UK Edition
The Government’s strategy for mass contact tracing is facing questions after scientists suggested the UK needed to recruit up to five times more people than planned.
Ministers announced on Thursday that 18,000 contact tracers including 3,000 health professionals would be deployed to suppress the spread of coronavirus by tracing anybody suspected of having contracted the disease.
But leading scientists said the UK would need to recruit an army of as many as 100,000 contact tracers for the approach to be effective.
Public health chiefs suggested the contact tracing programme might last until 2024 and beyond.
It came as Matt Hancock announced that millions of people are now eligible for a coronavirus test under an expansion of the testing programme.
As he seeks to reach his 100,000-tests-a-day target, Mr Hancock said key workers and anyone in their household will now be eligible for tests if they have symptoms of Covid-19.
Key workers on the list are the same as those for access to schools, and include police officers, teachers, social workers, those in the justice system, undertakers, some in local government, supermarket and food production workers, journalists, transport workers and some people in utilities and IT.
Mr Hancock set out his plans for "easier, faster and simpler" testing so that more people can access a Covid-19 test to tell them whether they currently have the virus. He said people can register for a test on the gov.uk website.
People will then receive a text or email with an appointment at a drive-through centre or can request a home test kit, although the latter are currently in limited supply.
However Whitehall officials have admitted “logistical difficulties” over how to ensure hundreds of thousands of swabs reach centralised labs within a 48-hour time limit.
The testing and tracing of the general population for Covid-19 is critical in easing Britain out of lockdown. Contact tracing has been key in limiting the spread of the pandemic in other countries, with UK officials under fire for abandoning its system very early on in the outbreak after transmission had become widespread.
Mr Hancock announced on Thursday that 18,000 people would be trained and ready to start contact tracing as numbers of new Covid-19 cases begin to fall, and mass testing has been ramped up to required levels.
"As we look ahead, this is critical to keep the virus under control," he said.
The aim would be to track more than 80 per cent of people with whom an infected person had been in contact within 24 hours of diagnosis. Infected people and those they had contact with would be quarantined until the risk that they could get the illness had passed.
However, leading scientists pointed to other countries including Germany and South Korea who have already deployed thousands of contact tracers as part of a strategy backed by the World Health Organisation.
Professor Azeem Majeed, head of public health at Imperial College London, said: “We need to use this lockdown to recruit large numbers of contact tracers, get them in post, get them working with local public health teams so we have a large scale programme in place as soon as possible.
“If for example you look at Wuhan in China, they recruited 9,000 contact tracers for 11 million people. That’s around 50,000 people for England. So we need to look at large volumes of contact tracers, not just a few hundred or a few thousand. We need tens of thousands, maybe even 100,000 people to do contact tracing.”
Mr Hancock said 3,000 of the contact tracers would be "clinical personnel" while the other 15,000 will be trained up and be ready within "a matter of weeks".
It is understood that the Government will consider recruiting volunteers if needed to reach the 18,000 number.
Thousands more will be diverted from their roles in local government, it is understood.
Cllr Ian Hudspeth, Chairman of the Local Government Association’s Community Wellbeing Board, said local authorities had the expertise to carry out tracing but added: “This extra demand on existing services would need to be met by additional resources and funding, if councils are to help test, trace and isolate those with Covid-19.”
Earlier this month the Government was accused of missing an opportunity by failing to deploy around 5,000 local authority workers already trained in contact tracing techniques.
Environmental health workers already use contact tracing to track the spread of salmonella, norovirus and legionnaire’s disease. It is thought the workers will now be deployed as Covid-19 contact tracers.
Contact tracing relies on an effective mass testing programme, such as the one announced on Thursday by Mr Hancock. However, Government sources admitted “logistical difficulties” in trying to obtain Covid-19 swabs from the general population and then trying to ensure their return to testing laboratories within 48 hours. Samples degrade after that time meaning an infected person could test negative.
Officials had hoped to use the postal service for the return of swab kits sent to people’s homes. But they admit that the postal service is not reliable enough to guarantee the quick turnaround. A courier service is likely to run into problems because of the sheer scale of the testing needed and scientists have now been asked to find ways to extend the shelf life of the swab.
A Government video campaign, posted on YouTube, will show the public how to take swabs themselves - it requires pushing the swab “up your nose until it is almost painful” said a source - but the difficulty is ensuring the swabs reach one of three ‘megalabs’ set up by the Department of Health and Social Care (DHSC) to process the tests.
One senior Whitehall source said: “If we can find a way of sending the test back by post then we can have mass testing. But it’s a big if. There are real logistical problems in getting tests sent back to the labs on that scale. It is unbelievably complex for us to set up an Amazon-style logistics network from scratch.
“If we can get something to extend the 48-hour window for the swab, then the postal system is best.”
A separate senior Government source said: "There are some logistical difficulties we are trying to work out including the degrading of samples. We also need to work out some distribution issues to make sure we can get everything to the right places.”
The source said a barcoding system was also being developed to speed up the processing of samples. The source added: “We are hoping to resolve these issues in the next few days, we are working at pace on this."
Ministers are partially pinning their hopes on a Covid-19 contact tracing app, which has begun trials at a Royal Air Force base in North Yorkshire.
The system works by sending automatic Bluetooth signals when users pass close to one another. If someone subsequently develops symptoms of coronavirus, an alert would be sent to other users they may have infected. The messages will be sent anonymously to protect privacy.
Developed by the health service's digital innovation unit, NHSX, the app will either tell users “You’re OK now”, or when the alarm is raised, “You need to isolate yourself and stay at home.”
Ministers will take the final decision on when the app will be available for general use, although NHS leaders hope it will be released by the middle of next month.
Epidemiologists have suggested that up to 80 per cent of smartphone users would have to download the app for the strategy to be successful.
Around 12 per cent of smartphones in the UK do not have the necessary Bluetooth technology for the app to work, however.
When coronavirus arrived in the UK, Public Health England deployed 300 PHE staff who traced 3,500 people, with around three per cent of their contacts found to be infected. The PHE teams were largely disbanded after the Government’s strategy moved to the contain phase.
Matt Hancock said: “We’re preparing for this now by hiring an initial 18,000 people, including over 3,000 clinicians, including public health specialists. We’ll be training up the massed ranks of our contact tracers over the coming weeks and roll out the service.”