Thread by @fascinatorfun

Can’t help but think that the MPs on the Science & Technology Committee should be running the COVID-19 response Strategy.

Several recommendation (almost certainly already provided to Government earlier) driving forward test- trace- isolate expansion

publications.parliament.uk/pa/cm5801/cmse…

Recommendations about transparency and the need to rely on scientific advice (more about that later).

They confirm, as I previously flagged, 92 out if 120 papers/ docs/ minutes from SAGE have yet to be punished, despite some being so early May after the 24/4/20 SC hearing .

I wasn’t sure of the number, although it was a virus there were substantial gaps.

An explanation about why the secrecy would be good given the CSO concedes that state security is hardly an issue (unlike with Skripal).

Public confidence turns on openess.

As does openness to excellence and proven good practice from other countries and WHO advice.

Finding that Test-Trace-Isolate has been inadequate. Capacity drove strategy rather than the other way around.

Sage and scientific advisors expressed the view that it had been too low.

The committee hears from Korea, Hong Kong and Germany.

Despite saying, on 25 March, that PHE WOULD share the basis for their pivotal decision to choose a smaller scale testing than other countries, it has still been unresponsive to the committee repeated requests for it.

Instead it points to a Royal Society study currently being carried out into another countries’ approaches.

It seems that SAGE had recommended expansion of test-trace but it ended up not being modelled due to feedback from PHE of the inability to provide capacity (as I suspected)

Indeed Sir Paul Nurse, Director of the Crick Institute, confirms that he offered his laboratories and staff to the testing effort, he did not receive a reply for weeks, and then only when they publicly announced their provision for testing healthcare workers.

Meanwhile residents in care homes with symptoms were not being offered testing.
Neither were care home workers.
Neither were patients being discharged into care homes from hospitals.

By 12/3/2020 community testing was abandoned altogether rather that urgently expanding capacity.

This decision appears to have been made within Government rather than on the recommendations of SAGE, and reveals the sometimes difficult line between advice, the factors leading to modelling outcomes, policy and process.

There appears to have been little in the way of strategy or delivery of rising to the challenge of identifying and managing the likely significant numbers of asymptomatic carriers transmitting to others.

2 Papers suggest that asymptomatic disease likely to be high:

1/ in one study 85% of pregnant women who tested positive asymptomatic.

2/. All of 200 in a homeless shelter who tested positive were asymptomatic. A vulnerable group.

Recommendation:
Capacity should not determine the amount or strategy for testing.

Surge should drive capacity.

I can understand, early on, there being Hobson’s choice re capacity.

Many countries faced the same problem but did not hesitate to enforce strict, precautionary and extensive isolation whilst they built capacity, thus curtailing spread.

The continuing failure to scale up, however, is hard to understand and appears to have been deliberate

Way back in March Prof Ferguson (Imperial) was asserting that reduction in lockdown would need a substantial increase in capacity for test, trace, but PHE said they did not have nearly enough capacity

Did they ask the Gov for capacity expansion & refused or did they not ask?

I think that is a pretty important question.

Were ministers told we had way too little test and trace capacity, needed more and how much more, but was refused and told to make do. Or did they not ask? If not, why not?

What is the dynamic going on?

Prof John Edmonds from LSTHM said contact tracing would play “a part” but the amount and extent was an operational decision for Gov and modelling would spring from those operational decisions made.

It is not clear whether there was an active recommendation from him to expand.

Recommendation: Gov must buildup contact tracing capacity urgently to reduce the impact of a second peak.

Reliance on a contract tracing app unlikely to be sufficient, altho’ manual contact tracing very resource intensive.

Meanwhile ISOLATION. We have not had an effective operation strategy

Even extensive test & trace on their own are insufficient on their own.

Effective isolation and active monitoring compliance with it are features in successful countries with designated living and treatment.

I am still not clear whether our contact tracing “call centre” set up includes capacity and a strategy for monitoring and supporting effective isolation OR whether ther is provision for state provided isolation facilities for mild cases that cannot effectively self isolate.

The committee recommends that the Government SHOULD make adequate provision as part of an effective strategy.

VACCINES: Manufacture needs to precede proven success if fast deployment of successful vaccines is to be possible.

RECOMMENDATION: Capacity for manufacture and planning for deployment NOW in advance of need so that mass deployment can start as soon as safety is proven.

HIGH DEATH RATE AMONGST ETHNIC GROUPS & STARK INEQUALITIES

RECOMMENDATION: Systematic collation of data in relation to these groups should be undertaken.