Effective contact tracing is key

As the saying goes, ‘it’s complicated’. The issue of contact tracing has never been far from the media over the past weeks and months. However, as with other aspects of the response to the current pandemic, there have been differing approaches across the UK, with England, Northern Ireland, Scotland and Wales all following different models and approaches.

From an infectious disease perspective, ‘track and trace’, as the model in England has been branded, was always going to be key to finding our way out of this emergency. Contact tracing and testing are well tried and tested techniques for containing and controlling infectious disease outbreaks. Indeed, even within this current pandemic in jurisdictions not far from these shores such as on the Isle of Man and Jersey, there is evidence that this has worked.

CIEH involvement in this area of response to the current crisis was largely in the early days of the pandemic. While a debate will rage in time over whether or not contact tracing should have stopped in March, rather than continue throughout as has been the case in other countries, nonetheless it was evident to us that Environmental Health Practitioners (EHPs) were, and are, a highly skilled profession to assist in this area.

We argued the case for this, compiled a national volunteer register and made that available to governments across England, Wales and Northern Ireland, and connected the relevant public health agencies with the relevant local government networks in each jurisdiction. And on that note, there may well be further efforts to revise and add to that list in the near future given the emerging need for additional capacity within local authorities, so watch this space on that. However, we were not and are not directly involved in the design of the models for roll out and implementation, nor in the recruitment process.

It is fair to say that, particularly in England, the design process and the recruitment has been fraught with problems. The reasons why that is the case are potentially many and varied. They could include any/all of the following for example:

• Government agencies and civil servants are working at 120mph
• Too much reliance on the private sector for solutions
• The tight command and control approach that seems to characterise everything emanating from government, again particularly in England
• Government acceptance that no contact tracing system can work without local arrangements and local government involvement – something we and others have argued for from the start

Whatever the reasons, suffice to say the system does not, as yet, in England, appear to be functioning properly.

I am reassured that colleagues who know what they are doing are now involved in the planning and design, particularly at local level. And I am also sure that, with that continued input we will get there. But I remain concerned about the relaxations that the Government are proposing, particularly in the absence of a comprehensive, functioning tracing and testing model across England. 

In a paper published late last night (16 June) in The Lancet, a recent peer-reviewed modelling study concludes that ‘case isolation and contact tracing vital to COVID-19 epidemic control’. There are three headline points from this paper that stand out for me:

• Combining self-isolation and contact tracing with moderate physical distancing measures, such as limiting social gatherings and remote working, could enable ongoing control of the COVID-19 epidemic
• Combined case isolation and contact tracing strategies appear to reduce transmission more than mass testing or self-isolation alone
• In a scenario where no social distancing was in place and 1,000 new symptomatic cases were reported each day, between 15,000–41,000 contacts would need to be quarantined each day if relying on contact tracing to achieve infection control

These findings not only reinforce the absolute criticality of an effective contact tracing system, but they also highlight the potential impact of no (or ineffective) social distancing. The infographic that accompanies this latest research further reinforces this assertion. It shows very clearly that effective tracing is key to controlling secondary infection and transmission and holding the R number under 1.

And finally, a word on social distancing. Anyone following recent government communications will I’m sure conclude that the Government, in England and potentially elsewhere, appears to be about to relax the social distancing guidelines from two metres to one metre. The World Health Organization guidance states this should be ‘at least’ one metre.

We are all fully aware of the pressure on the Government from the hospitality sector, the devastating impact this pandemic has had and is having on our economy, and the fact that many businesses have said they cannot survive unless these restrictions are relaxed. But on the other hand, if we relax restrictions too early without effective systems in place, and central to that contact tracing, is there a real risk that we could end up going backwards? What’s currently happening in Bejing should surely be of some concern and no one wants that.