Public health experts left in dark by government on local contact-tracing

Local public health experts have revealed that “no concrete plan” has been offered to them by central government for all-important contact-tracing for coronavirus.

Director for public health for the City of London and Hackney, Sandra Husbands, this week summarised how the tracing and tracking of people who have come into contact with Covid-19 is likely to play out at a local level.

According to Husbands, current plans are “quite confusing”, with none firm enough for her to confirm to her colleagues in the health system either “what we have been asked to do, when we are going to start doing it, [what] resources are required and […] how we are going to find them.”

Husbands told City & Hackney’s integrated commissioning board (ICB): “There is a disjunct between what is happening at national level and how things are going to work on the ground, including even that they have trialled the [contact-tracing] app in [the Isle of Wight], one of the places that is least representative of anywhere else in the United Kingdom.

“On the digital divide, we will have lots of people in our communities who simply don’t have smartphones, or won’t be able to log onto the website to interface with this, and good old fashioned contact tracing is what’s required.

“That might mean going out and knocking on doors, and that’s a different type of capacity from what they’re planning.”

Husbands explained that three tiers of contact-tracing personnel will be required under current plans.

Tier 1 will be specialists already working in public health, supplemented by staff with experience in the field within local authorities, such as environmental health officers and public health specialists.

The second tier will see 3,000 NHS professionals or returning staff recruited and given a refresher before being put to work making contact-tracing calls.

Meanwhile, Tier 3, recruited through private company Serco, will be made up of 15,000 people from “any background”, who will be passed information on contacts either through the tracing app or by Tiers 1 or 2, and who will then phone those who appear to have been exposed and read from a script telling them what to do next.

However, Husbands accused the government of “massive overreliance” on the app itself, stressing that even if people download it and use it, that it could not be a substitute for “good, old fashioned contact-tracing”.

Doctors present at the meeting said that any app would need 60 per cent take-up to be at all effective, with ICB chair Cllr Randall Anderson adding: “From the outside, it appears that [health secretary Matt] Hancock especially thinks that the app is just it, that’s all that’s needed, and somehow it will all just magically work.

“I don’t think there’s a real appreciation at the top level that this is not going to work. [Take-up on] the Isle of Wight is better than most international comparators, and that’s not nearly good enough.”

According to reports in the Daily Telegraph, the tracing app has so far been downloaded by only 40 per cent of people in the Isle of Wight trial.

Husbands is now planning how to engage “disconnected community groups” in any tracing effort, such as the Charedi community and those who are less tech-enabled, adding that a further potential “fly in the ointment” will be the easing of lockdown measures, which would push people who have offered to be a part of the effort back to their normal jobs right when they are needed.

Jake Ferguson, CEO of Hackney Council for Voluntary Service (CVS) said: “The Isle of Wight is vastly different from the Isle of Hackney. I’m hoping there will be resources, as we can do something quite interesting and progressive with our local communities.

“Messaging can be confusing for people, and there’s also a high level of mistrust in some communities about anything that’s deemed official. Given that we’ve got a high proportion of people in Hackney and London who don’t want the authorities to know they exist, for various reasons. So this is a huge logistical and ethical challenge.”

Ferguson added that plans needed to be made to “win the people’s trust” in order to download the app, adding that the idea of mass distributing free mobile phones to residents to ensure connectivity for the most vulnerable would be one he would support.

Husbands confirmed that such an idea is being discussed as a way of bridging the digital divide in the community, while underlining caution over providing people with devices which they may not be able to afford to keep.