We must test and trace to avoid new surge

 

Sir, – I despair. Since March it should have been obvious that, in the absence of vaccines and antivirals, there were two main complementary strategies for defeating the coronavirus pandemic – lockdown and quarantine (using repetitive rounds of testing and contact-tracing). The first protects the uninfected, the second finds and neutralises the infected until no more infected people remain.

South Korea, with a population of 50 million, using a vigorous high-tech regime of testing and tracing, minimal lockdown, and tight control of incoming travellers, flattened its spike in 20 days by about March 10th. Ireland, with a population of five million, which recorded its first death on March 12th, used a vigorous lockdown but a minimal trace-and-test system that has taken more than 60 days.

We have had 336 deaths per million; South Korea has had five deaths per million.

The Korean epidemic has ended, but ours is set to continue at a low level for the foreseeable future.

People seem to think our strategy has worked very well – and in one sense it has (deaths per day down from about 70 per day at peak to less than 10), and so they are looking forward to successive rounds of relaxation of the rules.

But let us be honest. We rank eighth in the world in death rate per million, nowhere near the successes of South Korea and other countries, we have done huge damage to our society and our economy, and we are still stuck without sufficient capacity for test-and-trace.

It’s as if we knew little at the beginning and we have learned little since – apart from lockdown.

And where are we now?

We are in about the same position as we were on March 12th with about the same number of cases per day and we know what happened then – we had an epidemic.

This is a very dangerous situation.

As we open up, we are set for a second surge of infection, with the number of cases rising roughly proportionate to the relaxation.

The reason is simple. Only 25,000 people have had the virus so there is no herd immunity, there are about five million susceptible people, the virus is highly contagious, there are no vaccines or antivirals, our test-and-trace capacity is small and disorganised, and we are going back to normal social behaviour, which will be very social.

People think we are out of danger. We are not.

The weakness in our strategy has been the failure to test and trace on a large scale. We need to admit that our coronavirus containment policy has been and is being determined by the inadequate supply, organisation and efficacy of tests instead of the need.

It is not too late to rectify this situation. So I plead once again for a totally new national test and trace agency, capable of carrying out tests with a turnaround of less than 24 hours, on a massive scale. It would have four main objectives.

1) To eliminate community based infections. We must hunt down and eliminate the virus as Korea did.

2) To minimise the importation of new infections from abroad we need fast-testing of all visitors at the ports and airports. Unless they have evidence of a recent test, they will remain at the port until tested negative.

3) To allow safe reopening of creches, schools and third-level institutions (and other group activities such as sports), test all children and students before they restart their activities, and at intervals thereafter, to allow normal care and education.

4) Have a system in place that will protect against the next pandemic, with the tests based on the same PCR technology.

The scale of the testing and tracing system depends on a number of factors.

First, the number of new cases per day, which are less than 10 but are likely to rise unpredictably, the number of contacts, and the numbers of secondary and tertiary contacts, etc.

Second, the number of visitors; Dublin Airport alone had 50,000 visitors per day in 2019.

And third, the number of children and students in each age group – age cohorts are about 60,000.

These numbers suggest that the testing agency should have a testing capacity about 10 times what we have at present, including laboratories at ports, and a contact-tracing system to match.

There should be one new purpose-built centre to carry out most tests and to manage the tracing system.

That sounds a major undertaking, but it can be done, and the cost will be a fraction of what we have spent already.

When the pandemic ends the system can be downsized and repurposed (PCR testing has many applications) but it would be ready to go into action immediately to deal with next pandemic.

Jim Breslin, the secretary general of the Department of Health, told the Dáil committee that, “The [test-and-trace] system was patched together but it now needs to be redesigned end to end”.

It does but I wonder whether the scale, the urgency and the quality of the redesign are fully appreciated? I suspect there are no plans for anything like the testing agency which I envisage and that means that we will not get out of lockdown until we are able to vaccinate the population.

We need a huge change in policy, otherwise I fear that we will face recurrent surges, a loss of confidence in our public health authorities, more deaths, stuttering attempts to normalise education, and persistent economic and social damage. I hope I am wrong.

DAVID McCONNELL,

(Fellow Emeritus

in Genetics,

Trinity College Dublin),

Caherdaniel,

Co Kerry.