Coastal area where the Covid-19 virus has never really taken hold
AS WALES takes the first steps out of lockdown and starts trying to find a way to live with Covid-19, people in one part of the nation could be forgiven for thinking they have almost entirely escaped the disease which reached crisis points in other parts of Wales.
With just 42 confirmed cases to date, and seven deaths, it seems that in the coastal council area of Ceredigion the virus never really took hold.
The initial flurry of cases in this rural part of Wales was comparable to the start of the outbreak in those local authority areas of Wales that ended up being worst-hit by the virus. Yet here it just sort of petered out.
On the face of it, the geography of the largely rural county could explain the relatively low spread of cases, with no large population centre like in Newport or Cardiff.
Mirroring the swift acceleration of cases already seen in countries like Italy and Spain, heavily urbanised Newport reached its peak on April 2, with Cardiff and RCT not far behind.
The latest data from Public Health Wales show Powys has had 216 cases for every 100,000 people in the area. Pembrokeshire 279. Gwynedd a painful 449.
In comparison Ceredigion has had just 57. Nor can this be accounted for by a lack of testing.
The pitiless eye of the Office for National Statistics (ONS) shows that Ceredigion has had the fewest deaths where Covid-19 is mentioned on the death certificate: 9.6 for every 100,000 people compared to 30 in Pembrokeshire, 53 in Gwynedd and 64 in Powys.
Neither can it be that the deaths simply weren’t attributed to Covid-19. Data from the ONS shows that there have been hardly any excess deaths in the Hywel Dda health board area.
The spike in the south and south-east of Wales simply doesn’t show up here. And Ceredigion has been the area of Hywel Dda with the least Covid19.
It might be tempting to think that the virus never got here. Yet this isn’t true either.
In the mainland UK, no local authority has had fewer cases. Even the Highland council of Scotland has had more (82 for every 100,000 people). So what happened? One big difference that sets Ceredigion apart was that even before it had recorded its first case of Covid-19, it had set up a “homemade” in-house test, track and trace system.
The man behind it, Barry Rees, the corporate director for Ceredigion Council, is a scientist by training. He believes contact tracing is the only way of “pursuing the disease then rather than following it”.
Is this the reason for why the county has emerged unscathed? Has a simple contact tracing system saved hundreds of lives, and what does it mean for the population in life after lockdown who haven’t yet built up immunity?
In the early days of the coronavirus pandemic, before the first death had been recorded in Wales, Ceredigion Council convened their first Gold Command meeting. Bringing together the key people in the council, including leader Ellen ap Gwynn and Mr Rees, they needed to decide what to do
ong before the national lockdown was announced, the council had instructed all holiday and caravan parks to close too.
Thanks to the council’s “proactive” action, by mid-March, they were down to their “core population”, said Mr Rees. But even so, Eifion Evans, the chief executive at CCC, challenged the group in Gold Command: “Are we missing a trick? Is there anything we haven’t done?”
“I piped up about having read about contact tracing in south east Asia where they had trialled it and were able to put the manpower in to do it,” said Mr Rees, who has been in his current post for two years.
“I knew we had the skillset and so I got a couple of colleagues together who created something, based on research which was happening internationally.
“At first, it was nothing complex – just a simple questionnaire which could be filled in manually, as a way of contact tracing. That’s the way it has developed really, probably helped by our lower numbers.”
Mr Rees says that simple system has enabled them to carry out contact tracing on every confirmed case in the county. He said: “We’ve done so for the past seven to eight weeks now. We’ve picked up all positive cases and been contact tracing on them all.”
A couple of environmental health officers were assigned to pick up on positive tests. Precautions were even extended to their own staff.
“We’ve got a HR system where people will put down a reason for their absence on a daily basis,” explained Mr Rees. “So we check to see if anybody has put down their absence for coronavirus symptoms. We picked those up and were able to contact them as well.”
Before they could begin, the team, led by Mr Rees, had to set out the “moral imperative”.
“We also had a colleague from data protection,” he continued.
“Because for the first time really we were using people’s data to contact potentially a secondary contact who was or wasn’t a member of their close family. So we were using their data in a new way, so we checked that out with our data protection officer and he liaised with the information commissioner’s office.
“We set up our own very simple data management system. It was a manual effort, with one of the environmental health officers picking up the phone, explaining what we were trying to do. In the beginning, people weren’t aware of a test, track and trace system, so we had to explain all of that to them.
“The data we collected was input to our data management system, which was very much homemade, so no one was scribbling down responses on a piece of paper. Then we used our in-house environmental health expertise to help decide how and when to contact people.”
Mr Rees, 51, is keen to stress he is “just the ideas person” who “facilitates the work”. He adds: “The doing has been done by other people.”
He believes effective contact tracing is a race against time which is why his system took a conservative approach and assumed that every symptomatic person was a positive case.
“Numbers started off pretty low and there was one busy weekend where we had a couple of positive tests we needed to follow up,” explained Mr Rees. “We also had some symptomatic members of staff and we really needed to snuff that out and pursue that.
“They’ve subsequently been tested and that test was negative, but we did some preventative stuff, prior to the test. One of the worries is that, if the starting point for the contact tracing is a positive test, you’re already some way down the line.
“If people aren’t following the advice being given, then you’re missing a few days for people to go through the further process of being tested. You might be losing 48 hours where these people may not be following the guidance and potentially spreading the virus.”
Mr Rees says a decision needs to be made between either speeding up the turnaround time for getting test results – “that’s got to be really really quick”, or instigating contact tracing with a starting point of when people exhibit symptoms.
Mr Rees is wary about putting Ceredigion “on a pedestal” for “doing anything better than anybody else”.
“We’re pretty pleased with the low numbers but I certainly wouldn’t want anything to suggest we’re complacent about it or that we’re doing anything better than anybody else,” he said.
He said: “If you measure the distance from the A55 to the M4, we’re probably the furthest away from both of those,” he points out. “It’s a combination of factors really.
“It’s difficult to get cause and effect and to look at all the different factors and metrics that have helped.”
Commenting on the spread of coronavirus westwards through Wales, Dr Phil Kloer, medical director and deputy chief executive at Hywel Dda University Health Board, said: “Evidence has shown that to date the number of positive coronavirus cases has declined as you move westward, through Cardiff, Cwm Taf, Swansea and then the Hywel Dda area, with the lowest rate in Wales being in Ceredigion.
“This demonstrates a pattern based on previous experiences of new infections arriving in Wales, with infections tending to arrive through travel pattern along motorways and trunk roads from more urban areas.”
“The job now really is to make sure what we’re doing is fully compatible and we don’t develop ourselves into a cul-de-sac,” added Mr Rees. “We’ve got to turn around and do something different because of the national model. So we’re not investing time and resources into further developing our system.”
The Wales-wide contact tracing system will roll out a national data management system, which is supposed to be up and running by June 8. The Welsh Government has set targets to scale up the contact tracing and the council is now recruiting additional contact tracers to help meet this and scale up “as required”.
The challenge now for Ceredigion is how it scales up its capacity for contact tracing.
“In Ceredigion, it’s been quite small-scale,” explained Mr Rees.
“We’ve made about 30 contacts all told because of our low number of cases. We haven’t missed anybody out.”