I am writing as a public health physician who is increasingly\nconcerned about the apparent failure to implement fundamental public health\nmeasures to address the COVID-19 outbreak \u2013 specifically, community contact\ntracing and testing \u2013 and about what seems to be one of the knock-on effects of\nthis failure, namely the blanket closure of schools. <\/p>\n\n\n\n
Tracing and testing of contacts, isolation and quarantine are the\nclassic tools and approaches in public health to infectious diseases. According to the WHO,<\/a> they\nhave been painstakingly adopted in China in response to the COVID-19 outbreak,\nwith a high percentage of identified close contacts completing medical\nobservation; and they have been strongly recommended by the WHO for other\ncountries.<\/p>\n\n\n\n In England, there are a lack of data – contact tracing appears to\nhave been adopted only initially. According to modelling conducted by the\nauthors of one of the papers published<\/a> by the government yesterday, \u2018The\nEfficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus\n(COVID-19) (Keeling et al.<\/em>) they expect that it would enable the\noutbreak to be contained :<\/p>\n\n\n\n \u201cAggregating\nacross all individuals and under the optimistic assumption that all the contact\ntracing can be performed rapidly, we expect contact tracing to reduce the basic\nreproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained\n(figure 2). Rapid and effective contact tracing can therefore be highly\neffective in the early control of COVID-19, but places substantial demands on\nthe local public-health authorities.\u201d<\/p>\n\n\n\n The basic reproductive ratio, R<\/em>0<\/sub>, is a standard epidemiological construct<\/a> for\nunderstanding the epidemic potential of an infection; the higher the ratio, the\nmore difficult it will be to control its spread. Ideally, R<\/em>0<\/sub> should\nbe 0. If R<\/em>0 <\/sub>is less than 1, an infected person will\ntransmit the infection to less than one other person, and so the epidemic\npotential is critically reduced. On the basis of this modelling, if contact\ntracing is not being rigorously conducted now, the possibility of critically\nreducing the epidemic would be missed. The Keeling paper when taken together with\nthe New York academics Shen et al <\/a> critique raises\nserious questions about the validity of Prof Fergusson\u2019s model<\/a> (whose apocalyptic numbers were was\nused by the Westminster government to justify its approach.) <\/p>\n\n\n\n I am truly concerned that contact tracing, testing, quarantine and\nisolation have not been exhaustively carried out before taking the blanket\ndecision to close all schools. I have sent the opposition spokespeople for\nhealth at Westminster some suggested PQs that my colleague Peter Roderick and I\nhave drafted, which I attach.<\/p>\n\n\n\n