LONG READ: Trying to track down Covid-19 testing numbers for Somerset - and why it's important

A week later, I started recording the Public Health England data each day, as the number of cases started to rise (I'm a bit of a data nerd, and I love a graph).

I found a graph to be the best way of showing people just how fast the virus was spreading (or not) across our county.

It was slow at first: five cases on March 17, but it doubled to 10 on March 19, to 21 on March 24...

I kept recording the daily data and publishing the graphs I made on this website, thinking perhaps people like me would be better able to comprehend the crisis with graphical representations.

It seemed this was so, as thousands read the stories each day to see how the graphs had changed.

March 28, 31 cases. April 1, 63...

As the days went by, many people commented either on this website or on my Twitter feed - where I also share the graphs (@GazettePaul if you care to give me a follow) - on how 'low' our numbers were, particularly when compared to places like London, Birmingham, even Devon.

'We're lucky to live here.'

'At least we're not London.'

But something was bugging me.

As while the number of confirmed cases in Somerset did seem low - relatively - was that actually the case?

And how could we find out?

One thing that could help us make an informed decision about just how 'low' the numbers in Somerset were, is the number of tests being carried out in the county.

Each day, the Government was releasing how many tests had been carried out across England, Scotland, Northern Ireland and Wales.

The numbers were growing as test supplies increased.

But how many had been carried out in Somerset?

In the early stages of the pandemic, we knew the only tests being carried out were in hospitals, which meant there weren't many being performed here.

So, on April 8, I emailed the Somerset Clinical Commissioning Group (CCG), which was handling media relations for the county's coronavirus response, and asked for a daily breakdown of test numbers.

April 8, 135 cases. April 9, 152…

On April 9, I received a reply, which told me 'information around testing is released by Public Health England or on gov.uk'. So I replied, saying this was a national figure, not a breakdown for areas like Somerset, which was what I had asked for.

I also asked if it would be easier for me to submit a request for details under the Freedom of Information Act (an FoI, as we call them) and was told bluntly, 'An FOI would have to go to the trusts in question'.

So, on April 13, I submitted an FoI request to the Somerset NHS Foundation Trust.

I have yet to receive a response or an acknowledgement my request has been received.

Then, on April 14, the CCG contacted me to inform me it was the Department for Health and Social Care (DHSC) that held 'the data on testing', so I would need to contact them.

I did, later that day, requesting a breakdown of testing in Somerset and neighbouring areas.

I was told they were 'not sure if regional breakdowns are available'. I persisted and they said they would look into it.

When I told them I would be writing about testing and the available - or unavailable - data, a DHSC official responded curtly.

"I did say I would look into this so I would advise against publishing ... until I come back on this properly," they wrote.

More than a month later, I am yet to hear back, despite repeated follow-ups from me (on April 20 and April 27) requesting any update on obtaining the data - or not.

It seems they either do not have the information, or they do not want to give it to me (I also asked if they would like to comment on the seeming lack of information, but again, I have received no response).

April 17, 274. April 20, 361...

Why is testing data important?

On March 16, director general of the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, told countries how important testing was in the fight against coronavirus.

"You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected," he said.

"We have a simple message for all countries: test, test, test.

"Test every suspected case.

"If they test positive, isolate them and find out who they have been in close contact with up to two days before they developed symptoms, and test those people too."

On April 2, Health Secretary Matt Hancock pledged the UK would be carrying out 100,000 coronavirus tests per day by the end of April.

In making the announcement, Mr Hancock said testing was vital in getting NHS workers 'back to the frontline' in the fight against the virus.

“But I took the decision that the first priority has to be the patients for whom the results of a test could be the difference in treatment that is the difference between life and death," he added.

So, tests were limited to those in hospital, but did rise continually over the ensuing weeks.

Government figures show they reached the 100,000-tests target.

And during Prime Minister's Questions on April 29, First Minister Dominic Raab - in response to a question from Leader of the Opposition Kier Starmer - said the 100,000 tests per day milestone was 'essential' to the Government's plan to manage the outbreak going forward.

"We are on track to make huge progress," he said.

"The right hon and learned Gentleman is right that the 250,000 target is still an aspiration, and I am not going to put a date on it, but the key point is that the 100,000 milestone - very important to me, and we are making good progress - is only the first stepping stone towards testing, which is essential to the wider testing, tracking and tracing regime that we will need as we transition to the second phase."

So, along with plans for an NHS contact tracing app - expected to be ready soon - it is clear testing (and tracing) is a vital component in the Government's plan to manage the disease going forward.

At the same time, a government spokesperson told the Full Fact website: “Tracing and testing those with symptoms of Covid-19 is essential if we are to limit the spread of this virus and save lives.

“We are working with clinicians, scientists and other specialists to plan a safe, staged path to national rollout.”

Many experts agree that testing could be key to manage the outbreak in the future - or not - depending on the strategy being employed by a government.

In the UK, as Mr Raab and Mr Hancock are quoted as saying here, testing is clearly at the forefront of the Government's approach in managing the coronavirus outbreak until a vaccine is in place, or treatments available.

Dr Sean L'Estrange, from the University College Dublin, has written about testing and why it is important - or not.

"Tests are conducted to gather knowledge on the location of a virus in a human body at a given time in order to place the virus under surveillance through the control of bodies via social regulations that can be reinforced by laws," he wrote.

"And this is why testing matters and why measures of testing practices - numbers of tests conducted; per capita test figures; testing rates over time (daily or weekly numbers, either absolute or per capita); testing capacities; testing turnarounds (length of time from initiating of testing procedure to production/receipt of (reliable) results); testing materials stockpiles (kits, reagent); testing costs/prices; testing sensitivity and reliability; and so on - matter too."

The number of tests carried out in the UK, per day

He says the data from testing, in Ireland as in England, appears to be aimed at establishing a 'testing, tracking and tracing regime that we will need as we transition to the second phase', as Mr Raab said.

"In the Irish case it is increasingly clear that leading health officials aspire to an extensive, comprehensive and sophisticated system of testing with the goal of rapid and ‘live’ interventions on infected bodies, that is, a strategy of suppression," Dr L'Estrange said.

So testing is clearly important as we move forward in England, the rest of the UK, and around the world.

But we still don't know how many tests are being carried out in Somerset.

April 23, 401 confirmed cases. April 27, 454...

As mentioned above, we do have a total of confirmed cases in the Somerset County Council area, in North Somerset, in Devon, Dorset and Wiltshire - but no figure for the number of tests being carried out.

On May 10, Prime Minister Boris Johnson announced a nationwide 'easing' of lockdown restrictions in England.

Unlimited outdoor exercise - in the location you desire - was to be allowed, while those who could not work from home were to be 'actively encouraged' to return to work.

Schools too, he said, could re-open on June 1, should certain conditions be met.

But Mr Johnson also said then, reiterating the strategy outlined by Mr Hancock and Mr Raab, that testing was vital.

"And if we are to control this virus, then we must have a world-beating system for testing potential victims, and for tracing their contacts," he told the nation.

"So that - all told - we are testing literally hundreds of thousands of people every day."

And on May 15, Boris Johnson's official spokesperson said lockdown restrictions could be eased at different times in different parts of the country, depending on local infection rates.

The spokesperson said: "It could lead to some of the measures being eased at different rates in different parts of the country and at the same time it could lead to some measures being re-imposed in some parts of the country but not in others."

So wouldn't it help the public understand this decision making process if we understood how many people had been tested for the virus, and how such infection rates were calculated?

STAGES: How the UK Government outlined a possible re-opening of the country on May 10, 2020

Meanwhile, the Government says it aims to trace 10,000 new coronavirus cases per day by June 1, 2020.

And in a letter to Matt Hancock on May 20, the NHS Confederation stressed how important its members viewed testing and tracing to be.

"We are aware there is a lot of work being done around testing and tracing, but we are concerned that time is running out to finalise a test, track, and trace strategy to avoid a potential second surge," wrote Niall Dickson, chief executive of the NHS Confederation.

"We are 10 weeks into the pandemic and developing a strategy with a well worked through local base should have been in place much sooner.

"Our members are concerned that unless there is a clear strategy, then there must be a greater risk of a second wave of infections and serious health consequences.

"We would therefore urge you to produce such a strategy with a clear implementation plan ahead of any further easing of the lockdown.

"The Prime Minister’s commitment today to launch the UK’s test, track, and trace programme by June 1, with 25,000 trackers, with the capacity to trace 10,000 new cases a day, is very much welcome. But delivery and implementation will be critical, and we await further details."

May 1, 492 confirmed cases, May 7, 556...

Why do we, the people, need to know the number of tests being carried out in Somerset?

Because the data matters.

We, the public, are being asked to endure lockdown and social distancing for a reason - to 'stop the spread', 'protect the NHS' and 'save lives'.

It's fair that we are given as much information as possible about the situation where we live, not only to justify the lockdown, but to inform us on what risks we take - and how our efforts are impacting on the number of infections.

We publish what we can in a bid to give you as full a picture as possible, as it is important the public has as much information as possible when making their own decisions - and understanding those of others.

The number of 'confirmed' Covid-19 cases in Somerset and across the country is published each day and, as mentioned previously, it has an impact in the community ('We're lucky to live here' etc).

It is vital this figure is put in some context - and adding the number of tests carried out would help provide some of that context.

Why?

Well, as an example - and in no way are these figures provided as any kind of actual guide, merely to show why context is needed - the World Health Organisation (WHO) says most people infected with the Covid-19 virus will 'experience mild to moderate respiratory illness and recover without requiring special treatment'.

So, testing only those in hospital, or those with symptoms, does not actually give us an accurate picture of just how many people in our county have this virus - or might.

It has been broadly speculated that around 80% of the population would experience mild or moderate symptoms - or none at all - so would thankfully never need to be admitted to hospital.

But they could still be spreading the virus.

To illustrate the difficulties this lack of data presents, there are other ways we could go about attempting to calculate the actual number of cases in our area.

On April 30, the Government said there were 482 confirmed cases of Covid-19 in the Somerset County Council area.

So we could deduce, from the 80% estimate, that the number of 'actual' cases in the Somerset authority area on that date could actually have been more than 2,400.

This is assuming the positive tests carried out are in hospitals, meaning those tested were in the 20% of sufferers who require hospital treatment due to severe symptoms.

That's a long way from 482, as so many assumed from the Government data.

Yes, it's still a low number - relatively - but still much higher than many believed was the case.

And it is also dependent on a range of assumptions, which isn't ideal.

May 15, 606 confirmed cases, May 20, 626...

So what is the actual number of Covid-19 cases in Somerset?

We don't know. And we can't really give an accurate 'guestimate', without knowing the testing numbers, for example.

Yet still, I am unable to get them.

For example, and again to illustrate the difficulties here, another way of coming up with an estimated figure of actual cases is via the tragic number of deaths in our area.

Also on April 30, we reported that the number of confirmed Covid-19-related deaths in the Somerset area stood at 53.

On April 1, the British Medical Journal reported that the estimated death rate of Covid-19 was 0.66% (which translates to around three in every 500 people who catch Covid-19 passing away).

In older people (those over 80), this rate rises to 7.8% - more than 15 people in every 200.

If we translate those figures using 53 deaths in the authority area as our guide, that would mean more than 8,800 cases on April 30.

If all of those who have died were over 80 (we don't know), then it translates to around 675 cases.

Again, these numbers are in no way intended to be accurate, the actual number is more likely somewhere in the middle. We don’t know where.

LETTER: The NHS Confederation wrote to Health and Social Care Secretary Matt Hancock last week

The point is, all of this is speculation, based on estimates of estimates and making a number of assumptions - which produce wildly varying results.

Without reliable testing data - from a broad range of people and areas - we simply have no way of knowing how many people in Somerset have Covid-19 - and how at risk we all are and indeed, what effect our social distancing and lockdown measures are having here - and how easing those restrictions may affect the number of infections.

It is clear the numbers have an impact.

There is no doubt the Government itself has an enormously difficult task in establishing a strategy to keep the country safe and ensure economic stability in a time of unprecedented crisis.

But as we are expected to put ourselves at more risk of contracting the disease, through schools reopening or returning to work, is it not only fair to give people the information they need to assess their own risk, and moderate their own actions?

Knowing what the true picture is in Somerset would help inform people, allowing them to make decisions about their own safety and that of their family.

Yet the fact remains, as the Prime Minister announces we have ‘passed the peak’ of infections in the UK and the drive to re-open schools and workplaces continues, we still don’t have a good idea of how many people in Somerset have, or have had, Covid-19.

Already, people are assuming that because we have ‘passed the peak’, it’s safer now.

There are calls to re-open shops, business premises, to start up sport again.

But the truth is, we - the public - don’t really know what the situation is in our area.

There are other measures which give an indication - such as the much-heralded 'R' number (which gives the number of people a person with Covid-19 is infecting (an R number less than 1 will see a decrease in cases over time, while when more than 1, cases increase exponentially).

According to researchers at Cambridge University, in the South West on May 11, the R number was the second highest in the UK, at 0.76.

But the truth is, the available statistics only allow us to estimate, to model the number of infections in our county, as we are being allowed to move around more due to the easing of restrictions.

The numbers are vital in helping us understand the situation in our county as we take steps to return to some sort of normality in the weeks and months ahead.

And we should all be able to see them.

Your County Gazette continues to share the data we have to keep you up-to-date.

If we don't have the data, we can't share it. But we are certainly trying.