It’s a bright, fresh Sunday morning in early autumn in Halifax, West Yorkshire, I’m one of two contact tracers given a list of people who have tested positive for Coronavirus. We are part of a team of 18 contact tracers assembled by Calderdale Council, and we search for individuals the national Test and Trace service has been unable to contact after a period of a day or more.
The initial call of the day takes us to a tidy former council estate. A middle-aged woman answers the door, having first warned us that she is in isolation. We are kitted out in safety goggles and masks. Most people seek a positive Covid-19 result test because they are feeling unwell, so we ask how she is getting on, and whether she and her partner are experiencing any practical difficulties in isolating. For people who are struggling to get food or medicines, have large dogs that need walking, or need to provide care for others, we can put them in touch with local support services run from council volunteer hubs.
If people are struggling financially, we can try and help them to get the financial support; if facing serious hardship, there are discretionary funds that can be unlocked.
The great majority of the people that we are speaking to seem to be complying. They are worried for themselves, their families and the people that they might, unwittingly, have infected. They welcome the opportunity to help. After a 20 minutes chat, we have the details of the people the woman has had close contact in the couple of days before she began to feel ill, plus the details of her workplace, the names of the places that she had attended and who she might have met there. We then ask her to think back further – a week before the illness – to people she had met and places she had visited, to try and get an idea of where she might have picked up the virus.
As time goes by, the same settings may be mentioned by various people that are otherwise unrelated – a warehouse, a factory, a pub, a part of the health service. If we recognise patterns, we can easily speak to the council’s Public Health Officers and see whether additional work needs to be done to make these settings as safe as possible.
This is one of many benefits of contact tracing carried out by local teams. We live in these communities. We know the geography. When people are telling us about the places they have been and the things they have been doing, we can form a clear picture in our minds, which can guide further questioning.
NHS contact-tracing contractors Serco and Sitel phone members of the public from an 0300 number and, unsurprisingly, many people are reluctant to accept such calls. We phone from local numbers and often get through. When we don’t get through, we can be on the doorstep.
To be effective, we should be identifying the contacts of infected people as quickly as possible, yet only around 60 per cent of results are being released quickly enough (within 24 hours) from the centralised laboratories to Serco or Sitel’s contact tracing. Once Serco has made a few attempts at phoning the person, more time has passed. Today, the people who we are visiting had their tests between four and eight days earlier. This is far too late.
We visit a small terraced house in the town centre. We have been given details of two people at that address, who had tested positive a week ago. We learn that there are actually seven members of the family living there, who have all tested positive, but the national system does not recognise that they are all in one household and has bombarded this family with 43 phone calls, leading to them feeling harassed. This is happening frequently.
The chief executive of Calderdale Council called for a locally based contact tracing service early on but our service was not allowed to go live until the middle of August. From the outset, Public Health England would only give us access to the details of people that the Serco and Sitel service had been unable to contact, so we are only able to see part of the local picture. This must be limiting our ability to plot the virus’s spread.
Locally, we don’t even know what proportion of the total number of cases we are dealing with, to be able to understand what capacity would be required to expand our service to cope with all new cases. And then, once we have identified those people who have been in close or direct contact with the infected person, Public Health England won’t permit us to speak to those contacts and support them when they are isolating, even if they are living in the same house we are visiting at that very moment. They insist we send those details back into the national system, with the further delay that entails. These contacts may feel perfectly well initially, and in our experience they are likely to require more convincing to stay off work, avoid social contacts, and stay in their home, than someone who is sick and worried. These are exactly the people who might be swayed by a timely conversation with local workers, and benefit from the support services we can offer.
Some of Dido Harding’s billions must be allocated to local authorities to build up their contact tracing services. More must be made available to increase the capacity of local hospital and academic laboratories to perform Covid-19 tests, directly linked to local Public Health Departments. We need to invest in a much more resilient system to tackle this pandemic, and the next one.
At the end of our shift, we have gathered a few more pieces of the jigsaw puzzle. And, the people we have spoken to understand that they are not alone.
Colin Hutchinson is local authority contact tracer