The end of community testing and tracing contacts

The end of community testing and tracing contacts

¶3.174. Testing is a vital tool in responding to a pandemic, yet the UK government and devolved administrations were forced to abandon community testing at an early stage of the Covid-19 pandemic. At COBR on 12 March 2020, Professor Whitty stated:

" [O]nce the policy of seven day self-isolation was in place the plan would be to stop all testing of people entering into self-isolation and to stop all contact tracing from other geographical areas."³⁸⁰³⁸⁰ INQ000056221_0007-0008 para 12

¶3.175. That day, the UK government announced that it would stop community testing and contact tracing in order to prioritise testing capacity for healthcare settings.³⁸¹³⁸¹ INQ000109142_0004 para 33; 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0003) Mr Hancock confirmed to the Inquiry that "the problem at this point was that we didn't have enough tests for community testing".³⁸²³⁸² Matt Hancock 30 November 2023 152/2-3 Neither did the devolved administrations. It takes time to increase test and trace capacity. The Inquiry is exploring the approach to testing, tracing and isolation in Module 7: Test, trace and isolate.

¶3.176. A similar decision was confirmed in Wales on 13 March 2020.³⁸³³⁸³ INQ000267867_0012 para 50; INQ000147243_0001-0002 Dr Tracey Cooper, Chief Executive of Public Health Wales from June 2014, said that, by 12 or 13 March, Public Health Wales and colleagues across the UK "didn't have the capacity to cope with all of the contact tracing".³⁸⁴³⁸⁴ Tracey Cooper 5 March 2024 187/18-20 By mid-March, the Welsh Government had a lack of testing capacity and confirmed in a public statement on 21 March that "Public Health Wales now has capacity for over 800 tests per day".³⁸⁵³⁸⁵ 'Written Statement: Coronavirus (COVID-19) – update', Vaughan Gething, Minister for Health and Social Services, Welsh Government, 21 March 2020 (https://www.gov.wales/written-statement-coronavirus-covid-19-update; INQ000509418) Dr Goodall confirmed that:

" [I]n hindsight, if testing capacity had been available, I believe that despite the extraordinary ask it would have represented, maintaining a universal contact tracing system may have more positively affected outcomes over the subsequent weeks of the pandemic."³⁸⁶³⁸⁶ INQ000396878_0085 para 332

¶3.177. In Northern Ireland, testing also ended on 12 March 2020, although this was not the subject of a positive decision nor of any analysis specific to Northern Ireland by the Northern Ireland Executive Committee.³⁸⁷³⁸⁷ Arlene Foster 15 May 2024 69/4-7; INQ000452486_0016 para 50; Richard Pengelly 7 May 2024 91/8-11 Professor McBride told the Inquiry that testing capacity at the time was insufficient to identify all cases that needed to be contact traced and that available tests needed to be prioritised for clinical care and settings with vulnerable people. He explained that this:

" in turn impacted the effectiveness of contact tracing, as only a limited proportion of cases in the community were being picked up through testing".³⁸⁸³⁸⁸ INQ000421704_0137-0138 para 298; see also INQ000426790_0001; INQ000065689_0031

¶Mr Swann explained that, in Northern Ireland:

" The decision to pause testing and contact tracing at this stage in mid-March was integrally linked to the decisions to move to the delay phase and to introduce population wide lockdown measures."³⁸⁹³⁸⁹ INQ000412903_0027-0028 para 72

¶Mr Pengelly told the Inquiry that the decision to cease testing and tracing in Northern

¶Ireland was:

" an issue that flowed from the COBR decision to move nationally from the contain to the delay phase, because there was – the UK-wide plan had been agreed, I think at COBR, a week before, and it included that – it included the point that when we move into the delay phase, the benefits of contact tracing were redundant, it would be stood down".³⁹⁰³⁹⁰ Richard Pengelly 7 May 2024 89/19-25

¶3.178. The decision to stop testing was also seen as consistent with the delay phase of the Covid-19 response by Professor Harries. She told colleagues on 13 March 2020 that the decision to stop testing was "a planned change in approach as part of the move from containment to delay".³⁹¹³⁹¹ INQ000151587_0001 It was seen as unnecessary to continue to test, trace and isolate during the delay phase. The Scottish Government also considered that it was not the best use of its resources to continue to test and trace once containment was no longer possible.³⁹²³⁹² INQ000273984_0029 para 124

¶3.179. However, just a few days later, Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization from July 2017, stated: "[W]e have a simple message to all countries – test, test, test."³⁹³³⁹³ 'WHO head: "Our key message is: test, test, test!"', BBC News, 16 March 2020 (https://www.bbc.co.uk/news/av/world-51916707; INQ000625219); INQ000625220

¶3.180. At a 10 Downing Street press conference on 26 March 2020, Professor Harries explained that the World Health Organization guidance was:

" addressing all countries across the world with entirely different health infrastructures and particularly public health infrastructures, we have an extremely well developed public health system in this country and in fact our public health teams actually train others abroad … so the point there is that they are addressing every country including low and middle income countries so encouraging all countries to test of some type".³⁹⁴³⁹⁴ INQ000273807_0145 para 10.18; INQ000587693_0002

¶Professor Harries added that, as the UK had moved to the delay phase, testing and contact tracing in the community was now "not an appropriate intervention" – although this would continue in high-risk settings such as care homes.³⁹⁵³⁹⁵ INQ000273807_0145-0146 para 10.18; INQ000587693_0002 In her evidence to the Inquiry, Professor Harries accepted that the World Health Organization advice applied equally to the UK and explained she had intended to communicate that test and trace in the community was no longer an "appropriate intervention" when "the peak of the pandemic rises so quickly that it becomes unmanageable".³⁹⁶³⁹⁶ Jenny Harries 28 November 2023 246/11-15 She confirmed that the decision to stop community testing was based on a need to prioritise the limited number of tests available for use in healthcare settings.³⁹⁷³⁹⁷ INQ000273807_0146 paras 10.19-10.20; Jenny Harries 28 November 2023 244/8-15; see also INQ000236391_0003 para 33 While Professor Harries did not intend to mislead the public about the reason that test and trace had ended in the community, her statement that it was no longer an "appropriate intervention" had the potential to do so and was therefore unhelpful. Her statement gave rise to a risk that the public might have believed there was a principled reason that test and trace in the community had ended, rather than because there was insufficient testing capacity.

¶3.181. The Inquiry is satisfied that the decisions to stop test and trace across the UK reflected a lack of test and trace capacity. The limited remaining capacity was prioritised for hospitals and other healthcare settings. There was inadequate capacity because pandemic planning had focused solely on pandemic influenza, which spreads too quickly for test and trace procedures to be effective. Covid-19 has a longer generation time of six to seven days, which would have made test and trace procedures more viable had greater capacity existed.³⁹⁸³⁹⁸ INQ000051883_0002 para 11

¶3.182. The consequences were dire. Community testing did not recommence in the UK until 18 May 2020.³⁹⁹³⁹⁹ 'Everyone in the United Kingdom with symptoms now eligible for coronavirus tests', Department of Health and Social Care, 18 May 2020 (https://www.gov.uk/government/news/everyone-in-the-united-kingdom-with-symptoms-now-eligible-for-coronavirus- tests; INQ000497453); INQ000232194_0097-0098 para 401 Until scientific advisers began to receive data from CHESS from 16 March, the UK government and devolved administrations were left without any effective means of monitoring the spread of Covid-19 in the community.⁴⁰⁰⁴⁰⁰ INQ000249526_0081 para 250 However, as outlined in Chapter 4: Realisation and lockdown, in this volume, it was not until late March that CHESS was able to provide a more complete data picture.⁴⁰¹⁴⁰¹ INQ000249526_0081 para 253 As a result, neither scientific advisers nor decision-makers had robust data on how many infections there were in the community. These data were essential to understanding how quickly NHS capacity might be overwhelmed.

The situation on 12 March 2020

¶3.183. The situation by 12 March 2020 was little short of calamitous. The Coronavirus: Action Plan, which had taken three weeks to produce, was significantly out of date at the point of its publication. Containment had failed. Community testing had ceased and the UK government and devolved administrations had no real understanding of the spread of the virus. Any opportunity to get on top of the virus had been lost.

¶3.184. Mr Johnson told the Inquiry that "it was clear" by 12 March 2020 "that the UK was going to be badly hit by coronavirus".⁴⁰²⁴⁰² INQ000255836_0038 para 158 At the press conference that day, Mr Johnson warned the public:

" [T]he number of cases will rise sharply and indeed the true number of cases is higher – perhaps much higher – than the numbers of cases we have so far confirmed with tests.

I 've got to be clear, we've all got to be clear, that this is the worst public health crisis for a generation.

Some people compare it to seasonal flu. Alas, that is not right. Owing to the lack of immunity, this disease is more dangerous.

And it's going to spread further and I must level with you, level with the British public, many more families are going to lose loved ones before their time."⁴⁰³⁴⁰³ 'Prime Minister's statement on coronavirus (COVID-19): 12 March 2020', Prime Minister's Office and Boris Johnson, 12 March 2020 (https://www.gov.uk/government/speeches/pm-statement-on-coronavirus-12-march-2020; INQ000086751_0002); 'UK Prime Minister Boris Johnson holds a press conference on coronavirus', YouTube, 12 March 2020 (https://www.youtube.com/live/cAE8-e5_EKY; INQ000231053_0001); INQ000255836_0038 paras 158-159Show full note