Following the unprecedented population-wide measures that have been in place over the preceding weeks, the country is expecting to return to a stage where the identification of cases and the management of the case and their contacts will again be key. This is because:
- Identification and self-isolation of the case prevents any further spread of the infection.
- Self-isolation/quarantining of the contacts prevents spread, even during the presymptomatic stage, or in the case of very mild symptoms.
- Understanding where infection may occur in the community can enable a wider identification of contacts and potentially reduce the spread in future through interventions for infection control and sharing of lessons learnt.
NHS Test and Trace Service
The NHS Test and Track Service has been put in place to help return life more to normal by replacing national lockdowns with individual isolation and, if necessary, local action where there are outbreaks. This service:
- Ensures that anyone who develops symptoms of coronavirus (COVID-19) can quickly be tested to find out if they have the virus, and also includes targeted asymptomatic testing of NHS and social care staff and care home residents.
- Helps trace close recent contacts of anyone who tests positive for coronavirus and, if necessary, notifies them that they must self-isolate at home to help stop the spread of the virus.
National testing structure
Tests for COVID-19 are carried out through different routes:
- Pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers (includes testing of suspected cases in a care home, school, or other community settings that are reported through to the Health Protection Team).
- Pillar 2: swab testing for the wider population, as set out in government guidance (includes whole care home testing, and symptomatic individuals in the community who access drive-through regional testing sites, drive-through mobile testing units, or home testing kits).
Steps we have taken
Ensuring availability of Mobile Testing Units and establishing Local Testing Sites
Establishing community asymptomatic testing sites in locations in Bath and North East Somerset, together with a wide range of communication materials encouraging the uptake of testing
Supporting the local introduction of national asymptomatic testing initiatives, for example in adult social care, universities and pharmacies
Ensuring clarity about where to go for which types of tests
Ensuring testing sites meet the needs of some vulnerable populations
- Responding to additional testing needed as part of controlling outbreaks of variants of concern
National Contact Tracing System
There are three Levels of contact tracers.
- Level 1 includes the Regional PHE Health Protection Team. This level deals with the most complex cases and outbreaks. PHE are themselves building up significant extra capacity to meet the challenges of the next phase of the pandemic.
- Level 2 comprises of 3,000 health care professionals and EHOs recruited to carry out contact tracing work of cases identified as part of the pillar 2 testing work.
- Level 3 comprises of 15,000 people who will be tasked with contacting those who have been in contact with a someone who has tested positive for COVID-19.
The NHS tracing app
Another component of the tracing system will be provided by the NHS contact tracing app. This is currently in development and it is unclear when it will be in use. The potential importance of the app is that it gives the possibility of identifying contacts who a case would have no means of identifying, for example someone with whom they shared a train carriage or sat near to in a bar. It is not impossible to find such contacts by other means but would be extremely difficult and labour intensive.
There have clearly been difficulties in developing and rolling out this app, but it is hoped that by the time risks of outbreaks increase towards the end of summer something will be ready to roll out across Britain. Of course when this happens it also depends on people being willing to download the app and enter relevant information when they are identified as a possible case.
The Local Authorities Contact Tracing role
The Local authority’s role is two-fold.
The first is to provide support to the local PHE, Public Health Tier 1 team, in the investigation of complex outbreaks if, and when, the local team is overwhelmed and requires additional resources.
This work will be undertaken by our in-house EHO’s and health practitioners.
The EHOs in the Health, Safety and Food team, routinely carry out contact tracing work as part of their normal duties, albeit, currently this is primarily for the investigation of Single Case Infectious Disease investigations. In addition the Health Practitioners in the public health team are available to support this work.
The second role is one which relies on the local knowledge and support that the Local Authority can provide when dealing with complex issues in residential settings such as care homes, hostels, as well as schools and workplaces, for example liaison between schools and parents of pupils or employers and employees.
The Local Authority will not be asked to routinely carry out COVID-19 contact tracing, as they have already been asked to support PHE by carrying out other ID investigations to free up PHE to deal with COVID-19 -19. However, when a local outbreak occurs in a local care home, school or workplace the LA will be notified by the Level 1 Contact Tracing team, and in some cases, officers will be asked to contact the cases and identify contacts.
Issues that will need to be resolved are:
- Hours of operation. The Level 1 team provide a 24/7 response, whilst the Local Authority traditionally operates on a Monday to Friday 9-5. In order to be able to support the demands it is recommended that an out of hours on -call system will need to be set up. Part of this might operate on the basis of partnership with other local authorities if it leads to needs in B&NES being managed more efficiently.
- Sharing of personal data. Confirmation is still required on how contact details will be shared between HPE and the LA, as the LA does not currently have access to HP Zone. ID information is currently shared by PHE with EHOs by secure email exchange, and it is expected that as a minimum, this will be extended to colleagues in the Public Health team to deal with the COVID-19 response. The case’s contact details will be forwarded onto the Level 3 contact tracing team for follow up.
- Amount of additional resource required. Contingency arrangements are to be put in place with other EHOs and public health professionals working within B&NES to assist if an outbreak occurs.
Steps we have taken
Establishing a strong local contact tracing team
Providing training to different teams on the process of contact tracing
Taking an active role in contract tracing - people are more likely to respond to calls from local phone numbers and listen to advice from local health professionals and this has meant help can be made available to vulnerable residents from the Community Wellbeing Hub at an early stage.
An expansion in local tracing, including “backward tracing”
Contributing to the investigation of complex outbreaks
Being flexible in responding to changing requirements as the pandemic continues to unfold and as the UK Health Security Agency is established
Our response to Variants of Concern
Variants of Concern were not an established theme of our response to the pandemic when the LOMP was first published, in July 2020. As the situation has developed, we have worked closely with partners to put in place prevention measures to address the evolving threat to public health.
Update: Managing Variants of Concern
Steps we have taken
Observing and learning from the experience of neighbours in Bristol and South Gloucestershire, with regard to surge (lateral flow) testing
Putting in place well-developed systems for testing and tracing, and excellent regional and sub-regional partnerships with Public Health England (PHE) and the NHS
Managing outbreaks quickly and efficiently
Planning to work with central and regional capacity to meet any needs for surge testing that might arise
Working with regional partners, and particularly the developing National Institute for Health Protection, as the new health protection system forms to further assure ability to meet surge demands
Developing and ensuring awareness of a Variation of Concern local response pathway