Insights on how to improve contact tracing from a community pilot project
The rates of daily infections are rising significantly. In order to save lives and to keep the UK economy open, improvements to the UK contact tracing system are urgently needed. Woolliscroft et al. outlined how the UK contact tracing system could be improved. Detailed evaluation of the Sheffield based community contact tracing pilot project offers additional insights. [1,2]
An independent group of mainly retired NHS staff called Sheffield Community Contact Tracers (SCCT) conducted a pilot contact tracing project from April to May 2020 before the national system was introduced. The project was assessed to determine the feasibility and impact of a volunteer staffed community contact tracing approach. The assessment found that contact tracing was enhanced by: trust, local knowledge, interviewer skills and expertise, cooperation from employers, and contact in a timely manner.
Others have reported that lack of trust and separation from local knowledge has been fundamental to the lack of success in the current national UK contact tracing system. [2] The SCCT pilot found that links with the local community organisation Heeley Trust (HT) was important in recruiting local volunteers with knowledge of the targeted communities. We found that trust needs to be established quickly. This was done by asking the trained volunteers to combine local knowledge, personal contact and regular communication to develop relationships. The quality and style of communication also matters. The task is not simply to tell people that they need to self-isolate, but needs to guide people towards making the right decisions about whether to self-isolate and pass on their contacts’ details. Heeley Trust also involved vital local networks that provide practical support such as shopping and medicines delivery to enable people to self-isolate. The people contacted in our pilot reported that the benefit gained from this support was as significant as the contact tracing itself.
Why do some people not trust the current contact tracing system? Our evaluation found concerns about data access and storage linked to the data breach suffered by the firm at the centre of the national scheme. [3] Locally led public health department programmes with knowledge of their local communities have been advocated as more trusted and effective. [4] We found that issues of trust are particularly significant in black and minority ethnic communities who are suffering disproportionally from covid-19. Working with community organisations that have already developed trust and relationships could lead to more effective information collection and practical support.
The lack of relevant skills and expertise of some in the national programme has also been noted. [4] All our contact tracers strongly emphasised that contact tracing cannot be done by “just anyone.” Most of the volunteers brought a significant skill set and had previously worked in health or care roles. This was combined with local knowledge.
Lack of cooperation from employers was found to be a significant barrier. Community tracers need to work in collaboration with official organisations to provide the legitimacy to gain access to contacts in workplace settings. As more people stop working remotely and get back to working in closer physical contact with their colleagues, such cooperation will become increasingly important.
Community organisations have the potential to provide a role that is complementary to and supportive of the role taken by local Public Health officers. They are well placed to proactively reach people with symptoms and their contacts as soon as possible, via their existing outreach networks. The essential elements are: (a) using healthcare professionals to mentor volunteers to develop the expertise required; (b) establishing a structure to mitigate the emotionally draining process of contact tracing by providing emotional and practical support; (c) sustaining an ongoing process of review and learning to address new and unexpected challenges.
The pilot found that waiting for post-test referrals led to unacceptable delay such that spread of the virus was not contained. We suggest that there may be value in collaborating with community organisations, to start contact tracing as soon as people have symptoms, rather than waiting for positive test results to appear.
Tim Woolliscroft, Research Fellow, Sheffield Hallam University.
Shona Kelly, Professor Interdisciplinary Health Research, Sheffield Hallam University.
Paulina Ramirez, Lecturer International Business and Innovation University of Birmingham.
Janet Harris, Honorary Senior Lecturer, ScHARR University of Sheffield.
Tom Heller, Former GP.
Paul Redgrave is a retired director of public health working in a voluntary capacity with Sheffield Community Contact Tracers. www.communitycontacttracers.com
Competing interests: No competing interests.
References:
- https://blogs.bmj.com/bmj/2020/09/08/best-practice-in-contact-tracing-how-should-an-effective-system-be-organised/
- https://www.communitycontacttracers.com/wp-content/uploads/2020/08/CCT- Volunteer-Evaluation-TW-Final.docx.pdf
- Proctor 2020,https://www.theguardian.com/business/2020/may/20/serco-accidentally-shares-contact-tracers-email-addresses-covid-19
- Iacobucci 2020, Covid-19: Is local contact tracing the answer? BMJ, https://www.bmj.com/content/370/bmj.m3248