Why our local test and trace teams are succeeding as national counterparts fail
DERBYSHIRE’S local contact tracing team are stopping one near-miss Covid-19 outbreak a week, including a group of people all linked to the same international flight.
Dean Wallace, Derbyshire County Council’s public health director, says the national NHS Test and Trace service is failing to spot a number of outbreaks and that his diminutive team has been picking up the pieces.
He says this shows the value of local contact tracers who know the area well, including local bus routes which may connect infections.
The authority has put itself forward to be in the next wave of mass testing. It was not included in the first batch of 66 local authority areas aiming to replicate the system rolled out in Liverpool.
Mr Wallace says the council and local government as a whole has shown its value in terms of using local knowledge and expertise to chase up contacts but he feels it was overlooked in favour of a costly national solution.
In the past month, his team of between 10 to 12 full-time staff – only around half of which are fully dedicated to contact tracing – successfully got in touch with 73.4% (1,054) of 1,436 contacts and were unable to reach 382 people.
In comparison, the £12 billion national team has a success rate in the week from May 28 to November 4 (the most recent available figures) of 64% in Derbyshire. This has seen 16,723 contacts reached and 9,380 missed.
Mr Wallace is now looking to appoint 20 more staff to tackle contact tracing locally, tripling the size of his team. He started the pandemic with just four staff to do this.
Since September, Derbyshire has been processing the details of people who have tested positive and trying to work backwards to see if they trace back to shared workplaces, schools or, in one instance, a flight.
This is what Mr Wallace describes as backwards contact tracing and often involves wading back through cases where there was insufficient data from the national team, such as their occupation.
From Monday, Derbyshire will have a formal partnership with the national test and trace team to take on the more complex cases which it has been unable to reach.
The county council will be attempting to contact these people for the first time and asking questions about where they have been and who their contacts may be – this dubbed is forward contact tracing.
Mr Wallace said: “When they [the national team] fail to contact someone within 24 hours we will get the information of those people and do the forward contact tracing of the people failed to be contacted by the national system.
“What we have been doing since September is more detailed backward contact tracing, so when we get the data through from the national system we follow those up directly and try and find out where those people may have got it [the virus] from to try and see where those settings are and see if we can connect further cases and try and close things down.
“On Monday we will do more of the forward contact tracing but we will have less capacity to do the backward contact tracing. The forward contact tracing will give us some advantages because the national system just doesn’t cut the mustard in terms of doing what you want it to do.
“We have identified more or less one outbreak a week through cases that the national system has failed to link. We’ve linked cases back to educational settings [such as schools], workplaces, large employers, medium-sized employers.
“We’ve done a lot of the work that we weren’t getting nationally, like the occupation data, when we get back in touch we are able to find out that information. information We try and have people who understand the local areas making those calls and having those conversations.
“We established eight cases in one area that were all given to us as eight individual cases and they all linked together. We established six cases that we linked back to an international flight and it gives you an idea of what we have been able to achieve.”
Mr Wallace also says the benefit of the council being the authority to contact residents is that it can also point them in the direction of welfare and mental health support and refer them to the community response team for food parcels or loneliness calls at the same time as chasing up their potential contacts.
This one-stop-shop approach is why, he says, local councils should have been considered to run the test and trace service from the start.
He said: “We support their whole health and well-being rather than just the need to have them self-isolate for the public health response. It is more likely they will be able or will actually self-isolate with that support. Also, if we find bad practice in a workplace we can refer it to the Health and Safety Executive to make sure that doesn’t happen again.
“There is frustration as to why we weren’t involved. £12 billion was spent on NHS Test and Trace and we almost felt like we were forgotten about.
“Government decided in 2013 to move public health from the NHS to local government and then since 2015 we have had our budget cut every single year.
“We went in to this on a lower base and local government has been constrained on its budget since 2010 so it almost felt like we had been forgotten, when we have all his expertise.
“All this is almost not recognised without thought for the local infrastructure.
“In total, in the summer, local government got £300 million to put together local Covid response plans, but the public health grant has been cut by £1 billion, and £300 million compared to the £12 billion nationally doesn’t really seem that equal.
“There is frustration and then you are trying to play catchup, deploying staff and training up staff and downgrading some other services, which are still important. We still need to keep stop smoking services running and weight management, we have to work out what we can flex and what we can’t.
“So you have got an under-funded public health system going into Covid and then you are trying to rapidly build capacity while you are trying to respond to a pandemic and then recruiting for certain staff skills in a pool within everyone competing against each other, it just creates time lags in trying to build the response and we are getting pulled in multiple directions and last minute asks.
“I’m not saying we are perfect and there will be mistakes, but for a county the size of Derbyshire, I don’t think we have done a bad job in setting things up and to do what needs to be done.
“It has been a massive test and I just hope public health gets more recognition. Everybody loves the NHS, I totally get that, we’d be lost without the NHS, it’s a national treasure, but equally, we have truly stepped up for local people and engaged on a social level, while the NHS by its nature is national.
“Our role is around generating health and well-being and protecting people and that has really come to the fore and I think, with what we had and what we have got, I think we have done a pretty good job. We can be proud of what we have done.”