Turn the light on the virus: more testing yesterday
We are in the midst of a fight against something we cannot see. It’s like fighting something in the dark. We must turn the light on our enemy, the coronavirus. How do we turn on the light in this pandemic? We must test and contact trace the infection. The testing I am referring to is the antigen test to check for the active coronavirus infection. We have heard for weeks that this will happen but where I work it has not. This is not isolated and is happening up and down the country. We are falsely reassured that the rate of increase in number of cases is slowing. How could you know things are better when we are testing in hospital and not testing the community…where 90% of healthcare contacts occur? Admittedly that number is a bit less now with the enforced measures.
Not testing means that of the 25% of our practice staff that are either self-isolating because of personal or household member infection have no clue if they have the coronavirus infection. GPs up and down the country are assessing chest infections almost on symptom basis with or without video consultations. No tests mean we don’t know if our patients have coronavirus or whether the key workers can go back to work if their symptoms stop. Just 2000 NHS workers have been tested. Lack of testing cripples our understanding of where the disease is and who should be isolating as well as crippling our ability to deal with disease by limiting our workers’ ability to return to healthcare system. This week, I was unable to tell a daughter whose father had symptoms of chest infection but was likely to die in a care home whether it was safe enough to say her final goodbye. My heart broke when I had to say that the safest option would be a video chat.
Whilst social distancing was the only strategy to limit the spread of the 1918 flu, 102 years later I would have hoped we would have moved on. Prof Devi Sridhar, chair of global health at Edinburgh University writes in the Guardian:
“If things carry on much as they are now, one possible scenario is that will find ourselves in an endless cycle of lockdown and release over the next year — while the population slowly acquires the virus and hopefully gains immunity.”
She envisages a better strategy as a two-week quarantine for people with symptoms as well as contact tracing with fines and tracking (controversial for privacy reasons) for those in breach of this. This is particularly important since the largest cohort to date looks at over 1000 inpatients and outpatients affected by coronavirus in China. The study identifies that 44% and 89% of patients had fever on admission and hospitalisation whilst 68% of patients suffered a cough. Clearly our case definition to isolate for 7 days and for 14 days for family members in the event of cough and fever must miss a significant proportion of people that may transmit the infection. A proportion of people may be asymptomatic which recent studies and analysis estimate between 5 and 80%: a sizeable share.
Every single minute wasted not testing keeps us blind to the reality of what is happening to the disease in our communities which feeds into demand in our intensive care units. Every single minute not testing prolongs the enforcement of physical distancing strategies and economic tightrope that we are now walking. Patients who have been diagnosed with cancer are having their treatment delayed given the potential risk of a fatal coronavirus infection. Delays risk progression of their cancer. For those on the frontline, we want those in the political, economic and healthcare spheres responsible for bringing testing on the ground to understand every minute is crucial. Hurry up and turn the light on the virus.
In the words of the late Kobe Bryant “don’t tell me how rough the water is, just bring the boat in” — please no more excuses. There has been talk about the risk of false negatives for testing for infection. Validate the tests and get things moving faster. Not testing wastes time and resources we simply do not have to offer.
