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The UK Government promised a ‘world-beating’ test and trace system to help combat the Covid-19 pandemic. Testing, then tracking and tracing contacts of people who have tested positive for the virus was seen as a major factor in controlling its spread and identifying outbreaks.

Post lockdown many countries have seen cases rising again as they try to open up. Here too in the UK, we have seen spikes in viral cases in some areas forcing local lockdowns and restrictions, such as in Leicester and Preston.

To ensure viral ‘hotspots’ are identified and controlled track and trace is crucial. Now that we are five months on from the promise of a ‘world-beating’ system how prepared are we? With the new school year rapidly approaching and many employees heading back to the workplace, scientific advisors are stating that track and trace is essential to managing control of the virus in the community and ensuring schools can stay open

The UK’s Track and Trace policy has seen many shifts and changes along the way. When the first cases of Covid-19 were confirmed in England in January, contact tracing began immediately, mostly handled locally as is the case for infectious diseases.

On March 12, the Government announced they were moving from the ‘contain’ phase to delay phase as the virus was spreading within the community and it was no longer possible for local health officials to track and isolate all people who could potentially become infected, so local contact tracing along with community testing was stopped — even in regions of the country that still had a very low number of cases.

To delay the spread, the Government stated that anyone with symptoms of Covid-19 must self-isolate and then imposed the lockdown. Testing was to be done in hospitals and in testing centres that were set up around the country, however, testing capacity was not enough as the virus spread and needed to be expanded.

At this time cases in London were rising and in other regions such as the West Midlands; there had been 10 deaths and 590 confirmed cases, and about 3,500 contacts had been traced. But many healthcare officials believed in regions across the country that still had a low number of cases; test, track and trace could have continued locally and would have been effective in reducing the spread of the virus and deaths. The World Health Organization (WHO) was advising countries to test, track and trace — and countries that continued to follow that advice, such as Germany, Singapore and South Korea had fewer deaths than the UK.

The Government announced it would develop a track and trace App to combat the spread of the virus. However, instead of using established technology developed by Apple and Google that uses Bluetooth protocols (and do not store data that can identify a person), the UK Government decided to develop its own App NHSx, which was later trialled on the Isle of Wight.

The App was also designed to use Bluetooth signals to detect other mobiles that were nearby and use the data to alert people if they had been near someone who had tested positive for Covid-19.

In addition, they were also running field tests along with an App designed by Google and Microsoft. However, tests revealed issues with both technologies, ranging from not being able to judge distances accurately enough between phones and not detecting iPhones.

The NHSx App could not get the same accuracy as Apple-Google’s software, so in June the Government abandoned developing its own app in favour of a model based on technology by Apple-Google. Other countries including Germany and Ireland had already launched Apps based on the system developed by Apple-Google.

In the meantime, with the App on hold, the Government hired around 25,000 people as contact tracers for tracking and tracing contacts, which was set up in May.

This was jointly operated by the NHS and two private contractors Serco and Sitel. Their job was to contact people who had tested positive for the virus within 24 hours, either by text, email or phone and ask them to log onto the NHS Test and Trace website and fill in the forms about where they had visited recently and who they had been in contact with (people you had spent more than 15 minutes with at a distance of less than 2 m).

Contacts would then be contacted by the Test and Trace team and told they had been in contact with an infected person and needed to isolate for 14 days, even if they do not have symptoms, to prevent viral spread.

Sage, the group of scientific advisers that advises the Government, stated that at least 80 per cent of contacts would need to isolate for the test-and-trace system to be effective. Data released for the period from when the Test and Trace system was launched (at the end of May) up to July 22 showed that 43,119 people who tested positive had been referred to the scheme and that 77.6 per cent of them had provided details of recent contacts of which 184,703 (83 per cent) were reached and asked to self-isolate.

However, there are concerns that the number of people traced and asked to self-isolate has been falling; data from the following week ending July 29 showed 72.4 per cent of close contacts of Covid-19 positive people were reached.

Soon reports were appearing in the papers that contact tracers were sitting at home waiting to be given cases to follow up on. One of the contracts was given to a private firm Serco, and demands have been made for their contract to be scrapped when it comes up for renewal after figures released recently showed its 10,000 contact tracers only spoke to an average of 2.4 people each, and only around 50 per cent from the same household as a person infected with Covid-19 had been contacted.

Local leaders and scientists have urged the Government to divert the £300 million cost of renewing the contract, on August 23, and invest in a more local approach using existing public health teams to track contacts — knocking on the door if necessary. Commenting on the Government’s approach, former Chief Scientific Officer and Sage founder, Sir David King, said, “The Government made a disastrous mistake giving contact tracing to a firm se.”

With the data suggesting that contact testing was not reaching the required number of people to avoid a second wave of infections, the Government announced that by the end of August it would reduce the number of people employed in its Test and Trace system by 6,000, out of a total of 18,000.

Instead, England’s Test and Trace system would shift to a more locally targeted approach, with the remaining contact tracers working alongside local public health teams to track down contacts. Information about people they cannot track will be passed to local teams who can use local knowledge to follow up on cases.

The approach has been used in virus hotspots like Blackburn and Luton. Some issues highlighted by the Test and Trace teams are that people do not always offer/do not have the contact details for people they have been in contact with, and also people do not always answer calls from numbers they do not recognize. By passing on the details to local teams, it is hoped these gaps can be followed up.

Local health officials are trained to deal with outbreaks and say that people are often more responsive to a conversation with a local health official. Data has shown that public health teams dealing with outbreaks in factories or care homes have reached more than 90 per cent of contacts on their list, demonstrating the effectiveness of this approach.

In the meantime, the Government has not given up on developing an App and have announced that trials of the latest App will begin in the Isle of Wight and the London borough of Newham by the end of August.

The App will enable everyone with a Smartphone to identify symptoms, order a test and use a QR code to scan into public locations such as pubs and restaurants, and then be informed if there are subsequent coronavirus cases at that establishment. It will also have an alert system to inform users of virus levels in their area based on the first part of their postcode.
The App might also include features such as personalized risk scores for individuals. However, there needs to be a high up-take and participation for any App to be successful.

The technology uses the Google/Apple technology and Governments do not have access to citizens’ data.It is hard to predict what will happen as we enter the autumn months and then winter — when we will be outdoors much less and the flu season starts. Hopefully, with social distancing in place and better hand washing practices, etc. it will help to also reduce the spread of the flu, and we can avoid a bad flu season this year.

But Covid-19 cases need to be identified quickly and outbreaks managed through people being told to self-isolate and prevent spread. Track and trace is essential to this — we will have to see if the switch to more local management of outbreaks helps and if the new app actually makes it past the testing phasing this time!

Rachel Kayani