Health promotion is at a crossroads with the demise of Public Health England. BMJ 2020;370:m3750.

Competing interests: No competing interests

18 October 2020
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr Anne Coufopoulos, Trustee, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK.