Contact tracing ‘should be led by local authorities’, say health researchers

Suspected COVID-19 cases have been missed due to Whitehall’s “abysmal response” to the epidemic, argued health experts in the British Medical Journal (BMJ).

They said the UK government has eroded England’s established system of local infectious disease control and created a parallel system, relying on private companies for testing and contact tracing.

Peter Roderick, a barrister and principle research associate at Newcastle University, and colleagues are concerned by “apparent failings” in the parallel system and call for contact tracing and testing to “be led by local authorities and coordinated nationally”.

They wrote: “That local system has gradually been eroded over several decades. But instead of prioritising and rebuilding this system at the start of this epidemic, the government has created a separate system, which steers patients away from GPs, avoids local authorities, and relies on commercial companies and laboratories to track, test and contact trace.”

They added: “We question why the government has created this ad hoc parallel system when a straightforward, if weakened, system already existed.”

Authors of the analysis called for infectious disease control of COVID-19 to be locally led with national coordination, so directors of public health, for example, are put in charge of contact tracing “coordinated, rather than led, by Public Health England (PHE)”.

They argued NHS111 and COVID-19 call centres and clinical assessment teams should be reintegrated immediately into primary care and resourced GP practices. And they want the advice changed, so that those with COVID-19 symptoms report to their GP or NHS111.

However, they warned that these steps were “remedial” and don’t amount to a “coherent and adequate” public health response to the pandemic in England. They argued: “Such a response requires local authorities, NHS, and PHE laboratories to be sufficiently resourced to take the lead on contact tracing and testing, and general practices being resourced to support patients, under central coordination.

“Parliament has given the secretary of state the powers to enable this to happen, and we urge him to exercise them. In the longer term, the abysmal response of the government to the epidemic has served to underline the need for legislation to rebuild and reintegrate a strong local communicable disease control system.”

The BMJ piece lists a whole catalogue of problems with the pandemic response and rollout. Local authorities, for example, still don’t have access to test results, and are only receiving aggregated data from the centralised call centres without details – such as postcodes, age, gender, of confirmed and suspected cases – needed to monitor localised outbreaks.

The authors also called out a lack of clarity on which agency GPs were supposed to report cases to, and when they did report whether they should be reporting asymptomatic cases. The several hundred thousand missing test records were red flagged, as well as the confusing reporting of national statistics on tests and results.