Again. The biggest problem with opening up the economy and life is identifying ESPECIALLY the asymptomatic transmitters (Maybe responsible for c44% of transmissions).

Test early symptomatic and super fast tracing of contacts through old fashioned leg work plus technology.
Test https://twitter.com/trvrb/status/1250855512226164736

A continuing cycle.

It is important to say that trying to test the whole population every week or two in the hope we will happen upon the right person at the right time is neither intelligent nor deliverable.

Labs need to be able to turn around results super fast to support early isolation.

This won’t be possible (as NY and parts of the US have found out) if you aim to test everyone. You just get long delays in the labs. Meanwhile the virus transmits and patients recover/die

Given so much of transmission seems associated with communal living I would like to see much lower tech, smaller, local isolation units so people isolating and positive are NOT mixing with the communal group. (A key component of both S Korea and Singapore),

People in larger houses and with multiple bathrooms (shared bathrooms seem to be an additional risk) really cannot isolate well.

This means the poorest and most disadvantaged are again hardest hit, especially if living in multi generational households.

The other reason we need to identify asymptomatic positives in particular subgroups (especially the vulnerable/elderly) is we really need large scale clinical trials as to whether early intervention with (eg) certain anti virals reduces the risk of the virus spreading.

If all of this is fed into surveillance software it will ALSO be much easier to set up comprehensive serology studies re antibody and post viral resistance.

Which groups produce the antibodies most and maintain it for longest?

Are other immune responses at work?

Now. Tracing. This requires quite a lot of preparatory work when the tracing personnel have been so badly depleted. A decade ago there were 10k people in PH and Environmental / local Gov who were trained to do this work.

Now there are 235 people spread around 9 PHE hubs.

“Volunteers! We have an army of volunteers!” I can hear.

Steady up. ALL volunteers are going to have to be checked for convictions and they are going to have to be trained in software systems, confidentiality, DPA...

(YEP. ...that traced person who didn’t spend Tues eve with the lads playing snooker or in their patchwork circle with the girls but lolling in bed with their lover or up to other japes they won’t want disclosed) They need to know how to handle that.

And this already depleted 235 personnel with other day jobs is going to have to train and manage them all.

Wuhan had 1800 epidemiologists each leading a team of at least 5 people. Hubei Province has 59 mill people but the Wuhei Region where most of the work was concentrated about 35% of that
We COULD have risen to the occasion 10 years ago with reasonable speed.

We are where we are

Anyone who does this work has got to understand they are a small but important cog in a very very big surveillance wheel, with the ability to put key data into software so that an every richer picture can be built about spread and severity.

This thread from @AdamJKucharski spells out why testing without tracing just will not work...and why physical distancing will carry on being essential.

https://twitter.com/adamjkucharski/status/1252241817829019648?s=21 https://twitter.com/adamjkucharski/status/1252241817829019648