{"id":48511,"date":"2020-09-08T17:00:04","date_gmt":"2020-09-08T16:00:04","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48511"},"modified":"2020-09-14T18:03:09","modified_gmt":"2020-09-14T17:03:09","slug":"best-practice-in-contact-tracing-how-should-an-effective-system-be-organised","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/08\/best-practice-in-contact-tracing-how-should-an-effective-system-be-organised\/","title":{"rendered":"Best practice in contact tracing: How should an effective system be organised?"},"content":{"rendered":"

Sheffield Community Contact Tracers (SCCT), a group of community activists, local volunteers, former GPs, and public health doctors, ran a contact tracing pilot project earlier this year. [1] We believe that what we have learned could be a model for a community-based contract tracing system that could achieve zero-covid throughout the UK.\u00a0<\/span><\/p>\n

Our recommendations are based on evaluation of this project, on the voluntary sector and professional experience of SCCT group members, and evidence from elsewhere. [2-4]<\/span><\/p>\n

Central government has a vital role in containing the pandemic\u2014giving a strategic steer to public health activities and messages to the general public and funding service providers. Improved national containment activities should be matched by well-resourced community-based activities. [5] The following are essential for an effective contract tracing system.<\/span><\/p>\n

People need to trust the tracing system<\/b>\u00a0<\/span><\/p>\n

Trust is crucial if the system is to be effective and gain the cooperation of people being asked to self-isolate to protect themselves and their community. Trust can be developed through regular communication that combines personal contact with the offer of realistic support.\u00a0The SCCT pilot project offered daily support by phone over 14 days. It found that guiding people towards making the right decisions over time, rather than direct exhortation, was particularly effective. Feedback from people who participated in the pilot was very positive. They appreciated the support that the daily call gave them in coping with self-isolation and the illness.\u00a0<\/span><\/p>\n

Links with the local community development organisation <\/span>Heeley Trust<\/span><\/a> were important to recruit volunteer contact tracers and connect with important local support networks. As a development of “social prescribing”, Heeley Trust also provided practical support such as shopping and delivering medicines to enable people to self-isolate.<\/span><\/p>\n

Contact tracing services need to be based on local authorities<\/b><\/p>\n

We need a Find, Test, Trace, Isolate and Support (FTTIS) service across every local authority\u2014not just Test and Trace. [6] This will involve extensive local publicity campaigns at the first sign of increased cases. People in each community should understand that if they have symptoms, they must self-isolate immediately, get a test, and inform their close contacts.<\/span><\/p>\n

Street-by-street targeted testing is necessary to find as many asymptomatic and symptomatic cases and contacts as possible. The SCCT pilot project found that waiting for test results to trigger action led to significant delays in contact tracing. [7]<\/span><\/p>\n

We need a<\/b> mechanism for listening to people from “seldom-heard communities”\u00a0<\/b><\/p>\n

In Sheffield, SCCT is working with its seldom-heard communities to develop “covid confidence” training and other mechanisms to build local resilience.<\/span><\/p>\n

People in these communities are at most at risk from the next wave of the pandemic. They are more likely to be working in essential roles in places where they are at high risk of contracting the virus and more likely to be living in crowded accommodation. People who are being asked to self-isolate need practical support, income replacement and reliable health protection information. [8]\u00a0<\/span><\/p>\n

People who are self-isolating need financial support<\/b><\/p>\n

The benefit system should support index cases and their contacts who are self-isolating for the required duration. Locally administered funds should also be available to provide financial support during isolation or quarantine periods.<\/span><\/p>\n

Other professions need to be involved\u00a0<\/b><\/p>\n

Local health protection teams and environmental health officers, using their statutory powers, should be enlisted to guarantee full cooperation for comprehensive investigation of workplaces, nursing homes, schools and so on.<\/span><\/p>\n

Primary care should be resourced and included in plans to control the spread of the virus. People should be encouraged to contact their GPs, who can use their clinical skills in addition to test results to diagnose and notify covid infection and trigger the contact tracing response. [9] This prevents delays associated with false negative test results.\u00a0<\/span><\/p>\n

Local quarantine facilities may be necessary to guarantee isolation of contacts not able to isolate at home.\u00a0Hostels or hotels could be used, as they have been in other countries.<\/span><\/p>\n

The SCCT pilot project in Sheffield reinforced the lesson that contact tracing is a skill but that it can be developed quickly by suitable volunteers, potentially in large numbers. Mentoring by experienced health professionals was effective in helping contact tracers develop the necessary confidence and expertise. The process of contact tracing can be emotionally draining as well as time consuming, so contact tracers need plenty of support.<\/span><\/p>\n

A transfer of focus, and crucially financial resources, towards local authorities and community-based organisations will deliver better tracing systems than a centralised, top-down approach. Each locality and community is different and will require local skills to develop the measures that will protect its unique population.\u00a0<\/span><\/p>\n

We believe zero-covid is achievable using these measures and will enable local economies to regenerate, schools and colleges to open with confidence, and vulnerable shielded people within each community to be safe again<\/span><\/p>\n

Tim Woolliscroft<\/strong>, Research Fellow Sheffield Hallam University<\/span><\/em><\/p>\n

Abdul Shaif<\/strong>, Hadfield Institute, Sheffield<\/span><\/em><\/p>\n

Andy Jackson<\/strong>, Manager Heeley Trust, Sheffield<\/span><\/em><\/p>\n

Steve Pagden<\/strong>, Volunteer Sheffield Community Contact Tracers<\/span><\/em><\/p>\n

Paul Redgrave<\/strong>, Retired Director of Public Health<\/span><\/em><\/p>\n

Tom Heller<\/strong>, Retired GP<\/span><\/em><\/p>\n

Competing interests<\/strong>: No competing interests<\/span><\/em><\/p>\n

References:<\/b><\/p>\n

    \n
  1. Sheffield Community Contact Tracers. Pilot Study Report. June 2020 <\/span>https:\/\/www.communitycontacttracers.com\/wp-content\/uploads\/2020\/07\/Pilot-Study-Report-Training-community-volunteers-to-undertake-contact-tracing-for-Covid-19.pdf<\/span><\/a><\/li>\n
  2. Sheffield Community Contact Tracers. Volunteer Evaluation Report. August 2020 <\/span>https:\/\/www.communitycontacttracers.com\/wp-content\/uploads\/2020\/08\/CCT-Volunteer-Evaluation-TW-Final.docx.pdf<\/span><\/a><\/li>\n
  3. World Health Organization. Contact tracing in the context of Covid-19. May 2020 <\/span>https:\/\/www.who.int\/publications\/i\/item\/contact-tracing-in-the-context-of-covid-19<\/span><\/a><\/li>\n
  4. Independent SAGE \u2013 On achieving a Zero Covid UK. July 2020 <\/span>https:\/\/www.independentsage.org\/independent-sage-on-achieving-a-zero-covid-uk-i-e-the-elimination-of-the-virus-from-the-uk\/<\/span><\/a><\/li>\n
  5. Fisher, D. and Carson, G. Back to basics: the outbreak response pillars. Lancet. August 2020<\/span> https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(20)31760-8\/fulltext<\/span><\/a><\/li>\n
  6. Vize, R. Too slow and fundamentally flawed: why test and trace is a weak and inequitable defence against Covid-19.\u00a0 BMJ. June 2020 <\/span>https:\/\/www.bmj.com\/content\/369\/bmj.m2246<\/span><\/a><\/li>\n
  7. Kretzschmar, M. <\/span>et<\/span> al. Impact of delays on effectiveness of contact tracing strategies for COVID-19: a modelling study. Lancet. August 2020 <\/span>https:\/\/www.thelancet.com\/journals\/lanpub\/article\/PIIS2468-2667(20)30157-2\/fulltext<\/span><\/a><\/li>\n
  8. Public Health England. Understanding the impact of Covid-19 on BAME groups.\u00a0 June 2020 <\/span>https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/892376\/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf<\/span><\/a>\u00a0<\/span><\/li>\n
  9. www.gov.uk\/guidance\/notifiable-diseases-and-causative-organisms-how-to-report<\/span><\/li>\n<\/ol>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Sheffield Community Contact Tracers (SCCT), a group of community activists, local volunteers, former GPs, and public health doctors, ran a contact tracing pilot project earlier this year. [1] We believe […]<\/p>\n

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