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Ministerial Foreword

Leading Wales out of the coronavirus pandemic, our framework for recovery is based on 3 pillars:

  1. The measures and evidence by which we will judge current infection levels and transmission rates for coronavirus in Wales
  2. The principles by which we will examine proposed measures to ease the current restrictions
  3. Enhancing our public health surveillance and response system to enable us to prevent infection and track the virus as restrictions are eased and how this system will protect people’s health.

In this document, we set out in more detail what we will do under pillar 3.

Our Test, Trace, Protect strategy is to enhance health surveillance in the community, undertake effective and extensive contact tracing, and support people to self-isolate where required to do so. Our actions will be informed by international experience and we will maintain strong engagement with the public throughout.

The current restrictions ask a lot of people. They impact on all of us, affecting our family lives, our jobs, our well-being. The next stage is to begin to relax restrictions, finding a way for people in Wales to live and work alongside the virus, whilst containing its spread. As lockdown restrictions are gradually eased, each and every one of us will need to take steps to protect ourselves, our families and our communities if we are to successfully limit the spread of the disease.

To date, our testing strategy has focussed on people in hospitals, care homes, and symptomatic critical workers. In the next phase, Test, Trace, Protect will mean asking people to report symptoms, testing anyone in the community who is showing symptoms of COVID-19, and tracing those they have come into close contact with. Contacts will be advised to self-isolate in order to stop further spread among family, friends and the community. Contact tracing is a long established public health approach to containing the spread of many infections and has proven effective in controlling coronavirus in other countries.  Our approach will bring together and build on the existing contact tracing expertise of our local health boards and particularly our local authorities to delivery this strategy on the ground.

Asking people to isolate in this way is not easy, but it is vital if we are to continue to save lives and reduce the rate of transmission. Test, Trace and Protect will potentially be with us for some time, until a vaccine is developed, which may be at least 12 months away. Because it is not easy and because we are asking people to protect others, it is vitally important that we support people to do the right thing, particularly when we may be asking them to isolate on repeated occasions.

The people of Wales are our most important partners. It is only through their willingness to do the right thing – report their symptoms, identify their contacts and heed advice when told to self-isolate - that we can break the chain.

This document sets out our approach, how we will work in partnership to deliver one of the biggest public health interventions of a generation.

Introduction

Transmission of COVID-19 is expected to continue until a vaccine is available or there is enough acquired immunity amongst our population for it to stop spreading.  The lockdown restrictions have had a profound effect on the lives of all of us across Wales, they have also helped contribute to falling levels of infection.  The virus remains a very serious threat to us all and so we must chart a course that helps avoid the risk of a second significant wave of infection. 

We have always based our approach on the best available scientific evidence, health surveillance and international learning and will continue to do so. 

Contact tracing has been, and is being used in countries around the world to limit the spread of the virus in the community by breaking the link in transmission. Contact tracing starts with self-reporting of symptoms, followed by testing suspected cases, tracing the contacts of those potentially infected and then protecting our families, friends and communities through self-isolation.

In Wales we have a robust public health system delivered by local health boards and local authorities with significant expertise in contact tracing which puts us in a strong position as we move into the next phase. For the next phase of the outbreak, we need to implement contact tracing on a scale never seen before.

That is why delivering Test, Trace, Protect will require partnership working: pooling our energies so that together, with common purpose, we can reduce the transmission of the virus. Public Health Wales, Local Health Boards, Local Authorities, third sector, academia, local business and other partners all have a role to play, working with the Welsh Government, if we are to succeed in easing restrictions, while at the same controlling the spread of infection. 

Roles and Responsibilities

Individuals – following public health advice, hand washing, social distancing, reporting symptoms and self-isolating when necessary.

Welsh Government – provide strategic direction, oversight, determine priorities and provide resources to enable test, trace, protect.

Public Health Wales (PHW) – our expert National Public Health body providing leadership and specialist advice on public health approaches.  Responsible for coordinating contact tracing, advising on sampling and testing, laboratory analysis of tests, health surveillance and providing expert health protection advice and analysis of the spread of the virus in our communities through a range of health surveillance indicators.

Local health boards and local authorities – providing a wealth of contact tracing experience and working in collaboration to deliver regionally coordinated local contact tracing teams – a mix of clinical and non-clinical staff who can support those who are symptomatic or have tested positive and their close contacts to stay safe.  This will sit alongside their existing role to provide testing facilities and environmental and public health responses to local outbreaks and clusters or preventative action in areas regarded as high risk.

Crucially everyone in Wales needs to know and understand the symptoms to look out for and what to do if they, their family or friends develop them. Everyone has to be prepared to do what is right and protect themselves, their families and their communities through self-isolation.

So as we implement Test, Trace, Protect we will be guided by 3 key principles:

  • Test Trace Protect in Wales will reflect the scientific evidence and our aim will be to maintain a UK-wide approach, only differing when our specific context requires it, and supported by the evidence. This is important because the Welsh public need to be clear about what is expected of them and their role in protecting themselves and others.
  • We will deliver Test, Trace, Protect in partnership, consistent with our values and principles and reflecting the need for everyone to play their part in combatting the virus.
  • Test, Trace, Protect will be designed to support citizens to contribute as much as they can to protecting themselves and others to encourage positive behaviour, making it easy for people to play their part in contact tracing and limit the spread of the virus and protecting the vulnerable.

Overview of Test, Trace, Protect

Test, Trace, Protect will work by:

  • Identifying those who have symptoms consistent with COVID-19, enabling them to be tested while isolating from wider family, friends and their community.
  • Tracing those individuals who have been in close contact with the symptomatic person, requiring them to take precautions and self-isolate (for 14 days).
  • Providing advice and guidance, particularly where the symptomatic individual or their contacts are vulnerable or at greater risk.
  • Ensuring that if the individual tests negative and the symptoms are not due to coronavirus, individuals and their contacts can get back to their normal routines as soon as possible.

To enable this we need:

  • Individuals who are symptomatic – even where those symptoms may be mild - to report their symptoms straight away and at the same time self-isolate and advise their friends and family that they may have COVID-19.
  • Easy and rapid access to testing, so that everyone who needs a test can get one – this could be through a mass testing centre, community testing unit, mobile testing unit or via home delivery, where they can administer the test themselves.
  • Individuals to recognise their role and responsibility to help protect others and provide information in order for their contacts to be advised of the necessary steps that they need to take to protect themselves and their families.
  • Contacts to self-isolate when advised, even if that is on several occasions.
  • The right support for those who need it as they self-isolate.  

There are specific features of COVID-19 that make all approaches to contact tracing including Test, Trace, Protect potentially challenging to operate:

  • The symptoms of COVID-19 are very similar to the symptoms of a range of other respiratory ailments and particularly as we move into the autumn and winter we are likely to see more people presenting with possible symptoms who test negative. This means there could be many people (those with symptoms and their contacts) isolating who do not have the virus. We will need to monitor this closely, and if needed adapt our approach.
  • Some people with COVID-19 have no symptoms and some people are infectious in the pre-symptomatic phase. So we cannot rely on Test, Trace, Protect alone to control the epidemic. Broader behavioural and public health measures remain essential.  
  • We aim to have contact tracing capacity in place across Wales by 31 May.

Test

Testing for COVID-19 in the next phase has a number of purposes, it is vital for:

  • Diagnosing the disease to help with treatment and care.
  • Population health surveillance, so that we understand the spread of the disease and can identify clusters and hot spots.
  • Contact tracing, to control the spread of the disease.
  • Business continuity, enabling key workers to return to work more quickly and safely
  • Knowing who has had the infection in the past, when antibody testing is available.

The scale of testing capacity needed in Wales and indeed across the UK to support these purposes and in particular Test, Trace, Protect is unprecedented.

We have significantly expanded our testing capacity in Wales with laboratory capacity now available to process over 5000 tests a day and with testing centres now open around the country. We will continue to increase this capacity over the coming weeks and months, potentially to as many as 10,000 tests a day, enabling us to test more people staying in hospitals and care settings and those working in these sectors and in other critical services. As we move to mass population testing to support contact tracing, we will be able to increase testing capacity further by drawing on the testing programme operating across the UK, with systems in place to ensure that data is managed appropriately. Using this additional capacity also brings the benefit of being able to have tests delivered to people’s home for them to self-administer.

Contact tracing combined with the other purposes that testing supports could require as many as 20,000 tests a day, that will come from a combination of tests from Wales and a share of the UK led testing programme. This is highly dependent on the spread of the disease, the prevalence of symptoms and the emerging evidence on how testing can best be deployed to prevent infection.  We will continue to keep this evidence under review and adapt our estimates of need accordingly.

Our capacity to test will need to grow over time to successfully constrain the spread of the virus. The health surveillance work that PHW will undertake to monitor incidence of the disease, will be crucial to ensuring we are able to anticipate national and regional need. We will continue to model the level of tests needed and develop our infrastructure accordingly. This includes the work to develop anti-body tests. Understanding who has been infected and potentially whether they are immune to COVID-19 is crucial to successfully managing and recovering from the pandemic. It also has a bearing on planning and implementing suppression measures, maximising workforce capacity in the NHS, and potentially supporting phased exit from social distancing.

Trace

Contact tracing is a tried and tested method of controlling the spread of infectious diseases. It will also help us prevent and understand how the disease is passing from person to person. 

We used contact tracing during the ‘contain’ phase of our initial response to COVID-19. The challenge now is to scale up our contact tracing capacity to levels not seen before, to be able to quickly trace potentially tens of thousands of new contacts every day. We will use strong partnership working and collaborative action to achieve this in Wales.

At a national level, Welsh Government will lead and provide strategic direction, including using developing scientific advice to inform our response. PHW will provide national co-ordination, expert advice and support on contact tracing methods and priorities, which will ensure that we have robust all Wales standards and comprehensive guidance for how contact tracing should operate.

Not all contacts, activities, or environments have an equal risk of transmission. PHW through their work to implement a rigorous health surveillance system will identify which contacts and settings confer the highest risk of transmission, helping direct contact tracing and testing efforts.

NHS Wales Informatics Service (NWIS) will ensure that there is a single digital platform for contact tracing across Wales. This will allow people to simply and quickly report their contacts, supporting contact tracing teams to work effectively, and providing real time intelligence across the whole of Wales on the coverage of the disease, how quickly it is spreading, and where there are hotspots of infection.

Contact tracing will be delivered regionally with Local Health Boards and local authorities working in partnership along with other public services to deploy contact tracing teams who understand the local context. This will help to speed up contact tracing activity, and to identify new trends or local clusters of the disease as early as possible.

Alongside this work, there will be a UK-wide digital app which people can activate on smartphones to anonymously track when two devices using the app are close together. This ‘proximity tracking’ is different to contact tracing, because it does not record any personal or location details. But it can help manage the spread of the disease, for example as an early warning system which works more quickly than contact tracing, and by sending an anonymous alert to strangers who would not be reported through contact tracing.

Contact tracing will be an essential part of our Test, Trace, Protect approach, trialling  of contact tracing will start imminently enabling us to learn and adapt and will be scaled up rapidly.  The scale of contact tracing will grow over time and will also need to be flexible to respond to the spread of the disease and the prevalence of symptoms.  For example as we move into the autumn and winter we are likely to see more people presenting with possible symptoms. Initially working with our partners in local authorities and Local Health Boards we are aiming to deploy a workforce of around 1000 staff.  We will then grow our workforce and adapt our approach as circumstances dictate.  Contact tracing will need to be maintained at a significant level, potentially for the next year or until a vaccine is found, responding to the latest evidence on how common the disease is across Wales and how quickly it is spreading.

It is crucial that we all play our part in reporting symptoms and adhere to advice to self-isolate and protect others.

Protect

Contact tracing is not an end in itself. It enables individuals to take the right steps to protect their families, friends and their community by self-isolating. Self-isolating means as far as possible maintaining distance from other family members, not leaving the house for exercise or work and not visiting the shops for food or other essential items.

Contact tracing means people may be asked to self-isolate multiple times. The more often people come into contact with others, the more likely it is that they will be required to self-isolate. We recognise the strain that this may place on individuals and their families if they are having to isolate on numerous occasions. This is something that we must all prepare for. If we are to maintain the gains that have arisen from lockdown, if we want to keep the R0 transmission rate down, then isolating to break the link in transmission is vital.

Across Wales families and friends; communities, third sector organisations and volunteers; and local authorities and health boards have been providing support which has enabled people to manage during lockdown. 

We will now also all need to work together to support people to self-isolate. While they are self-isolating, some people may need help to get food or medicine. Some people may need ongoing care or help in response to their mental health or physical support needs. 

We will work with our partners to identify the practical support some people may need while self-isolating, where they cannot rely on their networks to help, and agree how this will be provided.  

We will also talk to the UK Government about how they can ensure people are enabled to self-isolate through appropriate provision in terms of individual employment rights and the social security system.

What next

As lockdown restrictions are eased, we must find a way for people in Wales to live and work alongside the virus, whilst containing its spread. Each and every one of us will need to take steps to protect ourselves, our families and our communities if we are to successfully limit the spread of the disease.  To save lives all of us must test, trace and protect. 

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