Jennifer Richardson: Test and trace in England—from dysfunction to farce

On current form, test and trace in England will shortly slide from dysfunction to farce as the winter season of coughs and colds—especially in children—arrives.

Working on The BMJ’s News and Views journalism desk, I thought I had a pretty good idea of the flaws in the system. After  last weekend, I have the clarity of personal (and parental) experience—and it’s even worse than I thought.

Firstly, why are we missing the opportunity to test those actively presenting with symptoms at a healthcare facility? Attending paediatric A&E with a toddler with a temperature of 39.1C, I was asked on presentation if there were any symptoms of covid-19 (yes, the fever). It was never mentioned again, the toddler wasn’t swabbed, and soon(ish) we were back out in the community—where presumably I was expected to book a SARS-CoV-2 test.

I say presumably because, as I say, it wasn’t mentioned after presentation. Would it be unreasonable for a patient to assume that, if no medic seemed concerned about covid-19, and didn’t suggest or instruct them to book a test, they don’t need to? Even if they realise they are still supposed to, it is inconvenient for the patient to have to book and attend a further appointment— especially after a long night in A&E—so perhaps some simply won’t. Given that we are relying on people with symptoms getting tested in order to protect others, this seems a wasted opportunity to plug potential gaps.

The inconvenience to the patient is fairly small and therefore more likely to be borne, if it is easy, quick, and convenient to book, attend, and receive the results of the test. Over the past week, there have been growing numbers of reports that it is far from easy, quick, or convenient—and that was certainly my experience. Twenty-four hours of repeatedly filling in the government’s (non-user-friendly) form eventually yielded a testing site more than 1.5 hours drive away—which after clicking through didn’t have any appointments within the week—and then, finally, a home test (which did at least arrive the next day). Even that then leaves five days (assuming the results take 48 hours from posting) between A&E attendance and results when the whole household should self-isolate.

Not leaving the home for five days (unnecessarily, one may feel, if the result is negative) is a prospect few will relish—and none more so than the parents of small children (the latter of whom should perhaps be in nursery or school while the former work from home). Anyone with experience of small children will also know that fevers come and go like the wind over winter, as coughs and colds circulate in nurseries and classrooms. After perhaps one or two experiences of SARS-CoV-2 testing akin to the above and household self-isolation, at the next brief fever with no other covid-19 symptoms in the household—it is possible that some may decide not to bother.

Of course, schools and nurseries will as always send home children with a fever, and this winter particularly refuse to have them back until they have a negative SARS-CoV-2 test. But there will be children whose fever was only detected outside of school hours—and, unless the testing system improves significantly, the risk of an increasing number of parents who will send them in without uttering a word of it.

The user experience of England’s SARS-CoV-2 testing makes a mockery of the expectation that people book tests and self-isolate to protect others. It simply must be better or it will fail.

Jennifer Richardson, features editor, The BMJ. 

Competing interests: None declared.