Panorama 2020 E23

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Panorama 2020 E23
Transcript
00:00Tonight on Panorama, the great testing gamble.
00:07The stakes are very high indeed.
00:09Testing is absolutely critical and central to preventing a second wave now.
00:15Thousands of lives now depend on the government getting testing right.
00:21We should be very concerned until we can see there is a fully effective
00:27testing and contact tracing system in place.
00:31So why do our COVID investigators have nothing to do?
00:36I have had zero cases, absolutely zero.
00:40And why haven't millions of test results been shared with the NHS?
00:45There is no transfer of data into a clinical record at the moment.
00:48There's an aspiration to do that in the next few weeks.
00:51But we need it now.
00:52It would have been helpful to have it a few weeks ago.
00:57We're facing an invisible killer.
01:13So we need to see every road, every place where COVID is spreading.
01:21The only way to track the movement of the disease is to test.
01:26So we can follow the infections and trace those that may have it.
01:34Now, after so many deaths, the UK is relying on this system
01:39to keep us safe as we come out of lockdown.
01:45I think it's a real worry that we are lifting the lockdown restrictions
01:50in a slightly sort of shambolic fashion,
01:53without a proper test, trace and isolate system.
01:57Everyone wants to get out of lockdown,
01:59but we need to get out of lockdown safely.
02:01Otherwise, we're going to see mini flare-ups, epidemics around in regions
02:08and people are going to die as a result.
02:14So far, the data suggests our testing hasn't been impressive,
02:19only detecting around one in four infections in the community.
02:25We've already reached a target of 10,000 tests per day as committed.
02:33For most of this crisis, testing has been about numbers.
02:39We're ramping up the testing with capacity now at over 73,000.
02:44The number of tests yesterday, on the last day of April, was 122,347.
02:56I think it was helpful, and from a situation where we didn't have
03:00enough testing capacity, I think that decision to target 100,000
03:08and to really throw everything at getting that transformed
03:13the testing capacity that we had.
03:17The ambition clearly is to get up to 200,000 a day by the end of this month
03:23and then to go even higher.
03:29Of course, more tests are better than fewer.
03:34But some say focusing just on daily targets is not enough.
03:42Trusts were saying very clearly that they were concerned
03:45that the over-obsessive focus on the 100,000 target was distorting
03:50what should have been a strategic approach to testing
03:53and that we were just chasing that target and we were missing the fact
03:57that trusts were simply not able to get patients and staff tested quick enough,
04:01certainly within the 24-hour international standard turnaround time.
04:10The pursuit of big numbers was about a government trying to fight back
04:15from a bad start.
04:19When Covid first hit, the UK didn't have enough testing.
04:25We couldn't see the disease spreading.
04:31The government then stopped all testing apart from patients already in hospitals.
04:38We will pivot all of the testing capacity to identifying people in hospitals
04:43who have got symptoms.
04:47But we needed to urgently increase the number of tests we could do.
04:52Rather than relying solely on our public sector labs,
04:56the government asked private companies to build a new testing system.
05:13It includes the drive-through centres that collect samples
05:17and the not-for-profit labs that check for the disease.
05:22So this is one of the new labs that's being used to process Covid tests
05:28and we've been told that here they have quite a high rate of failed tests.
05:39But these void tests are still counted in the government figures.
05:45It's usually not the lab's fault.
05:47It's usually not the lab's fault.
05:49There have been problems with the samples collected nationwide.
05:54Mistakes and kit that doesn't work means that more than 90,000 tests have had to be voided.
06:01Accountancy firm Deloitte oversees the private companies that collect the samples for profit.
06:07It says 97% of tests are valid
06:12and that void tests are immediately investigated.
06:18Any improvements are implemented as quickly as possible.
06:25I don't think it would have surprised anyone in advance
06:28if you had said that in some cases there will be teething problems that will need to be ironed out
06:36and not everything will work right first time.
06:39But nevertheless I think it has been very important to establish that capacity.
06:51There's also a basic design flaw.
06:54The private network was built at speed and wasn't fully integrated with the NHS
07:00so test results weren't passed between the two systems.
07:04They're sent to the person who's been tested and Public Health England
07:09but local councils, hospitals and GPs are left in the dark.
07:16So if somebody is tested, somebody in this area gets tested,
07:19their GP and their hospital won't get to know that data?
07:23No.
07:24There is no transfer of data into a clinical record at the moment.
07:27I gather there's an aspiration to do that in the next few weeks.
07:30But we did it now.
07:31It would have been helpful to have it a few weeks ago.
07:33How big an issue is this parallel structure and this kind of data black hole?
07:38How big an issue is it?
07:39If you assume testing does contribute to our management of the pandemic
07:43and that eventually saves lives,
07:47if we're not delivering effective testing then that has to cost lives.
07:52The Department of Health says the public and private labs complement each other.
07:57It's working to link test results to patients' records.
08:03We've also examined how the tests are taken in the new privately run system.
08:12Either you're sent a test in the post office
08:15or you're sent a test in the hospital.
08:18Either you're sent a test in the post
08:21or you use one of the drive-through testing centres.
08:27I'm on my way to a testing facility
08:29which is in the car park of Manchester City's Etihad Stadium.
08:37Its staff are low paid.
08:39Workers told us they haven't seen a nurse or doctor on site.
08:44PPE isn't used properly.
08:47And frontline staff have had hardly any training.
08:54The words of one worker are spoken by an actor.
08:59I was really, really surprised by the lack of medical involvement.
09:02I assumed there'd be doctors or nurses on site
09:05and I assumed the tests would be carried out by healthcare workers.
09:08It's jarring to know the site's not run by the NHS,
09:12even though it's written everywhere.
09:14The same gloves are used all day
09:16by people on entry and exit lanes, from what I've seen.
09:19It's a hotbed for infection, so we need to take precautions.
09:24I feel the government has made a serious error
09:27with the reliance on untried private sector companies
09:30to run these drive-through testing centres
09:33when they could have chosen to use the expertise already there
09:36in our local government in Public Health England
09:39and build that up instead
09:41because you have there the clinical experts that you need
09:44to do this to the right standard.
09:48Deloitte says it doesn't oversee the daily running of the site,
09:52but all staff must have the required training for their roles
09:56and comply with national PPE guidelines.
10:02The Department of Health says it's a fantastic achievement
10:05to have built a large-scale testing programme,
10:08which can now provide a test to anybody who needs one
10:12and can deliver more than 200,000 tests per day.
10:178.7 million tests have been delivered
10:20thanks to the public and private sector working together.
10:39This is how they do testing in Germany.
10:53In Heidelberg, it's a doctor in full PPE,
10:57supported by medical students.
11:09And all the time they're wearing three pairs of hand gloves.
11:13And you're a doctor. Is there always a doctor here?
11:16It's necessary that one doctor is here all the time.
11:19If it's difficult to get in there, a doctor can maybe help.
11:30And the system seems to be working.
11:33There have been isolated outbreaks,
11:35but most of Germany is pretty much back to normal.
11:43Germany has a bigger population than the UK,
11:46but has had about a fifth of our Covid deaths.
11:50One big difference is they built testing capacity much earlier,
11:55so they could test those with symptoms and those without.
12:00That matters because many people who have Covid,
12:04they show no symptoms.
12:06So no-one knows that they're infected
12:08and they're spreading the disease around.
12:10And if they work in a hospital or a care home,
12:13then that can be deadly.
12:16If you only chase the people with symptoms,
12:19can you defeat the disease?
12:21I don't think so. Why?
12:23Because if you just only test those with symptoms,
12:27you just do not get the whole iceberg.
12:31You just only see the top of it.
12:34And so you're running behind, actually.
12:46All of this should be no surprise to the UK.
12:51I've been here for three and a half, four years now.
12:54So that's our lab environment there, that's my office.
12:58Researchers at this top lab put out a warning back in April.
13:02So these are actual swabs, or what's coming from the swab?
13:05That's right. This is the sort of residue from the swab.
13:10And the government was told about the risks.
13:13Covid-19 was different from other viruses
13:16and had a dangerous characteristic.
13:20Just under half of infections
13:23could be associated with a significant period
13:26where that person is asymptomatic.
13:29We've been very surprised about this and quite shocked.
13:32There can be a peak period of infectivity
13:35two to three days before the onset of symptoms.
13:38And so if you don't know you've got symptoms but are highly infectious,
13:42that, to us, is a very dangerous position to be in
13:45when you're providing healthcare,
13:47to vulnerable patients.
13:49The difficulty is, if you don't look for it, you won't find it.
13:57But because we only had limited testing capacity,
14:00for months the UK could only test those with symptoms.
14:04That meant people who didn't know they were infectious
14:08were spreading the disease in our communities and in our hospitals.
14:12Should the government have reacted more quickly
14:15when they became aware that asymptomatic carriers were a big problem?
14:19My view is, yes, they should have done.
14:21The only conclusion I can come to,
14:23on the basis of the evidence that is widely available now,
14:26is that asymptomatic transmission occurred
14:29in healthcare worker environments,
14:31in community care homes, almost certainly.
14:34The numbers of deaths, I would not be able to estimate,
14:37but I'm certain that the number of deaths
14:40occurred as a result of this.
14:49Healthcare workers can infect vulnerable patients
14:52as they move between wards,
14:54so the warning was straightforward.
14:56Test front-line staff in hospitals or the disease will spread.
15:02I think, looking back, this is a major flaw
15:05that follows directly from what we've seen.
15:08It's a flaw that follows directly from a lack of capacity.
15:11It goes back to this question of choice and prioritisation,
15:15that if you had enough capacity, you wouldn't have to do.
15:19But if you have a limited number of tests available,
15:22then it's not surprising that you will focus them on people with symptoms.
15:30The government says it's prioritising NHS staff
15:33and wants to introduce more regular testing.
15:37But routine testing still isn't widely available.
15:43You can't describe the testing regime as fit for purpose
15:46until you've got a regime that is able to consistently
15:49and regularly test all staff and all patients,
15:52and the really worrying bit is we don't have a clear plan
15:55and timeline of when we're going to get there.
15:59MUSIC
16:05It matters because when NHS staff aren't tested, lives are at risk.
16:14In May, the loosening of the lockdown
16:17drew big crowds to Western Supermare.
16:23The local hospital was forced to shut for more than two weeks
16:27after being overwhelmed with Covid cases.
16:36Many thought the day-trippers had brought the disease with them
16:40here to Western Supermare, but it wasn't their fault.
16:44Covid was actually being spread around the hospital
16:47by NHS staff and by patients.
16:51MUSIC
16:57Many staff didn't know they had the disease
17:00because they hadn't been tested and they didn't have symptoms.
17:06There wasn't easy access to testing and it was very, very hit and miss.
17:12The reality seems to be that the lack of testing
17:15meant that staff were going into work being exposed to the illness
17:19and asymptomatic staff were still going about their work
17:23and quite innocently, you know, adding to that infection risk.
17:30And the lack of testing meant the hospital didn't know
17:33how widely the virus was spreading.
17:39A dad never had, like, a picture by himself.
17:42Like, it was always with family, one of us.
17:46Amar Diaz was a hospital worker who fell ill at the start of April.
17:52My dad is a very fun, loving, kind, gentle, humble man
17:57anyone can ever meet, honestly.
18:00Like, me and Amy are just truly blessed by God
18:04that we had a dad like him.
18:10Amar's whole family are health workers,
18:12though we don't know where he caught Covid.
18:15He isolated at home but was refused a test until he was taken to hospital.
18:21When he was taken to the hospital, I called my dad up and he said,
18:26I'm getting put on a ventilator, darling.
18:28I love you. I have to go because they want me. I need to go.
18:34Mum told us that the last she saw my dad was him waving kisses
18:40and saying goodbye to her.
18:46It was horrible, like, horrible of a feeling.
18:49And at 9.30, the nurse said, he's gone.
18:57She said, Mini, he's gone.
19:05It was like, what else can we do?
19:07To see, like, my dad walk out the door with his own two feet.
19:10He walked out on his own and he never came back.
19:16Six weeks after Amar died, the hospital closed
19:21and all staff were finally tested.
19:24The results were shocking.
19:26100 members of staff at this hospital were infected with the disease.
19:33And patients were infected too.
19:37We've discovered that in April, there were 29 Covid-related deaths.
19:42In May, there were 27.
19:46Amar died in April.
19:48But the hospital says his infection occurred before the outbreak
19:52and was unconnected.
19:56I know for a fact that my dad was taken care of very well
19:59by the hospital people.
20:01They all know my mum and dad.
20:03The only thing that could have been done, a lesson that could be,
20:08is for a simple thing as the testing could have...
20:11If that was there, you never know what the outcome could have been.
20:21Western Hospital says it's tried to follow national testing rules
20:26and made significant efforts to minimise staff movements.
20:30The trust is now undertaking a serious incident investigation
20:35and has commissioned a lessons-learned review.
20:48It wasn't just here.
20:5120% of all Covid patients are thought to catch it in hospital.
20:58It seems to me that we ought to have cracked,
21:01actually probably some weeks ago,
21:03and put in place a regime of testing asymptomatic people,
21:09at least in those settings that are particularly risky,
21:13especially in care homes and in NHS settings.
21:21The price of the missteps and the mistakes the government has made
21:25is that more people have died than should have.
21:28There have been avoidable deaths in this country from Covid-19.
21:45Testing is only half the answer.
21:51In Germany, and almost every country that's successfully contained Covid,
21:56it's about tracing everyone who might be infected.
21:59And this is the model that we're now putting our faith in.
22:06The way this works in a community is anyone who tests positive here in Germany,
22:10they're phoned and they're asked who they've been in contact with.
22:13Those contacts are then asked to isolate.
22:16Bit by bit, the disease is chased out of the city.
22:27They've been contact tracing since the start of the outbreak.
22:31It's run by the local public health authority.
22:38We tracked down people who've gotten contact
22:41without knowing that they have gotten a contact to the coronavirus.
22:45So we were trying to, like, close it down.
22:49And the tracers keep in touch to make sure
22:52everyone potentially touched by the disease is identified.
22:59We're asking, it's like a little bit of Sherlock Holmes situation,
23:03you know, we've been detectives.
23:05We're asking people who have been in contact
23:08who have been in contact with the disease.
23:11We're asking people who have been in contact
23:14like a little bit of Sherlock Holmes situation.
23:17We've been detectives.
23:19It takes a lot of patience to ask on the telephone,
23:22where have you been the last day?
23:24Where have you been two days before?
23:26And so we've been able to find, let's say,
23:29one patient, about 10 people, contact people.
23:32What has test and trace done for this community?
23:37I think it's saved life, lives.
23:40It's saved maybe a lot of lives.
23:44It's saved lives.
23:51Tracing allows us to see
23:53how the disease is spreading through our communities.
24:00But with the phone app now delayed,
24:03do we have a strong enough system in place?
24:07We will have a test, track and trace operation
24:11that will be world-beating.
24:13It's in place. It will be in place by June 1st.
24:20England's new tracing system has only been running for a month.
24:25It's in two parts.
24:27There are existing teams of local public health experts
24:31who work on the bigger outbreaks
24:33in places like schools and care homes.
24:38And then there are 25,000 new contact tracers
24:42working from home.
24:43Most are low-paid and working for private companies.
24:47They're supported by staff with medical experience.
24:52So, prior to today, I've had zero cases.
24:56Absolutely zero, none at all.
24:58And I've done approximately two to three shifts per week.
25:03I feel guilty for being paid to do nothing.
25:09The workers we spoke to didn't want to be identified
25:13because they could lose their jobs.
25:15The majority of the days that I have worked,
25:18I have not had any contacts to trace at all.
25:22At first I thought that I was doing something wrong
25:25and I've joined some help groups on social media
25:31and other staff are saying the same.
25:33They're reassuring me that it's the same for everybody.
25:36Me sitting here, click and refresh, and I'll do that now.
25:40Click and refresh, nothing.
25:42There are no cases for me to do. No, absolutely nothing.
25:47But the government says it's built a new service
25:51on a scale never seen before
25:53and having an overcapacity is a real success.
25:57It's already helped to stop more than 100,000 people
26:02from unknowingly spreading the virus.
26:07So what's going on?
26:09How can the new tracing system have contacted that many people
26:14if the call handlers say they're hardly speaking to anyone?
26:19But the government's figures weren't just for call centre workers.
26:24They also include cases that were being managed
26:27by professional teams on the ground.
26:29And it's these public health experts
26:32who are responsible for identifying and tracing most of the contacts.
26:39So it's not the government's 25,000 new recruits.
26:45The most recent figures show 113,000 contacts traced.
26:52But if you dig into the detail,
26:54you find that only 15,000 of those
26:57were traced by the expensive new call centre.
27:02The vast majority were contacted
27:04by just 870 staff in the public health teams.
27:12It was a surprisingly positive result.
27:14We thought, great, at last maybe they're getting to grips with this.
27:17So then to discover that actually this was largely down to the work
27:21that was already going on in the background,
27:23I do find that very disappointing.
27:25I think the government, you know, weren't clear about that
27:28and the public have been misled.
27:33It's hardly surprising the new call handlers have nothing to do.
27:38In the first three weeks of the scheme,
27:41on average they've had less than one successful contact call each.
27:46That matters because almost a quarter of people
27:50who test positive for COVID are still not being reached at all.
27:55We've got to get it right.
27:57This cannot just be swept under the carpet.
28:00We need this to work now.
28:03It's really surprising when you see the politicians at the briefing
28:07saying how well the contact tracing service is going
28:11because the people that are actually working for the service
28:15know that that's not true.
28:17Absolutely not true.
28:29Right now, keeping the disease in check
28:32is the difference between life and death.
28:37Thousands of lives are at risk if test and trace doesn't work.
28:43Fighting against a pandemic situation
28:45means you have to know who has the disease.
28:48If you do not know, you're running behind all the time.
28:53With less than 10% of our population having been infected,
28:57I think the maths are quite clear in my mind
29:01that the stakes are very high indeed.
29:10Our fight against this killer disease
29:13depends on finally getting testing right.
29:19A profound portrait of one doctor battling COVID at its peak.
29:23Italy's front-liner Doctor's Diary is over on BBC Two in an hour.