Covid inquiry submission
Our Full Submission to the UK Covid-19 Inquiry
SCCT were keen to make sure our experiences of the pandemic were shared with the UK Covid-19 Inquiry. When we found that our story didn’t fit with any one particular module of the Inquiry, we decided to write up our whole experience as a group, and submitted it in January 2024. We want to share our submission here, too, so that anyone who wants to find out more about what we did, who we worked with, what the outcomes were and what other projects we’ve undertaken can do so by reading on….
Submission to the UK Covid-19 Inquiry
by Sheffield Community Contract Tracers
02.02.2024
1. Introduction
Sheffield Community Contact Tracers (SCCT) is a small voluntary group that was set up in March 2020. This was when the UK Government, breaching basic Public Health principles and World Health Organization (WHO) guidelines, stopped almost all contact tracing for Covid-19. To highlight what seemed a dereliction of duty, SCCT implemented an experimental, volunteer-led, initially unfunded, local model for managing Covid-19 and supporting and mobilizing local communities. The Covid pandemic threw up a great number of challenges for Public Health authorities and all sections of the NHS. Although SCCT remained a small organization, with support it could have been scaled up and replicated elsewhere – which would probably have saved very many lives throughout the UK. Section 2 of this report gives the background of how SCCT came into existence. Sections 3 to 10 briefly describe what SCCT did. There are references which direct readers to more detail of action taken and outcomes achieved, including the numerous publications produced by the group and media coverage of the group’s work. A key message throughout this report is that in an emergency situation in which statutory services are often rapidly overwhelmed with demand, recruitment and training of volunteers and mobilization of local community resources should be considered more seriously. Section 11 draws some important conclusions. The evidence already given to the Covid-19 Inquiry by senior civil servants and politicians has confirmed our worst fears of inadequate decision making in Government in the early stages of the pandemic.
2. Background
SCCT is a volunteer-led project sitting within Heeley Trust, a community anchor and charity working in a suburb of Sheffield, UK. Members of SCCT have included local volunteer contact tracers, admin, IT and social media staff, retired Public Health doctors, local academics and retired local general practitioners. Active membership fluctuated but during 2020 and 2021 up to 65 volunteers worked for SCCT organized into eight different subgroups. Initial motivation to set up the group was shock and disbelief that the Government was not taking contact tracing and isolation of cases seriously. This became apparent when two local retired health workers became seriously ill during the very first wave of Covid. They had not even been asked whom they might have contracted the infection from or to whom they might have passed on the virus. The very simplest Public Health measures were just not being followed at that time. The plight of these people became apparent when one developed a serious pneumonia and accessing health care was fraught with difficulty and uncertainty. It became clear that more support for ill and isolated people was essential.
SCCT started work in March 2020. The initial pilot project was designed to set up a contact tracing initiative for residents of Meersbrook and Heeley in Sheffield. The question we asked was, “Is it possible to establish a robust, sensitive contact tracing service using local trained volunteers?” After conducting the initial study that established the feasibility and effectiveness of a community-based service, SCCT grew and expanded its work. Other projects included: campaigning work using local and national media and academic publications to argue for better strategies to manage the pandemic; the delivery of Covid Confidence training workshops to diverse, under-resourced communities throughout Sheffield; hosting regular update webinars on management of the virus; front line vaccination work with Heeley Trust and local GPs; setting up a geographical vaccination database demonstrating inequalities in uptake; contact tracing for hospital in-patients with Covid 19; supervision of medical students on research and community attachments; and, a study of the use of CO2 monitors and improved ventilation in community venues. An evaluation group including three professors of Public Health, four senior lecturers and three former Directors of PH oversaw evaluation of the different projects and helped with the publication of results.
SCCT remains active (January 2024) in the hope that some of the lessons learnt in the heat of the Covid-19 pandemic can be recorded and could be useful in future Public Health emergencies. It has recently submitted two further academic publications to journals that give evidence of the effectiveness of some of the local initiatives and is also submitting this report to the Government UK Covid-19 Inquiry. It is developing local support groups for people with long Covid and continuing research on safe working environments for community organizations. In addition, SCCT has laid the foundation for further collaborations with community organizations on health inequalities and digital inequalities.
3. Initial community contact tracing project
SCCT was established by a group of four retired Public Health professionals, three retired GPs and around ten concerned local community-minded people. A small proof of principle study was set up to answer the question, “Is it possible to train volunteers to undertake contact tracing for Covid-19 effectively and safely?” The contact tracing undertaken followed the then current WHO Guidelines. Details of the rationale, methodology, results and conclusions are set out in a full report and a summary was published in an Opinion piece in the British Medical Journal (BMJ). Support for the project came from many quarters. Effective community mobilization underpinned this and all other SCCT projects. Strong personal and professional local links were crucial. These included relationships with several local volunteer hubs in Sheffield, with a wide range of community groups and with local general practices who referred patients with Covid to the project. SCCT built upon strong existing links to gain trust at a time when disinformation on the internet was rife and many people were questioning statements made by the Government. Despite this being a pilot study, training just 6 volunteers and enrolling 13 cases which generated 59 contacts, many important issues became apparent.
The key findings of this pilot included:
- Although contact tracing for Covid-19 is often complex, volunteers can be trained and supported to undertake this work safely and effectively. Our training was interactive and entirely online. Ongoing support was always focused on how to enable the volunteers to support those with Covid and their contacts.
- Community involvement was important because people with Covid-19 and their contacts could be introduced to local support services where necessary.
- Where direct contact could not be made by phone or email, volunteers could drop by with a letter or speak directly to people on the doorstep (observing an appropriate distance.)
- A local approach by trusted organizations increased cooperation, particularly from marginalized, seldom heard communities and was shown to increase community resilience.
- From our contact tracing work, we realized in the early months of the pandemic that there were serious problems in social care and hospitals. Issues raised were: that infected care workers appeared to be transmitting Covid to clients; that care home and hospital management were not aware or were actively not wanting to be aware, of transmission issues because of staffing shortages; that staff who were close contacts of cases were not allowed to isolate; and that lack of knowledge resulted in the anomaly of hospital staff taking all precautions with PPE on the wards, but behaving normally with each other in the rest areas and staff dining rooms, creating an opportunity for transmission.
For contact tracing to work efficiently it is important that index cases (people with Covid-19) are identified early in their illness. People who are cases or close contacts and so need to be isolated should receive financial and practical support when necessary. Also, there should be strong efforts locally and nationally to create a culture of public cooperation. At the same time contact tracers need local support from statutory agencies, including legal enforcement by environmental health officers working with individual cases or employers. SCCT trained a number of volunteer contact tracers from West Yorkshire and made its online training material available to a group in Hackney in London. The conclusion of the initial proof of principle study coincided with the launch of the Government’s national test and trace service.
Volunteers with SCCT continued to provide informal advice on contact tracing to the numerous community groups we worked with and via a help line which was kept open into 2021. Contact tracing issues were frequently raised at the online webinars described in section 5 below and volunteers were involved in the in-patient contact tracing described in section 9.
Most of the retired medically trained volunteers had their license to practice restored by the GMC and gave advice in this context. One was a recently retired regional advisor on communicable diseases and so was able to provide expert advice. In addition, currently practising Public Health doctors were available and did provide advice when needed.
4. Campaigning
Members of SCCT were aware from the beginning of the pandemic that the UK Government was choosing radically different strategies from those recommended by the WHO. Their strategies were also different from those adopted by many foreign governments, particularly those who had had experience of managing outbreaks of SARS in the early 2000s. Initially the Government was over keen to continue with ‘business as usual’ for too long, then implemented strategies for the whole country based on experience in London and unrelated to levels of Covid locally and regionally around the UK. They seemed to assume levels of cooperation from the public would be low and that people could only cope with one message from central authorities in London. Local authorities were disempowered, which did not allow for local arrangements to suit local situations and differing levels of illness. The Government was quick to offer very expensive contracts to private enterprises, for example for PPE, lab testing, test and trace, Nightingale hospitals, etc., rather than using tried and tested services within the public sector which may well have been more effective and more efficient. SCCT was also concerned at the lack of discussion of alternative strategies. Independent SAGE, several high-profile individuals and certain medical journals did heroic work, criticizing the inadequacy of the strategy being pursued by the UK Government. Many organizations and particularly most leaders of the medical profession, seemed too quiet on many important matters. Public Health doctors openly stated to us that they were unable to comment or criticize Government policy for fear of losing their jobs.
Throughout the pandemic the main issues that SCCT members argued vociferously for were: that WHO guidelines should be followed; that contact tracing should be established by local authorities; that practical and financial support should be given to people with Covid and their contacts who were required to isolate; for general practices to be fully engaged in managing cases in the community rather than relying on the 111 phone and web based advice; that local communities, particularly those in disadvantaged areas who were suffering disproportionally from Covid-19, should be funded and empowered to support their members; and that although the voluntary sector did a lot, they were a massively underused resource for day to day support of isolated people and even for contact tracing.
A list of the most important publications that SCCT presented in medical journals and media appearances are listed on the SCCT website. The BMJ was particularly supportive of work done by SCCT. They published more than a dozen Opinion pieces by SCCT members, some specifically commissioned by the journal. During the spring and summer of 2020 SCCT often featured on national BBC TV and radio, ITV, Channel 4 as well as on Sheffield’s local radio and TV channels. Full use was made of social media with regular updates. In summer 2020 there were up to 70,000 hits per month on our Facebook page. On 3 occasions SCCT featured in Sheffield’s annual Festival of Debate and links were made with Sheffield Hallam University media students who produced two short documentary films on Covid.
From an early stage SCCT focused a large proportion of its work on the Black, Asian, Minority Ethnic and Refugee communities (BAMER) in Sheffield. Historically these communities have been called ‘hard to reach sectors’ by the NHS and local authorities. Many members of SCCT had worked in districts with large numbers of people from different ethnic groups and understood that different approaches to contain the pandemic might be needed in these communities. A number of ways of working with these seldom heard communities were developed. Local data was presented at a series of meetings and seminars with groups to develop tailored strategies for particular communities. These contacts became especially important during the roll out of the vaccination campaign when disinformation spread quickly via social media. It soon became apparent that many of the local BAMER organizations already had highly developed mechanisms for supporting members of their communities, including very practical help. Some of the positive ways that Sheffield’s BAMER communities looked after each other during the pandemic were captured in a short documentary film.
Throughout the pandemic SCCT developed links with local trades unions through Sheffield Trades Council. Members spoke at several Council meetings and to specific unions with an interest in Covid-19, notably the National Education Union and a number of health service unions. Updates on the local situation were provided and advice given on best practice. This was particularly important as unions working with people who were exposed to widespread myths and disinformation.
Unsurprisingly, the Government was not happy with SCCT’s approach and especially any criticism of the centralized, privatized, non-evidence-based responses to the pandemic. We were informed that questions had been asked about our activity in several Government departments including the Department of Health and Social Care and even in the Cabinet Office.
5. Covid Confidence workshops
In the summer of 2020 a number of local community and statutory organizations, in collaboration with the SCCT, started the delivery of Covid Confidence training workshops to a number of communities in Sheffield. Zoom meetings with local champions were set up and facilitated. The initial purpose was to provide locally relevant data and collectively make sense of most up-to-date information on all matters related to Covid. This work was led by an academic with experience of evaluating health champion programmes elsewhere. A detailed report has been completed covering a series of 11 sessions held between September 2020 and April 2021 and is available on the SCCT website. Around 30 people attended each session with up to 16 local organizations being represented. The report provides deep insights into the issues faced by ordinary people during the pandemic and goes some way to understanding why disadvantaged and BAMER communities suffered disproportionately in the pandemic.
Between December 2020 and late 2022 SCCT hosted around 20 update webinars on management of Covid-19. Generally, about 35 people attended but for several sessions there were around 100 and for one, 350 attendees. Recordings of these events and the material presented is available on the website. It appeared that SCCT had become a locally respected source of public health information and we were training health champions to become local “community scientists”. This felt important in the face of so much disinformation, particularly on social media.
6. Volunteer support circle
This group was established in spring 2020 using Zoom calls and an active WhatsApp group. Its purpose was to provide an opportunity for volunteers to get together informally. It was very important initially when volunteers were undertaking difficult contact tracing work and when the organization was under close scrutiny by the media. Several of the volunteers were not health workers and found the detailed health, social and financial problems experienced by people with Covid outside their normal experience. The anxieties that this produced could be ‘nerve wracking’.
On-going training, mentoring by the medically trained members and the peer support proved essential to maintaining the quality of the contact tracing and support work.
The organization and entire ethos of the SCCT volunteer contact tracing system provided a stark contrast to the privatized, centralized call-centre based system established by the Government at enormous cost and with such poor results. Detailed evaluation of the effectiveness of the role of the SCCT volunteers is available. Subsequently, the volunteers and their support circle played an important role in most of SCCTs projects ensuring the views of volunteers were always heard and could be fed into the Steering Group on a regular basis. All in all, support was provided to those ill with Covid, their contacts, volunteers doing the contact tracing, their clinical supporters, medical students, council workers and hospital doctors. This support function was critical to the SCCT ethos.
7. Vaccination work
When Covid-19 vaccinations became available and rapid rollout of the programme became imperative, SCCT members undertook front line tasks working closely with Heeley Trust and local general practices. One member, a former consultant in Public Health, set up a vaccination database which was frequently updated using information from NHS England and ONS mapping. (This database website is no longer active, but is described and demonstrated in a video.) It enabled us to target action on the communities in Sheffield with the lowest vaccination uptake. We found that these were frequently the most disadvantaged areas with the highest concentrations of BAMER communities. It enabled us to target the work on Covid Confidence training for community champions. Working closely with local BAMER community groups allowed SCCT to analyze the reasons why some people from these communities are reluctant to have vaccinations. The Government often labelled ‘vaccine hesitancy’ as being due to ignorance. This is in contrast to the understanding developed when community leaders and SCCT members listened directly to people and their lived experience. Some of the detailed work that is needed to combat vaccine-related misinformation on social media was captured by SCCT in a second documentary film, ‘Postcards from the Pandemic’.
8. Medical student involvement
Following an approach from the Sheffield University Medical School staff, SCCT supervised several cohorts of between 4 and 12 medical students on either their research or community attachments. They enthusiastically undertook a wide range of Covid-related projects supervised by SCCT members. The quality of the work they produced was remarkable and made a significant contribution to the work of SCCT and its publications. They presented to the webinars run by SCCT which were very well received and their work is available on the website.
Community groups like SCCT were eligible for a payment from Sheffield University for supervising students on their attachments. The income raised in this way has been used to pay staff employed by Heeley Trust and Darnall Well Being to manage the administration of the wider SCCT activities, maintain an intranet site, manage the social media accounts and update the website. Some resources have also paid for equipment and research into ventilation, filtration and maintenance of clean air environments for people working in community settings.
9. In-patient contact tracing
Spread of Covid both by health and care workers and within NHS hospitals was obvious but poorly addressed in 2020. It would appear equally obvious that intense contact tracing activity should be focused on people who were ill enough to be admitted to hospital with Covid and shocking that this was not taking place, even when the official ‘Track and Trace’ had been established. Following an approach by an Infectious Diseases consultant working in a local hospital, SCCT supported a collaborative pilot study conducted jointly with Sheffield Teaching Hospitals Foundation Trust and Sheffield City Council (SCC). The contact tracing work was undertaken by Sheffield University clinical medical students who had worked with SCCT and supervised by a consultant physician. Subsequently, after a successful bid for funding, the work was taken over by paid staff in conjunction with SCC. Staff and students continued to attend SCCT’s Volunteer Support Circle to discuss difficult issues. The model of using medical students for contact tracing has been used successfully in some other countries. The Sheffield pilot study found that around two thirds of hospital in-patients with Covid-19 were not engaged by NHS Test and Trace and that their close contacts were not advised to self-isolate. It suggests that face to face interviews can address this shortfall and that further collaboration will improve contact tracing for in-patients. A poster presentation was prepared by the medical students for the Royal College of Physicians Annual Conference in 2023 and is on the SCCT website. The project also resulted in a publication.
10. CO2 monitors and ventilation in community venues
Later in 2021 it became clear that Covid-19 was airborne and spread by aerosols in exhaled air from people carrying the virus, rather than by heavier droplets or by touching contaminated surfaces. An SCCT volunteer with a background in engineering undertook a project with Heeley Trust to assess the safety of community venues. CO2 monitors were used as a proxy for risk of spread of Covid-19 along with our knowledge locally of the incidence of infection. The effectiveness of improved ventilation and the use of air filtration units was assessed. This work is ongoing and is being evaluated. It has already been beneficial in encouraging anxious vulnerable people to rejoin their pre-pandemic activities and groups.
11. Conclusion
SCCT’s activity was one of many small-scale voluntary interventions that had an impact in local communities during the pandemic. Its raft of activities, based on local knowledge and experience, should have been replicated and they could have been linked in more strongly with local authority pandemic work. SCCT members were seen as local and trusted “citizen scientists” providing information to communities whose voices are seldom heard. SCCT’s view is that in the future pandemic strategies must be more evidence based, must engage, empower and work collaboratively with local communities, the voluntary sector, trades unions, local authorities, primary and secondary health care and established Public Health systems. This was in stark contrast to the Government’s approach which has been described as ‘free market fundamentalism’. For far too long they used inappropriate pandemic flu guidelines and their strategies generally disempowered local organizations. We believe that the Government’s approach cost a great many lives at all stages of the pandemic. We also believe that these lessons must be learnt. Levels of Covid-19 continue to rise and fall, new unfamiliar variants continue to emerge and there is always a risk of future pandemics of new viruses. Probably more importantly, as we enter the next few decades when large climate related emergencies could make the Covid-19 pandemic seem like a relatively small-scale event, we must learn the best ways for communities to organize to become more resilient and reduce harm.
Authors
Fran Arnold – Darnall Well Being and SCCT employee
Dr Jack Czauderna – retired GP
Dr Janet Harris – retired Reader in Public Health
Dr Tom Heller – retired GP
Andy Jackson – Trust Manager Heeley Trust
Dr Bing Jones – retired Associate Specialist Haematology
Steve Pagden – SCCT volunteer retired engineer
Dr Paulina Ramirez – Associate Professor Birmingham Business School (Sheffield resident)
Dr Paul Redgrave – retired Director of Public Health
Professor Shona Kelly – retired Professor Public Health
Judy Stewart – retired Public Health officer
Dr Mike Thomson – retired GP
Professor Jeremy Wight – retired Director of Public Health