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Public health leaders were slow to act on repeated warnings over Christmas 2020 that contact tracing and isolation should begin immediately after a positive side-stream test result, evidence leaked to the Covid inquiry shows.
A senior test and trace officer Dr. A scathing “lessons learned” document, written by Achim Wolff and submitted to the inquiry, gives his account of missed opportunities to improve the NHS test-and-trace regime in the first winter and spring of the pandemic – before vaccines were available.
It suggests that people may have spread the virus unnecessarily to friends and relatives during the first Christmas of the pandemic and the subsequent January lockdown period because they were not legally required to isolate and trace their contacts as soon as they got a positive lateral flow test.
Instead, for about two months, those who qualified for the rapid test were asked to undergo a confirmatory PCR test after a positive lateral flow. A third of those who subsequently had a negative PCR result were likely to have had Covid anyway.
The policy was changed on 27 January 2021 to require some people to contact and isolate the trace immediately after receiving a positive lateral flow result – after about 6m lateral flow tests had been carried out.
However, confirmatory PCR testing was still required for NHS workers, adult social care workers, primary school teachers and hauliers and therefore no immediate contact tracing. This was continued until the new contact-tracing regime from the point of a positive lateral flow test in late March 2021 – months after being issued.
Daily deaths from Covid were running around 400 per day in the weeks before Christmas 2020, when limited household mixing was allowed as part of the tier and bubble system. Johnson announced a third lockdown at the start of January 2021, with around 70,000 confirmed cases per day. Daily deaths in the epidemic peaked at more than 1,000 per day during the last two weeks of the month.
In a “lessons learned” document seen by the Guardian, Wolff says: “During the winter months, the prevalence of individuals who have 1) positive lateral flow; followed by 2) negative PCR; can be above 30%. These individuals are then sent to their high-risk workplaces. was allowed to return to
The former head of NHS test and trace policy highlights how it took a long time to get clear advice from Public Health England about policy on contact tracing and isolation rules in the face of changing scientific evidence on the accuracy of lateral flow.
He also pointed to a “lack of appropriate expertise” in the science of testing at Public Health England and NHS Test and Trace, which led to a failure to evaluate the evidence.
In the document, Wolf shows how he first attempted to address the lack of modeling in relation to Inova Lateral Flow and how false positives they would generate in September and October 2020 and again in November.
Officials then became increasingly concerned in December 2020 that the positive side-stream result was more likely to be true than existing studies suggested, and even at a time of high prevalence of Covid — regardless of a confirmatory PCR result, the document says.
At the time, rapid testing was increasingly available to NHS workers, care workers, staff in care homes, prison staff, food production workers, those delivering and administering the Covid vaccine, teachers, some students and university students, as well as pilots.
This meant that people who tested positive through lateral flow were still allowed to go about their business, and no contact tracing was taking place until a confirmatory PCR came back.
According to the “lessons learned” document, Wolf conducted his own analysis and repeatedly tried to raise the issue of the low rate of false positives in the lateral flow test with senior public health officials on December 21 and 22, 2020.
Susan Hopkins, the then incident director of Public Health England’s Covid response, said on 22 December that this was against consensus, although she agreed to give “further views”. Wolff reiterated his concerns by email the next day. By 24 December, Public Health England reversed its position and said it agreed that it was appropriate to suspend confirmatory PCR tests.
However, it took another month to implement the decision on January 27 – weeks too late to stop people with positive lateral flow results but negative PCR results from mingling with friends and relatives over the Christmas period.
In addition, NHS and adult social care settings, primary teachers and hauliers were exempted from the policy – it was believed that many people would be forced into isolation and would result in staff shortages.
Since January 2021, Woolf has made 13 attempts to get official updated advice from Public Health England on whether they should start contract tracing for everyone as soon as they get a positive lateral flow result.
He eventually redid his analysis and submitted it to senior public health leaders in early March. This was later followed by Wolff, Jack Hulmes and Dr. Turned into a scientific paper by Susan Hopkins, now chief medical adviser, published on the Gov.uk website, it questioned previous assumptions about the likelihood of a positive LFD result being correct versus a negative PCR result. .
Hopkins decided on 15 March 2021 to trigger contact tracing from the point of all positive lateral flow, overturning previous advice from other Public Health England and testing and tracing by public health experts. By this point, technology was available to cancel contact tracing if a confirmatory negative PCR was obtained – and confirmatory PCR was reinstated as policy in late March, even though about a third of the original LFD results were likely to be correct.
Dr. Subsequent analysis by David Spiegelhalter suggested that confirmatory PCR was of little value at times of high prevalence, as about 40% of those testing positive by lateral flow and negative by PCR would still have the virus and be falsely confirmed.
However, the issue of suspending confirmatory PCR remained controversial, with some experts arguing following the publication of the government paper that the risk of false positives and unnecessary isolation was still too high, particularly among school children.
Wolff’s efforts to sound the alarm over the issue of testing, isolation and contact tracing are documented in evidence from the Covid investigation, which is collated on a central Whitehall database.
The inquiry, led by Heather Hallett, will seek to examine the response to the pandemic and identify lessons learned for future public health emergencies. The “lessons learned” document details concerns that Public Health England, later UKHSA, had insufficient expertise in relation to the science of testing and diagnostic epidemiology, as well as an over-reliance on consultants without relevant knowledge in these areas.
Safia Ngah, who lost her 68-year-old father, Zahari Ngah, to Covid-19 in February, and is a spokeswoman for the Covid-19 Bereaved Families for Justice campaign, said: “These revelations are incredibly difficult to hear, even as they are. Not surprising. This advice is ignored. A few weeks after arriving, cases spread so quickly that one in 20 people in my borough had Covid-19, and my family was desperately trying to do everything we could to keep my father safe. Unfortunately it wasn’t enough.”
She said: “It was clear before the second wave that the test-and-trace system was a complete disaster, so why was advice that would have saved lives ignored? If the advice had been heeded, thousands of lives could have been saved, months The lockdown could have been avoided and I might be spending today with my dad. How and why this happened should be investigated now, so that this kind of tragedy does not repeat itself in the future.
Wolf declined to comment. Prof. Hopkins, now UKHSA’s chief medical adviser, said: “The advice given over this period was clear; Anyone with a positive lateral flow test should self-isolate.”
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