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The end of Self Isolation?

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BJames

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News just in, expected to be announced tomorrow:
https://www.telegraph.co.uk/news/20...covid-cases-government-reveals/Self-isolation
Self-isolation will no longer be required for contacts of positive Covid cases under plans announced by the Government on Monday.
Instead, contacts of those who test positive will be asked to undergo daily tests for seven days, and allowed to go about their business in the meantime.
Ministers will say that the current system – which was criticised by the Government’s own advisers as “massively ineffective and hated” – will be dismantled nationwide in January, if pilot schemes succeed.
As well as ending the self-isolation system, it could form part of an exit strategy from tiered restrictions. Poor adherence to the current system of isolation – requiring people to stay home for 14 days – is one of the key drivers of infection rates, which has pushed areas into higher tiers. Officials hope that people will be more likely to comply with quick tests that free them from restrictions, than to adhere to two-week quarantines.
The plan to end self-isolation is part of a wider mass testing strategy which could also see care home residents allowed to receive frequent visits from their loved ones.
Tests will be rolled out for visitors to care homes, allowing family members to hug and hold hands. If that pilot scheme in 20 homes is successful, from next month every care home resident in the country will be allowed to have up to two visitors who can be tested twice a week.

The Prime Minister will say the new system of repeat testing for contacts of positive cases, which will begin being piloted in Liverpool on Monday, would help the country to “get the virus back under control”.
Under the current system, those with a positive result are required to stay home for 10 days, while their “close contacts” must stay home for 14 days. There is no limit for the number of times people can be asked to self-isolate, meaning that individuals can be repeatedly told to spend two weeks in isolation.
There are also no exclusions for those who have already had the illness, including Boris Johnson, who is in currently self-isolation which is due to end this Thursday.
Boris Johnson is expected to detail the testing plans – part of “Operation Moonshot” – as he sets out a new tier system on Monday, and plans for the relaxation of restrictions over Christmas.

Areas that fall into the highest tiers will also be given early access to expanded testing to give them “a direct route out of the toughest restrictions”. Officials said the Liverpool pilot scheme, which has seen more than 200,000 people tested, has contributed to a substantial fall in Covid cases.
Warning that Britain is “not out of the woods yet” despite a flattening in new cases, the Prime Minister will say: “The virus is still present in communities across the country, and remains both far more infectious and far more deadly than seasonal flu.
“But with expansion in testing and vaccines edging closer to deployment, the regional tiered system will help get the virus back under control.”

On Sunday, 18,662 infections and 398 deaths were recorded. However, the death figure was inflated by 141 cases which should have been added to Saturday’s figure of 341.
Health officials said: “Crucially, visitors will be able to have physical contact, such as a hug or holding hands, with their loved ones.”
Daily testing for those in close contact with positive Covid cases will rely on “lateral flow” tests, which give results in less than 30 minutes.
Note that this is not expected to actually happen until January.

It's certainly an interesting development, if they can pull it off...
 
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Crossover

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The URL seems to be broken now!

If it is true, it sounds like a very positive development. I know a few people who are essentially hermits for fear of being ordered to isolate for 14 days. Hopefully such a scheme will help greatly all round
 

PG

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The URL seems to be broken now!

If it is true, it sounds like a very positive development. I know a few people who are essentially hermits for fear of being ordered to isolate for 14 days. Hopefully such a scheme will help greatly all round
I managed to find it from the home page so maybe they've changed it slightly.

It's currently here.

Seems that the lateral flow tests upon which this approach is based have a false positive rate of 0.32% (Source) so hopefully people will view it as reliable.

Yet to be seen if it will work better than the current approach in reducing the amount of transmission, though I believe that is likely to be the case due to a certain amount of non compliance with the measures required by the current approach.
 

A Challenge

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From what I can see of the article (given it's behind a paywall) it seems to be the same, so I shan't quote it again.

I think it is a very good idea, but I fear it might not work if based on Lateral Flow tests as that suggests, if this article from the BMJ is accurate, given this seems similar to a test an release strategy:
Covid-19: Innova lateral flow test is not fit for “test and release” strategy, say experts

The government has claimed that rapid lateral flow covid-19 tests, which are being used in mass testing pilots in England and can provide results in 30 minutes, are “accurate and sensitive enough to be used in the community,” after evaluation results were published.1

However, experts warn that the tests may miss as many as half of covid-19 cases, depending on who is using them—making them unsuitable for a “test and release” strategy to enable people to leave lockdown or to allow students to go home from university.

The ongoing assessment, carried out by Public Health England’s Porton Down laboratory and the University of Oxford, tested a number of lateral flow devices in different settings including hospitals, schools, and universities.
(https://www.bmj.com/content/371/bmj.m4469)

The comment on Universities is interesting when you consider that some Universities will be using these for testing students, despite this article saying they are unsuitable (but then I'm not sure of the accuracy of this article).
 

birchesgreen

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How is this going to work in practice though? I question whether the capacity is ready for this kind of thing, you might be talking about the need for several (maybe many) millions of tests a day (currently its just below 400k a day). Are they going to have the personnel to do this AND administer the vaccine AND all the other health needs? Also when and where would people have to have these tests? At a set time (awkward if you are at work) or after work... which if you have a long commute will be a welcome addition to your day.

Still its less far fetched than the Freedom Pass idea at least, which would require tens of millions of tests a week!
 

DelayRepay

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How is this going to work in practice though? I question whether the capacity is ready for this kind of thing, you might be talking about the need for several (maybe many) millions of tests a day (currently its just below 400k a day). Are they going to have the personnel to do this AND administer the vaccine AND all the other health needs? Also when and where would people have to have these tests? At a set time (awkward if you are at work) or after work... which if you have a long commute will be a welcome addition to your day.

This is my fear too. A great idea, but no doubt the government will mess it up, just like they messed up the original testing programme, and the track and trace programme, and the original app, and the supply of PPE...

I also wonder if the overlap with the mass vaccination programme has been thought through - I believe both are planning to make extensive use of the armed forces.
 

WelshBluebird

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How on earth is this going to work when it takes upto several days to get a test result back right now?
 

PG

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How on earth is this going to work when it takes upto several days to get a test result back right now?
See here.
Lateral flow tests are rapid turnaround tests that can process COVID-19 samples on site without the need for laboratory equipment, with most generating results in under half an hour.
As others have said, the practicalities of running it +/- Boris et al messing things up may make it not so great!
 

Smidster

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I wonder if this approach could also be used to get rid of the international quarantine requirement?

As others have said my big concern with this, and any other "mass testing" pledge is how exactly it will work in practice. As somebody who lives in a more rural location and is working remotely how would I go about getting all these tests for my "freedom pass" or equivalent.
 

MikeWM

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It's certainly an interesting development, if they can pull it off...

They don't help their case much by saying nonsense like this

Officials said the Liverpool pilot scheme, which has seen more than 200,000 people tested, has contributed to a substantial fall in Covid cases.

when cases in Liverpool started falling at least *6 weeks* before this scheme could have had any effect. Any effect from the scheme would start being visible around now, but the rolling average of 'cases' is now only about 12% of the peak in early October.
 

DelayRepay

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Surel#
when cases in Liverpool started falling at least *6 weeks* before this scheme could have had any effect. Any effect from the scheme would start being visible around now, but the rolling average of 'cases' is now only about 12% of the peak in early October.

I share your scepticism. I really want this to work - anything that gets us out of lockdown.

But as previous posters have highlighted, case numbers in Liverpool started to decline before the mass testing started. You would expect that, initially, mass testing would lead to an increase as asymptomatic cases were picked up. You'd expect the increase to continue for few days at least, as the contacts of the asymptomatic cases are traced and tested, and then the contacts of the contacts traced and tested. Then you'd expect to see a drop off in case numbers as the chain of transmission is broken.

This article quotes Professor Louise Kenny, the executive pro-vice-chancellor of the faculty of health and life sciences at Liverpool University, which is running the pilot scheme with the city council:

Kenny said it had been harder to reach people in the poorer areas in the north of Liverpool. “Testing has been incredibly successful in the south – we’ve had greater than 50% uptake in some suburbs. But we know community transmission in those communities is relatively low.

“In the north of the city, where most of the economic deprivation is clustered, areas have high population density, a lot of multigenerational housing, a lot of social housing and social exclusion. Making testing available on their doorstep is really important.”

Mass testing needs to cover all communities - are people in the poorer areas not participating because they can't get to the test sites, because they don't know about the scheme, because they daren't risk loss of income if found positive, or because they don't care?

I really, really want this to work. I want anything to work that helps us get out of this massive hole we've dug for ourselves. But I have a low level of confidence at the moment.
 

SJN

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Surel#


I share your scepticism. I really want this to work - anything that gets us out of lockdown.

But as previous posters have highlighted, case numbers in Liverpool started to decline before the mass testing started. You would expect that, initially, mass testing would lead to an increase as asymptomatic cases were picked up. You'd expect the increase to continue for few days at least, as the contacts of the asymptomatic cases are traced and tested, and then the contacts of the contacts traced and tested. Then you'd expect to see a drop off in case numbers as the chain of transmission is broken.

This article quotes Professor Louise Kenny, the executive pro-vice-chancellor of the faculty of health and life sciences at Liverpool University, which is running the pilot scheme with the city council:



Mass testing needs to cover all communities - are people in the poorer areas not participating because they can't get to the test sites, because they don't know about the scheme, because they daren't risk loss of income if found positive, or because they don't care?

I really, really want this to work. I want anything to work that helps us get out of this massive hole we've dug for ourselves. But I have a low level of confidence at the moment.

I think a lot of it is people don’t want to isolate if they’ll lose pay. I know of a few people who’ve been told they won’t get paid for isolating. Not sure how easy the £500 grant is to get.
 

trainmania100

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Daily testing won't work - sent a test off last Thursday and despite being inundated with calls from 'track and trace', noone in my household has had their results back
 

DelayRepay

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Daily testing won't work - sent a test off last Thursday and despite being inundated with calls from 'track and trace', noone in my household has had their results back

I think the lateral flow (?) tests they're using for mass testing are different - I think they're processed on site rather than sent to a lab, so results come back quicker. But if it comes back positive, you then have to have a 'proper' test to confirm.
 

island

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I wonder if this approach could also be used to get rid of the international quarantine requirement?
This is already under consideration with a negative test on or about day 5 enabling travellers to end their quarantine at that point.
 

DelayRepay

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I wonder if this approach could also be used to get rid of the international quarantine requirement?

Yes: Covid-19: England arrivals to be able to cut quarantine with private test (BBC).

People arriving in England will be soon able to reduce their quarantine period by more than half if they pay for a Covid test after five days, the transport secretary has announced.
The rules will come into force from 15 December and the tests from private firms will cost between £65 and £120.

Under the new travel rules, passengers who arrive from a destination not on the government's travel corridors list will still need to enter self-isolation.
However, if they pay for a test after five days and it comes back negative, they will no longer need to self-isolate.
Results will normally be issued in 24 to 48 hours. This means people could be released from quarantine six days after arrival.
 

LAX54

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See in the news today, that you will be able to pay for a 'test' after arriving in the UK after 5 days, thus reducing the isolation time to about 7, it was suggested that this may allow more to go on holiday! but 1) you still need to have another week off at least. 2) It will cost £65 to £120 pp, and more importantly really we need to be allowed by other Countries to actually go there ! (and not isolate for 14 days...or even 7!)
Pre-departure tests surely would be the way to go? And of course Government to chnage the no travel rule, and the likes of Spain / USA etc to allow 'tested' visitors with no isolation
 

MikeWM

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Mass testing needs to cover all communities - are people in the poorer areas not participating because they can't get to the test sites, because they don't know about the scheme, because they daren't risk loss of income if found positive, or because they don't care?

It seems an odd quote anyway. I know Liverpool fairly well (I grew up there) and it seems a strange characterisation to say the north is deprived and the south is much less so. I'd have guessed the deprivation was fairly evenly distributed to the north, south and east. For example, Toxteth - a place most people will have heard of - is to the south.
 

Jonny

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It would be interesting to see the legislation that enables/supports the new scheme; it raises a question...

Would testing be a form of medical treatment, which would not be compatible with the limitations on Section 45 A-C of the Public Health (Control of Disease) Act 1984 powers as limited by Section 45E (precluding mandatory treatment)?
 

PG

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It would be interesting to see the legislation that enables/supports the new scheme; it raises a question...

Would testing be a form of medical treatment, which would not be compatible with the limitations on Section 45 A-C of the Public Health (Control of Disease) Act 1984 powers as limited by Section 45E (precluding mandatory treatment)?
Interesting indeed...

Section 45E seems concerned with vaccination and/or prophylactic treatment.
I'm not sure that testing for something is actually treatment;​
Treatment is something to alleviate symptoms or a condition whereas I believe testing is to confirm a diagnosis.​
That said surely an individual has to give consent to be tested?​
An exception to gaining consent would be if an individual is deemed by a qualified medical professional to be unable to consent and testing is in their best interests.​
 

Jonny

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Interesting indeed...

Section 45E seems concerned with vaccination and/or prophylactic treatment.
I'm not sure that testing for something is actually treatment;​
Treatment is something to alleviate symptoms or a condition whereas I believe testing is to confirm a diagnosis.​
That said surely an individual has to give consent to be tested?​
An exception to gaining consent would be if an individual is deemed by a qualified medical professional to be unable to consent and testing is in their best interests.​

It is going to be close to the borderline, but the doubt is around whether testing is mutually exclusive to treatment or if it is a subset of treatment, as it involves a physical procedure.
 

DelayRepay

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It would be interesting to see the legislation that enables/supports the new scheme; it raises a question...

Would testing be a form of medical treatment, which would not be compatible with the limitations on Section 45 A-C of the Public Health (Control of Disease) Act 1984 powers as limited by Section 45E (precluding mandatory treatment)?
I don't think there is a mandatory element to testing. If you don't want to be tested, you have alternative options - quarantine for 14 days as per the current rules, or simply don't travel at all.
 

Skimpot flyer

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How is this going to work in practice though? I question whether the capacity is ready for this kind of thing, you might be talking about the need for several (maybe many) millions of tests a day (currently its just below 400k a day). Are they going to have the personnel to do this AND administer the vaccine AND all the other health needs? Also when and where would people have to have these tests? At a set time (awkward if you are at work) or after work... which if you have a long commute will be a welcome addition to your day.

Still its less far fetched than the Freedom Pass idea at least, which would require tens of millions of tests a week!
Testing after work would not be a good idea.
Potentially, a person mixes with their colleagues all day and then discovers they are positive??
We had a case of an agency worker yesterday being overheard telling a friend they had just got an NHS message that their test, taken on Saturday, was positive. The guy had been on shift the previous three days o_O
 

birchesgreen

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Testing after work would not be a good idea.
Potentially, a person mixes with their colleagues all day and then discovers they are positive??
We had a case of an agency worker yesterday being overheard telling a friend they had just got an NHS message that their test, taken on Saturday, was positive. The guy had been on shift the previous three days o_O

Oh yeah i know but the alternative would be for people do it earlier in the day, paid time off otherwise many people won't do it. Good luck with that!
 

PG

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It is going to be close to the borderline, but the doubt is around whether testing is mutually exclusive to treatment or if it is a subset of treatment, as it involves a physical procedure.
Nearest parallel I can think of is a motorist who fails to provide a specimen (of breath?) for analysis, which I believe is an offence. So the law would require amendment if the government thought that it would be in the public interest, not so sure that those concerned with civil liberties would be in agreement...
 

_toommm_

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Let’s hope so. I’ve had to isolate twice in the past two months after being in contact with someone with COVID.

One of those is my housemate who’s just been rushed to hospital, which has really made me realise how deadly this is, but as a nation, we can’t keep putting an abrupt hold on life.
 
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