The First Minister’s Freudian slip

The First Minister’s Freudian slip

by Linda Holt
article from Saturday 23, January, 2021

AT THIS WEEK'S First Minister's Questions, the LibDem leader Willie Rennie had his customary go at Nicola Sturgeon about testing. This time he focussed on the 50,000 PCR tests that go unused each day, which he wants deployed for frontline workers in supermarkets, the Royal Mail and the police (surprisingly he failed to mention schools). 

With perhaps not quite intentional sarcasm, he pointed out that "since Christmas, the SNP Government has failed to use almost a million 'gold standard' – that is the phrase that it uses – PCR tests; to be precise, that means that 908,585 potential tests have been wasted".

So far, so predictable; but then came Nicola Sturgeon's reply:

“Willie Rennie says that we have failed to use all those PCR tests. Those tests are there so that people can be tested when they have symptoms. Remember, if you have symptoms, you should self-isolate and get tested. If we had used all those symptomatic tests, we would have a prevalence and an incidence rate that was many times higher than it is. That would not be a good thing; it would be a bad thing and a terrible position for us to be in.”

What does the First Minister mean here? There seem to me to be two possibilities.

First, she might be saying that only if the number of symptomatic cases were far higher would it be necessary for  nearly a million people to receive what she calls the “symptomatic test”,  and this would indeed be a terrible situation. But we are not in that situation because the million people did not have symptoms and so weren’t tested.

What an absolutely fatuous and self-serving non-answer! Despite Rennie expressly asking about using extra tests for the asymptomatic, the implication is that he and we should be impressed that there weren’t enough people with symptoms to need the test.

The second possibility is that the First Minister is referring to PCR tests as they are used in reality. This is surely the straightforward way to understand and answer Rennie’s question. Because Nicola Sturgeon surely knows that PCR tests are routinely used to test certain asymptomatic groups. Frontline health and social care workers and patients in hospital and care homes, as well as others in private settings such as workers in the offshore oil sector, are being given PCR tests at regular intervals – symptoms or no symptoms. She cannot have forgotten the resistance she and Jeane Freeman put up to the idea of regularly PCR-testing care home workers in early summer last year, before finally caving in. 

Seen in this light, her claim that if all the PCR tests had been used, then the prevalence and incidence rate would be "many times higher than it is ... a bad thing and a terrible position for us to be in" is a truly astounding admission. In other words, extending PCR testing to other frontline workers beyond health and social care staff would cause official infection statistics to explode. 

Of course that would be a very bad thing, but presumably it is better for people to know they are infected and have the opportunity to self-isolate, than not? And surely it is better for a government so focussed on managing a pandemic to know the level of infection among its citizens so it can make policy accordingly?

Apparently not –  because as Sturgeon lets slip, that would be "a terrible position for us" to be in.

The key to this conundrum, is, the fact that the PCR test is, in Jason Leitch's immortal words, "a bit rubbish". It was not designed as a reliable diagnostic test, and various factors can produce a significant false positive rate. One of these is testing people who are asymptomatic.

It's impossible for Nicola Sturgeon and her advisors not to know about the shortcomings of PCR testing, particularly for the asymptomatic. But they cannot admit it publicly – as the official reaction to Jason Leitch’s gaffe showed. To do so would undermine the daily scare-mongering about case numbers, and hence the justification for current lockdown policies.

As testing has increased since the first lockdown,  the metrics determining policy have shifted: positive tests, not deaths or ITU admissions, are now the key factor in deciding how hard and long to lockdown. Doubts about PCR testing would fatally damage public messaging, and government credibility.

If we do not have a reliable test for Covid-19 infection, how do we know how bad the pandemic is? How can a government hope to "control" something it has no means of identifying the extent of? Without accurate infection data, how on earth can we assess the efficacy of  specific restrictions or lockdowns? 

No wonder when questioned about the scientific basis for her measures at her daily briefings, Nicola Sturgeon’s reflex is to deflect to the "common sense" argument of reducing opportunities for social contacts and a plea to every individual as a potential spreader to follow her rules. 

Linda Holt is an independent councillor for East Neuk & Landward and a prospective candidate for alliance4unity in next year's Holyrood elections. lindaholt.org.uk

 

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