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A time-lapse view showing the increase in infection rates in Preston at LSOA level – the left-hand image shows the situation in the period 6-19 July and the right-hand image from 20 July to 2 August. Such localised data facilitates contact tracing.

Coronavirus statistical update: test and trace finally goes local

The government has finally accepted that if test and trace is to work properly, local expertise and resources need to be incorporated alongside the centralised system, though there is as yet no indication that local authorities will be given extra funding to do local contact tracing. Separately the Department of Health and Social Care is said to be planning a merger of NHS Test and Trace with the pandemic response work of Public Health England. Research and graphics by Russell Hall, text by Nick Terdre.

A new body, the National Institute for Health Protection, will be set up to take over the pandemic response work of Public Health England (PHE), including the NHS Test and Trace system, the Sunday Telegraph reported at the weekend. It is due to be operative in time to lead the response to a likely second wave of coronavirus infections in the autumn.

Dido Harding, currently head of NHS Test and Trace, is reportedly lined up to head the new institute.

The Sunday Telegraph reported that over the next few months NHS Test and Trace call centres would be wound down and replaced by local teams run by councils, which are seen to be more effective and persistent at tracking cases.

PHE – set up in 2013 by then health secretary Jeremy Hunt in the wake of a public health shake-up by his predecessor Andrew Lansley – has been blamed for a number of failings during the pandemic, the latest being an over-estimate of coronavirus  deaths by counting all deaths of persons who at any time had had a positive CV test. New measures, including a daily count of the number of deaths occurring within 28 days of a positive test, and a weekly count of all such deaths within 60 days, were announced last week.

The establishment of local test and trace teams was announced by the health department on 10 August. “These dedicated teams of NHS Test and Trace contact tracers will focus their work on specific areas, alongside the relevant local public health officials, to provide a more tailored service,” it said.

“If the dedicated national team cannot make contact with a resident within a set period of time, the local public health officials can use the data provided by NHS Test and Trace to follow up, which in some pilot areas has involved local authority teams and voluntary partners visiting people at home.”

According to openDemocracy, it is not the case, as has been widely reported, that national call centre staff employed under the generic contact tracing contracts outsourced to private companies Serco and Sitel – so-called Tier 3 – will be redeployed to regional teams. Instead, the health department told the independent news researcher, it will be Tier 2 staff – a much smaller group of clinically trained professionals working for Public Health England and the Department of Health.

The numbers of Tier 3 staff will be reduced from 18,000 to 12,000, but none of these, at least for the time being, will be moved to locally ringfenced teams, openDemocracy said. It also reported that there were no plans to provide local authorities with funding to run the new service.

Contracts extended

Meanwhile Serco and Sitel, some of whose staff have said they have been left to twiddle their thumbs with virtually no work to do, have had their contracts extended beyond the initial review date of 23 August. In addition to the £190m they have already been paid, they stand to gain an additional £528m if all extension options are exercised.

The head of NHS Test and Trace, Dido Harding, denied that the switch of emphasis to local activity was a U-turn. “We have always been clear that NHS Test and Trace must be local by default and that we do not operate alone – we work with and through partners across the country,” she said.

However, there is ample evidence of the central authorities’ failure to provide the localised data to enable councils to chase down the contacts of people testing positive for coronavirus – a detailed example already mentioned in this column was given recently by the mayor of Leicester.

The benefits of involving local resources were explained this week by the director of public health of Blackburn with Darwen, which like Leicester is one of the current hotspots subject to restrictions. The local council had taken on case tracing – tracking down confirmed cases that the national system had been unable to trace in 48 hours, Dominic Harrison reported: “We are now managing to make contact with nine out of 10 of these cases and pass on their contacts to the national system for tracing.”

In a statement the health department explained that, “This integrated national and local system…will now be offered to all upper tier local authorities which are responsible for public health locally.” This includes East Sussex County Council.

HOT has asked ESCC if it plans to accept the offer, and Hastings Borough Council whether it is ready to participate in local case and contact tracing, but had not received a response from either when this article was published.

Rother ready to assist

However Richard Parker-Harding, head of Environmental Health for Rother and Wealden councils, told HOT: “The Environmental Health service of Rother and Wealden has always been ready to assist with the tracking and tracing of CV19 suspect cases, in order to control the disease. We already carry out this work for several mostly food related diseases-working with Public Health England.

“The change in the current system, devolving more responsibility and staff to local areas is currently being developed and our staff are involved in these discussions. Our understanding is that Director of Public Health (ESCC) will be more directly involved. We have weekly meetings with the Director of Public Health and our environmental health officers will be available to assist, if the need arises to control a local outbreak.”

The latest Test and Trace statistics provide evidence of the centralised system’s shortcomings. In the week ending 29 July, 4,642 new cases of infection were referred to it, of whom 3,688, or 79.4%, were reached and asked to provide details of contacts to whom they might have passed on the infection; 19,150 were identified as recent close contacts, of whom 13,866 (72.4%) were reached and asked to self-isolate. That means only 57.5% of potential contacts were reached.

An interactive graph of East Sussex cases.

Statistics for Test and Trace at a regional level are now available. These show that in East Sussex, over the whole period of its functioning, from 28 May to 5 August, 398 confirmed cases were transferred to the national system. Of these 319 were reached and gave details of 682 close contacts. In turn 440 of these were reached and asked to self-isolate.

In other words 80% of cases were reached and 65% of contacts. Assuming that the cases not reached would have provided close contacts in the same proportion as those who were reached, another 169 contacts would potentially have been identified, making a total of 851. The 440 contacts who were reached represent 52% of all identified and estimated contacts, suggesting that there were another 411 who had possibly picked up the infection but had not been reached and alerted to the situation by the national system.

It is clearly the hope that local teams will bring a dramatic improvement in results. No estimate however is available of how many contacts follow the recommendation to self-isolate for two weeks – as has often been observed, some may feel they cannot afford to take such a long period off work, and government has not responded to appeals to provide them with financial support.

More local data available

More local data is now available, including weekly changes in infection rates at lower tier local authority level such as Hastings Borough Council and Rother District Council – see interactive graph above.

Weekly figures on new confirmed cases are available by Middle Layer Super Output Area (MSOA – areas of around 7,200 population). For the week to 9 August, these show that three new cases were confirmed in Bexhill Central, three new cases in the Whitehawk area of Brighton and five new cases in East Saltdean and Telscombe Cliffs in Lewes district. All other neighbourhoods in Sussex came in the category of 0-2 new cases.

The three cases in the Bexhill Central neighbourhood account for 60% of the five cases reported in Rother district for the seven days up to 12 August, and the East Saltdean and Telscombe Cliffs outbreak represents half of the jump of 10 cases reported in Lewes district that week.

ESCC director of public health Darrell Gale will no doubt be keeping a close eye on developments in both these areas.

Rolling seven-day average of new cases in East Sussex lower tier local authority, as published on the ESCC website. Latterly all areas have been below the national average, as the graph shows.

Posted 10:14 Tuesday, Aug 18, 2020 In: Covid-19

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