A group of retired doctors who set up the UK’s first Covid-19 contact-tracing scheme has warned that the government system faces major challenges after they struggled to persuade health and care workers to self-isolate.
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.
“Whereas here, everything is reversed – there’s no real incentive to self-isolate, particularly as everybody’s keenness wears off… So there’s a disincentive.
“I personally think our volunteers are probably in a better position than these minimum-wage … employees are going to be. Maybe the government will employ really top-notch people who will have loads of authority, time, energy and insight and they will be able to sort this out, but I’m sceptical.
“Certainly the way that they seem to be trained, the way the government is rushing, the way that generally the performance of these companies have been operating in other arenas, I don’t think it’s going to work.”
The group hopes lessons can be learned from the pilot project, and its work continues. It has trained 25 more volunteers and is expanding its reach further into Sheffield and Calderdale, West Yorkshire