Government hyperbole and exceptionalism hides serious flaws in coronavirus programme

People on low income are avoiding Boris Johnson’s self lauded coronavirus (Covid-19) Test and Trace programme. The equally self lauded Oxford/AstraZeneca vaccine may have significant flaws in its study design and outcomes.

Both are examples of government promotion without examining the full facts about the vaccine trials, or likely consequences of Test and Trace on livelihoods.

Test and Trace problems

In August, Greater Manchester mayor Andy Burnham warned of “the poorest communities in the country – they simply cannot afford to self-isolate when they are asked to do so by NHS Test and Trace because they won’t be paid. Or worse they will fear losing their job”. In September, TUC general secretary Frances O’Grady warned that Test and Trace would fail unless those who have to self-isolate were paid the real living wage of £320 a week.

Then came the news in September that people on low incomes would be entitled to receive a £500 one-off payment. But there are catches.

For example, it’s claimed someone will only be will eligible for the payment if they:

have been told to isolate by NHS Test and Trace.

However, this only generally applies to people who’ve either tested positive for coronavirus, who are close contacts of someone who tested positive.

This is despite the fact that if you get coronavirus symptoms, you are still meant to self-isolate, either for 10 days or until your test comes back negative.

More recently, the BBC reported that only half of “close contacts given to England’s NHS Test and Trace are being reached in some areas”. Contact tracers explained that:

When we do get through, people are often uncooperative. They have lives to get on with and work they have to do to get paid.

Affordability

On 23 November, the BBC’s Katie Razzall tweeted how a Newsnight programme revealed that mass testing in Liverpool isn’t working, with only 4% of residents in certain areas taking up the test.

Thoughts for what's it's worth on mass testing after a day or two in Liverpool. Our story on @BBCNewsnight tonight reveals that the testing pilot is failing to reach the poorest communities in the city. In some parts, only 4% of residents have turned up to be tested

— Katie Razzall (@katierazz) November 23, 2020

One local MP claimed that 80% of applications for the one-off payment have been rejected:

@DanCardenMP the MP for Walton, a deprived part of the city, relays his belief that people can't afford to self-isolate so don't want to find out they may have the virus. He says the criteria for the Gov's self isolation grant are too tough & 80% of applications are rejected

— Katie Razzall (@katierazz) November 23, 2020

Unite the Union leader Len McCluskey also referred to how the self-employed also fall through the cracks:

As one of the millions of the so-called self-employed in this country he does not qualify for statutory sick pay, and despite having friends die of the disease, he will not use the NHS app, for the same reason. A ping from the app would instantly plunge him into poverty.

— Len McCluskey (@LenMcCluskey) November 26, 2020

False positives

Razzall further tweeted about the problem of false-positives/negatives and whether the Liverpool mass testing pilot is good enough for a wider roll-out:

On Newsnight we've previously looked at the accuracy of the lateral flow tests being used & the number of false positives/negatives. Now this – if hard-to-reach communities aren't getting tested, what value is the testing? And should it be rolled out wider?

— Katie Razzall (@katierazz) November 23, 2020

Professor Jon Deeks, head of Birmingham University’s Evidence Synthesis and Test Evaluation Research Group, commented on the test’s flaws:

This test has not been properly evaluated. The Government’s own evidence shows these tests miss positive cases – which means people could unwittingly go out and cuddle their grandparent without realising the risk to them.

It could also mean up to half of those who get positive results and are told to isolate do not need to.

In a recent BMJ article, in reference to a 0.32% false positive rate for the lateral flow testing programme at Liverpool, Deeks remarks:

While this is a very low rate, the numbers of false positives can still outnumber the number of cases detected when used in mass screening where very few will have the virus. For example, if 100 000 people are tested in a city where the prevalence of covid is 400 per 100 000, assuming the Innova test has a sensitivity of 58% and specificity of 99.6% (as per the testing centre performance), these figures predict the test will give 630 test positives. However, only 230 of these will have covid; 400 of them will be false positives.

He adds:

The poor detection rate of the test makes it entirely unsuitable for the government’s claim that it will allow the safe ‘test and release’ of people from lockdown and students from university.

Bing Jones, former associate specialist in haematology, Sheffield; Jack Czauderna, former GP Sheffield; and Paul Redgrave, former director of public health, Sheffield, further commented that Test and Trace is a “disaster”. They added how: “It fails to detect asymptomatic people and those who are unwilling or unable to be tested and it ignores false negatives”.

Vaccine study design problems

If all that wasn’t enough, Wired has identified several problems with the vaccine trialled by Oxford University in conjunction with AstraZeneca and Vaccitech. They point out that the results presented were from a UK and a Brazil study and that:

These two studies were substantially different from one another: They didn’t have standardized dosing schemes across the trials, for one thing, nor did they provide the same “control” injections to volunteers who were not getting the experimental Covid vaccine. The fact that they may have had to combine data from two trials in order to get a strong enough result raises the first red flag.

Wired also pointed out that Oxford/AstraZeneca reported only on “certain subgroups ” with each trial, and that half of the people in the Brazil trial were left out of its report.

Vaccine dosage problems

Then there’s the matter of dosage. Oxford/AstraZeneca claim that the best outcome is achieved where people are given half a dose followed by a full dose a month later. However, says Wired:

neither of these [UK and Brazil] trials had been designed to test this hypothesis. In fact, it’s since emerged that the half-dose/full-dose option started out as a mistake, and one that was only caught when some people in the study didn’t have the usual high rate of adverse effects.

Immunisation expert Professor David Salisbury commented:

You’ve taken two studies for which different doses were used and come up with a composite that doesn’t represent either of the doses. I think many people are having trouble with that.

Another problem concerns age. Wired adds how:

it has since been revealed that the people who received an initial half-dose—and for whom the vaccine was said to have 90-percent efficacy—included no one over the age of 55. That was not the case for the standard-dosing group, however, where the reported efficacy was 62 percent. …

Overall, the Oxford-AstraZeneca trials appear to include relatively few participants over the age of 55, even though this group is especially vulnerable to Covid-19. (People over 55 were not originally eligible to join the Brazilian trial at all.)

That raises serious questions as to the vaccine’s suitability.

Transparency

While Johnson exclaims that the Oxford/AstraZeneca vaccine trials’ results were “fantastic” and that Test and Trace is “world-beating“, it’s clear there are significant problems with both. Test and Trace needs improvement. So too does the financial support to those on low income, whether employed or self-employed, who are advised to self-isolate. Similarly, the public needs more assurance that the Oxford/AstraZeneca vaccine is appropriate and as good as, if not better than, the other vaccines that were trialled.

Meanwhile BMJ’s executive editor Kamran Abbasi has stated how coronavirus science is being “suppressed” by politicians and governments. Indeed, it’s transparency, not hyperbole or British exceptionalism, that is key to obtaining widespread public support for the anti-covid programmes.

Featured image via Pexels/RF._.Studio