This paper outlines the importance of testing and the suggestion of a new structure around decision-making to get it at scale with speed.
It is not a criticism of government efforts up to now. Everyone within government is working with enormous energy and commitment in dealing with a crisis, unique in complexity and difficulty, global in nature, and where the strategic decisions involve agonising trade-offs in the assessment of the public interest.
Those working in our NHS are demonstrating the finest parts of the British character and have rightly been praised and celebrated. But I know that everyone in the frontline of serving the public, including carers, workers in essential businesses and services, and civil servants involved in the fight, will all be doing their utmost and deserve our gratitude.
This includes those in government. Having done the job of prime minister for 10 years I know how hard it is to do and how easy it is to criticise from outside. This is constructive advice, not criticism.
I do not see a way out of this crisis without mass testing and the development of a clear exit strategy involving testing and tracing, together with innovations in treatment and the use of technology.
The coronavirus dilemma is simply expressed: The disease is more serious than flu. Its lethality may be anything up to 10 times more. Therefore, we cannot let it “run through the herd”.
On the other hand, we know that probably between 40-50 per cent of those who get it show no symptoms at all. Many more get a mild version. But for the 5 per cent or so who get it severely, it is life threatening.
Hence the decision to suppress the disease through prevention of social interaction, bringing the rate of infection right down, so that our health-care system can manage the inflow of severe cases and so that many fewer people get the virus.
The aim is to ensure that only a small percentage of the population contracts the disease. But, of course, the economic consequences of such a lockdown are profound. With each week that passes, more people lose their jobs, more businesses go under. This is sometimes presented as a choice between prioritising the economy or people’s health. But the reality is more complicated.
If we shut down our economy for a long time, the economic damage impacts our health, directly through reducing the money available for the public spending and indirectly through the effect of unemployment and poverty on people’s health, both mental and physical.
Exiting lockdown is only possible through a chartered course that finely balances public health and economic considerations. My Institute’s second paper presents a series of conditions and options for an eventual exit strategy. This is a national debate we need. None of the options are without problems, but it does remain crystal clear that mass testing is fundamental to exiting lockdown. Any other approach is to do this balancing act blind. A road to unacceptable loss of life or financial ruin so grave that it will crush those public services that have performed heroically in this crisis.
At any one time, only a small fraction of the population will be at risk of serious illness from Covid-19. But because that number is not negligible, and because we do not know who has the disease and who has had it – and therefore are likely immune at least for this season – the whole country has to shut down.
So, it follows that unless we can track who has the disease and who has had it, we cannot release ourselves from the otherwise irrational situation in which everyone has to be isolated so that we don’t miss the small number of cases which need to be isolated.
Even then, because we have those who must work, the system is not watertight. This is why testing is not simply of importance. It is fundamental to success. It is not one dimension which ranks alongside all the others. It is paramount. Without it, the lockdown is longer and the exit less predictable and more hazardous.
Yet, the logistical and procurement challenges of testing – to say nothing of the science – are vast. There are two types of test – antigen and antibody. As for the latter, it is not clear there is one which works completely.
The companies which manufacture tests are totally unused to operating at the scale and with the speed necessary to meet demand. The effort required is Herculean I don't think it can be met in the time we want, without radical redirection of resource and focus.
Think of it like the provision of armaments in wartime. Both in the First and the Second World Wars, some time into the conflict we had to make radical changes in management to secure the industrial-scale production we needed.
I think this is similar. That is why I suggest the government appoints one senior minister of capability whose sole task is to step up to the challenge of producing testing capacity, both PCR and antibody. Alongside him or her should be a team which includes business people familiar with industrial production and procurement; and of course those with the scientific expertise.
They should form one dedicated unit, reporting directly to the prime minister. It can be an already serving minister. It’s just that they need to be solely on this task and nothing else.
I would do the same around mobilising what technology can do in all the different aspects of this fight, as we set out in another paper.
In this paper we make other suggestions besides the structure of government and we raise one very important point which may seem a point of science but is actually a political judgement: is it better to wait until we have an antibody test which we regard as virtually near 100 per cent accurate, or is it better to have a lower specification of accuracy – though still high – and go with that now and take the risk there will be false negatives. This is a vital question to interrogate.
The same issue arises around treatments presently trialled.As I say, this is not offered as criticism, but as the only way we can get out of this unprecedented situation of lockdown without damage from which we take a decade or more to recover.
This is the foreword to a new paper by the Institute for Global Change, "UK Covid-19 Testing: Unpicking the Lockdown"