Local public health director slams quality of data from national test-and-trace effort

Hackney Council’s director of public health has dismissed the quality of data received from the national test-and-trace system to fight coronavirus as “not particularly useful information”.

Sandra Husbands was speaking at a meeting of health professionals and experts this week, where Professor Anthony Costello, a former director at the World Health Organisation (WHO) and a member of the Independent SAGE Committee called for local authorities to “take back control” of the centralised system from government.

Also present was Professor Kevin Fenton, regional director at Public Health England (PHE) London and contributor to his organisation’s report on the virus’ impact on different ethnic groups, who underlined that “structural issues including racism, discrimination, stigma, distrust [and] fear” underpinned disparities suffered by ethnic minority communities in coronavirus’ spread.

When asked what data Hackney receives from the national test-and-trace system by councillors, Husbands said that the council receives daily figures of how many people have been tested, but does not know when these tests occurred or who has been tested.

The Town Hall also receives the number of people who have been through the system who have tested positive and the number of their contacts, but no specific details of their names or addresses.

Husbands said: “We are getting data, and to give PHE some credit, they have been doing some work on trying to give us more timely data and more detailed information. As a local director of public health, I find that just being told, ‘This number of people, this number of positive tests that we followed and this number of contact tracing in your area’, is not particularly useful information.

“It doesn’t help me to know what the context was. Without having any further information about it, neither they nor I know whether it was related to a care home unless the person tells them. If it was somebody who worked in a care home, and they didn’t convey that partiicular information, then Public Health England wouldn’t know, and I wouldn’t know.

“The information we get is quite sparse in terms of helping us to understand what we do locally to really get on top of things and stop the spread, and to support the settings. We could more easily provide support to people proactively if we were more in touch with what was going on.”

Costello, whose independent SAGE group has branded England’s test-and-trace programme “not fit for purpose”, urged councillors listening to use its own data channels, testing channels and primary care system instead, arguing that only 10 GP hubs would be needed to cover 30,000 people each in a locally-led system.

Costello added: “If I’d been deciding this, I would have put contact tracers under local authority control, then your director of public health would then distribute them out according to need. Then they build trust into the system as they are linked into the people who are providing care.

“My GP can reassure me. People will be frightened, they need to be reassured, monitored or referred if there’s a problem. GPs have all the data and know about all the close contacts. The whole thing needs to be integrated, and that data needs to flow back to the GPs and the local authority.

“How can you do that with home testing, or these car park tests run by Deloittes? Whereas if you have a trained nurse doing it at a GP surgery, they will get a much better swab result.”

The former WHO director added his hopes that Baroness Dido Harding, appointed in May by the government to chair the programme, would “realise quite quickly that the results are going to look terrible, and will try and tweak the system so that first of all you must allow GPs to be able to test and you have to get your data flowing back to local areas.

“This is a big crisis, as if we don’t get this right, we’ll have outbreaks.”

Cllr Emma Plouviez said: “It seems to me that we’ve been thrown a huge political challenge. We need the data and the resources, and I don’t think we ourselves are going to be the people who are going to change the prime minister’s mind.

“I do think we have a responsibility as politicians to take this to a London level and to work through London Councils and with the Mayor, as we have a responsibility especially to our ethnic minority communities who have suffered so badly already, we have a responsibility to make the case for a better system. We’ve been challenged, and we need to look at it.”

The meeting also underlined the pressing need to take into account the range of factors making Hackney’s ethnic minority community more vulnerable to the virus, with Professor Fenton making calls to ensure communities were “resilient, prepared and have learnt the lessons as we prepare for perhaps a second wave in the autumn”.

The public health expert went on to stress the need for “culturally competent messaging” on how to prevent the virus, while echoing Costello’s calls for a locally-led system by telling councillors to identify the “unique capabilities” of local authorities and use them to support the contact-tracing system.

Fenton said: “Socio-economic deprivation plays a role in the risk of vulnerabilities of communities. Those vulnnerabilites can have a huge iompact on how Covid becomes rooted in communities, how it gets transmitted, and what impact it will have.

“Any conversation about actions must take into consideration those social and structural factors, which we know are a driver of poor outcomes for Covid.

“There are factors among Black, Asian and Minority Ethnic communities increasing the risk of exposure to Covid. For example, the occupational risk, whether you are a key worker coming into contact with many individuals like taxi drivers or bus drivers, or a key worker working with people likely to be infected with Covid.

“It’s really important to understand how Black, Asian and Minority Ethnic communities are perhaps at higher risk both because of what they do, and how they interact with their communities.

“We need to think about factors which increase severity, such as uncontrolled diabetes, obesity, hypertension, cardiovascular disease. Some of the structural issues including racism, discrimination, stigma, distrust, fear, these are real issues which are challenging for the community and are seen as underpinning some of the disparities which we see not only for Covid but for other conditions.”

People from Black and Asian backgrounds, and those with protected characteristics, are up to twice as likely to die of coronavirus than those from White backgrounds.

The Town Hall’s equalities chief Cllr Carole Williams had sent out a welcome to the independent SAGE experts, including Professor Fenton, ahead of the meeting, while spelling out her “disappointment” that the PHE report did not investigate further the reasons behind the higher death rate, and asked for recommendations for other ethnic minority communities not covered by the report, including Orthodox Jewish communities.

Williams said: “Both the council and partners in the wider health system are working on new risk assessments and working conditions to make workplaces safe for all staff, but this task is difficult without clear recommendations from national bodies like PHE and NHS England.

“Though we are disappointed with this report, we welcome the news from the Equality and Human Rights Commission, that they will be investigating the impact of coronavirus on Black, Asian and Ethnic communities, and are hoping to develop evidence-based recommendations so as a country we can take urgent action to tackle entrenched racial inequalities when fighting the virus. We also welcome assurances from Professor Fenton who is making efforts to provide local councils with actionable recommendations.

“We need to address the questions of underlying causes, we need something that speaks from the community perspective and provides examples and case studies of how we start addressing these disparities. We need meaningful actions now that will ultimately help us save lives.”