WeeklyWorker

09.04.2020

Testing times

James Linney has no doubt where the blame lies for all the failures

It has now been just over three months since China alerted the World Health Organisation about a cluster of unusual pneumonia deaths, resulting from an unknown virus, in Wuhan. It is likely though that this novel form of coronavirus (SARS-CoV-2) did not spill-over to humans in the seafood market, as initially thought, but was infecting humans in China at least as early as mid-November 20191 - probably earlier.

Like most coronavirus, SARS-CoV-2 is thought to have originated in one species (probably bats) and been amplified in a (as yet unknown) vector animal, before spilling over to humans. It will take time to fill in the blanks around the origins of the worst pandemic since the 1918 Spanish Flu. But that is for another time: the urgent and immediate task is to halt its devastating spread. It has now invaded 193 countries and sadly the worst is still to come. As is now inevitable, with outbreaks in India and throughout Africa, in the coming weeks and months we will see it take hold in cities and slums, where most people do not have the privilege of being able to self-isolate and where running water and soap are a luxury.

Covid-19 - the clinical syndrome resulting from infection by SARS-CoV-2 - still has no effective treatment. Thankfully the majority of cases are either asymptomatic or of a mild upper respiratory tract infection, and serious illness is rare in people under 30 years. Yet, when serious complications such as acute respiratory distress syndrome or pneumonia occur - often in the second week of the infection and linked to a volatile inflammatory immune reaction to the virus - the condition can quickly deteriorate, leading to many needing high intensity care and ventilation. In such cases survival rates are very low, particularly in older people or those with underlying health conditions. Hence in Italy we have seen medics having to make the difficult decision to prioritise younger patients where intensive care beds and ventilators are in short supply.

Working out how many people die from the complications of Covid-19 is not as straightforward as it might seem. One thing to keep in mind is that all of the official figures are an underestimation. Because Covid-19 can be asymptomatic or very mild, in any given population there will be lots of infected people who never get included in the data. The case fatality rate (CFR) of countries varies significantly, so, for example, currently in China it stands at 4%, 6% in Iran and 10% in the UK, whilst it is only 2.4% in Japan, 1.7% in South Korea and 1.3% in Germany.2 These differences cannot be explained by just comparing the quality and capacity of critical care from country to country - partly because the outcome from serious complications is so dire. The more important factor is the ability to identify potential cases and the quantity of tests each country is carrying out: obviously the more tests on people who are not just severely unwell, the lower the CFR.

There is a more important reason to test lots of people than to just make your CFR look good: the more people you identify as Covid-19 positive, the better your chance of slowing its spread. Mass testing identifies cases that are very mild or asymptomatic, allowing these people and their households to more strictly self-isolate. The other bedrock of infectious disease containment is contact tracing: the testing of people having had prolonged contact with a known infected individual, so that they can be isolated and then their close contacts tested and so on. This task is made much easier in a lockdown situation, where social contact has been minimised. Each identified infected person in the community helps us to illuminate what was previously largely an “invisible enemy”, as Donald Trump likes to call it. If testing en masse and contact tracing are the key to containing Covid-19, then, as we will see, the UK’s response to the pandemic can be used as a case study in how not to do things.

UK policy

The UK’s first death from Covid-19 was recorded on February 28, two months after the first official deaths in China: plenty of time for the UK government to have taken emergency steps to lock down the country and start a programme of mass testing. Yet Johnson and his government wasted this precious time in a state of arrogant complacency. Despite the devastation in China and Italy, their message was initially one of ‘business as usual’. Only a few weeks ago Boris Johnson was still trying to play the buffoon in a jocular news conference, telling us to sing happy birthday, whilst he bragged about shaking hands with Covid patients and needing to “squash the sombrero”.

Even when the reality of thousands of deaths forced the government to take some steps to mitigate the spread, its message was weak and contradictory. People were advised not to socialise as much, but bars, restaurants, theatres and cinemas remained open. Unbelievably, three weeks ago major sporting events were allowed to go ahead, where tens of thousands were crammed together - super-spreading events. By the time the official lockdown was announced on March 23, there had been nearly 500 recorded deaths in the UK and the virus was reproducing, largely unidentified, throughout the country. During this entire time very few tests for SARS-CoV-2 were taking place and only those most unwell in hospitals were being offered them.

To briefly summarise, there are two types of tests: one detecting active or very recent infection (the antigen test), which uses a technique called real-time polymerase chain reaction (RT-PCR) to detect amplified genetic (RNA) material from the virus. A result can be obtained in about three hours, but, depending on the laboratory’s capacity, most PCR tests take a couple of days.

The second is an antibody test, which helps determine the immunity of a person post-infection; it can take up to a month for immunity to be established, but there are currently no accurate antibody tests available in the UK. Developing an antibody test will be very useful for the future, and researching immunity will hopefully help the development of a vaccine, but this will not be available for at least another 12 months, probably longer. In the acute pandemic phase the priority should be to carry out the PCR tests - this is the one that helps us arrest the spread of the virus and minimise deaths.

Germany and South Korea have carried out the most PCR tests and they also have a much lower number of deaths, compared to their neighbours. As of April 3, Germany had carried out 11,127 antigen tests per million of population; with just under 92,000 positive cases, 1,446 deaths have been reported. South Korea, with 8,606 tests per million, has had 10,156 positives and only 186 deaths.3 The above countries, plus Malaysia, Singapore and China, have put a strong emphasis on large-scale testing, followed by contact tracing.

The UK by comparison has only carried out 2,500 tests per million, with 42,441 positive tests and now over 6,000 deaths - there has been no contact tracing in the community at all. The only testing of people with mild symptoms were for the rich and privileged - including, of course, Prince Charles and Boris Johnson. One profiteering private medical clinic took advantage of the lack of testing by selling them for a hugely inflated price of £375 each, reportedly making £2.5million in one week.4

On April 3 health secretary Matt Hancock hosted the daily Covid-19 update, where he announced that by the end of the month the UK would be aiming to increase testing to 100,000 a day. This is a drastic shift in policy, considering that at that time the UK had only carried out 173,000 tests in total. At the same time he stressed that testing was going to initially remain focused on those admitted to hospital and NHS staff, but that at some undetermined time there was going to be a shift to carrying out testing among the general population. Leaving aside the unreliability of any government promise for now, this announcement equates to an admission that its previous reluctance to test en masse was a policy error. But now it is obviously too late: the peak of infection is expected to be reached some time in the next two weeks. Mass testing should have started months ago, when the first case arrived in the UK. By the end of April the horse will have well and truly bolted.

Herd immunity

There has been much speculation on whether the lack of testing was due to the government unofficially agreeing on a ‘herd immunity’ strategy. This is a term used to describe what happens as a result of a population being vaccinated against a pathogen. At some point in the vaccination process, so many of any given population have gained immunity that those not immune are protected, because the infecting agent struggles to come across a host and the disease dies out. The horrific reality of allowing the development of some form of ‘natural’ herd immunity by allowing Covid-19 to spread unchecked throughout a population essentially equates to welcoming the suffering and death of tens of thousands of the most physically vulnerable - an utterly despicable attitude.

A Sunday Times article reported on a meeting in late February, where Dominic Cumming supposedly said: “… herd immunity, protect the economy and, if that means some pensioners die, too bad.” The government has since denied this happened, but it has undoubtedly been strongly influenced by both the Scientific Advisory Group for Emergencies and the Behavioural Insights Team (BIT - the ‘nudge unit’). These have largely determined the UK’s Covid strategy. The decisions have been made behind locked doors and with no evidence published, but these two organisations have clearly been advocates of the ‘herd immunity’ strategy. On March 11 David Halpern, chief executive of the BIT, said:

There’s going to be a point, assuming the epidemic flows and grows, as we think it probably will do, where you’ll want to cocoon, you’ll want to protect those at-risk groups, so that they basically don’t catch the disease, and, by the time they come out of their cocooning, herd immunity’s been achieved in the rest of the population.5

The governments’ lack of testing so far reflects this strategy, despite almost universal criticism from leading epidemiologists, the WHO and - god forbid - even Donald Trump.6 No matter how many tests are being carried out by the end of April, the months of delay can never be undone. During the April 3 press briefing Hancock gave a list of feeble reasons why more had not been carried out so far: lack of laboratories, a shortage of PCR reagent and a lack of swabs. Most universities in Britain have hundreds of machines capable of carrying out PCR tests and they have been offering them, and staff to run them, for months. The chemicals involved in PCR analysis are common and abundant in most labs, and any pharmaceutical or biotech firm not prepared to produce them on a mass scale for free should have been immediately nationalised. No, these were all just straw-man fallacies, invented to make the government’s inaction seem reasonable.

NHS workers know all too well about the daily promises to ‘ramp up’ efforts: they should be taken with a large pinch of salt. For months now we have been promised more personal protective equipment (PPE) for frontline health workers; PPE is another crucial weapon in not just defending staff from getting unwell and so keeping them from their work, but in preventing them spreading the virus to their vulnerable patient population. The UK government not only recommends a lower standard of PPE than the WHO, but even this lower standard has not been available to large sections of NHS staff. Hospital doctors and nurses are having to share and re-use gowns and masks, whilst hospital cleaners, healthcare assistants and community carers have not been deemed important enough to have any form of PPE.

Where I work in primary care, GP surgeries were only given a small number of sleeveless aprons, gloves and inadequate surgical masks. We were offered no face-protecting goggles or visors, no FFP3 ventilator masks and no full body gowns. Additionally we were told that, when we ran out of the small number provided, we would have to locate and pay for further PPE ourselves! This led to the desperate situation of trying to source medical scrubs from the likes of Amazon, and face masks from the local B&Q (when they had some available), and beg for goggles from local schools.

Covid-19 continues to ravage the UK and we will not know the final devastating toll for some time. In the meantime, we can see the only thing being daily ‘ramped up’ is the death count. The Institute for Health Metrics and Evaluation has predicted that the UK will have the highest death count from Covid in Europe - over 66,000 victims. It puts the delay in action directly down to the initial ‘herd immunity’ policy.

Facing the reality of his failed policy, Johnson switched from his clown act to a wartime Britain-Churchill impersonation, accompanied by the predictable ‘all in this together’ hyperbole. Equally predictably, sections of the mainstream media and ‘scientific community’ have gone along with this narrative and thus we are told: now is not the time for criticism, but for us to obey. This is accompanied by the usual attempt to shift blame to us lumpen proles: first it was anxiety-inducing reports on panic buying, followed by newsreels of police drone footage of people walking their dog in the countryside or kids sitting in parks.

This is clearly utter rubbish and part of the government’s strategy to avoid being held accountable for the thousands of deaths we are going to see in the coming months. Of course, the idea that criticism of the state should be suspended during times of crisis is not a new one, but, as any communist worth their salt should know, it is in these times that a critical, principled voice becomes most crucial. If during a flight your pilot announces that there has been a catastrophic engine failure and that they will be making an emergency landing whilst blindfolded, you do not mumble to yourself, ‘Well, I’m not sure that’s wise, but I will save my criticism for when the crisis is over.’

If only the left was strong and organised enough, we could force the state to act - isolating their toxic and diseased ideology for good.

  1. . www.livescience.com/first-case-coronavirus-found.html.↩︎

  2. . www.cebm.net/ Covid-19/global- Covid-19-case-fatality-rates.↩︎

  3. . https://ourworldindata.org/covid-testing.↩︎

  4. . www.independent.co.uk/news/health/coronavirus-test-kit-private-harley-street-clinic-randox-mark-ali-a9422966.html.↩︎

  5. . www.theguardian.com/world/2020/apr/01/absolutely-wrong-how-uk-coronavirus-test-strategy-unravelled.↩︎

  6. . https://inews.co.uk/news/health/coronavirus-donald-trump-says-uks-herd-immunity-plan-would-have-been-very-catastrophic-2525253.↩︎