Many people in UK Public Health are doing a brilliant job manning 111 lines and giving excellent advice and triage. So too are our local authority teams. Front-liners taught me how the system works. Here’s how they +primary care, are the solution to suppressing #COVID19 (1)

I’ve tested the 111 service, questions +survey online. Easy to answer + fine triage questions about symptoms, severity, timing, no of contacts +postcode. Positive cases are routed to local GPs. Same for people who call in. But delays in getting through to 111 are a problem. (2)

We can therefore MAP cases in every postcode in the country in REAL TIME. This data could be analysed to give a full breakdown of cases with time of onset of symptoms and symptom severity. Great data for modellers and for community feedback. (3)

We will know where are the hotspots and where intensity is lower. PHE could publish and update this detailed data every day online. Feedback to communities is important to build trust (4)

From Asia experience, WHO emphasises personal contact w suspected cases to assess clinical progress, reassure, trace contacts, answer their Qs, reduce stigma + ensure compliance with quarantine. We only need one more step to make home visiting happen. (5)

For LOW INTENSITY areas, volunteer pairs (one clinical and non-clinical) attached to every general practice might do this in hotcars. Retired nurses and doctors, medical/nursing students cd assist GPs to assess, reassure, collect swabs (maybe) + monitor clinical progress. (6)

COMPLIANCE will quarantine will be much better. Non-clinical volunteers can ask about contacts and how to trace them. All would need PPE. (7)

In HOTSPOTS like London, the Midland and Northern cities, workload is too high and contact tracing too difficult. The emphasis here is on GPs in hotcars in PPE to assess sicker patients at home. Mobile phone conversations and reminder texts could be used to monitor quarantine.(8)

In hotspot areas overload to 111 means long delays in answering calls. We must find ways to speed it up. The ambulance service is overstretched, and COVID queries must be separated from conditions such as a suspected child with meningitis. (9)

After hours in London, out of hours doctors take over 111 to speed up triage. For COVID patients they can send them to ‘hot tubs’ to get tested in car parks, or referred to a GP hot car service. (10)

So the UK the 111 system linked to GPs offers a great way to know the number of definite/probable cases, + map where they are. It's a simpler and better screening method than a virus swab test which is negative in around of 30% of cases. (11)

Testing would be nice but it is NOT essential for an effective way to isolate cases and contacts in the community. (12)

What about TESTS? Neither virus nor immune response tests are totally reliable. Health worker protection is really difficult. With a viral swab it could be a FALSE negative, when you cannot be certain they don't have the infection brewing. Dangerous to send them back to work.(13)

If you have an antibody test which tests as a FALSE positive (for example, the test is picking up antibodies to other viruses), you cannot be certain that they are IMMUNE. People will go to work with false confidence. (14)

That's why IMMUNE tests may not come on stream because their ’specificity’ for COVID is probably not good enough. But they are important to understand the spread of immunity across the population and see how long it lasts.(15)

In summary, our public health and GP system can measure probable COVID cases + map them in real time. With a little adjustment, they cd provide personal follow-up, esp in low intensity areas, to tighten up quarantine of cases + contacts. Prob as effective as S.Korea/China. (16)

For lifting LOCKDOWN, we could review case density and death rates in low intensity and hotspot areas. Below a threshold for these indicators determined by the modellers we could do a phased lifting of the lockdown in LOW INTENSITY areas to get the economy going again (17)

In HOTSPOT areas we might delay lifting the lockdown (as in Wuhan, China) until they reach the same threshold. Once they do we shd return to community surveillance for cases, contacts and quarantine. And preserve + intensify community surveillance in every region. (18)

Hopefully, we can then maintain our ECONOMY with only cases and contacts in isolation, maybe 5-10% of the population, rather than national lockdowns with >50% in isolation. National lockdowns cause huge economic damage. (19)

For now, Korea and other Asian states are managing to restore their economy with only community case detection, testing and isolation. And they suppressed spread in 6-8 weeks. We can do the same. Slowly, we can also solve the viral testing issue. But its not essential. (20)

I must have made errors in this thread. Feel free to correct me. Our UK primary care + public health system hold the key to breaking the transmission of COVID in our population.(21)

In the meantime we must do everything to protect our frontline health workers in hospitals. They are risking their lives. New science yesterday means masks for everyone. We must show our enormous gratitude for their incredible dedication and bravery. (22) https://www.nature.com/articles/s41591-020-0843-2