Re: Covid-19: NHS Test and Trace releases first figures, with experts calling for improvements
Dear Editor
As one of the early cohort of doctors with Covid and one of the last tested and contact traced on 11th March 2020, I am aware of the importance of self contact tracing based on symptoms alone.
I have found no significant mention of or advice on self contact tracing in current UK guidance. Jacinda Ardern, the New Zealand Prime Minister has actively promoted contact tracing diaries, but there is no easily identified, specific, clear, proforma or advice readily available to everyone on the internet.
Even in the best system there will be delays between symptoms onset, test, result and contact tracing. Add in a weekend, difficulty accessing a test, poor swab technique, a false negative test rate of say 20%, late seroconversion, difficulty with phone contact and shortage of contact tracers. Then the delays or failed contact tracing rates increase.
Most contacts are with people who are known by the primary source “patient” and contacts can be told immediately if people are advised to self contact trace. Based, that is, on the three key symptoms of cough, fever and (later) loss of taste. Personal emails and phone numbers can be used which may not be readily released to professional contact tracers.
The risks of self contact tracing appear lower than the benefits of reduced Covid (or other infection) transmission. With a good contact diary there is a time saving and better preparation for the professional contact tracer who can focus on situational contacts where the people in contact are unknown to the patient.
In the event of my own Covid 19 infection (reported at http://docrick.co.uk/health/coronavirus-covid-19-disease/ ) I self contact traced all my family contacts as soon as I had clear symptoms, on the 9th March 2020. My one hour interview with the professional Public Health contact tracer, was two days later, on the 11th March. The contact tracing service stopped the next day. I infected no patients as I self-isolated from the 9th March and had been on leave, abroad, prior. I hope I minimised spread from my twenty known contacts, including several in healthcare, who all self-isolated before any patient contact. My known contacts all survived, none were offered antigen tests, none were contacted by Public health, and antibody testing which started at the end of June 2020 is now confirming which of my contacts had infection.
Competing interests:
No competing interests
02 July 2020
Mark A Rickenbach
GP and Professor of Healthcare
Winchester University, Faculty of Health and Wellbeing
Park and St Francis Surgery, Pilgrims close, Valley Park, Eastleigh SO534ST
Rapid Response:
Re: Covid-19: NHS Test and Trace releases first figures, with experts calling for improvements
Dear Editor
As one of the early cohort of doctors with Covid and one of the last tested and contact traced on 11th March 2020, I am aware of the importance of self contact tracing based on symptoms alone.
I have found no significant mention of or advice on self contact tracing in current UK guidance. Jacinda Ardern, the New Zealand Prime Minister has actively promoted contact tracing diaries, but there is no easily identified, specific, clear, proforma or advice readily available to everyone on the internet.
Even in the best system there will be delays between symptoms onset, test, result and contact tracing. Add in a weekend, difficulty accessing a test, poor swab technique, a false negative test rate of say 20%, late seroconversion, difficulty with phone contact and shortage of contact tracers. Then the delays or failed contact tracing rates increase.
Most contacts are with people who are known by the primary source “patient” and contacts can be told immediately if people are advised to self contact trace. Based, that is, on the three key symptoms of cough, fever and (later) loss of taste. Personal emails and phone numbers can be used which may not be readily released to professional contact tracers.
The risks of self contact tracing appear lower than the benefits of reduced Covid (or other infection) transmission. With a good contact diary there is a time saving and better preparation for the professional contact tracer who can focus on situational contacts where the people in contact are unknown to the patient.
In the event of my own Covid 19 infection (reported at http://docrick.co.uk/health/coronavirus-covid-19-disease/ ) I self contact traced all my family contacts as soon as I had clear symptoms, on the 9th March 2020. My one hour interview with the professional Public Health contact tracer, was two days later, on the 11th March. The contact tracing service stopped the next day. I infected no patients as I self-isolated from the 9th March and had been on leave, abroad, prior. I hope I minimised spread from my twenty known contacts, including several in healthcare, who all self-isolated before any patient contact. My known contacts all survived, none were offered antigen tests, none were contacted by Public health, and antibody testing which started at the end of June 2020 is now confirming which of my contacts had infection.
Competing interests: No competing interests