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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 main 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.

Ensuring access to testing for both people who have symptoms and those who do not (asymptomatic) is a critical component of the government’s recently published roadmap.

Testing capacity for people with COVID-19 symptoms has significantly increased in recent months. Within Devon on an average week over 16,000 tests for symptomatic people (Pillar 2) are undertaken.

In addition, testing for asymptomatic people through lateral flow devices (LFDs) has now also started to roll out. At present over 100,000 LFD tests are being undertaken every week, with the expectation that this will continue to increase in numbers.

Devon County Council has developed a Community Testing Programme aimed at people who are not able to work from home and/or may come into contact with vulnerable individuals.  Examples include bus drivers, food outlets, taxi drivers and carers.

The local programme complements the already established national LFD testing programmes for workplaces and education for example University students, teachers and pupils, visitors to care homes and NHS staff.

The use of LFDs for testing asymptomatic people is being increased significantly through the NHS Test and Trace programme and this will include the ability to collect kits and the ability to order tests online for home delivery.

The tests are focused on the following 3 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)

As restrictions are lifted, having a comprehensive local and national testing programme is crucial to help identify asymptomatic people who are infectious and ensuring that they isolate to help break the chain of transmission.

If a new variant of concern (VOC) is identified by Public Health England (PHE), Operation Eagle will be activated. This will include surge (PCR) testing in an agreed location identified by PHE with associated communication messages to help reduce any onward transmission.

Within Devon, we have developed a local framework to respond swiftly if required to undertake surge testing as part of Operation Eagle.

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.

While the national Test and Trace Service contacts over 80% of the confirmed positive cases within Devon to complement the national service a local Contact Tracing Partnership has been established. The Devon partnership follows up on Devon residents for whom the national Test and Trace Service has been unable to make contact with within 24 hours.

The local service has been able to successfully contact positive cases who have not been contacted by the national service and gather the relevant information and instruct them to isolate.

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.

High-risk settings/communities

Throughout the pandemic, the most complex outbreaks have taken place in higher-risk settings. These settings include care homes, educational establishments, health care premises and workplaces usually related to food processing.

Outbreaks within these settings have required extensive collaborative working between agencies highlighted above and the setting itself. It is because of this collaborative working that swift control measures were able to be put in place to help contain the outbreak.

An example of the success of good collaborative working was the significant outbreak in Exeter University. The Outbreak Control Team were able to agree on a set of control measures for partner agencies and the outbreak was contained within the University with no noticeable onward community transmission.

As part of the planning process, additional training and support have been given to the risk settings including, for example, additional IPC training for the care home sector through webinars and the testing of plans such as an outbreak in the University.

While to date we have not had any significant outbreaks within a community a plan is in place to support the management of a community outbreak through the Devon Community Support Plan.

In some areas of the country transmission rates have remained stubbornly high and above the national average for long periods of time.  This enduring transmission often requires additional intervention such as restrictions above and beyond the national restrictions.

Enduring transmission happens more often in the most deprived communities, areas with a high density of multi-generational households and overcrowded accommodation.

Within Devon, overall levels have tended to be much lower than the national average and we have had no areas of enduring transmission.

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.

The contain framework is currently in the process of being updated.

Vaccination

The mass vaccination programme, led by the NHS, is the priority to help prevent and reduce COVID-19 mortality and morbidity and help protect 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).

The local authority has played a crucial role in ensuring the programme roll out considers the needs of those most vulnerable individuals and communities to avoid health inequalities in relation to vaccine uptake.

There are two phases to the vaccination programme. Within phase 1 those most vulnerable are prioritised into nine cohorts. The top four cohorts were all offered a first dose by 15 February and will be offered their second dose by mid-May; cohort 5 and 6 first dose will be offered by 15 March, with all cohorts 1-9 (over 50s) being offered a vaccination by 15 April:

Phase 1

  • Residents in care homes for older adults and carer
  • All those over 80 years of age and health and social care worker
  • 75 years +
  • 70 year + and clinically extremely vulnerable (CEV)
  • 65 years + adults identified a clinically vulnerable
  • 60 year +
  • 55 year +
  • 50 year +

Phase 2

Adults under 50 who do not fall into any of the JCVI’s priority cohorts 1 to 9 will receive their vaccination in the second phase of roll out. The government has set an aim to offer everybody aged 18 and over a first does vaccine by 31 July 2021.

The prioritisation for phase 2 will follow age groups, for example, 45-49 years, 40-44 years and so on.


The government published its COVID-19 Response – Spring 2021 document on 22 February 2021. Within the publication was a step-by-step roadmap to ease restrictions in England cautiously, starting with schools and colleges.

The easing of the restrictions was based on the government reviewing the latest data and identified four key tests for easing lockdown. These four tests are:

  1. The vaccine deployment programme continues successfully.
  2. Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated.
  3. Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS.
  4. Our assessment of the risks is not fundamentally changed by new variants of concern.

The following are the four steps with the corresponding ‘no earlier than dates for the relaxation of some of the current restrictions.

Step 1: (8 March 2021)

  • Schools and colleges are opened for all students.
  • Recreation or exercise outdoors with household or one other person.
  • Care homes residents can nominate 1 visitor who can be tested and visit relative indoors.

(29 March 2021)

  • Stay at home message ceases
  • Rule or 6 or two households outdoors (no indoor mixing)
  • Outdoor sport and leisure facilities
  • Organised outdoor sport allowed

Step 2: (12 April 2021)

  • Indoor leisure open for use
  • Rule of 6 or two households outdoors
  • All retail and personal care premises
  • Outdoor hospitality
  • Domestic overnight stays

Step 3: (17 May 2021)

  • Indoor entertainment and attractions
  • Rule of 6 or two households indoors
  • Domestic overnight stays
  • International travel (subject to review)

Step 4: (21 June 2021)

  • No legal limit on social contact
  • Larger events
  • Nightclubs

The government’s COVID Response Plan identifies several components which are going to be the key programmes nationally, regionally and locally to help us ‘return to normal’.


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