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200728 | Test, track and trace in Cornwall: a tangled web

Test, track and trace in Cornwall: a tangled web

 Photo by Anna Shvets at Pexels

Cornwall has the resources to do effective Covid-19 contact tracing. So why is it not being allowed to do so? Jane Stevenson talks to Councillor Colin Martin, who has been trying to find out.

Our national Test, Track and Trace system has come into sharp focus as we come out of lockdown. Boris Johnson’s “world-beating” system has failed to materialise and Council leaders in virus hotspots such as Manchester and Leicester have spoken out about not receiving detailed data quickly enough to manage regional spikes in cases.

Wanting to find out what was happening in Cornwall, I approached Councillor Colin Martin, Vice Chair of the Cornwall Council Scrutiny Committee that’s responsible for Health and Social Care.
Colin had posted on Facebook about his wife’s personal experience of the failing testing system, and about worrying gaps in the publicly available regional data. He agreed to an interview for West Country Bylines.

Colin’s wife Kate, a teacher in a Pupil Referral Unit, fell ill in May with coronavirus symptoms. She used the government website to book a test at a drive-through facility in Bodmin jointly run by accountancy firm Deloitte and the army.

Turning up at her allotted time, she found no-one there apart from several other people in their cars, looking confused and unwell. Returning the next day, she had to self-administer the challenging tonsil and nasal swab test while in her car in the car park. After five days of waiting for results, Kate rang the helpline only to discover that they had no record of her test.

This shambolic experience continued when, three days after her second test, she received her result from the original ‘lost’ test. This was 14 days after it was taken.

In his capacity as a councillor, Colin noticed that crucial testing data was missing back in June. The UK reported data includes hospital data (known as Pillar 1) and community data (Pillar 2). However, the regions did not have access to the vital community data. Cumulatively, thousands of regional cases were missing from the DHSC public ‘dashboard’ up until early July, when the data started to be more completely reported.

As someone who held responsibility for scrutinising health and social care in the region, Colin found this deeply disturbing; and, as community testing increased relative to hospital testing, “week by week, the figures given to councillors have been more and more misleading,” he told me. “I’ve tried to tell the media, but as it required opening a spreadsheet, no one was interested.”

As Covid-19 is a notifiable disease, Cornwall Council’s Public Health and Protection team is supposed, by law, to have data on suspected cases – all the more vital as responsibility for managing outbreaks is now in the hands of councils.

At present, community testing and data accumulation is run centrally by private contractors such as Deloitte and Serco. The tracing of contacts and further testing is also run centrally. Information on identified hotspots is given to councils, who are then responsible for bringing that hotspot under control. But to do this, councils need granular data down to names and contact details of individuals. At the time of writing, Colin had received an update saying postcodes of cases were finally being given, but is this enough?

The issue with outbreak identification in Cornwall, Colin explained, is that cases in disparate postcodes over a large geographical area might be connected to a school or supermarket with a wide rural catchment. Will centralised, briefly trained contact tracers without local knowledge be able to identify such outbreaks quickly enough to stop significant spreading? Colin has his doubts – and is especially frustrated because the resources to do rapid test, track and trace are right here in Cornwall.

Colin explained that, up until 11 March, anyone in Cornwall who was suspected of having Covid-19 was tested, as was anyone they had been in contact with, and the tracing was run by experienced public health staff. At that point, the national picture was of overall rapid growth in cases, but Cornwall only had five known cases. In fact, on 11 March, the Director of Public Health in Cornwall offered Public Health England (PHE) help with testing and tracing, but the offer was rejected.

The very next day, PHE declared that contact tracing and widespread testing of anybody with symptoms was no longer appropriate for the current stage in the outbreak. In doing so, it appears to have been following guidance from the Scientific Advisory Group for Emergencies (SAGE). The modelling used by SAGE had suggested that there simply would not be the testing capacity at this point, although many public health experts – including SAGE member Sir Jeremy Farrar – now see this as a serious error.

Colin Martin thinks it was “a massive mistake” to treat the whole of the country in the same way. With just five cases in Cornwall at that point, Cornwall itself had the capacity to test and contact trace – and indeed, could have helped with national testing too. All the more so if lockdown had been introduced then instead of 12 days later.

Had Colin had the opportunity to communicate his view formally during lockdown? “There have been no formal opportunities for us to ask about public health. There have been informal, ‘behind closed doors’ briefings but, on the record, it’s been very difficult.”

It’s not all bad news: Colin does think things have improved. The online system to book tests is clearer and the turnaround time quicker. Even so, he believes the centralised system cannot be as fast as a local one, not least because of the time it takes to transport samples from areas such as Cornwall to the mega-lab in Milton Keynes. If someone waits 48 hours for a result, that person could potentially be infecting people for two days. Colin explains:

“If we had a local testing system in place, Public Health could drive to the house on the same day, administer the test (properly), drive the sample back to Treliske. You’d know the same day.”

He says that the Peninsular Pathology Network in Devon and Cornwall has got the capacity to handle the number of samples from the two counties at present. The centralised system should be used as overspill, he believes, rather than not using any local capacity at all for community testing.

As well as giving faster results for individuals, this would mean that Cornwall would have timely, reliable, granular data which could be sent up the chain rather than the other way around. Local Public Health officers would be more able to identify hotspots and the trusted local NHS and Council staff would be more effective in supporting people to isolate.

The national tracing system only offers tests to traced people who report symptoms. “We know Covid can be spread by people without symptoms,” Colin says, “and so they should be tested too.”

Despite the Council now being given case data at postcode level, the private contractor Serco holds on to personal contact details. The rationale for this is to avoid the risk of Serco and the Council contact tracing the same people. But Serco – which has a terrible reputation in Cornwall after its appalling handling of the local out-of-hours GP service – is unlikely to recognise the common threads connecting cases without detailed local knowledge.

With the tourist season now in full swing, the centralised test and trace system is likely to face even greater challenges, and Colin seriously doubts that it’s responsive enough.

Take a possible hotel outbreak, for instance. If there were a local test and trace system run by Cornwall’s Public Health team, as soon as someone reported symptoms the Public Health Officer could instruct the hotel manager to inform guests to isolate in their rooms while waiting for a rapid result on the initial case. Further contagion would be limited immediately.

Under the current system, the person with symptoms could drive to, say, the Plymouth testing centre and then travel on home (or indeed travel home and then get tested). They would not get the result until 48 hours later. Only then would the central Serco tracing of their contacts begin. Meanwhile other visitors in the hotel could be circulating as normal. Not only could the virus be spread into Cornwall – it could also spread amongst tourists and then be taken back to all four corners of the country.

Colin stressed that Cornwall Council staff are eager to do whatever they can to help. However, he believes that the Council’s leadership – the Chief Executive, the Leader of the Council, the Cabinet Member for Public Health and the current Interim Director of Public Health – need to speak out, step up and take charge. This would mean criticising the government’s system, which they have so far been reluctant to do.

On 11 March there were five known cases in Cornwall. Six weeks later (with 12 days between stopping track and trace and lockdown starting) there were hundreds. At the time of writing, 119 new Covid-19 deaths in England had just been announced, bringing the seven-day rolling average to 65 a day – nearly as many as died in Grenfell Tower.

Until we have a vaccine, the only way to keep the virus under control and avoid further lockdowns is an effective track and trace system. Listening to Colin, it’s clear that we do not have this yet – but also that Cornwall and other counties with fewer cases could lead the way in creating one.

On 18 July, sources close to Matt Hancock signalled a U-turn, indicating that from now on details of people with coronavirus would be issued to local government public health teams. Colin’s response was cautious:

“It’s good that the government has finally acknowledged that it has a legal duty to share full details with councils. But how quickly will the information be shared? Knowing who was poorly a week ago is very little help. We need to know who is poorly today and who they contacted yesterday.”

It’s certainly difficult to be optimistic about this government’s ability to learn from its mistakes. And the day after Hancock’s announcement, the entire basis of the Test and Trace programme was thrown into question when the government admitted it to be in breach of data protection law.

I asked Colin if he thought the current system would stop a similar outcome happening again.

“No. It’s not fast enough to clamp down, because of those time delays in each step. I’m very worried.” He thinks the current system could be enough to stop a major spike, but it will be “like trying to put out a forest fire by only putting out the big bits. That burn will keep on re-starting.”

 

 

 

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