Anaesthetist... NHS_Training_in_Primary_Care_General_Practice

If we ever go to the pub aain, here’s a neat question for the Friday night quiz.

‘What’s Queen Victoria got to do with track and tracing?’

Keep reading… I’ll tell you!

In the mid-eighteen hundreds, in and around, London’s Broad St (now Broadwick St), a cholera outbreak was wreaking devastation. Government at a loss.

Enter John Snow, a doctor, who spoke to the sufferers and their families. He realised they’d either used the public water pump, or been in contact with someone who had.

He took the handle off the pump and the contagion subsided.

That’s how track and tracing was born. It’s simple, it works and we’ve used it to track-n-tracing sexually transmitted diseases, TB, SARS, measles, all sorts.

It’s labour intensive, refined in the stubby-pencil era and for want of a better alternative, survived. In the hands of experts, it works. It’s a skill and nothing like tracking and tracing a delivery from Amazon.

It is also very complicated and pointless, unless it’s underpinned by a rock solid, reliable, accessible, testing infrastructure. Track people, trace people, test them and repeat.

Here’s a little factoid; South Korea and Australia, who made something of an art-form of TnT, tell us the average number of tests required, per case, was 52 and 64, respectively.

BoJo wants, ‘world beating’, 10,000 TnT cases delivered, a day. That’s 70,000 a week, every week.  If Oz is a marker, let’s hope he’s got 4,480,000 tests a week lined up.

World beating? Beats me… something that works is good enough for now.

BoJo’s plan is 25,000, on-line-trained, fresh out-of-the-box, TnTpeople who will make contact, with newly infected people, in the jargon, called ‘the index’.

Then, calling, calling back, jogging memories, teasing out the truth of trysts and clandestine meetings, encounters, building trust, remembering phone numbers, leaving messages, physical visits… you get the picture?

And, there’s persuading people who have, unknowingly, brushed the life of ‘the index’ to isolate, stop working, stop earning a living and stopping the temptation to say; ‘To hell with it, I feel OK, I’m going to work…’ and get tested.

Plus, the privacy, confidentiality and the legal requirements TnTpeople have to act on, warn and perhaps, prosecute people.

Stubby pencil TnT, works when the contagion is local and the spread is through definite and identifiable contact, as in sexual disease transmission.

Do we know enough about the transmission of CV-19, to keep pace with a geographical spread across the UK, the TnT gang could, easily, be blown away and testing blown apart.

TnT worked in the gas-lamp era. Today, with more mobile populations, sitting on trains and busses, visiting supermarkets, the corner shop, we won’t know who to refer the TnT gang to. They stand no chance. Hence, the NHS, TnT App, that might.

The original hope was the NHS TnT app would take a lead. Now it seems relegated to ‘supporting’, the stubby pencil.

From what I have learned from the IoW trial, on the right phone, the software works but the end-2-end, the largely manual bits it connects with, testing, notifications, call-backs, follow-ups, are fragile. Interfaces again… t’was ever thus.

Throughout the dark days of our macabre dance with the deadly corona-virus, we’ve been stepping blind. 

Leadership working with the old data they juggle into R0. Science running weeks behind other countries and WHO. Without testing we’ve walked ourselves into blind-alleys, without TnT we are trapped in cul-de-sacs and dead-ends.

We must start anew.

To the TnT gang, I say; you’ll never do more important work, yours is a trace against time, your work will save lives and help the nation and its economy, see its way clear.

To the testers I say; your time has come, you must see that.

To the TnT leaders and App makers, I say; hindsight is a wonderful thing but you will be remembered for what you do next.

… and I promised you Queen Victoria. Her two children, Beatrice and Leopold, were delivered with the help of chloroform, administered by our man, John Snow. 

He was an anaesthetist.

Have the best weekend you can.


PS: I was inundated with good wishes for the family whose story was told in the email I published yesterday.  I’ve passed them on.  I’m sorry to report, the gentleman who refused to be labelled DNAR, some-how managed, in a care home, to fall and break his hip.  He is now in hospital awaiting an operation.  Good luck and if you pray, say one for him.

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