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The NHS Test and Trace system – which has been branded “world beating” by the prime minister – is meant to be a serious weapon in the government’s arsenal in the fight against Covid-19.
But serious concerns have been raised about its effectiveness – so much so that some councils are setting up their own procedures.
At the centre of concerns about the Test and Trace service – and whether it can really protect the UK from a second wave – are questions about how many people are actually being reached by contact tracers.
Figures released by the government showed on Thursday showed that just 72% of people who tested positive for Covid-19 between July 23 and July 29 were contacted by NHS Test and Trace.
In turn, contact tracers were only able to reach 72% of those coronavirus patients’ own close contacts, representing 52% of the potential pool. That means thousands of people could be going out and spreading the disease unknowingly.
With a significant number of contacts missed at each stage of the process, researchers from the London School of Hygiene and Tropical Medicine have warned that the system may need to reach 68% of at-risk close contacts to avoid a second spike at or before Christmas.
To make matters worse, there are warnings of a second spike in virus infections when schools reopen in September if the tracing system is not scaled up significantly.
For the councils who have forged their own paths and created local tracing schemes, there are a number of holes in the national strategy – many of which focus on the one-size-fits-all approach by the government.
On Wednesday, Calderdale Council in West Yorkshire became the latest local authority to announce plans for its own tracking system, which is expected to be launched next week.
According to current estimates by the council, the NHS Test and Trace system is only reaching 68% of contacts in Calderdale amid a surge of coronavirus cases in the area, which is currently subject to stricter lockdown rules.
“The rates of coronavirus in Calderdale are increasing really quickly and we desperately need to get this under control,” said Deborah Harkin, the council’s director of public health.
When it’s launched, the local tracing scheme will focus on contacting the people who have been missed by the national system – which attempts to reach people for 48 hours before moving on – and live in areas with high levels of coronavirus.
Like other local systems, the Calderdale scheme will take the data collected by the NHS Test and Trace scheme and follow it up.
In Calderdale, many of the people who are falling through the gaps of the NHS system do not have English as a first language or are asylum seekers or refugees, Harkins said.
“We have local knowledge of our communities that no national system could ever have,” she said. “And that local knowledge of our communities will really help us tailor the contact tracing intervention to particular communities.
“So for some groups it will be speaking the community language. In other instances it will be working with voluntary organisations who are trusted in the local community.”
People don’t answer the phone
Calderdale’s local tracing system will use local phone numbers to contact people, but will also go door-to-door to reach people – another difference from the national programme.
“Some people in our really disadvantaged areas live in circumstances which mean it’s difficult for them to engage with a national service,” Harkins said.
“For example, worries about unrecognised phone numbers – ‘Who is that ringing me?’ There are lots of reasons people might be afraid of receiving calls from numbers they don’t know.”
Unlike other councils, which have blasted the national service, Calderdale wants to work “in partnership” with the NHS system.
But the council has warned that it must get additional support from the government in order to make tracing in the area effective and push down rates of coronavirus.
“When we put together our local outbreak prevention and management plan, we were told that it wasn’t something we would be expected to do – the local contact tracing,” Harkins said.
“So the allocation the government gave us for outbreak prevention and control, we have allocated that for other functions we are responsible for.”
It’s too slow
Other local authorities have issued much more direct criticism of the national system. Sandwell Council – one of the first councils to set up their own tracing system – accused the NHS Test and Trace scheme of lacking “urgency”.
“I wouldn’t quite go as far as to say we’ve given up on Test and Trace, but we’re not happy with just allowing them to do their job any more,” Lisa McNally, Sanwell’s director of public health, told Sky News on Saturday.
She estimated that national tracers were only reaching 60% of contacts in the area.
“As soon as the new case comes in now, we’re not waiting for Test and Trace to fail to reach them – we’re phoning them the same day.”
Like Calderdale, Sandwell Council is focusing on using its local language resources to reach the people missed by the national system.
“We will have a language speaker available for them, immediately – if we find out they only speak Punjabi, Urdu, Arabic, et cetera – so we can first of all give the important messages that they need to know,” she said.
In Leicester, a similar system by the city council has seen a success rate of 89%, with 122 of 136 people who were missed by the national system reached by the local authority.
It only looks forward, not backward
But not every council that has launched its own tracing programme to plug the holes in the NHS Test and Trace system is focused on reaching the contacts missed by national tracers.
Liverpool City Council is carrying out “reverse contact tracing” – something director of public health Matthew Ashton branded “complementary but different” from the national system.
While Test and Trace officials said in July they were trialling backward contact tracing – which tries to identify where a coronavirus patient contracted the virus in the first place – it has not yet been rolled out across the country.
“Reverse contact tracing is asking positive cases where they have been for the last 10 to 14 days and therefore where they might have got the virus from in the first place,” Ashton said.
This strategy is key for tackling outbreaks of coronavirus head-on, he explained.
“It allows us to try and understand where the sources of the virus might be – the risk factors. Is it coming from a school, a business, a meat-processing plant, a religious setting, a community gathering?
“It allows us to then put other interventions into place to control that risk.
“We have an outbreak in our Princess Park ward and therefore we have a small group of people on the streets, going door to door with positive cases and asking them more questions to try and understand those routes of transmission.
“It also means we can understand their situation and offer them support if they need it.”
Like Calderdale, Liverpool wants to work “hand in hand” with the national system.
The Local Government Association has called for councils to be given everything they need to help reach those missed by national tracers, saying Covid-19 must be seen as a “pattern of local outbreaks, rather than a national pandemic with a similar impact in every community”.
“Councils’ public health teams need to be able to use their unique expertise, including speaking other languages and understanding of their communities, to try to reach those who cannot be contacted by the test and trace system,” a spokesperson said.
They must be given the right “powers, flexibilities, data and long-term funding”, they added.
Defending NHS Test and Trace
A government spokesperson insisted NHS Test and Trace “is working”, saying more than 2.6m people have been tested for coronavirus and more than 218,000 told to self-isolate.
“Every day local authorities receive test, case and contact tracing data, with further data being shared with local directors of public health, to support with their outbreak management responsibilities,” they said.
“Our priority is to curb the spread of this virus and save lives. Local action to tackle outbreaks is crucial, which is why we are working so closely with all local authorities to provide additional support where needed.”
This article originally appeared on HuffPost UK and has been updated.