Operation Moonshot: how effective is the track and trace system?
If we shoot for the moon but miss, asks Kevin Lewis, will we all end up seeing stars?
Encore un fois. Not quite a lockdown perhaps, but quite a knockdown for morale anyway. The mood differs compared to the spring. With blind faith and optimism supplanted by a divisive cynicism about compliance. Contact tracking and tracing, and access to a dependable vaccine.
The Prime Minister announced Operation Moonshot on 9 September. At the daily Downing Street briefing, he must have realised that he had created something of a hostage to fortune.
When Matt Hancock filled in the details, he got more laughs from a sparse House of Commons audience than most jobbing stand-up comedians would dare to hope for.
The fact that the word ‘ moonshot ’ shares many characteristics with the word ‘b***sh*t’ made it all too easy for the ‘naysayers’ (as the Secretary of State described them). But then the serious debate started, fuelled by an article in the BMJ that questioned the chosen methodology. I will return to that shortly.
Many people already expressed dissatisfaction at the offering of their COVID-19 test in Aberdeen or Inverness. Not the people who actually lived in the Highlands, I grant you. More those living just down the road – places like Brighton, Cornwall or Aberystwyth.
They must have viewed Operation Moonshot with some degree of dismay. If Aberdeen and Inverness seemed a long way to travel on public transport for their test, the moon must have seemed a quarter of a million miles away.
Lost without trace
Testing, tracking and tracing has been fraught with one problem after another. In finally declaring that he realised that the system ‘wasn’t perfect’, at least confidence got restored in the PM’s road to recovery after his own brush with coronavirus had allegedly robbed him of his mojo.
But one of the most insurmountable of the catalogue of problems surrounding COVID testing over the summer months has been tracking down and tracing the whereabouts of the person in charge. Dido Harding was selected for this role from a shortlist of one, being headhunted from her previous position as the chair of NHS Improvement.
Yes, there is a certain irony in that, I know. Dido was heading up the infamous national test and trace operations during the reaction of the new National Institute for Health Protection (NIHP) in August, into which Public Health England was subsumed.
And who better to appoint as the interim chair of this behemoth at such a crucial time than Dido? The dodo may be extinct but our Dido certainly isn’t. At least, we don’t think so, but if anyone has actually seen or heard from her can they please let Matt Hancock know?
Dido’s appointment to head up NHS Improvement took place in October 2017. Critics pointed at this and the fact that she was Baroness and Conservative peer. She had no previous experience or background in healthcare. I have an open mind on such matters. Fresh perspective coupled with the right skillset in other respects can provide what’s needed.
Prior to joining the NHS, Dido had spent seven years as chief executive of the Talktalk telecomms group. It was on her watch that Talktalk mislaid the personal and financial details of more than 150,000 of its customers. The share price subsequently fell by a third. Talktalk lost tens of millions of pounds. She shrugged off that minor setback and stayed at the helm for a further 18 months. So she is nothing if not a serial survivor.
Looking on the bright side. Her ‘track and trace’ team has a head start because for those 150,000 people at least, they do know where they live and how to contact them; they even know their bank account and credit card numbers. As do a lot of other people, of course.
The central government sent its tracking and tracing contract outsourcing specialists Serco. Dido likely insisted on receiving the same approach because back in May, Serco went further and accidentally shared the personal email addresses of nearly 300 trainee contact tracers.
The pursuit of Excel-lence
But it isn’t just Dido herself that went missing in recent months. NIHP was barely a month old when its other adopted problem child. Public Health England (PHE), was forced to admit that a ‘technical issue’ had resulted in 15,841 cases in a single week between 25 September and 2 October going missing from the reported daily coronavirus case numbers.
I am sure I shared the disbelief of millions over the explanation that the Excel spreadsheet used to record all the cases in England, reached its maximum file size. OMG. The team kept busy trying to track and trace anyone who knew how to use an Excel spreadsheet, or perhaps introduce them to a database designed to capture and hold more data.
So, where next for Dido? Most senior executives and managers ride off into the distance loaded down only with the weight of the adios payments in their saddle bags. When the time comes, Dido will ride off into the distance because she takes part in racing as an accomplished jockey.
She rode her own horse Cool Dawn for three National Hunt seasons, with success. It went on to win the Cheltenham Gold Cup the following year with another jump-jockey on board.
So she may know next to nothing about healthcare, but she knows about horses and will climb back onto the saddle every time she falls off. But unless things improve quickly with the test, track and trace performance, she may have to dismount before she is ready.
China is more than capable of mounting its own bona fide moonshot. Nobody was laughing there at the recent announcement that nine million people were about to be tested within a five-day period. This was happening in Qing Dao province in reaction to having six new cases.
Six cases? Seriously? In the UK where six potential cases are waiting to be served at any covert student bar you care to visit, the Qing Dao approach might be viewed as an overreaction. It certainly gives a whole new meaning to the ‘rule of six’.
The very scale of nine million tests is staggering of course. Behind the headlines lies the crucial question of what kind(s) of testing we are talking about. How quickly the results come to light and how much one can rely upon them anyway. That is a highly relevant question for primary care dentistry here in the UK. For how it moves back towards something approaching full capacity.
None of us want a dangerous situation (or to see others placed at risk) due to ‘false negative’ test results. No one wants to have our professional and/or personal lives shredded by ‘false positives’, the quarantining that this necessitates and the costs and upheavals that result. More than anything else, we crave certainty in a world that has become so uncertain and (for many) so scary.
Boris Johnson’s ‘moonshot ’ was to spend £100m on developing the capacity. This was to carry out a comparable number of tests to those in Qing Dao. He wanted to deliver that number (10m tests, in fact) not over a five-day period, but each and every day from early 2021.
The BMJ article I mentioned earlier in this column suggested that achieving that is ‘a nice dream’. Although it will probably require ‘testing technology that currently does not exist’. If and when it does exist, it will then need to go through rigorous scientific evaluation and validation.
Jon Deeks, is professor of biostatistics at the University of Birmingham. He is also leader of the Cochrane Collaboration’s COVID-19 test evaluation activities. Jon challenged the underlying thinking of Operation Moonshot.
He said ‘This is not the way we should be tackling something when people are dying right now: thinking about things we have not got. We should be thinking about the things we have got and we know work. Backing a horse that hasn’t yet been born is a really bad strategy.’
Suddenly, Dido’s appointment makes perfect sense. Once that horse is born, her equine knowledge could prove indispensable.