COVID-19 – letter to North of Tyne Combined Authority, 23 March 2020

COVID-19 – local contact tracing and case finding measures in the North-East

The purpose of this letter is to urge you as soon as possible to do everything you can to make the case with your local authority colleagues and Public Health England to institute an immediate and meticulous contact tracing and testing programme in each local authority within the NoTCA area, and more widely in the North East.

As an academic public health doctor, I was pleased to see control measures against COVID-19 being escalated since Friday. One important concern remains, however, about the national and local response to managing the epidemic and it relates to contact tracing and case finding. This is fundamental in the arsenal of approaches to managing infectious diseases, including the current pandemic. The World Health Organization has strongly urged all member countries to continue contact tracing, case finding and related measures after seeing demonstrable success in managing the outbreaks in China and South Korea. A recent Government paper clearly demonstrates through mathematical modelling that effective contact tracing and case finding is likely to remain a highly effective approach after “lockdown” and a local approach is vital and will enable restrictions to be lifted following local risk assessment. Contact tracing measures were not included in the (other) mathematical model which the government used to support its decision.

The epidemic is at very different phases in different parts of the country. Clearly, conducting contact tracing and case finding thoroughly would place substantial demands on local public health authorities. However, within the NoTCA area (as with many other areas in the UK), the three localities still have low case numbers (Newcastle 34, North Tyneside 18, and Northumbria 10), and numbers are even lower in Gateshead and South Tyneside. Even at hotspots, the challenges are not insurmountable – our colleagues in Wuhan and Daegu showed that it is achievable with far larger numbers. If Public Health England agrees, I believe we could mobilise our local communities to assemble the capacity to support local approaches. For example, many junior medical and nursing and other students would only need very brief training before they can take on the necessary tasks. During the 2009 influenza pandemic, many volunteers were recruited for the purpose. As the severity of this pandemic is on a different scale from the 2009 one, the level of urgency felt by the public suggests that we would have little difficulty in assembling the necessary number of people to assist colleagues in local government and public health authorities. I am also in discussion with public health colleagues in other parts of the country, including the West Midlands. You would have an important leadership role in these endeavours.  We need to act quickly as the window is narrow, given the number of cases is doubling every four to five days.

I therefore urge you as soon as possible to discuss this proposal with local government authorities and PHE. I would be happy to support in whatever way possible. I will also forward this letter to Dr Duncan Selbie, CEO of PHE; Professor Paul Johnstone, PHE North of England, Regional Director and Professor Peter Kelly, Centre Director, PHE North East.