Britain’s contact tracing conundrum

If there is hope, it lies in contact tracing. The countries that have successfully managed Covid-19 outbreaks and reopened without second peaks (at least so far) have done so through extensive track and trace infrastructure to prevent recurring outbreaks, sometimes after instituting general lockdown.

The UK plan is no different: for weeks, ministers have been talking up efforts to build a UK infrastructure to handle the difficult task of rapidly testing every suspected case of Covid-19, and then quickly contacting everyone they may have recently come into contact with, and testing them too.

The effects of these efforts where they work can be dramatic: South Korea had a recent outbreak caused by a single individual going to a series of nightclubs, which could have led to a second peak – but contact tracers found more than 5,000 individuals and managed to isolate more than 30 people infected by the super-spreader. Hong Kong restaurants are open as usual, and Wuhan in China has largely reopened too.

Having largely missed out on SARS, MERS, and other recent outbreaks, the UK had no existing track and trace infrastructure in place, so clearly started at a disadvantage versus other countries in terms of early track and trace: when the deputy chief medical officer said this wasn’t a suitable intervention for the UK in March, she was speaking in terms of capacity – it was entirely impossible for the UK to build capacity to handle so many cases so quickly.

The problem is that building that capacity was supposed to be a large part of what lockdown was for, but we appear to be failing on every level. The most successful part of the operation seems to be building testing capacity. While the government had to rely on fudging the figures by adding posted tests to the figures – the results of which are still not properly tracked – the health system sort-of-met its target of 100,000 tests a day.

It has rarely hit that figure of tests since, and test results are often taking five days to arrive – far too long for an illness that is infectious several days before sufferers are symptomatic. So far, this is as good as the UK response gets.

For the actual track and trace component of the strategy, the UK has been building an app and recruiting contact tracers. Several weeks ago, the app was hyped as the great white hope that would herald the return of business-as-usual. Now is being referred to as 'the cherry on the cake', something that will launch after other efforts, and not essential to track and trace.

The reason will doubtless be the subject of numerous lengthy features, but came down in large part of an internal decision to build a large centrally-controlled app that could store substantial quantities of additional data – versus the privacy-respecting decentralised model Apple and Google had built tools to provide. Headaches caused by this, coupled with an unpromising trial in the Isle of Wight, have dramatically lowered expectations for what an app can deliver.

That leaves the core of track and trace: an army of people to help chase down each new person who has come into contact with COVID-19 . The UK, we are told on a daily basis, is hiring 25,000 such people. Different ministers claim we’ve hired them already, have hired a majority of them, or are far earlier in the process. No-one seems to know.

What is clear is we have decided to treat the job as a relatively low-skilled call centre roll: some people apply for generic customer service jobs, only to find when they attend online training they are now expected to be on the virtual front lines of our pandemic response. Others have applied for contact tracing jobs paying £8.72 an hour, the UK minimum wage.

By contrast, New York State for example is seeking to hire 17,000 contact tracers paid $40,000 (£32,000) to $57,000 (£46,000) a year, with New York City looking to hire up to 5,000 more, paid up to $65,000 (£53,000) – with many of the roles being degree-level or higher.

The plans would leave New York, population 20 million, with more contact tracers than the UK, population 70,000 – or around four times more contact tracers per person.

The irony here is New York is hardly a paragon of how to handle the pandemic: it has had an outbreak worse than the UK’s, with a relative death toll that is dramatically higher. Its own track and trace programme has been slammed as inadequate and too slow, with serious concerns about whether it will be remotely fit for purpose. It’s just that it’s better developed than the UK’s.

Contact tracing where it has worked has delivered a level of normality almost unimaginable in the UK: to many here, the idea of an open nightclub right now seems like a dream (or a nightmare). But the means of delivering that may be similarly jarring to UK sensibilities: South Korean contact tracing staff can access credit card bills, CCTV, and more – to track down where you’ve actually been and who you’ve actually been close to, not just a handful of half-remembered names and places. Could we ever actually deliver that without a huge Big Brother backlash?

The government is coming under muted pressure for the length of the lockdown – but so far is largely getting away with vacillation and fudge over taking the action needed to actually end it. If they think the pressure is bad now, what will happen if the public come to believe their leaders have wasted the months of lockdown – time bought at such a high cost?

Furloughing workers costs the UK government £14 billion a month. The wage bill for the UK’s current contact tracing scheme would come to just £40 million – why raises the question why is the government so spectacularly half-arsing it? It would be cheap at ten times the price, and more affordable than the status quo at one hundred times the price.

Why is the government wasting our time?