The Socialist 6 May 2020 |
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Test and trace: workers need a real plan
Coronavirus (Click to enlarge)
Only a national plan and workers' control can guarantee a safe exit from lockdown
Martin Powell-Davies, Socialist Party national committee
There is a growing scientific consensus that successful management of the coronavirus crisis requires a comprehensive plan - combining mass testing, contact tracing and supported isolation of potentially infected individuals. But a managed plan of action is precisely what chaotic capitalism is struggling to achieve.
Medical science was already well aware that contact tracing has to be a key part of any strategy to tackle a viral epidemic, particularly where no vaccine is yet available. It is a technique already proven to work when tackling Ebola, Sars and Mers, for example.
The strategy is simple enough to understand. If you can quickly identify the close contacts of someone who is found to be infected, and then make sure that all these individuals are safely isolated, onward transmission of the virus is hopefully prevented. If this is done consistently, most new cases can be identified, isolated, and the outbreak eventually brought under control, avoiding further peaks of new infections.
Of course, what works medically has a social and economic cost too. Who pays to look after the income and welfare of the isolated individuals and their dependants for what, in the case of Covid-19, might need to be at least 14 days in isolation?
Their jobs and income must be guaranteed, or the strategy will fail to operate successfully. Similarly, resources have to be in place for food deliveries and other practical support to those who need it in order to remain isolated.
How is contact tracing itself going to be carried out? Commentators place hopes in the development of tracing apps that could use smartphones to alert people that they have potentially been infected by someone who has been close to them.
But, even if they prove reliable, many, particularly the oldest and worst-off, may not own the kind of phones needed. Fears about privacy will also need to be addressed for take-up to be sufficiently high - perhaps requiring 60% of the population and 80% of smartphone owners - for such a system to work.
So, in addition to tracing apps, mass recruitment of contact tracers is going to be needed. Some of the work can be done remotely though phone interviews, some may require direct visits with adequate PPE.
A group of retired doctors and public health experts in Sheffield has set up a community contact tracing team. They train volunteers who identify contacts and then make daily phone calls to monitor symptoms, guard against mental health problems developing through isolation, and organise practical support like food delivery.
Health Secretary Matt Hancock has announced the recruitment of 18,000 tracers. But, yet again, it's without the necessary urgency, clarity and infrastructure. All will need to be properly trained and paid for this important role. Meanwhile, 5,000 local authority environmental health officers, who already have the necessary skills and experience, have not been mobilised for this task.
The government is even proposing that 15,000 contact-tracing call centre staff will be hired through notorious outsourcers Serco and G4S, responsible for a litany of corner-cutting and incompetence in the public sector. Once more, the inability of the Tories and capitalism to apply a clear strategy is being exposed.
For a disease like Covid-19, where some proportion of infections seem to be passed on from people without obvious symptoms, mass testing is also vital.
It's not good enough to set up random access to headline-grabbing testing centres that take hours to get to, with the risk that some carriers may spread the virus as they travel there. We need testing properly integrated into an overall strategy, firstly to identify individuals who have the virus, and then to test their traced close contacts.
If this could be done in sufficient numbers, and with sufficiently reliable tests, this could alleviate some of the isolation requirements. It might also identify more of the individuals who actually need hospitalisation rather than just isolation.
Given the nature of the virus and uncertainty over immunity, testing will need to be regularly repeated, not just a one-off. It also requires much faster results - turnaround times can reportedly be as fast as six hours; backlogs mean processing times of several days. All of this demands an increase in capacity, certainly far greater than the 100,000 tests a day claimed by Hancock.
Having moved the goalposts multiple times, he finally announced the 100,000 target had been beaten on 1 May. The day before, there were apparently 122,347 tests. However, this only represented 73,000 new people tested, the rest being retests. And fully 39,000 of the total were counted before they had even been carried out!
As the Socialist commented last issue, one respected epidemiologist estimates the UK has capacity for ten million tests a day. It is only the Tories' lack of a national plan to requisition and direct the resources, preferring to leave as much as possible to the private sector and the market, which holds this back.
A socialist government would have been in a far stronger position to manage this. Nationalisation of the healthcare and medical supply sectors, as well as big business generally, under the democratic control and management of workers, would allow a rapid and thorough democratic plan of emergency production and distribution.
Of course, identifying carriers and contacts quickly is one thing. Ensuring they then isolate themselves is another.
No 'quick fix'
Contact tracing is not the 'quick fix' that some sections of big business seem to think it is. For it to work, employers need to understand that some of their workforce may well receive a message to say they need to quickly isolate themselves. Workers need to be assured they can do so without loss of income.
If, as in the case of schools, health, transport, construction, and so many other sectors, work is being carried out without adequate social distancing and PPE, the risk of being a close contact of an infected person increases significantly.
Where possible, workplaces must close to allow for deep cleans after confirmed cases. Where, as in schools, consistent physical distancing is hard to guarantee, closing
altogether may even be necessary. In workplaces where this cannot happen, like transport hubs, PPE, staggered usage, hygiene provisions and other protocols are doubly important.
The National Education Union has rightly set the following condition for schools to fully open: "Protocols to be put in place to test a whole school or college when a case occurs and for isolation to be strictly followed."
Another problem is that it is unclear exactly how accurate these tests are, because this is a new disease. Early research in China - unconfirmed as yet - suggests the most common test could give false negatives up to 30% of the time. So workers must have a negative test and be symptom-free before returning to work.
On top of this, the government states that if you live with someone experiencing symptoms, you should self-isolate for 14 days. This rule does not extend to working with someone experiencing symptoms - but we say it must.
Workers with underlying conditions should also continue to be 'shielded' at home, and given full pay. And the government guidance on at-risk age groups begins at 70 - but the stats indicate it should begin at 60.
Safety v profits
Bluntly, unless workplace safety is put ahead of short-term profits, the outbreak cannot be properly managed. If the employers won't guarantee it - and experience shows they will not - trade unions must assert control over safety with elected workplace health and safety committees.
Of course, if these necessary measures had been carried out earlier, then it wouldn't now be so difficult to repair the damage. But on 12 March, the government stopped contact tracing.
The Cheltenham Festival went ahead that same week, and pubs and schools stayed open, all while Johnson claimed the 'science' didn't prove further steps were needed. After a decade of austerity, including £500 million 'efficiency savings' to Public Health England, it only had 290 contact tracers in its team at that time.
In reality, the evidence from China and other countries that had already been battling the infection already showed what was needed. There, early application of contact tracing and testing was used to isolate the outbreak to more manageable hotspots. Here, Tory delay means it will take a lot longer for a similar strategy to work. However, it is the only realistic approach to ending the lockdown safely.
Contact tracing apps: big data, big potential - and dangers
Joe Fathallah, software developer, Cardiff East Socialist Party
Contact tracing is not a new idea. For example, it has been used for decades by sexual health clinics to try to identify and inform anyone who may have had sexual contact with a patient diagnosed with an STI. It's a lot harder, however, to keep track of everyone you've been within a two-metre radius of.
Community-based contact-tracing teams would provide the necessary local knowledge, accountability and flexibility that a purely central scheme lacks. But if contact-tracing staff re operating alongside new technology, in particular smartphones and big data, it could help maximise that system's power.
Not all phones have the technology required to operate an app-based system, however. Indeed, some of those most at risk, including the elderly, are the most likely groups to have older or basic mobile phones, or even not have them at all. This necessitates the use of manual-only tracing for these at-risk demographics.
The government has announced recruitment of 18,000 tracers working with councils and the NHS, asking people who they've been in contact with. This is a start, although probably much more will be needed, along with proper resources rather than just headline-grabbing announcements.
And there are also political complications that come with new technology. On 29 April, 177 cybersecurity experts wrote to the government. They said "it is vital that, when we come out of the current crisis, we have not created a tool that enables data collection on the population, or on targeted sections of society, for surveillance."
One approach is a smartphone app which monitors the phone's location. If the phone's user is later diagnosed with coronavirus, it then automatically informs other phones which had come within two metres by text message.
This would involve sharing an uninterrupted stream of location data with either the state or a private company. We've already seen how tech companies collect highly personal data and sell it for a profit. As they say in Silicon Valley, if you're not paying for it, then you're the product being sold.
In the internet age, companies like Google and Facebook can know us better than we know ourselves. They use that data in an unaccountable manner for profit interests. Effectively, almost every app we use is a kind of legal spyware.
This design might also run into technical problems with multi-storey buildings. If you're living in a block of flats, the satellites tracking your location may struggle to tell which floor you're on, and could think you've been in close contact with those living above or below you. This issue would, of course, disproportionately affect working-class people living on estates and in tower blocks.
Nonetheless, in South Korea this kind of approach has been successful. On 30 April, it became the first country to have suffered over 10,000 cases that was able to report a day with no new cases.
However, it came with draconian restrictions on personal freedoms, such as credit card transaction monitoring, tracking wristbands for those breaking quarantine laws, and making
it compulsory for new arrivals in the country to download the app.
More to the point, South Korea also implemented an effective mass testing programme. Meticulous searches and confirmed diagnoses informed that system. It is this which has been the major factor in keeping the number of recorded deaths to less than 300 so far. The UK system will apparently rely on self-reporting of symptoms instead.
The UK app seems to use an alternative to constant location tracking - Bluetooth technology, which also avoids possible 'height off the ground' problems. Phones coming within one another's radius for a given length of time would exchange private 'tokens', rather like electronic business cards.
These could be stored for a certain time on the other phone. Then, if one of the app users develops symptoms of Covid-19, they can inform the app, which will text every phone holding a token from the suspected carrier's phone.
The Tories have proposed the Isle of Wight as the test zone, because it is isolated and so easier to control. But if, as senior cabinet minister Michael Gove has hinted, it involves early lifting of lockdown measures, then residents will effectively be guinea pigs.
We say any testing of the app must not entail reduction of other safety measures. Workers and residents should decide democratically when and how it is safe to begin lifting restrictions.
A Bluetooth token system could be preferable from a privacy point of view as it can operate without a central database. But the government's app seems to be a kind of hybrid, using both Bluetooth technology and a central database.
Central databases do have important legitimate functions, such as data analysis by medical and public health professionals to find hotspots. However, in the context of mass working-class anger even before the pandemic, and likely social upheavals after it, a precedent for this kind of detailed mass electronic surveillance is troubling.
Britian's capitalist state already has a record of secretly infiltrating democratic workers' movement organisations, including trade unions and the Socialist Party. The Chinese state and other regimes have shown how surveillance can be used to repress workers and youth organising to fight for workers' and democratic rights.
It's vitally important that any database or central processing system be publicly owned, limited, and subject to transparent and democratic control.
At the very least, we demand oversight committees comprising elected representatives from the workforce and the wider trade union movement. These committees could have remote access to the database at a 'metadata' level - without being able to see personal details - to keep track of whose data is being stored, how long it has been held for, and who else has had access to it.
Medical data can have exemptions from data protection laws, for legitimate reasons. But we say democratic rights within contact tracing must include free and immediate access for any individual to all data stored about them, as well as an agreed expiry date on records, and even the right to delete personal data in certain circumstances.
Ultimately, only by removing the profit motive will it be possible for big databases to exist without threatening personal privacy and democratic rights. Public ownership of the banks and big business would eliminate the imperatives to sell advertising data, or to undermine movements which threaten private profit.
This would also enable democratic, socialist planning of the economy. In this context, big data would not only be safer, but more thorough. It could finally be exploited to its full potential, to benefit the health system and all humanity, not to enrich tech billionaires and facilitate state snooping.