After having over three months to prepare, the government test & trace strategy appears really poorly thought out. Here's a thread about the gaps between a successful test, trace & isolate strategy and what the govt appears to be doing. https://www.theguardian.com/world/2020/may/27/englands-coronavirus-tracing-plan-beset-by-conflict-and-confusion?CMP=share_btn_tw

1. The success of test, trace & isolate is firstly dependent on the turnover time of testing- ideally this should be less than 1 day. It is very unclear what the actual testing capacity in the UK actually is, as stats around this are deliberately opaque. https://www.theguardian.com/world/2020/may/28/government-target-of-200000-covid-19-tests-meaningless

2. It's dependent on the ability to trace contacts. This is not a simple endeavour- it needs public health expertise, and experience with local communities, as well as trust. It makes no sense that the govt has outsourced this to commercial companies that lack any expertise.

Especially when local public health officials who have experience with this have been sidelines. Furthermore, it undermines public trust, where this is essential to the success of the campaign.

Serco has been implicated in fraud, which doesn't engender trust, and why is the campaign being led by someone who presided over a massive data breach, and has no experience with a public health campaign. This frankly makes no sense.

3. The success of the campaign also depends on the last bit- the ability to convince people to isolate. This isn't as straightforward as the govt is making it out to be. Here's why:

Given the currently high transmission in the community, it's possible that large proportions of the population may need to isolate. Other countries that have implemented this, have done so with measures that mitigate the overall impact on society.

E.g. organising work (esp for key workers) in shifts, or physically separated teams that never change or mix, so that if one of them is infected, the impact doesn't extend widely across the entire team. This has allowed crucial sectors like health care to function.

There is no sign that there are any guidelines for key workers to do this - essentially, each organisation has been left without guidance to make up its own rules, which will likely lead to significant impact on the workforce. Why is this important?

Isolation is voluntary, and if the impact on the workforce is high, it's likely to lead to work cultures, where employers do not encourage or allow absences, which may make it less likely that people feel ready to report colleagues as contacts, and to isolate when contacted.

There does not appear to be any regulation that forces employers to comply with this, or support workers who may face retaliation due to absences. In healthcare, HCWs may have to make choices between the high impact of absences on health care capacity, and isolating themselves.

Lastly, the govt always said that contact tracing is something that's best done through a combination of approaches. Yet, their digital contact tracing appears to have been beset with problems, as they've taken a different route to most other countries.

It is very unclear if and when this digital system will be ready, it's legality with regards to processing identifable data, & whether the uptake will be sufficient given the justifiable lack of public trust.

Manual contact tracing is also likely to be beset with problems as early reports suggest, given training of contact tracers involves just watching a video, for a job where experience really matters. This is unlikely to be sufficient for a job that is quite complex.

It makes no sense to have contacted local authorities who should have led this initiative so late. They had the relevant expertise, and know the local communities. Yet, we've again chosen a route that makes no sense, and is most likely to not deliver to the extent we need.

Lastly, the lack of centralised data collation (from testing) which is a real issue really stunts the potential of any campaign to actually identify specific outbreaks and take measures to control them. To date, data from outsourced testing is not available to local authorities.

Essentially local authorities that need to be empowered to make decisions around controlling local outbreaks in schools, in the community, in care homes have not been given the data to do so. It's unclear if this will be made available to them in time to actually be meaningful.

Sorry, realise there were 2 'lastly's there'. Just reflects my generally poorly organised tweeting off the cuff. Sorry!