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Background

1. Contact tracing and Protect support are designed to interrupt the spread of transmission of COVID-19 by ensuring cases and their contacts isolate. Tracing those people who have been in close contact with a person who has tested positive, and providing advice, guidance and support to help people self-isolate is therefore critical to stopping the virus spreading through our communities.

2. The establishment and operation of contact tracing and protect in Wales has been shown to be highly effective and has made a material difference keeping the population safe during the pandemic. It has also separately shown the value of locally delivered public services, the capability of our public servants and digital workforce, and the efficiency and innovation of the organisations involved – Test, Trace, Protect (TTP) is rightly a source of pride in Wales.

3. The service has been supported by the UK Contact Tracing app - there are around 550-570,000 devices/users with the app installed in Wales. This has been used, alongside traditional contact tracing, to notify users if they come into contact with someone who later tests positive for coronavirus. The app allows people to report symptoms, order a coronavirus test, check in to venues by scanning a QR code and it helps the NHS trace individuals that may have coronavirus.

Building the current system

4. Welsh Government adopted population-wide contact tracing as part of TTP on 1 June 2020. It has played a crucial part in the Welsh Government’s (WG) response to the coronavirus (COVID-19) pandemic, operated in partnership by Public Health Wales (PHW), local authorities, health boards and wider partners. The structure of TTP in Wales has been commended as a real strength of the programme, for example in the Wales Audit Office report on TTP (1)

5. Our aim was to scale up contact tracing capacity to be able to quickly trace tens of thousands of new contacts every day, whilst gathering local and national intelligence to detect hot spots and inform tactical management of infection. Performance of contact tracing has been and remains excellent, despite challenging increases in volumes in cases and their contacts.

6. In total, between 21 June 2020 and 22 May 2021:

  • of the 174,295 positive cases that were eligible for follow-up, 173,768 (99.7%) were reached and asked to provide details of their recent contacts
  • of the 379,003 close contacts that were eligible for follow-up, 359,385 (94.8%) were successfully contacted and advised accordingly, or had their case otherwise resolved (2)

7. Since March 2020, there has been a vast amount of hard work undertaken at unprecedented pace to stand-up an entire testing, contact tracing and protect service from scratch. The process of establishing the service included a number of partners working together, including WG, PHW, 7 health boards, 22 local authorities, NHS Wales Informatics Service (NWIS) (now Digital Health and Care Wales (DHCW)), Military colleagues and UK government. Strong partnerships and an all-Wales ethos have been formed across the TTP programme, with regions and colleagues doing everything possible to help each other to keep Wales safe.

8. The contact tracing service is underpinned by a national Customer Records Management (CRM) system which was procured, built and deployed within 6 weeks. NWIS worked to ensure a single digital platform and robust information governance was available for contact tracing, which has supported contact tracing teams to work consistently across Wales and ensured cases and their contacts could be contacted speedily, alongside providing additional intelligence on the spread of the disease.

9. Strategic operational procedures were developed and approved in consultation with all partners, alongside the Standard Operating Procedures (SOP’s) for contact tracers and advisers, which included pathways for escalation through to the regional and national tiers. National guidance documents were also developed and published in preparation for the 1 June start.

10. Welsh Government worked with health boards and local authorities to develop workforce plans that could realistically deliver the service required. Staff from within health boards and local authorities were redeployed to contact tracing teams in order to commence the service in June. Parallel to this WG secured funding to fully support the contact tracing operation. Workforce plans were developed, submitted, approved and contracts awarded by 6 July.

11. Over the course of 2020, Wales experienced significant rises in cases and contacts on multiple occasions and the workforce was scaled up to meet this. Contact tracing was initially allocated £45m in July 2020, which enabled a contact tracing workforce of around 700 staff to be deployed. That quickly increased to approximately 1000 staff by September 2020. A further £15.7m was allocated in November 2020, resulting in increases in additional workforce recruitment and capacity within the system, along with a 70 person dedicated surge team to be stood-up to support contact tracing on a pan Wales basis. During December 2020 the average number of positive cases that were eligible for follow-up was around 14,000 per week, more than twice the average weekly figure for November 2020 (around 6,000 positive cases).

At its’ peak in January, almost 2,500 people worked in contact tracing across Wales.

12. Further work was also undertaken to expedite the process and expand the tools available to the contact tracing teams in order to reach, isolate people and offer them the relevant support more quickly. This included a process to enable mutual aid between regions of Wales, the introduction of backwards and enhanced contact tracing, and the increased use of automation, e.g. the use of an e-form.

Current context

13. The public health situation in Wales continues to improve and the prevalence of the virus has been on a downwards trajectory since February. Overall transmission rates, numbers of cases of COVID-19, hospital admissions and deaths are continuing to fall, with restrictions being eased correspondingly. The vaccination programme continues to go from strength-to-strength, and delivery timescales have already been moved forward. As at the week ending 28/05/2021, a total of 2.13 million doses of COVID-19 vaccine were given in Wales and recorded in the COVID-19 Welsh Immunisation System. Of the 2.13 million doses given nationally,1.08 million were second doses.

14. There are a variety of possible scenarios for the severity of the pandemic for the coming months, so a central concept for testing, contract tracing and protect will be adaptability for what lies ahead. In a scenario where the prevalence of the virus remains low, the focus of contact tracing and protect will be on the fastest, most comprehensive, forensic and targeted action possible to identify and prevent transmission and to encourage isolation compliance. In this scenario, contact tracing teams will need to adapt to take on additional functions to support wider action on the pandemic.

15. Since the peak in January, the workforce has reduced down to around 2,000 in April (including some 800 contact tracers and 800 contact advisers). This is a consequence of the sharp decline in the number of positive cases. This has allowed health boards and local authorities to expand the role of their teams and to add some additional functions to support wider pandemic recovery:

  • managing and providing assurance of almost 18,000 amber list arriving
  • travellers required to quarantine and take tests
  • supporting the vaccination programme by taking calls from public, arranging bookings and following up on those that do not attend
  • providing the contact centre for the interim solution for a Welsh Vaccination Certificate Service
  • proactively contacting large businesses and local employers to encourage them to take up the offer from Welsh Government on asymptomatic Lateral Flow Tests (LFTs)
  • proactively contacting local business, including licenced premises, hospitality and care homes, to establish correct proprietor contact details and to establish if any support is required relating to COVID-19 measures, regulatory requirements and other public health issues
  • supporting the setting up and running of community testing sites

16. As we move into full recovery, the need to take on additional tasks are likely to continue to grow, however should prevalence of the virus increase, contact tracing must – as it has previously – adapt to high volume operational activity, re-engaging redeployed, highly-skilled contact tracing staff quickly and supporting wider action across Wales to increase isolation and break transmission.

Current drivers and future focus

17. As set out in our Testing Strategy published in January 2021, testing helps to identify people who have COVID-19. Our strategy outlines how symptomatic and asymptomatic testing can play a part in reducing the harms associated with COVID-19.

18. Current demand for PCR (Polymerase Chain Reaction) symptomatic tests is around 60-65k a week. Around 60% of the samples are processed at lighthouse laboratories of which 70% are sent to the lighthouse lab in Newport. The remaining samples are processed at our NHS Wales laboratories. A high percentage of Welsh test samples therefore benefit from our investment in pathogen genomics  capacity. This means we can detect and identify variants of concern and our contact tracing teams can undertake in-depth work to help contain any new outbreaks.

19. Our strategy outlines under five key strands how we also use asymptomatic testing to identify new cases.

  1. Test to diagnose – To support NHS clinical care we need to identify patients who are infected/infectious as quickly as possible, particularly those presenting to hospital. We test patients on admission; 5 days after admission; and within 3 days of a planned admission.
  2. Test to safeguard – COVID-19 is a challenge in closed settings such as hospitals, care homes and prisons because it can be difficult to control the spread once infection is introduced. To protect our most vulnerable, we test asymptomatic staff working with vulnerable people to identify infected/infectious individuals who might otherwise pose a risk. iii. Test to find – By targeting outbreaks & enhancing community surveillance we can identify and isolate COVID-19 cases in the community, thereby reducing the transmission of infection, and helping to slow or stop the spread of the disease. This involves providing access to lateral flow selftest kits at collection points and directly to the home.
  3. Test to maintain – Finding cases faster reduces the spread of infection. To support education and workplaces we have introduced regular testing to find cases and support surveillance.
  4. Test to enable - Appropriate and effective testing schemes may provide additional safeguards alongside the vaccine roll out to help support the easing of restrictions and promote social, economic and cultural wellbeing. We have recently used testing as part of the risk mitigation measures in piloting a number of events. Learning from these events will help shape future plans for entertainment and hospitality.

20. However testing will only tell us who has the virus – contact tracing and relevant support is essential to stop the virus spreading further. We have therefore been focussed on reaching as many people with COVID-19 as quickly as possible, to identify and isolate their close contacts. This has been vital in the Government’s approach to helping slow and prevent the transmission of COVID-19 being passed onto others. During the period of high transmission and prevalence this winter (outside of firebreak), TAG estimated TTP reduced R from approximately 1.7 to 1.3. Using recent R values and improvements to case ascertainment and test and trace times, the effect may be a reduction from approximately 1.3 to 0.83 (3).

21. The following 2 drivers are foundational to our future work:

Virus transmission remains a very serious threat and the need for TTP and contact tracing will continue alongside the national and global vaccine roll-out.

22. ‘Core’ contact tracing remains a priority. The vaccination programme has been very successful, with high uptake in Wales and early evidence that 2 doses currently reduces the chances of becoming seriously ill with COVID-19 by over 90%, and the chance of catching and passing on the virus by more than 85%, although these could be lower for a variant virus (4). Further, whilst we are seeing much lower numbers of cases and contacts than experienced in December 20 and January 21, we must continue to take a cautious approach. The public’s continued compliance with the self-isolation duties and the rules around social distancing, face coverings and frequent hand-washing continues to be critical. The contact tracing service, including the communications strategy, will need to flex around the operational, policy and clinical requirements as we learn more about the vaccine and its role as we move from pandemic to endemic. Variants of concern represent a substantial threat to the progress we have made in tackling COVID-19. Contact tracing will play a central role in managing variants and preventing transmission.

23. We have seen multiple, separate COVID-19 variants of concern develop both within the UK (Kent) and across our borders from other countries such as Denmark, South Africa, Brazil and India. It is highly likely that further variants of concern will emerge, which may impact on the future severity of the pandemic with significant risks being posed by the increased international travel commencing on 17 May.

24. Our TTP strategy focusses on three interdependent purposes, to:

  • identify close contacts of positive cases
  • interrupt the chains of transmission and the prevention of the virus being passed onto others through self-isolation, with Protect support provided to cases and contacts
  • provide Insight, informing our approach and increasing compliance through the use of behavioural insights and stakeholder feedback
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Venn diagram

Identify

25. SAGE and the Welsh Government’s Technical Advisery Cell, (TAC) advise that the objectives of a test and trace system should be to isolate as many contacts as possible, as quickly as possible (5),(6), however TAC also note that reductions in R due to contact tracing increases notably with greater ascertainment of index cases (7). Asymptomatic testing helps to find positive cases of COVID-19 who are unaware they have the virus. SAGE advise that ‘contact tracing that rapidly identifies and quarantines the vast majority of cases and their contacts could plausibly reduce the unmitigated reproduction number by the order of 30-60%’ (8). We will ensure we identify the contacts of positive cases quickly to notify them to self-isolate promptly, along with the index case, which interrupts further spread of the virus and prevents clusters and outbreaks occurring.

26. Building on our existing contact tracing offer, in 2021 we will focus on improving the identification and support for those close contacts through:

  • continuing to improve performance and to focus on the speed of endto-end journey, from test taken to contacts traced
  • expanding digital capability
  • continuing to improve the quality and consistency of the TTP service
  • identifying sources of infection through backwards contact tracing

Key objectives for Identify are:

  1. At least 70% of close contacts contacted within 24 hours of an index case entering the contact tracing system
  2. Establish a working group to understand the impact of reduced case numbers on performance measures and objectives
  3. Develop end-to-end metrics for measuring the time from when cases are tested to when their contacts are contacted
  4. Develop operational metrics for backwards contact tracing

Improving the speed of contact tracing and end-to-end journey

27. New testing policies and technologies provide opportunities to test and diagnose more people, more quickly and timeliness is at the heart of effective contact tracing services. Keeping our strong links with testing to provide an integrated TTP service, our over-arching priority continues to be identifying close contacts of positive cases as quickly as possible, so they can selfisolate and prevent them passing the virus onto others. The recent introduction of testing of close contacts will further enhance our commitment to Test to Find.

28. Currently the percentage of positive cases and close contacts reached within 24 hours is 92% and 81% (16 to 22 May 2021). If the prevalence of the virus remains within manageable levels we will work with regions to ensure at least 70% of close contacts are contacted within 24 hours of an index case entering the contact tracing system, utilising tools and resources available to manage performance regionally, such as tight processes surrounding 'uncontactables' and correct use of case resolutions. In response to the recommendation of the Wales Audit Office, we will also develop an additional end-to-end metric (8), and close contacts are reached and asked to self-isolate by the contact tracing service. Expanding and increasing the use of the digital capability of our contact tracing service to reach people quicker and improve the use of the entire system from a public perspective.

29. So far, most contact tracing has been undertaken through a telephone call, based on traditional contact tracing methods. We continue to strive for equality of access to the contact tracing service and have been working to expand our tools, including:

  • the translation of SMS messages into approximately 30 languages so that we can engage with those in Wales whose first language is not English or Welsh
  • the design and implementation of a web-form, to improve the speed, ease and simplicity of access to the service

30. We are working with our partners to improve the use and quality of existing functions and will collaborate to bring on-board new tools and ways of working. We are listening to the experience of the public and using behavioural insights to inform that process, making it easier for our cases and contacts to interact with our service, register their information more easily and through a variety of ways that meets their needs, including supporting people who do not have digital access.

31. Our focus will be to streamline the entire end-to-end contact tracing process safely and where possible, to meet the varying needs of our public while being focussed on making sure cases and their identified contacts are notified to self-isolate quickly. We are also working with our colleagues and partners in our Protect strand of TTP, to ensure that people using the App can also receive further support through integration with our CRM.

32. System requirements are being continuously reviewed and developed in ‘sprint’ phases. We will continue to work with partners to ensure the single, digital system evolves to provide a fit-for-purpose platform to complement the on-going local, national and international epidemiological developments.

33. We will also strive for further use of the CRM information to help inform more, targeted TTP approaches and automating data analysis where possible – for example using information gained from cases and contacts though contact tracing to build-on the existing capability to help identify trends and particular hot-spots of infection and provide targeted testing deployment, contact tracing and protect support on a weekly basis, both locally and nationally. The integration of genomics data from testing will also enable further detailed analysis and provide data to regional Environmental Health Officers to support potential clusters identified via contact tracing.

Identifying the sources of infection through backwards contact tracing

34. Backward Contact Tracing has a vital role to play in ‘backward looking’ over the 14 day period before the case became infectious, to identify the possible source of the case infection.

35. Backward contact tracing aims:

  • to identify possible sources of the infection of confirmed COVID-19 cases
  • to enhance the ability to detect clusters and outbreaks of COVID-19 in community settings, to support public health action
  • to add to surveillance / situation awareness regarding outbreaks and chains of transmission of COVID-19 in Wales

36. Backward contact tracing SOPs, script amendments and functionality were introduced to deal with settings that conferred the highest risk of transmission to help identify possible sources of the infection in October 2020. However with surges in cases and numbers, the focus moved to ensure identification and isolation of cases and contacts from the last 48 hours as quickly as possible to interrupt chains of transmission.

37. With the number of cases and contacts now lower than in previous months, backward contact tracing provides opportunities to work differently and shift towards a more, targeted approach on a wider scale than before. If incidence continues at a lower level, it is important we make every effort to identify the source of infection of each case. Offering tests to backwards contacts will hopefully identify more cases and therefore more contacts, ever increasing the cases and contacts self-isolating and preventing onwards transmission.

Making use of all available intelligence

38. We will continue to explore innovative ways to identify areas of high transmission. Since June 2020 a programme monitoring coronavirus in Wales’ sewage systems is finding that virus spikes in the community can be detected in local waste water. Researchers from Welsh universities were the first to start the national surveillance of COVID-19 in major urban centres in the UK, and the technology to do this was first developed in Wales also. The amount of virus in wastewater has already been used to monitor the success of coronavirus restrictions and the data is shared with the Welsh Test Trace Protect system to inform where new outbreaks may be.

Interrupt and protect

Identification is the first step in the contact tracing process. Interrupting chains of transmission means ensuring people who have the virus and those at risk of developing the virus are self isolating and are provided with Protect support to do so successfully. Building on our existing offer, in 2021 we will focus on interrupting virus transmission through:

  • continued focus on our Protect strand to provide tailored support to people asked to self-isolate
  • continued support for our testing priorities as set out in our testing strategy
  • maintaining the legal duty to self-isolate, including initiating followup/regulatory intervention by partners where necessary 
  • monitoring arriving travellers and Variants and Mutations of Concern (VAMC)

Key objectives for Interrupt and Protect are:

  1. Publish guidance on updated Protect offer
  2. Review Protect pilots and use analysis to inform contact tracing and protect offer
  3. Analysis of incoming call queries to inform policy
  4. Ensure new positive cases from new technologies are captured on the CRM for follow-up (on-going)
  5. Work with partners to develop operational metrics for arriving travellers

Protect

40. The Protect strand of Test, Trace, Protect identifies any support which may be required to help and enable people to engage in testing and successfully selfisolate to prevent the spread of COVID-19. Local Authorities co-ordinate this support to a wide range of specific groups at a local level, working with the public, County Voluntary Councils and third sector organisations to deliver services and referring to other agencies, where appropriate.

41. In some cases, people who are instructed to self-isolate do not have the support of friends and family and, therefore, may face  difficulties during their isolation period. Contact tracers will refer these people to their Local Authority to undertake a more detailed assessment of any support needs.

42. Much of the support currently available is similar to that offered in the early months of the pandemic to those who were on the shielding patients list, as well as non-shielding vulnerable people and others who required help. This includes:

  • befriending services
  • supermarket shops
  • pharmacy pick-ups
  • dog-walking services 
  • financial support (through Self-isolation Support Scheme and Discretionary Assistance Fund)

43. Positive cases and close contacts told us that one of the main reasons they were struggling to self-isolate was financial hardship. In October 2020, the Welsh Government made funding available to support people and remove the financial barriers faced by people needing to self-isolate. The self-isolation support scheme is for those on low incomes, who cannot work from home and must self-isolate. It is also for parents and carers on low incomes with children who are self-isolating. A £500 fixed payment is available to eligible people who are asked to self-isolate because they have tested positive for coronavirus or because they have been identified as a close contact by the NHS Wales Test Trace Protect service. The Statutory Sick Pay Enhancement scheme also provides full pay for certain social care workers when they need to take time off due to COVID-19. We will therefore ensure our contact tracers continue to provide quick, bespoke signposting to the people they trace, so they reach relevant support services to enable their successful compliance with self-isolation, aligned with their personal circumstances.

44. We are also trialling new approaches to self-isolation support through enhancing our offer to positive cases and close contacts to help them stay at home. Individuals’ needs will be assessed and a tailored package of support will be made available through local authorities.  This could include support with alternative accommodation, food, essential items such as cleaning and baby products and mental health services to increase compliance with selfisolation requirements.

45. We also recognise that the journey out of the pandemic will be more challenging for those who have been more adversely affected through isolation or shielding. A recovery plan to re-integrate our most vulnerable back into the community is in development and will provide practical support to local authorities, the voluntary sector and community groups on how to reengage people who have lost confidence over the past year. We are also developing detailed guidance on our updated Protect offer for local authorities and the voluntary sector to ensure greater consistency of the Protect offer and to support closer working between the local authority ‘Protect leads’ and the regional TTP teams.

46. A national in-coming call functionality has now been introduced in all regions, to support further accessibility and interaction with the public. This will help with further collection of information and primarily be used as a continued support function being an additional link to Protect services for those who have to self-isolate. As we head towards the end of government-funded schemes such as furlough, we can also expect that people will face significant challenges that might not be directly related to self-isolation or initial COVID19 aspects. Integration of this in-coming call functionality with wider Protect services and analysis of the types of queries coming through will be fundamental in communicating a single offer of local, bespoke support to the public dependent on their individual needs. 

Testing

47. New testing technologies are enabling rapid turn-around of test results and at a far greater scale, across a number of sectors including schools, private industries and health and social care. We will ensure contact tracing will begin as soon as possible after a positive result enters the system, monitor cases that develop from being contacts and generally remain abreast of up-coming testing developments, including daily contact testing, to inform our contact tracing offer locally and nationally. Our Protect services will also need to adapt to ensure that people know tailored support will be on offer if they are asked to self-isolate as a result of a positive test or as a close contact. Additional support will be offered to meet specific needs of individuals and communities to ensure that people engage in ongoing testing programmes.

Duty to self-isolate

48. On 9 November 2020 new duties to self-isolate were introduced in legislation. If you have been notified by NHS Wales Test, Trace, Protect that you need to isolate because you have tested positive for COVID-19 or have been in close contact with someone who has tested positive, self-isolation is a legal duty. Employers are also under a duty to take reasonable measures to minimise risk of exposure to, or spread of coronavirus, one of which is to enable employees to stay at home if required to self-isolate. These Regulations do not apply to App users, unless they have agreed for their information to be shared with NHS Wales Test, Trace, Protect through the financial support button on the App.

49. We have been working closely with police and wider partners to implement a carefully managed disclosure process around the enforcement and monitoring of these duties and adherence levels. If a person should be self-isolating and isn’t, the police will explain what they need to do and encourage them to adhere. If they continue to not adhere then police forces can exercise the legal powers available to them as necessary. They can issue fixed penalty notices to those aged 18 or over, starting at £60 and rising to £1920 where repeated over a number of occasions.

50. A joint tactical group has been established to review and improve this process on a regular basis, keeping the safety of the people of Wales at the forefront of the process. 

Monitoring arriving travellers and Variants and Mutations of Concern (VAMC)

51. As previously highlighted, Variants and mutations of concern (VAMCs) represent a substantial threat to the progress we have made in tackling COVID-19. We know that variants can be more transmissible. For example, on average 10% of contacts develop COVID-19, increasing to closer to 15% with the Kent variant (9). TAC (10) state that even with lockdown restrictions, the higher rate of transmission of the variant would lead to more cases and have high confidence that it would lead to significant increases in hospital activity over a short period.

52. We have already introduced a dedicated, national team to work alongside the traditional contact tracing teams to specifically identify arriving international travellers and their household contacts. This includes making them aware of the relevant legal requirements to take regular tests and/or quarantine, and supporting their compliance through proactive monitoring and intervention. As more travel corridors are opened, more TTP regional teams are being proactively trained to be able to manage larger numbers of arriving travellers.

53. Where people are arriving in Wales from overseas, people are required to book and take a test which is sent for genomic sequencing. Genomics is an important tool in helping to identify variants of the virus being imported into Wales, a capability that has already been used during the first wave and over the summer of 2020. Welsh Government remains to be assured of the private testing market established and continues to press the UK government to improve the testing arrangements for travellers, ensuring the timely referral of results and sequencing data from private and public labs in England to the CRM. Until assurance is provided, Welsh travellers are asked to continue to use NHS tests. Moreover Welsh Government are committed to keep working with UK government to improve the quality of passenger locator form data that also flows into the CRM. The national team has, and will continue to be, supported by swift regional action, including delivery of doorstep testing where necessary. This ensures that the identification of cases of COVID-19 is achieved promptly and the quarantine strategy is as effective as possible.

This capability will be critical as global travel is restored.

54. Where genomic sequencing identifies variants of concern in the population, contact tracers and advisers play a key role in supporting the local Incident Management Team by undertaking enhanced contact tracing. Welsh Government will continue to co-ordinate dedicated training by Public Health Wales and experienced Environmental Health Officers to build capability and capacity in teams to manage these urgent threats.

Insight

55. Our approach has always been based on the very latest scientific, medical and public health advice. As we move forward, there is more lessons we can reflect on and implement our learning from experience and stakeholders. We will therefore focus on:

  • informing our approach through the use of behavioural science
  • increasing the capacity to undertake the fastest possible contact tracing when undertaking targeted community testing for new variants
  • working with Public Health Wales and partners to inform the continuous development of the national contact tracing policy

Key objectives for Insight are:

  1. Review and enhance arriving traveller scripts using behavioural science
  2. Bring together the regional Black, Asian and Minority Ethnic outreach leads on a regular basis to inform on-going policy development
  3. Train and upskill all contact tracers and contact advisers to deliver enhanced contact tracing

Informing our approach through the use of behavioural science

56. It is critical that cases and contacts know what to do and what support is available to self-isolate successfully, to help prevent further spread of the virus. 91.4% of 408 contacts are confident they know what to do after talking to a contact tracer (11), however the UCL COVID-19.

Social study reports that 12% of contacts and 13% of symptomatic people are not isolating at all. Furthermore the study suggests that self-reported complete understanding of the rules remains very low (12). Welsh Government will work with partners, including the County Voluntary Councils and third sector organisations on the types of support being sought or needs being highlighted through the TTP processes, in order to shape the TTP offer aligning to public needs and identify prevailing trends to prepare for further waves. Furthermore, Welsh Government has procured additional behavioural insight expertise to inform policies around self-isolation and other COVID-19 regulations.

57. Playing particular attention to the impact of the progression of the vaccination programme (and expectation of a subsequent booster) on people’s behaviours and the risks of the perception that TTP or social distancing is no longer relevant because of the vaccination  programme, we endeavour to raise the profile of TTP communications as part of the broader programme of work to ensure communications and engagement remains relevant. We will achieve this by keeping up-to-date, improving the understanding around the need and meaning of self-isolation, by listening to the public and using behavioural science, including PHW’s ACTS & CABINS surveys, to help inform our communication campaigns, informing the roll out of training to Tracers and Advisers and on-going work with our partners to increase community engagement in TTP and to maximise the effectiveness of each interaction with the public, including the changes to the roles of TTP as it adapts. This will include amending contact tracing scripts so conversations encourage greater compliance with self-isolation.

58. We are committed to continue providing up-to-date information, based on the latest scientific and medical, public health advice to ensure the targeting of public health action to break the chains of transmission. Increasing the capacity to undertake the fastest possible contact tracing when undertaking targeted community testing for new variants.

59. Environmental Health Officers (EHO) are a fundamental resource for public protection and control of any communicable and infectious diseases - their experience and core skills in dealing with communicable and infectious diseases was at the heart of the profession before the current pandemic. They have been key in setting up TTP, their integration with PHW has been extremely positive and they sit within the regional TTP cell structure itself. Throughout the pandemic EHO resources have been essential to the COVID19 response but have also found themselves stretched to balance the response to COVID-19 whilst maintaining other critical public protection statutory functions, highlighting a critical gap in this specialist resource. Despite this, EHOs continue to be a driving force on a number of issues.

60. Recognising that EHOs are already stretched to capacity and as more restrictions are eased and anticipating that pressure on EHOs will be compounded as they need to be released to their usual statutory duties, work has already began where existing EHOs and PHW are providing training to enhance the skill-set of some of our established contact tracing workforce. This is in order to support EHOs in their enhanced contact tracing, for example around schools and variants of concern. Not only is this crucial given the increasing complexity of cases involving variants but it also highlights the significant risk of reducing the workforce too quickly and then having to scale up again by attempting to recruit new teams. This early work will be built-on and expanded to further develop highly skilled teams and evolve a more multidisciplinary workforce that can support and enable both EHO ‘pre-COVID’ statutory work and the EHO TTP work, adapting to the changing needs of the virus as we move into the summer and beyond.

Working with Public Health Wales and partners to inform the continuous development of the national contact tracing policy

61. The latest scientific evidence and clinical advice has always been at the forefront of Welsh Government’s response to the pandemic from the very beginning. We continue to be advised by experts in Public Health Wales and evidence and learning from the global efforts around health surveillance will continue to provide insights on risk factors to inform national policy and guidance for contact tracing and TTP throughout 2021 and beyond. We also remain committed to maintaining a UK-wide approach wherever possible, as guided and reflected by the scientific evidence.

What next?

Operationalisation

62. The ‘Coronavirus Control Plan: Alert Levels in Wales’ sets out that as we travel the road to recovery, self-isolation remains essential for anyone with COVID-19 symptoms, for people who have tested positive for COVID-19, or are close contacts of a positive case. As restrictions are eased, we must move to being future-focussed wherever possible, whilst continuing to prevent the spread of the virus alongside the operationalisation of the testing strategy and while the roll-out of the vaccine continues to build pace.

63. Our next steps are to continue to work closely with PHW and partners at a national, regional and local level to operationalise the priorities described above on the ground. We will work with partners to review and refresh existing work-plans, including assessing the contact tracing capacity required from October to March 2022, and the workforce necessary to deliver the priorities set out above, agreeing full year regional funding allocations in June.

64. As part of this work we will work with partners to scope any additional resources that are needed to take this forward alongside the new testing strategy and other parallel work-streams, with a view to ensure our communications plan continues to evolve with the impacts of wider and everchanging programmes of work.

Long-term recovery planning

65. The existing contact tracing offer was designed to respond to the early emerging challenges of the pandemic, we now need to consider and implement a longer-term, fit-for-purpose delivery model that will flex and evolve as we move forward into a post-pandemic world.

66. The most recent TAC modelling (13) for the period beyond June into summer, autumn and winter has a reasonable worst case scenario showing another wave is expected in late summer. It is anticipated that infection and incidence levels will reduce but also fluctuate throughout this time, particularly due to the risks of imported infections or new arising variants, as well as public.

Key objectives for 'what next' are:

  1. Refresh of regional workforce plans to feed into future plans for public protection
  2. Undertake a learned lessons exercise to feed-into wider Welsh Government pandemic learning behaviour and compliance levels. As is set out above, in circumstances where there is low virus prevalence, teams may need to support other COVID-19 work, whilst maintaining critical contact tracing skills.

67. TTP has been a success and a highly-skilled and effective workforce has been developed. There is a need to plan now for a long term, sustainable model of delivery that remains responsive and agile, so that where clusters arise, they are interrupted and contained quickly to avoid sustained community transmission. We will continue to work closely with local authorities, health boards, Public Health Wales and wider partners to plan for how contact tracing transitions into a wider, refreshed public protection model in a post-COVID-19 landscape.

68. We must realise the opportunities from the TTP system we have developed, particularly exploring where the existing Environmental Health / Public Protection workforce and system can be enhanced, thereby ensuring TTP makes a lasting difference to the health of people in Wales.

Footnotes

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