February 18, 2021 - 5:00pm
You may have forgotten that we have a test-trace-and-isolate (TTI) system. I almost had. But it was quite an expensive thing; £22 billion has been made available for it, although I don’t know exactly how much has actually been spent. It’s also widely said that it didn’t work very well.
Interestingly, a Government report came out last week which seemed to confirm that point. But it’s been (as far as I can see) largely ignored; the estimable Full Fact has just published a piece on it as I’ve been writing this, and the Guardian mentioned it a few days ago, but other than that I don’t think it’s got much attention.
Partly, that’s because the report was not press-released; partly it was because Dido Harding, the chair of NHS Test and Trace, somewhat overstated how positive its findings were, in front of a Commons select committee.
The report was based on a mathematical model, rather than an observational study. It found that the entire TTI system reduced R by between 18% and 33%. But the actual tracing bit, the phoning-people-up-and-tracing-their-contacts bit, made a very small contribution — reducing R by between 1.7% and 4.6%.
All the rest of the impact, the model said, was down to people self-isolating when they got symptoms, which you don’t need contact tracers for. Harding told the Commons science and technology select committee that the model suggested TTI brought down R by “between 0.3 and 0.6”, but that’s using the 18-33% figure. Using the 1.7-4.6% estimate, it would be more like a reduction of between 0.02 and 0.05.
Of course, the model may be wrong. But it’s the government’s own report, so it’s a bit embarrassing, and probably ought to be more widely known. I should have said that the phoning-people-up contact tracing only accounts for a part of the £22 billion cost, probably a billion or two; the rest was on testing. But a billion here, a billion there, and pretty soon you’re talking about real money.
I think there’s a bigger issue here, too. A statistician I spoke to grumbled that TTI was assessed entirely on “process metrics”: how many people were contacted, things like that. But there were no “outcome metrics”: as in, how many people actually didn’t get ill as a result. That’s hard to measure, but it might have been possible if it were carried out as a randomised control trial (RCT), with contact tracing randomly assigned to some areas and not others.
That would, in fact, be a good general policy. We don’t know the impact of schools on R. We would like to. If we were to randomly select schools and open them for two weeks, we might be able to see differences in R, and as a result do policy better. Policy RCTs are weirdly unpopular, but they would be extremely powerful now.
“They love to decide, announce, defend,” says my grumbling statistician, “instead of experiment, adapt, improve.” The TTI system has, per the government’s own report, been an expensive failure, even if no one is talking about it.
There’s no shame in things not working out, but there’s quite a lot of shame in not admitting when they don’t work out, and not trying to learn from the failures.
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SubscribeAll Western governments have been between a rock and a hard place on this, but none more so than our government, faced with a media victriolically keen to find something to criticise.
The WHO said “test, test, test”, so we test, test tested. It doesn’t seem to have made much difference.
The WHO said don’t wear masks, so we didn’t. Then it said wear masks, so we did. It doesn’t seem to have made much difference.
The WHO said “trace, trace, trace” so we trace, trace, traced. It doesn’t seem to have made much difference.
It’s almost as if you can’t micromanage your way out of a pandemic. Who’d have thought it?
(Well, prior to march 2020, just about everyone – including WHO)
They even had a document on what to do when a pandemic comes along. Had the government followed that document we would be down the pub right now exchanging stories of the things we got up to on our holiday to Busch Gardens last summer!
(Busch Gardens?, much better than Disney or Universal)
Amen!
Hey – you forgot gelling your hands on entry & leaving.
You’d think if we had a media “victriolically keen to find something to criticise” that they would have covered the criticisms in this report.
My impression is that instead we have a media quite happy to churn out whatever is in the press releases they are handed. Followed, in some cases, by two talking heads – one of which says “boo, yah, rubbish” and the other says “brilliant job well done” – and neither of which does anything like analysis of the story.
Dougie suggests that we followed WHO advice rather more closely that we did. The WHO DG said “test test test” back in 16 March 2020. The advice was based on the experience of countries which had already been doing this. NHS/Serco Test and Trace wasn’t launched until the end of May, by which time we had over 250,000 cases (based largely on only testing people who were sick enough to be hospitalised), and the first peak had significantly subsided.
And as for “trace trace trace” – the point of this article is that we are still conspicuously failing to do this.
Asymptomatic and presymptomatic spread have been suspected for over a year now, and it’s pretty much proven that many cases are mild. Was there any scientific reason for mainly tracing the contacts of hospitalised cases?
I’m still waiting for any form of evidence (as opposed to opinions or claims that confuse association with causation) that any of the restrictions and strategies against covid, other than vaccinations, have worked.
None of their strategies worked, and there is no evidence to show that they did. All the evidence suggests that countries and states that did not lockdown – Sweden, Croatia, Florida, the Dakotas – fared much better. One reason for this is the obvious fact that the virus does not spread outside, so if you tell people to ‘stay at home’ they are more likely to get the virus. Numerous national na and state authorities will have killed thousands of people in this way. The other fact is that social distancing and masks force the virus to work harder in order to spread, thus creating stronger strains.
The other fact is that social distancing and masks force the virus to work harder in order to spread, thus creating stronger strains.
What a quaint idea ! This virus can only survive and most importantly replicate by being in a very particular warm, wet environment (respiratory tract, maybe conjunctiva, inside a cell of some sort or another). It requires the factory processes present inside a viable cell in order to replicate.
This virus changes (at a relatively slow rate compared with some others) by undergoing random changes in it’s genome. These changes can only occur when it is in a suitably cosy environment (a body) and replicating.
Therefore the main selection pressures exerted on this virus are present in its host – that particular body’s immune system. Absolutely nothing to do with social distancing and wearing masks – interferons, antibodies, B and T cells etc do not exist outside a warm body.
The contested “increased transmissability” of the B1117 (UK variant of concern) strain and others is down to apparently increased binding of this virus to ACE2 receptors on cell surfaces (a larger proportion of virions that you breathe in get stuck to your cells and then replicate) and possibly an enhanced ability to evade antibodies produced by the early, innate immune response (more virions can get on with replicating without interference).
All this and much, much more at “This week in virology. The podcast about viruses (the kind that make you sick)”.
Proper scientists talking about proper science.
You cannot cite 4 disparate places as proof of a general assertion that lockdowns do not work. There could be any number of confounding factors that are the cause, and this is quite apart from the fact that you are wrong about these places. The Dakotas have done particularly badly in excess deaths last year and deaths are surging in Sweden and Croatia – you need to get up to date and modify views in the light of facts.
Your last sentence is laughably ignorant of how viruses work. Do you think that if people wearing masks and standing far apart, the viruses start doing a few press ups and some aerobics so they can batter their way through masks?
“The Dakotas have done particularly badly in excess deaths last year and deaths are surging in Sweden and Croatia “
Deaths in Croatia, Sweden and South Dakota are very low. look it u at the worldometers website go to Coronavirus Updates and see for yourself. Also Florida is doing much better than comparable states in the USA.
The vaccines are not working for this year either . At this moment we are seeing the end if Jan Feb flu season. Only time will tell how much they work and how many we will need per year till we stop pretending it is an existential threat to mankind & start treating it like flu by preparing for mentally, physically as well as boost & improve resources to deal with it rather than use crude lockdowns and idiotic masks etc just because WHO say so.
Plain masks are said to work just as well.
Simply compare the death curves for different countries or US states with similar demographics that have done things differently. I particularly like the Florida and California comparison especially since Florida has an older population. Sweden is an inconvenient classic for the lockdowners.
Conclusion : SARS-COV-2 is behaving like a typical respiratory illness that rises up and falls away irrespective of anything humans do. The only thing humans have done is isolate some populations and thus delayed the inevitible.
Are you seriously suggesting that the drop in cases each time lockdown was imposed is just a coincidence? Or that New Zealand is an intrinsically inhospitable environment for SARS-CoV-2?
They just got lucky
by failing to have a buffoon as their leader.
Pleas show the data? PS. In Australia now isnt summer season?
TTI was never going to work with a virus that is easily spread by people who have no symptoms. The tests that are fast enough and accurate enough for it to work do not exist. TTI was and is a complete fantasy.
The TTI model is based on the assumption that people in East Asia respond to COVID the same way other people do. This is completely false. TTI “works” in South Korea, just as doing nothing “works” in Cambodia. Neither country has had high mortality, even while following diametrically opposite strategies.
Doing nothing in Cambodia?
Real world RCTs are an excellent idea but also considered immoral by people who already know what’s best.
If we made 1000 schools old fashioned, disciplined places with hard exams, and 1000 schools touchy feely do what you want type places, we could then compare long term outcomes. But proponents of both ideas already know what’s right.
It does feel a bit immoral to use real people in tests, but it’s also the best way to test things in the wild.
Track and trace appears to be a fools errand, and a very expensive one. If you’re clearly sick with a contagious illness stay away from people, we shouldn’t have needed Covid to support that thinking.
You might also need a working sick pay system for zero-hours workers who otherwise can’t afford your perfectly sensible advice to “stay away from people”.
One aspect is that nobody used it to “check in” to shops that remained open during lockdown. When pubs were open they were very strict making sure everyone who entered ‘checked in’ on the NHS app. However, none of the shops I have ever been to have ever asked me to check in. So what’s the point? Although I don’t particularly think the app is a good idea, the most simple thing they could have done, which was to spot check shops to make sure people were checking in, was ignored. Lots of QR codes in windows but nobody scanning.
I think the point is you spend minutes in a shop and are constantly moving, whereas you spend hours in a pub or restaurant in the vicinity, largely, of the same people.
I am against the idea of being traced at all times & I suspect many may have the same misgivings about being on constant surveillance
There is a legitimate public health justification for contact tracing during a pandemic (though clearly not “at all times”). But you should express your concern about data privacy to the government, to ensure that future initiatives (unlike track and trace) do consider privacy from the start.
It was obviously always going to be a complete waist of time a bit like herding cats. Boris was too timid he should have told Skammer to stick it.
is that why we continue with Track and Trace by having children testing 2x per week? is that the ususal strategy of doubling down when things do not work?
the room for discrimination is massive and needs to stop
Yes! Akin to the promotion of double masking.
I would have made a lot of money betting that this wouldn’t work…
I doubt it, bookies employ quite sensible intelligent people to set the odds. The odds you’d have got would have presumed failure as the almost certain outcome.
The bookies don’t have pretty theories to promote or obvious biases to apply. When they set odds on a football match for example they work it out in a dispassionate way, they don’t overrate their favoured team massively.
True!
You could always have made bets with supporters of the government – they have been much less dispassionate in assessing the risks.
Compared to the varied, long term and significant costs of lockdowns, £22,000,000,000 for a failed ‘track and trace system’ was a snip.
When Germany started its test & trace program we get having it thrust down our throat how much better they were doing than the UK. When they had their second wave and it fell apart for a while it wasn’t really mentioned. Can’t think why.
If the problem with RCTs for public policy is that we don’t want to withhold the intervention from the control group, we could use ‘stepped wedge’ RCTs: all participants get the intervention eventually, but the roll-out is staggered.
Well if you wanted to run a complex organisation ….
You would choose someone with a good track record. And you certainly wouldnt choose anyone related to a senior person in or near Govt for obvious conflict of interest reasons.
Of course Test and Trace was never going to work when the population is still reeling from the mandating of first Racial Equality and then all the other equality nonsense we have had to put up with.
In fact vaccine hesitancy is an unsurprising unwanted consequence of the Left’s desire for a truly multicultural society.
That’s a bit of a stretch. You might as well blame it on a third of the country reeling from the trauma of losing the Brexit referendum, another third from having their desired Brexit dragged out for years, and the remaining third reeling from having to listen to the other two thirds fighting about it, and all of us reeling from how it’s going so far.
And isn’t there also vaccine scepticism on the right?
The only thing that works is a lockdown. To date, UK’s lockdowns have been a joke – with so many people out and about that the spread has continued almost unimpeded.
Do a proper lockdown. They work,
Then TTI will make sense.
The real problem is that TTI looks the wrong way. If we asked what contacts an infected person had had in the week running up to his test then we could identify who had been his ‘spreader’ and where and when the infection had occurred. The former might well have been asymptomatic, and hence unknown to the programme, and his contacts would have been a fruitful line of enquiry. More importantly, the ‘where’ and ‘how’ of infection would have been identified, and this could then have informed public policy in an objective manner.
“All the rest of the impact, the model said, was down to people self-isolating when they got symptoms.”
Is that really how the UK system worked? In Cambodia, all contacts of anyone testing positive are traced and tested, and all positives and their contacts are isolated until testing negative twice. Symptoms are an entirely separate thing. Zero deaths so far. (Andrew Harvey, ‘doing nothing “works” in Cambodia,’ please note!)
Having just experienced it I thought it was pretty good actually. The thing I have to remember of course is that my part in it was only activated because I chose to activate it by ordering test kits online (my partner started showing symptoms so I ordered for both of us). But the process, the speed, the efficiency, the regular phone calls, I thought wow, seemed pretty good to me – but what do I know?
I noticed.
Absolutely.
Now Tom to apply the same logical thought process to lockdown.
Sweden, Japan etc are your RCT.
When are people finally going to wake up from their fugue state?
I don’t know when PCR tests were invented but consider a thought experiment:
Another highly infectious corona-virus occurred without PCR or lateral flow tests. The experts would have told people with identified symptoms to isolate for ten or fourteen days. No early release!
However with TTI system, even if the results take 24hrs to 48hrs all persons receiving negative tests save between eight and thirteen days, some of those being working days. Even, allowing for working from home, retired etc this might pan out as five days work saved per tested person, say @ £100 a day or £500 saved for between 98% and 85% of those tested. The Government would get income tax and NI on this say average 30% or £150. Everybody wins.
Plus from a mental health point of view you only have to self-isolate if you actually are infectious!
The bonus is through tracing some persons infected by a positive case might be tested and asked to isolate!