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Testing and tracing


The NHS test and trace service has been set up with three primary goals:

  1. To ensure that anyone who develops symptoms of coronavirus can quickly be tested to find out if they have the virus.
  2.  To provide a targeted asymptomatic testing programme for NHS and social care staff and care home residents.
  3. To help trace close recent contacts of anyone who has tested positive for coronavirus (COVID-19).

A diagram illustrating the 4 main elements of the NHS test and trace service. The 4 elements are test, trace, contain and enable.

The NHS test and trace service includes four key elements:

  • Test: rapid testing, at scale, to identify and treat those with the virus.
  • Trace: integrated tracing to identify, alert and support those who need to self-isolate.
  • Contain: identify outbreaks using testing and other data and contain locally and minimise spread.
  • Enable: use knowledge of the virus to inform decisions on social and economic restrictions.

Test

Anyone in England who has symptoms of coronavirus (a high temperature, a new, continuous cough, or a loss or change to your sense of smell or taste) and whatever their age, can access a test by going to the NHS website or by calling 119.

It will be possible to book an appointment at a drive-through or walk-through test site or ask for a home test kit.

There is a different testing route for essential workers who have symptoms of coronavirus or for someone who has symptoms and lives with an essential worker.

Essential workers include, for example:

  • NHS and social care staff
  • police
  • transport workers
  • education and care workers

Tests can be accessed by the individual at GOV.UK or they can be referred by their employer.

In addition to these two routes, there is specific testing for care home residents and staff (whole care home testing) and NHS Trusts can test patients and make use of local capacity to test staff.

Trace

When someone tests positive for coronavirus the NHS test and trace service will trace contacts of the positive case.

A ‘contact’ means a person who has been in close contact with someone who has tested positive for coronavirus and who may or may not live with them.

The critical timeframe is 48 hours before they developed symptoms and the time since they have developed symptoms.

Close contact means:

  • having face-to-face contact with someone (less than 1 metre away)
  • spending more than 15 minutes within 2 metres of someone
  • travelling in a car or other small vehicle with someone (even on a short journey) or close to them on a plane
  • working in – or recently visiting – a setting with other people (for example, a GP surgery, a school or a workplace)

The NHS test and trace service will assess, and if it is necessary, inform the close contact that they must self-isolate at home to help stop the spread of the virus.

There are 3 tiers to the contact tracing operating model with each tier being bridged by a team leader function to ensure information flows and cases are escalated and de-escalated accordingly:

Tier 3: There are approximately 15,000 national contact tracers who are trained to make initial contact and provide advice to those testing positive and their contacts.

Tier 2: There are approximately 3,000 health care professionals employed nationally who are trained to interview cases and identify contacts.

Tier 1: Where Tier 3 and Tier 2 identify a degree of complexity and a ‘context’ for concern, for example, a school, health setting, care home or workplace, they will escalate to Tier 1.

At Tier 1 the Local Health Protection Teams from Public Health England (PHE) will work with local partners, including the Local Authority Public Health Team, to follow up cases and agree on actions to contain the outbreak.

The expectation is that the vast majority of people requesting tests and/or being contacted by the NHS test and trace service will not require any local involvement and will be supported through Tiers 2 and 3.

However, for more complex outbreaks (Tier 1) the knowledge and relationships which local partners have will be invaluable in providing a timely and appropriate response to a local outbreak working in collaboration with PHE.

This will include the ability to swiftly mobilise local testing units, support local intelligence gathering, provide infection control advice and ensure timely communications to the public and their representatives.

Increasingly local authorities are offering enhanced contact tracing to complement the NHS Test and Trace Service. Devon is working closely with colleagues within the peninsula to scope a local contact tracing partnership model for implementation as soon as possible.

The use of mobile phone technology also has an important role in contact tracing. The NHS COVID-19 app provides information on local alert status, venue check-ins and contact tracing.

Contain

Early identification of an outbreak is critical to help contain the spread of the infection. There are four outbreak scenarios:

  • Cases: individual confirmed cases
  • Clusters: two or more cases with no evidence of a link
  • Outbreaks: two or more cases with evidence of a link
  • Community spread: sporadic or linked cases on a limited or extensive basis

The Devon Tactical Management Group will undertake an initial risk assessment based on the information received from Public Health England.

If, following the initial risk assessment, it is considered necessary to identify additional information and investigate further a Devon Risk Assessment Team (DRAT) meeting will be called.

The DRAT will seek to find out as much information as possible from PHE, NHS Test and Trace as well as other local intelligence about the case or situation which will help inform the overall risk rating and subsequent actions.

For complex outbreaks (Tier 1), which will be deemed as high-risk, the Local Authority will convene an incident management team. The team will consist of key representatives applicable to the setting.

In some circumstances, it will be necessary to create an outbreak control team (OCT). The OCT will usually be chaired by a member of the Local Health Protection Team or by a consultant in public health from the Local Authority Public Health Team.

The membership of the OCT will vary depending on the setting but includes public health expertise, communication leads and the manager or appropriate staff from the outbreak setting.

The main aim of the OCT is to contain the outbreak and minimise any risks.

Enable

The gathering of data and intelligence (covered in Using data) and national and international research is critical to inform national policy and local action.

We will ensure that as and when new research and policy is produced the plan is updated accordingly.

In July 2020 the government published the COVID-19 contain framework which sets out how NHS Test and Trace works with PHE, local authorities, the NHS and local business and community partners and the wider public to take actions against local outbreaks.

Wherever possible, the intention is to work in partnership with local stakeholders and communities on the basis of informed engagement and consent to ensure the necessary actions are taken to reduce onward transmission.

The contain framework does, however, set out new regulations giving local authorities additional powers to help stop the transmission of the virus by restricting local public gatherings and events and close local businesses premises and outdoor spaces.

In November 2020 the government published the COVID-19 Winter Plan. The plan describes a new tier system for local authorities; Tier 1 (medium); Tier 2 (high) and Tier 3 (very high). The decision on which tier a local authority will be allocated will primarily be based on five key indicators:

  1. Case detection rates in all age groups.
  2. Case detection rates in the over 60s.
  3. The rate at which cases are rising or falling.
  4. Positivity rate (the number of positive cases detected as a percentage of tests taken).
  5. Pressure on the NHS, including current and projected occupancy.

The national COVID-10 Winter Plan also describe the ‘route back to normal’ highlighting the following key actions; mass vaccination, treatment and testing.

Mass vaccination

The mass vaccination programme is being led by the NHS and the first priority will be the prevention of COVID-19 mortality and protection of the health and care system.

While the NHS is leading the programme wider partners are supporting the planning and roll out of the programme against the priority groups identified by the Joint Committee on Vaccine and Immunisation (JCVI).

Once vaccines have been authorised (currently only the Pfizer vaccine has been authorised) the following groups will be offered the vaccine in phase 1:

  • Residents in care homes for older adults and carers.
  • All those over 80 years of age and health and social care workers.
  • 75 years +.
  • 70 year + and clinically extremely vulnerable.
  • 65 years +.
  • Adults 16 -64 years with underlying health conditions.
  • 60 year +.
  • 55 year +.
  • 50 year +.

Treatment

Throughout the pandemic, the trial and use of drugs such as Dexamethasone have helped reduce mortality.

Testing

Testing capacity for people with COVID-19 symptoms has significantly increased in recent months. Within Devon on an average week over 15,000 tests for symptoms people (Pillar 2) are undertaken.

In addition, testing for asymptomatic people through lateral flow devices (LFDs) has now also started to roll out. There are a number of national LFD testing programmes being rolled out such as university students, visitors to care homes and NHS staff.

In addition, Directors of Public Health have an allocation of LFDs to be used locally.

Testing has three key objectives:

  1. Test to protect (those at highest risk and prevent transmission).
  2. Test to find positive cases (help reduce transmission in the community).
  3. Test to enable (support return to social and economic activities).

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