Gerry Gajadharsingh writes:
“The recent UK government imposition of a 14-day quarantine on travellers from Spain has caused chaos, after giving just 6 hours-notice. There are an estimated 600,000 people from the UK holidaying in Spain, with an estimated 1.2 million booked to go there in the next few weeks. Coupled with FCO advice against non-essential travel to Spain, making it extremely difficult to gain refunds on insurance, it has caused significant stress and monetary loss to travellers, travel businesses, airlines and of course businesses in Spain. It seems a “blunt instrument” given that 14 out of 17 regions in Spain have minimal outbreaks, with the numbers of positive COVID 19 people much less than the UK, in these regions. It will probably get worse with other European countries lined up to be added to the quarantine. As well as a major hit to confidence, with many people probably avoiding booking holidays, the economic cost will be enormous. We simply have to learn how to live with the novel coronavirus, manage local lockdowns where necessary and not introduce blanket bans on whole countries and the chaos that ensues.
There must be a smarter solution and there may well be.
What I suggest is to travellers is to have a SARS-CoV-2 PCR antigen swab test the day of arrival back in the UK before going into self-isolation, results are usually available between 24 and 48 hours in the private sector, and to repeat the test 5 days later. Why 5 days? It’s the average incubation period for COVID 19. Airport testing is used by Germany, Dubai, Iceland, Russia, Austria and the Netherlands, which free those with a negative test result from quarantine, but will not pick up asymptomatic carriers or those who have been exposed in the previous 5 days.
Although airport testing is not yet available in the UK, private providers such as The Health Equation offer both SARS-CoV-2 antigen and antibody tests. Both in person at our London clinic and via a home sample kit posted directly back to the TDL laboratory.
A study by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) concluded yesterday that the present policy (14-day quarantine is keeping out 99 per cent of imported infections, whereas a single test on arrival, as used in some countries, would keep out only 50 per cent. However, releasing people if they tested negative after five days would reduce imported infection by 88 per cent. Testing after a week would reduce it by 94 per cent, according to a team led by Professor John Edmunds, a member of the Scientific Advisory Group for Emergencies.
One other major problem with a blanket 14-day quarantine will be compliance, mainly due to the financial impact on individuals and businesses.
Personally, I would choose testing on the day of arrival and on day 5 and take the 88% reduction in potential infection spread. Let’s see if the UK government agree.”
Quarantine for Britons returning from holiday could be halved with smarter testing, scientists have told ministers, who hope to be able to shorten isolation within days.
Modelling by a key government adviser has found that testing travellers a week after return could keep out as many cases as the present 14-day rule.
Consideration is being given to using testing after a week to cut the fortnight of isolation demanded by NHS Test and Trace amid concern that the cost of taking two weeks off work is reducing compliance. Less than a third of Britain’s daily capacity of 338,000 tests is being used.
An alternative plan would see air passengers arriving in the UK being given swab tests at Heathrow. Collinson Group, a family-run medical assistance company, is in talks with Public Health England over a scheme in which passengers would be given an initial test before being released to a named address where their compulsory two-week quarantine would start. The result of that test would be received within seven hours and a negative result would free the traveller from the quarantine requirement.
All arrivals would, however, have to take a second test within four or five days. It is said that this would show up any asymptomatic passengers.
Airport testing is used by Germany, Dubai, Iceland, Russia, Austria and the Netherlands, which free those with a negative test result from quarantine.
Last night the chief executive of Heathrow Airport suggested that the summer tourism season could be saved if holidaymakers were tested for coronavirus on arrival.
John Holland-Kaye said that it would cost passengers from Spain and other European countries £150 to be tested, but that negative results could allow them to come out of quarantine a week early. “Testing is the only viable way of [opening up the country] in the absence of a vaccine,” he told the Daily Telegraph. “A lot of countries which are
‘red-listed’ have millions of people who don’t have the disease and can’t travel. That’s holding back economic recovery.”
He added that ministers need to find ways of “getting ‘red countries’ opened up again” and said that testing at airports could be “up and running” in a fortnight.
Scott Sunderman, head of assistance at Collinson, said: “We think that the one-test solution works but we are saying there is an extraordinarily remote possibility that someone who has just picked up the infection [could be missed], which is why we are now looking at a second as well.” The company said that talks with Public Health England were “very positive indeed”.
A government source said 14 days had been chosen for the roundness of two weeks, but that there was a move to shorten it as evidence grew that the vast majority of people stopped being infectious before then. The source said that it was not yet clear which was the best approach.
A study by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) concluded yesterday that the present policy is keeping out 99 per cent of imported infections, whereas a single test on arrival, as used in some countries, would keep out only 50 per cent. However, releasing people if they tested negative after five days would reduce imported infection by 88 per cent. Testing after a week would reduce it by 94 per cent, according to a team led by Professor John Edmunds, a member of the Scientific Advisory Group for Emergencies.
Sam Clifford, first author of the LSHTM paper, which has yet to be peer reviewed, said: “For current prevalence in the US and entire EU, [with] both the seven days plus a test, and one day turnarounds, and the 14-day quarantine, we expect no infectious travellers to be released into the community.”
He said testing on arrival and four days later “is less effective than the ‘test at seven and release at eight days’ strategy” because of the five-day incubation period of the virus.
Officials are also looking to use testing to halve the two-week isolation demanded of contacts of confirmed cases of the coronavirus in Britain.
Tom Riordan, who has just stood down as the government’s tracing lead, said the system was now “pretty good” but argued: “The one thing that I would be most concerned about is self-isolation. If you look at the maths there’s hard economics about it. If you’re on the minimum wage working a typical week you get three times more than statutory sick pay.
“People on such tight budgets need help from either employers or the government. Shorter self-isolation periods would also help but only if the science supports it.”
Yesterday Baroness Vere of Norbiton, a transport minister, confirmed that the government was considering ways to use testing to cut isolation periods. “For the time being, we are taking the approach by country for border measures, but it is the case that it could be that we put them in place for regions in the future,” she told the House of Lords.
Professor Paul Johnstone, regional director at Public Health England, said in evidence: “What was becoming clear in the back-end of March and certainly from the beginning of April was that there was an asymptomatic phase, which means that people can transfer the virus without ever having symptoms, or a significant pre-symptomatic phase, which is where the virus could be shared.”
The travel industry welcomed the suggestion that quarantine could be cut and is lobbying for the introduction of testing at airports in the UK.