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What 16,000 missing coronavirus cases tell us about how the UK is handling the pandemic

Written by Darrin Baines, Professor of Health Economics, Bournemouth University


The temporary loss of data relating to 16,000 positive cases of COVID-19 has raised serious concerns about the operation of the UK’s test and trace system. The NHS body responsible, Public Health England, blamed a technical glitch and said cases were added to the system immediately after the problem was spotted. Despite this quick action, many thousands of people have been affected because they were not warned about their contact with an infected person as soon as they could have been.

Most of us would agree that human life is sacred and that COVID-19 deaths should be minimised, if not eradicated. On this basis, we could argue that the Test and Trace system has, until now, shown some serious flaws. However, we are living in a time of great social, medical and personal uncertainty and this must be taken into account.

Across the globe, all governments have faced the same problem: no one is sure what we are dealing with in terms of severity, spread, impact, solutions, and a whole range of previously unencountered problems. In response, we can say that no government has the correct answer because everything is so uncertain.

A crowd of people enters Oxford Circus underground station next to a sign warning them to maintain a social distance of 2 metres.
16,000 cases of coronvairus were left out of official figures for England.
Kirsty O’Connor/PA

Managing uncertainty

Uncertainty is a concept familiar to scientists and the medical profession, but less popular with governments and voters. At the beginning of the pandemic, everyone was uncertain of the total number of COVID-19 deaths that would happen across the globe. Even today, no one knows. So governments face the challenge of trying to make popular decisions when the true facts are not known. In turn, the desire for certainty affects policy decisions, which impacts voter opinions and election outcomes.

Systems like the UK’s Test and Trace programme are designed to reduce uncertainty by collecting more information, analysing the growing dataset and helping the government, the NHS and the public better understand the risks. When the system failed to include 16,000 known cases, an opportunity to reduce uncertainty was missed. If the affected individuals had been given the information that they had been in contact with an infected person, then they would have better information about their own probability of catching the virus.

COVID-19 has stimulated a range of different policy choices across the globe. At one extreme, New Zealand is pursuing a policy of complete certainty: the goal is zero COVID-19 cases. At the other extreme, Sweden’s lax approach leaves many citizens unsure if they will become ill. In between, UK policy is like a pendulum, swinging back and forth between more controls and more freedom, trying to respond to the inevitable balance between certainty and uncertainty that all countries face.

People on a street in Stockholm.
Sweden has taken a remarkably lax approach to the virus.
Fredrik Sandberg/EPA

While the general perception is that governments are trying to fight the pandemic with differing degrees of success, from an analytic perspective the truth is different: politicians are focusing on trying to create policy certainties during a time of immeasurable medical uncertainty. In this situation, there will always be errors, mistakes, unforeseen consequences, bunglings, confusions and wrong steps.

Because no one really knows what will happen with COVID-19 in the coming months and years, the UK Test and Trace system was a political compromise. Like the idea of total eradication from a new vaccine, the system will never give the population complete certainty in terms of risks, cases and personal health status. COVID-19 is just too complex to be managed by an information system alone. But if reports are correct, analysts in the NHS should have known that their Test and Trace system was too data-rich to rely upon the manual use of Excel to record patient COVID-19 data. On this ground, the NHS has failed to manage its system properly.

Worrying times

The Test and Trace system will never work with the certainty that politicians promise. The virus is too chaotic when it travels through society; managing health services effectively is notoriously difficult and information systems are famed for failing to deliver as promised. Instead, perhaps the message should be that the situation is complex and messy, but an imperfect system is better than nothing. Therefore, the 16,000 cases are not a failure of the system, but an expected uncertainty that is just a sign of worrying times.

Although we must be realistic about what is possible in the current pandemic, there are definite lessons to be learnt from the Test and Trace fiasco. First, the government should manage expectations and explain that systems fail, especially when they are new. Next, the government is clearly working outside its comfort zone in dealing with the pandemic and urgent action should be taken on what policy is trying to achieve. Finally, it’s clear that the NHS doesn’t have enough people with the right analytical skills to run a modern health system in these troubling times.

Whilst there may be many different opinions on what to do next, there is one thing we must face: the uncertainties created by COVID-19 are real and no policy, however well designed, will make them go way any time in the foreseeable future.

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