Find, Test, Trace, Isolate, Support (FTTIS).

In this thread, I’m going to summarise the premise of FTTIS, and why it is absolutely crucial to have a robust FTTIS system in place ahead of schools, unis, & wider society reopening.

1/

Find – Finding cases is the bedrock of FTTIS. If you don’t find the cases, you can't isolate them, you can’t trace their contacts, and so you don’t break the chains of transmission.
The more cases, and the earlier you find them, the more chains of transmission can be broken.

2/

The @ONS estimates 24,600 people are currently infected/would test +ve for COVID19, & @timspector KCL symptom tracker suggests 20,000 symptomatic patients. We arent finding all of these. But apart from encouraging symptomatics to get tested, how do we actually find more cases?

3

Testing – As well as assisting with the diagnosis of symptomatic cases, testing can also help find cases. We should continue to test symptomatic people who need a test, but we should increase our efforts to do mass screening in outbreak areas.

4/

This mass screening can go a long way to suppressing outbreaks & avoiding the need for lockdowns. Testing can be made 5, 10, 20 times more efficient than it is currently by using pooled qPCR, saliva samples, & other innovative testing strategies. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30362-5/fulltext

5/

Ideally, testing should be done with <24h turnaround and performed locally, utilising local and mobile labs, and setting up in community spaces too.
LAMPore & rapid at-home kits are contentious but have huge potential. I expect these to eventually be approved for mass use.

6/

We do need to keep in mind the potential for false -ves (a lot of these likely caused by self-swabbing), and ‘false’ false +ves.
@who/ @phe/ @ECDC_EU & the scientific community as a whole need to do more to put together comprehensive guidelines for SARS-Cov-2 mass testing.

Tracing – Contact tracing is critical to breaking the chains of transmission. This should be done by local public health teams, who are well trained and know the area and the people. Atm, the average number of contacts given to tracers is 2, and many aren’t reached.
7/

In SK, NZ, Germany, 10s, or sometimes 100s of contacts are traced. We are now also doing cluster busting’, where we trace back up the chain. This has been used very successfully in SK & Japan, and is especially important for COVID given the potential for superspreading events.
8/

Isolation – The only one that actually matters. We can test and trace as much as we like, but if infected people don’t self-isolate, the chains of transmission aren't broken & our efforts are in vain. Atm the UK has no data on how many people are isolating when advised to do so
9

In Senegal (& China & elsewhere), they offer isolated accommodation to anyone who needs it. https://twitter.com/ScienceShared/status/1268578015086358528?s=20
We could do this too (hotels/Nightingales), & it would go a long way to preventing spread within multigenerational households, where transmission often occurs.

10/

Support – In order to self-isolate properly, people need to be supported properly.
A recent study showed that if we don’t pay people sick pay when they have to isolate, many won't isolate and will continue to go into work. http://oecd.org/coronavirus/policy-responses/paid-sick-leave-to-protect-income-health-and-jobs-through-the-covid-19-crisis-a9e1a154/
11/

Out of all the countries in Europe, the UK is at the very bottom paying sick pay for isolation. https://twitter.com/The_TUC/status/1289456328293875714?s=20
If we don’t invest in support systems which enable people to isolate, the rest will be in vain.
12/

As well as financial support ensuring sick pay and ensuring no discrimination comes from employers, we also need to ensure healthcare professionals can check up on those with symptoms. Currently, you can go through symptoms, test, *recover,* with no contact with a doctor.
13/

Given the potential for things to turn south quickly, and the damaging effects of long COVID, it is important to monitor people with symptoms, both to help them recover but also to better understand long COVID in general.
14/

If we implement this FTTIS system, we will be able to really drive case numbers down, and make the reopening of schools, society, and the economy safer. We will also be much better placed to deal with the (likely) potential second wave in the autumn/winter.

And if we dont...
15/

'If we don’t take FTTIS seriously our economy will spiral downwards. With better pandemic planning, we could and should have had an effective isolation policy in February. Not to have one 6 months later is nothing short of public health malpractice.'
https://www.independentsage.org/an-independent-sage-discussion-document-on-contact-tracing-and-self-isolation/

End

https://twitter.com/ScienceShared/status/1288454043438850048?s=19