- Chris Baranyukjournalist
In England, contact tracking for covid-19 was supposed to resume by mid-May,1 after he was abandoned throughout the UK on March 12th. In the end, it was not renewed until May 28, when “test and tracing” was launched, and the system often reported problems with teething2. Contact tracing was resumed on May 28 in Scotland and June 1 in Wales.
However, another story unfolded across the Irish Sea in Northern Ireland. A contact tracking pilot appeared there on April 27, more than a month earlier than in the other three countries of residence, and the Northern Ireland Department of Health reports in a strategic document that “has been on May 18 [the Public Health Agency] there were contacts tracking all confirmed cases. “3
Currently, 92% of all positive cases of type 19 and their contacts are tracked within 24 hours, said Johnny Herron, clinical director of the Northern Ireland Public Health Agency (PHA), which is responsible for tracking contacts. Some days contact trackers in Belfast reached 100% of cases and contacts.
“The numbers speak for themselves,” Herron says. “The thing is, we talked to people in person.”
The population of Northern Ireland is 1.8 million, which is significantly different from the 56 million in England, and the number of confirmed cases of 19 witnesses4 reported daily in Northern Ireland over the past two weeks rarely exceeds 10. However, daily positive case reports were an order of magnitude higher during April, and there were some logistical problems with resuming contact tracking after March 12th. This is the story of how Northern Ireland managed to do this before any other part of the UK.
Small team expanding the scope
Jackie Hyland, a health consultant who led the Belfast Contact Tracking Center for the PHA, recalls the early days of the pilot program. She says that she and Mary Carey, the emergency planning coordinator, were looking for a room at PHA offices in central Belfast where contact trackers could work. They thought about working remotely, but feared that contact trackers kept sensitive data on the screen at home. A room of a suitable size was soon found, and training began on April 21 with several staff members.
Hyland, who has now completed her job at PHA and lives at home in Scotland, was adamant that hundreds of employees were not needed: she estimated that she would need a maximum of 80-90 shift shifts. This was based on the small population of Northern Ireland and the fact that during the blocking, most people with a positive test had a small number of close contacts to tell if any. This meant a reduction in the workload in each case. According to Hugo van Woerden, director of the PHA’s public health department, as of May 25, 78 instructors were fully trained.
People with positive test results call within 24 hours of receiving the result and ask for close contacts that may also be infected. These contacts are also called. Close contacts are defined as people who, for example, lived in the same house as an infected person, or spent more than 15 minutes with a person at a distance of less than two meters5. for self-isolation.
Initial contact tracking renewal requests focused on positive cases among nursing home staff and health workers. But, as the program expanded in early May, tracers soon became aware of clusters of cases 19 related to meat processing plants in Northern Ireland.
Since all tracking was carried out exclusively by phone, Highland and her team decided to compromise. “The principle underlying all this was:“ We are good people, we will be friends with people, ”she recalls. “If they don’t want to give us an answer, we won’t push them, because we need the reputation of the one with whom they can communicate, and not the one who persecutes them.”
This strategy, says Highland, meant contact responsiveness was high. When PHA tracers call someone, the phone number is displayed on smartphones as hidden, but the vast majority of recipients will nonetheless answer. Highland believes this is partly because the PHA is spreading a lot of information to local media about how the contact tracking program will work to raise awareness. She also explains that it doesn’t matter if one person is wary of giving out information because the clusters will still become apparent through testing and reports from others. Clusters of affairs in certain buildings or organizations were monitored using a system of boards: for example, on the board next to the name of the employer, ticks were marked that began to be associated with several or potential cases.
Overall, Highland and her team were helped by the small size of the healthcare system in Northern Ireland compared to England. “It’s all one system,” she says. “We had the opportunity to move fast.”
However, she and her colleagues are reluctant to call themselves race winners in other parts of the UK. Van Woerden says: “I would not want it to be perceived as a competitive thing – we are not here to defeat others, we are here to work together.” However, he adds that, in his opinion, Northern Ireland still coped well with the pandemic and is clearly proud of the employees who “approached the plate very responsibly” and worked overtime.
Highland also praises the human factor. She explains: “Everyone said:” Let’s find solutions. ” In fact, it was inspiring when I worked in Belfast, it was just amazing. ”
Verification and criticism
This is not to say that those who organize the response to covid-19 in Northern Ireland have not been criticized or verified. For example, calls were made to hire far more contact tracing staff7. Local environmental officers were identified as potential contact trackers and then “refused,” says Donal O’Kofey, Counselor in Ferman and Om County. in the southwest of Northern Ireland. “I think it would be more reasonable for me if it could be done remotely,” he says.
Ballymena, a large city in northeast Northern Ireland, is currently seen as the site for an extended contact tracking operation. About an hour and a half drive from Fermany, which, according to O’Kofay, is too far for staff in his area. He and his colleagues asked the Northern Ireland Department of Health to explain why environmental health officers were ultimately not hired, but they had not yet received an official response.
Herron says at the wanted center in Belfast: “We have people from all counties. I don’t think that the location of the center itself will be of great importance. ”
Some people also wonder why contact tracing was suspended on March 12, most notably Colm Gildernew, chairman of the Northern Ireland Health Committee and member of the legislative assembly, Sinn Fein (Irish Republican).
“The contact tracing operation should be continued here,” he says, arguing that the suspension of contact tracing on March 12th was “caused by what was happening in England and, in particular, in London,” and not by what was appropriate on the island of Ireland . ,
Bmj asked the Northern Ireland Department of Health why the tracking was suspended, and was directed to the Test, Track, Protect strategy paper, which said: “On March 12, the UK moved from the containment phase to the delay phase. Our focus then shifted from individual contact tracing to broader measures, including the advice of the entire public to isolate themselves immediately if they even had mild symptoms. ”
Hyland says she herself supported the suspension of the program in early March because there was limited case testing at the time, and general practitioners inundated the PHA with requests for patients reporting possible symptoms of covid-19. “The definition of the case has become too broad. .., we relied only on symptoms, ”she says. “Without testing, it was impossible to establish contact with every person who met a broad definition of the case.”
At the moment, the contact tracking operation in Belfast is clearly coping with demand. But, since the blocking rules are relaxed and people move again, it is possible that covid-19 will begin to expand exponentially again.
According to the Ministry of Health, various measures are being considered to solve this problem, including the application. Herron says that people can be “more careful” about data privacy issues in applications, and that the people who cause them can sometimes remember who they were talking to.
But the software can still record useful data, says Jim McLaughlin, a physicist at the University of Ulster who worked with colleagues to develop the covid-19 application. Its features, including automatic contact detection based on smartphone proximity and a reporting function for antibodies, test results can be assigned and integrated into the symptom-testing app in Northern Ireland, 9 he suggests.
Northern Ireland Health Secretary Robin Swann said he would not encourage Northern Ireland residents to download an app recently tested by the UK government on the Isle of Wight. He also claimed that a single application should be used throughout the UK. Ireland.11 Due to the open land border between Northern Ireland and the Republic of Ireland, healthcare providers exchange information from contact tracing12 between both parts of the island.
At the moment, officials in Northern Ireland are committed to tracking contacts – and for a very long time. As stated in a strategy document by the Department of Health, “this approach is likely to become part of everyday life in Northern Ireland until an effective vaccine is developed and a vaccination program for covid-19 is developed.”
Competing interests: I have read and understood BMJ’s policy regarding the declaration of interests, and I do not have any relevant interests to declare.
Provenance and peer-reviewing: ordered, not peer-reviewed.
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