Coronavirus: how can Test, Trace, Protect be improved?

Published 08/02/2021   |   Last Updated 08/02/2021   |   Reading Time minutes

“The contact tracing system in Wales has performed well so far, with over 90% of contacts being traced successfully since it started”; that’s what Wales’ Health Minister Vaughan Gething MS said in November 2020, when he announced additional funding to nearly double the contact tracing workforce in Wales.

The Welsh Government publishes weekly testing data for coronavirus and weekly performance data for contact tracing. But while the data is important, it only tells us part of the picture.

That’s why Senedd Research has been working with academics at Swansea University to find out more about people’s experiences of the NHS Wales Test, Trace, Protect service. The research recommends improvements to elements of the service, including consistency of communication, financial and mental health support, and the identification of people who do not have the capability, opportunity or motivation to self-isolate.

This article sets out the policy context for contact tracing in Wales and the main findings of the research.

Test, Trace, Protect

Contact tracing is an important part of the Welsh Government’s Test, Trace, Protect strategy. Testing is the spotlight that shows where the virus is, and contact tracing helps to prevent the virus spreading:

As soon as people start to display symptoms of coronavirus (COVID-19), they should arrange to take a test as quickly as possible whilst they and members of their household self-isolate. Contact tracing is reliant on tests being taken quickly.

On receiving a positive result people are asked to support the NHS Wales Test, Trace, Protect service by reporting their recent contacts to the local contact tracer so that they can be contacted and notified to self-isolate (and take a test if they too are displaying symptoms), to help stop the spread of the virus.

Since the contact tracing system was introduced in Wales in June 2020, over 156,860 (99%) positive cases and 350,987 (92%) close contacts have been successfully traced.

The Scientific Advisory Group for Emergencies (SAGE) has suggested that for a contact tracing system to be effective, it needs to trace around 80 per cent of contacts of an index case.

The figures for the latest week (24 to 30 January 2021) show that:

Numbers contacted

  • of the 4,008 positive cases that were eligible for follow-up, 3,832 (96%) were reached and asked to provide details of their recent contacts
  • of the 8,762 close contacts that were eligible for follow-up, 7,864 (90%) were successfully contacted and advised accordingly, or had their case otherwise resolved

Timescale for contact

  • of the 4,008 positive cases eligible for follow-up, 90 per cent were reached within 24 hours of referral to the contact tracing system, with 94 per cent reached within 48 hours.
  • of the 8,762 close contacts eligible for follow-up 81 per cent were reached within 24 hours of being identified by a positive care and 85 per cent within 48 hours.

The performance of the contact tracing system varies from week to week, with an increase in positive cases putting pressure on the system. The effective working of the system is dependent on two things:

  • Public engagement: when people respond to calls from contact tracers and when they are open and frank about their contacts; and
  • Capacity: the contact tracing workforce has the capacity to contact people testing positive to tell them to self-isolate as quickly as possible, and to reach their contacts and persuade them to stay home too.

In Wales, the contacting tracing system is a joint effort between the Welsh Government, Public Health Wales and local authorities. There are currently close to 2,400 people working in local and regional contact tracing teams across Wales.

Research into people’s experiences of Test, Trace, Protect

Research undertaken by Dr Simon Williams, Dr Kim Dienes and Dr Paul White at Swansea University looks at people’s experiences of the NHS Test, Trace, Protect service. This research was conducted on behalf of Senedd Research through our COVID-19 Register of Experts

The full report is available on the Senedd Research website.

The research shows that the contact tracing programme in Wales is not yet as effective as it could be. The key findings are:

  • Experience of Test, Trace, Protect Service (TTPs): Participants’ experience of TTPs was variable. There was considerable variation in the time taken for TTPs to contact individuals from the time of presumed exposure (33% within one day and 64% within 3 days, 36% four days or more). There was also considerable variation in terms of the frequency of follow-up contact (e.g. 25% daily contact versus 50% no further contact).
  • Views on TTPs: Participants’ satisfaction with TTPs was mixed. Overall, roughly half (48%) were satisfied with their experience of TTPs, compared to little over one-third (36%) who were dissatisfied. Roughly half of the survey respondents were satisfied with the ability of TTPs to answer their questions (54%). Most participants felt the advice from TTP was clear (70%) and easy to carry out (76%)
  • Adherence: Reported adherence to self-isolation guidance was high, with 80% of survey respondents reporting having fully isolated and only 1% suggesting they didn’t isolate at all.
  • Most commonly reported challenges to self-isolation were: physical health challenges (e.g. lack of exercise, unusual aches and pains etc.) (46%), mental health challenges (e.g. anxiety, feeling down, loneliness etc.) (46%), adjusting to usual daily routine (34%).
  • Although not as common, important challenges which may require some self-isolators to be provided with additional support included lack of access to essentials (20%), care commitment challenges (14%) and financial challenges (12%).
  • Self-isolation support scheme: Very few survey respondents (8%) were informed about the self-isolation support scheme by TTP contact tracers. Just over half (53%) didn’t know about it at all. Just under one-in-four (27%) felt that their income was negatively affected by having to self-isolate (of which, one-in-ten (10%) strongly agreed that it had).
  • Mental health: One of the main challenges that participants experienced was the mental health impacts of self-isolation. Three-quarters of survey respondents (75%) did not have their emotional or mental wellbeing checked on by TTP contact tracers. Over half (53%) felt that they would have liked more information about support for their mental health while self-isolating.

The report makes 4 recommendations:

  • Recommendation 1: TTPs should ensure greater consistency in communications between contact tracers and those being asked to self-isolate, for example in terms of time-to-contact (consistently low, ideally within 1-2 days) and in terms of the frequency of subsequent contacts (consistently high, ideally daily).
  • Recommendation 2: TTPs should consistently ensure that all those required to self-isolate are asked about their financial situation and, where relevant, provided specific information support for applying for self-isolation payments or other forms of financial assistance.
  • Recommendation 3: TTPs should consistently enquire into the mental and emotional wellbeing of all those asked to self-isolate and should provide resources and links for available and relevant mental health support.
  • Recommendation 4: People who do not feel they have the capability, opportunity or motivation to adhere to self-isolation need to be systematically identified and provided with support resources to help them adhere.

The study combined quantitative questionnaires with qualitative interviews conducted in December 2020 and January 2021. As of 26 January, 78 questionnaire responses had been received, and 14 interviews had been conducted, and data collection is ongoing.

Next steps

As the coronavirus vaccines are deployed, testing and contact tracing will continue to be a critical tool for controlling the pandemic; not least because it is still not certain whether being vaccinated stops someone from passing the virus to others.

In evidence to the Senedd’s Health, Social Care and Sport Committee, the Health Minister explained that when it becomes possible for restrictions to begin to be eased there will need to be more focus on contact tracing. Ministers will want to avoid the situation in early December, where case numbers were so high in Wales that they completely overwhelmed the test and trace teams, particularly in light of the new, more transmissible variant.

Dr Giri Shankar from Public Health Wales told Members of Senedd’s Health, Social Care and Sport Committee on 27 January that there are two things that might still be a challenge for the system:

One is if we have more new variants that have different characteristics and are much more transmissible. Secondly, if the population compliance is not satisfactory and we still see that people don't pay enough attention to the regulations and guidance, we might see that the system can get overwhelmed.

But in addition to the expansion of contact tracing teams, and the performance monitoring of cases, the Swansea University research puts a spotlight on the experiences of those who have been advised to self-isolate. It offers an insight into the financial, social and emotional impact of testing positive for coronavirus, or being identified as a close contact, and sets out what needs to be done to better support individuals and their families during this difficult time.

Article by Sarah Hatherley, Senedd Research, Welsh Parliament

Research study authors: Dr Simon Williams, Dr Kimberly Dienes, Dr Paul White, Swansea University.