key: cord-0904027-j5ntdqem authors: Bright, Diana; Brown, Graham; Roberts, Richard J.; Cottrell, Simon; Gould, Ashley; Jesurasa, Amrita; Daniels, Philip; Davies, Llion title: COVID-19 Contact Tracing: The Welsh Experience date: 2020-08-13 journal: Public health in practice DOI: 10.1016/j.puhip.2020.100035 sha: 07063edd87f976cf5b7db561496ebfda6a47e28a doc_id: 904027 cord_uid: j5ntdqem Abstract Objective Contact tracing is one of the key public health response actions to control the outbreak of a novel virus. This paper describes the preparation process, activation and operational experience for contact tracing of individuals in response to confirmed COVID-19 cases in Wales. Study design A descriptive approach has been adopted and lessons learned from our initial public health response to COVID-19 will be used to develop a new operational model for contact tracing in Wales. Methods As part of preparations for the response in Wales, Public Health Wales formed a Contact Tracing Cell (CTC) ready to be mobilised in the event of a confirmed case. Results Trial activation of the CTC during the preparation period helped to resolve some issues before ‘real’ activation. A highly flexible approach was needed due to the constant changes to the guidance that required rapid understanding, updates to pathways and clear communication to contact tracers. Conclusions Our experience and recommendations may benefit future efforts to control the spread of the virus in Wales and elsewhere, particularly in supporting COVID-19 outbreaks in enclosed settings such as care homes or in geographically localised areas. Learning from the initial public health response to COVID-19 will guide the delivery and implementation of a new contact tracing model as we move to a later stage of the pandemic when containment measures become feasible in localised outbreaks. This may include scaling-up the CTC to mobilise contact tracers to local teams and the potential use of digital technologies to support the next operational model of the CTC in Wales. Abstract Objective: Contact tracing is one of the key public health response actions to control the outbreak of a novel virus. This paper describes the preparation process, activation and operational experience for contact tracing of individuals in response to confirmed COVID-19 cases in Wales. A descriptive approach has been adopted and lessons learned from our initial public health response to COVID-19 will be used to develop a new operational model for contact tracing in Wales. As part of preparations for the response in Wales, Public Health Wales formed a Contact Tracing Cell (CTC) ready to be mobilised in the event of a confirmed case. Results: Trial activation of the CTC during the preparation period helped to resolve some issues before 'real' activation. A highly flexible approach was needed due to the constant changes to the guidance that required rapid understanding, updates to pathways and clear communication to contact tracers. The outbreak of COVID-19 caused by SARS-CoV-2 has rapidly spread to many countries since it was first announced on 31 December 2019 1-2 . COVID-19 outbreak dynamics indicated sustained human-to-human transmission, including family clusters and healthcare settings in January 2020 3 . On 11 March 2020, The World Health Organization recognised COVID-19 to be a global pandemic 4 . Contact tracing is one of the key public health response actions to control an outbreak of a novel virus [5] [6] [7] , particularly in the absence of a vaccine 8 . As part of the preparedness response, Public Health Wales (PHW) formed a Contact Tracing Cell (CTC) ready to be mobilised in the event of a confirmed case diagnosed in Wales. This article describes briefly the preparation process, activation, and operational experience for contact tracing of individuals in response to confirmed COVID-19 cases in Wales. We describe our experience and some of the lessons learned so that our learning may be transferable to later stages of the pandemic or future novel virus outbreaks. The CTC was established as a component of the UK 'containment phase' of the COVID-19 response, to be activated in the event of a confirmed case in Wales. The purpose of the CTC was to identify and follow-up individuals who had close contact with a confirmed case to provide them with public health advice to protect them and to protect the wider public from onward transmission. A room was prepared for the CTC. It included eight stations that were equipped with computers, dual monitors, phones with dial-out capabilities and paper stationery. Call handler packs containing the following were produced: • Non-prescriptive script to guide call handlers Although there were some concerns around providing written information given the fast-changing nature of the outbreak and subsequent changes in official guidelines, two leaflets were designed for e-mailing out to contacts. PHW also had a contingency plan to establish an active surveillance cell in a larger room in the event of identifying large numbers of individuals requiring daily phone calls. Staff with different skills set, such as administration staff, could make these phone calls to maintain the contact tracing capacity of the CTC. Real-time IT support was vital to rapidly troubleshoot hardware and software issues. Training As health protection staff were already working at capacity to deal with possible cases of COVID-19 and other aspects of the response, it was decided to mobilise PHW staff from other departments to staff the CTC. These volunteers were trained in the use of the established protocols and how to accurately record activity using the CIMS system. Those with the skill set deemed appropriate to 'cold call' contacts (mainly comprising those with medical or nursing backgrounds and more senior public health practitioners) were also required to attend CTC specific training provided by a public health consultant or registrar (n=42 trained within one week). On 25 February 2020, the CTC was trial activated with an urgent call to the individuals on the shadow rota to attend. As a result, additional staff were rapidly mobilised to be trained and staff the CTC shadow rota. Staff familiar with providing training were re-deployed to take over the COVID-19 in-house training (including the CTC specific training). Early feedback from staff identified concerns around abilities and confidence to undertake calls. Therefore, less experienced staff were reassured that they would have the opportunity to shadow more experienced personnel as part of the training. During this period, the CTC location was moved to a larger space with the capacity to expand the number of work stations as required. It was also co-located with other elements of the COVID-19 response to facilitate communications between the various cells. There was an interval of 6 days before the next confirmed case in Wales. During this period further staff were trained and senior leaders were identified to support the increasing logistical complexities and manage the communication around changing guidance and situation-specific requirements. Formal teleconferences including the devolved administrations were established by PHE, facilitating shared learning across the UK. Over the following weeks, the CTC remained active, with an increasing workload, including daily active surveillance phone calls. The maximum contact tracing demand in one day was in response to nine new confirmed cases. Once it was apparent that sustained community transmission was occurring in the UK, it was recognised that existing contact tracing capacity would be overwhelmed. The UK Government announced the move to the 'delay phase' of the COVID-19 response on 12 March 2020 10 .In line with the UK approach, the CTC stopped contact tracing and wound down activities. Final calls were made to those on active surveillance to ensure they were updated on the current advice and to inform them that follow-up daily calls would not occur. On a single day, 234 individuals were contacted by the CTC. This article describes the Welsh experience of contact tracing in the event of confirmed cases of COVID-19. The mobilisation of non-health protection staff within the organisation to staff the CTC (from administrative to senior leadership roles) provided resilient support to the acute health protection service and freed up health protection teams to deal with more complex issues in relation to the COVID-19 response. Planning the CTC based upon previous experience in contact tracing meningococcal septicaemia cases was logical, however, major differences were noted once the CTC was activated. For example, many contacts (around 50% for the first activation) had symptoms in keeping with the possible case definition for COVID-19, thus required adding to the 'possible case' line listing and community testing pathway. There were also many changes to the guidance that required rapid understanding, updates to pathways and clear communication to contact tracers and therefore, a highly flexible approach was required (See Box 1). The PHW CTC role in contract tracing individual cases has now been superseded by supporting COVID-19 outbreaks in enclosed settings such as care homes. Learning from the initial public health response to COVID-19 is needed to enhance the delivery and implementation of contact tracing as we move to a later stage of the pandemic when containment measures may be introduced in localised areas including outbreaks in food and meat processing plants. This may include scaling-up the CTC to mobilise contact tracers to local teams and the potential use of digital technologies to support the next operational model of the CTC in Wales. J o u r n a l P r e -p r o o f Comprehensive update on current outbreak of novel coronavirus infection (2019-nCoV) COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? First cases of coronavirus disease 2019 (COVID-19) in France: surveillance, investigations and control measures World Health Organization. Rolling updates on coronavirus disease (Covid-19). WHO characterizes COVID-19 as a pandemic Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road Assessing the role of contact tracing in a suspected H7N2 influenza A outbreak in humans in Wales Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts When is contact tracing not enough to stop an outbreak? Guidance for public health management of meningococcal disease in the UK COVID-19: government announces moving out of contain phase and into delay The authors would like to acknowledge the efforts of all CTC staff, many of whom volunteered at short notice to work outside their usual fields of expertise. We would also like to acknowledge the support received from the CDSC team, the IT teams and to mention the following individuals for their specific roles: Zosia Parker and Jane Salmon. Finally, we wish to acknowledge the support from PHE both in terms of their guidance protocols and verbal communications.