Dr Bing Jones, a retired Sheffield GP, helped start the group a month ago out of frustration that contact tracing had been abandoned in England. “We sat down and thought: this is a major omission – a schoolboy error. We have got one of the biggest crises you can possibly imagine and one of the major building blocks of the public health management of an epidemic is not being done,” he said.

They were surprised to find that most contacts of people with Covid-19 were workers from the NHS, care homes or care provider agencies – and that those people were not always happy to stop work and go into isolation for seven to 14 days. “The majority were in health and care settings. That’s the really big and worrying message here,” said Jones.

The group set up its pilot project in Sheffield, using volunteers who called up people with Covid-19 referred to them by GPs. The volunteers offered support and asked for the names and numbers of anyone the patient had spent more than 15 minutes with in an enclosed space.

Their early report of what happened – with 13 people who had Covid-19 and 58 of their contacts – paints a worrying picture. People were unwilling to let them have details or the volunteers were unable to reach 39 of the 58. In 29 cases, those were care workers.

“You talk to somebody and they will sometimes give you the names of their fellow cleaners or kitchen staff in a care home, but as soon as they start talking to each other they think, well we’d better talk to our manager, and the manager says oh no – you’d better not do this,” said Jones.

“And the fact is that in all of these care settings but also in the NHS, there is no culture for contact tracing. There’s also no culture of self-isolation.

“The emotional side of this is me listening to our volunteers every night saying: ‘I have got all this information, I’ve tried to get in touch with the helper at the care home and then the shutters come down. I got in touch with the trust – the teaching hospital trust – and bang, the shutters come down.’”

He added: “We’re talking here about a major problem and a major deficiency particularly around health and care workers. My analogy is that health and care workers are unwittingly acting as the vectors of this … spread.”

The group’s volunteers had the authority of GP practices and a well-respected community development organisation yet were unable to convince people to self-isolate. Jones thinks the government scheme – due to be up and running by 1 June staffed by 25,000 contact tracers, most of them call handlers with a script and minimal training – will fare no better.

“I feel sad to have to say this but the whole way that this is unfolding – I have no confidence in the government. The app has failed, they’ve failed in their testing, on their PPE. I wouldn’t put any money on their sorting out this contact tracing,” Jones said.

The spreading of infection through health and care workers was predictable, he said, and identified in a study in the town of Vo’ in Italy.

He said: “Why does it take a group of retired doctors to come up with this? It is fatuous that people haven’t twigged that in the care home setting it is quite obvious – there is very little expertise, very little money, no reserve of staffing, so it’s inevitable that people will be moving around within and between care homes. A lot of care homes are run by big firms and what else are they to do?”

In an ideal world, contact tracing would be done by environmental health workers, as for previous outbreaks of infectious diseases, he said.

“If you had meningococcal meningitis, a sexually transmitted disease, TB… that’s the established system. You would be backed up by the law, by the environmental health officers who have absolute authority, but also you would have the incentive to comply because if your child had meningitis, they would get antibiotics and get better.

Data from the COVID Symptom Study suggests there are currently 9,900 daily new cases of COVID across England.

This excludes care homes [*] and asymptomatic cases. These results are based on a group of 980,000 people using our app, of whom 18,000 were invited to do COVID swab tests after showing early signs of coronavirus infection. These tests were provided by the Department of Health and Social Care, either via a self-administered home test kit or regional testing centres.

Developed by health technology company ZOE, the COVID Symptom Study app now has more than 3.6 million users across the UK, US and Sweden, making it the largest ongoing coronavirus study in the world.

All areas of England are seeing new cases, but levels in the North are around twice those in the South. These figures give an up to date view of COVID infection rates, unlike deaths which lag by about a month.

How we are calculating these figures

The figure of 9,900 was calculated using swab testing and app symptom data collected over the last two weeks (2-15 May), from users of all ages and spread throughout England. This makes it the first time that digital health data from a very large population has been combined with physical COVID swab tests to create an accurate view of what COVID looks like in the population on a day-by-day basis.

These results were based on 980,000 people contributing digitally of whom 18,000 received rapid testing for COVID infection in the two weeks from 2-15 May. Those invited for testing include individuals using our app who have reported being healthy for at least nine days before they log new symptoms for the first time. We have aggregated these two weeks in order to get a large enough population to allow us to estimate regional variations, as well as overall levels in England.

Facilitating a safe exit from lockdown

The ability to accurately estimate the number of new daily COVID cases within the community via technology can be a critical part of the UK’s fight against COVID, alongside ONS surveys that report weekly or monthly based on random swab testing or changes in antibody testing.

With all eyes on “r”, it is critical that the number of daily new cases does not rise as we ease out of lockdown. The COVID Symptom Study enables over 3 million people to contribute, and so provides a more current picture of how the COVID situation is changing. It can also highlight regional differences and show potential increases in the virus before other detection methods.

Daily new cases across England

The map below shows the rates across the different regions of England. The data for each region is presented as a range, because the absolute infection rates are now low. These estimates show a two fold difference between North and South, but should be treated with caution as the number of actual cases is relatively small.

We do not yet have sufficient numbers to estimate Northern Ireland, and Wales and Scotland have not yet joined the COVID testing scheme, but we hope to extend testing to those nations shortly.

The daily new cases estimate does not account for those in the population who are asymptomatic (i.e. show no symptoms but can still spread the virus), as we cannot detect these cases by those reporting their health using the app. These figures also exclude care homes as there is not enough data from the app to estimate this population at this point.

Notes

[*] This analysis requires swab testing, which was kindly provided by the English Department of Health and Social Care. The results do not currently include Wales & Scotland as they are not currently participating in this study, but ZOE hopes to extend testing to those nations shortly.  Testing is happening in Northern Ireland, but the number of participants is too few to generate an accurate estimate. These figures exclude care homes as there is not enough data from the app to estimate this population.

The regional breakdown of daily new cases per 1M people is:

• England overall: 156-199
• South East: 101-176
• London: 88-179
• Midlands: 169-310
• East of England: 109-224
• South West: 71-172
• North East and Yorkshire: 157-304
• North West: 217-412

The regional breakdown of total daily new cases is:

• England overall: 8700-11100
• South East: 900-1600
• London: 800-1600
• Midlands: 1800-3300
• East of England: 700-1500
• South West: 400-1000
• North East and Yorkshire: 1300-2600
• North West: 1500-2900