Countries should find and test every case of coronavirus to stop the pandemic, the World Health Organization has said a day after the UK announced that only the most seriously ill will be tested.
“You can’t fight a virus if you don’t know where it is,” the WHO’s director general, Dr Tedros Adhanom Ghebreyesus, said at a briefing on Friday. “Find, isolate, test and treat every case to break the chains of Covid transmission. Every case we find and treat limits the expansion of the disease.”
The UK government said on Thursday that it would no longer try to “track and trace” everyone suspected of having the virus. Instead, under plans outlined by Boris Johnson and his medical and scientific advisers, testing would be limited to patients in hospital with serious breathing problems, which may be caused by coronavirus but could also be because of flu. Isolation at home would be a voluntary measure, but anyone with a persistent cough or temperature would be asked to do so.
The prime minister’s briefing, which followed an emergency Cobra meeting, also marked a sudden and significant U-turn in NHS policy. Just a day earlier NHS England had announced an increase in testing in the community. A “significant expansion of coronavirus testing, with enhanced labs” would help the health service carry out 10,000 tests a day, it said.
However, after the WHO declared coronavirus a pandemic, the government moved the UK from the “containment” phase into “delay”, accepting the inevitability of millions of infections. This also moved the testing strategy to one where people are no longer tested, but anyone with a temperature or a continuous cough is advised to stay home for seven days, to reduce the number of people they will infect.
People with symptoms are not even advised to call NHS 111, but look at the online advice. The only time to seek medical help is if they get worse, not better.
Many people still waiting for a test will probably not get one. Those who have been tested and are waiting at home for results will be informed because the backlog will be cleared. But within a week or so, testing will only be done on people with serious symptoms who have been admitted to hospital.
Some doctors said the government strategy was pragmatic; others that it was dangerous.
Testing was “incredibly important”, Devi Sridhar, a professor of global public health at Edinburgh University, said on Twitter. “It’s mind-boggling that the UK has stopped testing those with mild symptoms and is now asking them to self-isolate instead.”
Paul Kellam, a professor of virus genomics in the department of infectious diseases at Imperial College London, said modelling in the UK and in Washington state, US, suggested the actual number of cases was five- to 10-fold higher than those already detected. People without symptoms or only very mild disease were not being counted. Johnson said up to 10,000 people in the UK were probably now infected.
Kellam said the value of community testing to find individuals who had a mild case of the disease was now questionable.
“Early on in the epidemic, in Taiwan and countries immediately adjacent to China, there was not at the time an absolute certainty that the virus would spread worldwide, so early on the policy was to contain. Finding all the people who are infected and the people they have been in contact with to try to bring that infection chain to a standstill was the right strategy,” he said.
But now it was a pandemic and likely to be an endemic infection, one that lingers in the population and could largely disappear, but will recur the following winter or year.
Prof Sheila Bird, the former programme leader of the MRC Biostatistics Unit at the University of Cambridge, said the number of cases had risen so far already that it would be hard to trace all the contacts of an infected person.
“They are being realistic. The capacity to do that sort of track and trace is probably already overwhelmed,” she said. “The focus is now on monitoring the more serious end of the disease spectrum.”
However, she said, it did mean that the basis of the data being collected on the epidemic in the UK would change, and that that needed to be marked by a break in the figures; simply adding the new numbers to the old totals would skew the understanding of the epidemic.
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