A contact tracing programme involving all confirmed positive cases of Covid-19 has started in Northern Ireland.
The region has become the first of the four devolved nations to launch the plan, with all new positive cases now being traced.
Finding all the people someone has been in contact with once they have tested positive for Covid-19 is seen as a key part in preventing the spread of the disease, according to the Public Health Agency (PHA).
“This is another example of the herculean work right across the HSC system to fight back against Covid-19 and keep people safe,” said Health Minister Robin Swann.
“The battle against the virus is a long-term challenge and contact tracing will have a very important role as part of that.”
Dr Jackie Hyland, Consultant in Health Protection at the PHA, said contact tracing at this stage involves new ways of working given the scale and the fact that new evidence is continually emerging about the illness.
“We have teamed up with colleagues in the university sector and Health and Social Care Trusts to put in place all the necessary logistics,” he said.
“We are now rolling out contact tracing further and working with the public to support people who may have been exposed so they can get tested and self-isolate to help prevent spread of infection.
“We are progressing our plans for scaling up the second phase of the Northern Ireland contact tracing service, informed by the learning from the current pilot programme. This work involves testing all aspects of the programme.
“From May 14 we have been undertaking contact tracing for all confirmed positive cases of Covid-19.
“Testing is also now available to everyone in Northern Ireland aged over five with symptoms, which will form an important part of the contact tracing programme.
“The number of staff currently required changes each day in line with workload, but we have sufficient staff trained and available to manage contact tracing and meet demand.”
The Department of Health is also taking forward work around digital solutions that can support the wider contact tracing programme when it goes live.
The land border with the Republic of Ireland is an important factor in the spread of infectious diseases and therefore contact tracing.
There are well-established systems in place to work with colleagues in the Republic on contact tracing and management of infectious diseases, and the health service is working at pace to develop new, more efficient ways of working collaboratively to reduce the spread of Covid-19, and help protect cross-border travellers.
For now contact tracing is being carried out exclusively by telephone and in a similar manner to the method used at beginning of the pandemic.
“Our very first case was an individual who landed in Dublin Airport then travelled to Northern Ireland back to their home and we saw the Public Health Agency and the Health Service Executive actually working together to do that contact tracing, so we’re taking that approach to begin with,” the Health Minister said.
Mr Swann said he had spoken to his counterpart in the Republic, Simon Harris, on Tuesday morning regarding the development of a contact tracing app and he was also monitoring progress on digital technology within the NHS.
“We’re still looking to see which will be the best fit for Northern Ireland,” he said, adding that two apps could be used in Northern Ireland until a bespoke app could be created.
He had previously said that his preference would be for a single app which would work across the British Isles, but if different apps were used they would be compatible.
Contact tracing was suspended in Northern Ireland in mid-March. A pilot programme resumed on April 27 and Mr Swann said he expected the contact tracing service to be in place “for the next year at a minimum”.
The Executive, guided by health experts, now believes the focus on contact tracing can help limit any impact of a second wave of Covid-19.
On Tuesday evening, a virtual meeting to discuss the ongoing response to coronavirus on both sides of the border took place between Northern Ireland Secretary Brandon Lewis, the First and Deputy First Ministers Arlene Foster and Michelle O’Neill, Tanaiste Simon Coveney and the two health ministers.
In a joint statement, Mr Coveney and Mr Lewis said they discussed the respective plans for emerging from lockdown “given the importance of implementing consistent approaches wherever possible and strong collaborative arrangements”.
“Strong data-sharing arrangements North/South would be a necessary part of the easing of restrictions,” they said.
What is contact tracing?
Contact tracing aims to identify and alert people who have come into contact with a person infected with coronavirus.
The process starts with someone who has been tested positive for Covid-19 being asked to list all the people they’ve recently been in prolonged contact with.
A contact tracing team member will then phone these contacts and talk to them about their risk of infection. Everyone who has the infection and who is a close contact will have to self-isolate. To be successful in contact tracing people need to provide their phone number when they get a test.
Why is it important?
Contact tracing has been credited with helping to lift restrictions in other countries, like South Korea, when combined with stringent testing measures.
The most important element is speed.
The five-stage process — sampling, testing, communication to a positive case, contact tracing and contact quarantine — all needs to be done in a 72-hour window to be effective in preventing spread.
Why was it halted?
Contact tracing was halted by the UK government on March 12, though that proved to be a controversial move as many experts believed it was key to slowing the spread of the virus. The government was subsequently accused of not having the capacity to run it effectively.
On April 27 the Department of Health in Northern Ireland restarted an ‘enhanced contact tracing pilot’, which, it says, is now operating five days a week. It’s felt by the Executive that it could prove crucial in limiting the impact of any second wave of coronavirus.
That service is set to be expanded to operate over seven days soon.
How does it operate in Northern Ireland?
For now, Northern Ireland is relying on telephone contact, but the speed of the process should increase dramatically if a mobile phone app becomes available.
The process is off to a slow start and on May 20 the Health Minister said 58 staff were trained and working on contact tracing. On that date there were said to be 24 more tracers in training with a further 800 volunteers having come forward to join the list.
In April Chief Medical Officer Dr Michael McBride had said he estimated 300 to 600 staff would be needed for contact tracing to work efficiently.
Is a contact tracing app likely to be used?
The development of an app to speed up the process of contact tracing is seen as key to maximising the impact of the scheme, but that has raised questions over whether Northern Ireland should be involved with the UK or on an all-Ireland basis.
At the moment the UK and Irish governments are working on separate apps, but Health Minister Robin Swann said no decision has yet been made on the best way to proceed.
The app would be able to identify people the patient may not know — like fellow passengers they have been in contact with on public transport or in supermarkets.
But there have been concerns about privacy, particularly in Northern Ireland where security workers who may be reluctant to use it over fears their personal details could be compromised.
Should contact tracing be organised on an all-Ireland basis?
Addressing media earlier this week, the Health Minister insisted there needed to be “a clarity of message”.
And while a single app that works across both the UK and the Republic of Ireland would be the best solution for Northern Ireland, the logistics of that are proving problematic. Northern Ireland might have to settle for a compromise, if it can be agreed, that would see UK app compatible with one in the Republic, arranged as part of the memorandum of understanding between authorities north and south of the border.
Since Ireland is one geographical area, and if contact tracing is to be a long term project, then it makes sense to have an all-island approach.
Is this likely to be a long term project?
The NI Executive has maintained that contact tracing is a crucial component for ending the lockdown, and that wider surveillance of the virus in the community is necessary.
The system is expected to be in place for at least a year, possibly longer.