Local contact tracing: Liverpool

• A local contact tracing service was launched in September, initially staffed by public health practitioners  
• It has now been expanded as infection rates have risen and with the city due to take part in a whole population testing pilot  
• Fire service staff and external recruitment are both playing a role  

Local context  

Liverpool is home to 500,000 people. The city experienced some of the highest infection rates at the start of wave two.

By mid October there were close to 500 cases per 100,000 in a week, nearly three times the national average at the time. The situation saw Liverpool became the first area to be placed in tier three – a move which involved some hospitality venues closing.

By the time the second national lockdown was announced though infection rates had started falling and were just above 300 per 100,000 in the first week of November.  

What was done  

During the summer Liverpool had an outbreak in the Princes Park area of the city, which the council’s public health helped with as part of their role in complex cases. 

The episode highlighted the benefit of having local contact tracing provision and in mid September the public health team started doing some regular local contact tracing to supplement the work of the national team. 

Cases judged “lost to follow up” by the national team were handed down to Liverpool. These were cases that NHS Test and Trace had been unable to contact for several days, including those which had incorrect contact details or who had previously refused to cooperate.

 The team developed a script and began contact tracing with the primary focus of establishing where cases had recently been in order to prevent spread wherever possible and warn their close contacts of any risks. 

The revenue and benefits team was also mobilised in order to cross reference the contact details for cases across other council databases.

From the start of October the council went live a more enhanced version of contact tracing. The national team started passing down cases after 24 hours and Liverpool’s contact tracers were given access to the CTAS recording system. To develop capacity and meet the demand to contact rising numbers, the public health team were joined by 16 members of the culture department.

Public Health Consultant John Lucy, who has overseen the creation of the service, said: “When we started were doing it on top of our day jobs and with the increasing numbers we were seeing in Liverpool that was a having a major impact on what else they could do.  

“We needed to expand the team quickly and thought carefully about what sorts of skills we would need. The temptation is to assume you need clinical knowledge – and there are times when you need access to that, but for the contact tracing it is actually good communication and customer skills you need.”  

He said other parts of the council also played a vital role in developing the service, including support from IT and some operational delivery help from staff who were involved in setting up the vulnerability support service in the first lockdown. “It was a real team effort,” he added. “You need a wide variety of skills to get something like this up-and-running.”  

The impact  

At the start, Liverpool’s service was receiving around 30 cases a day from NHS Test and Trace. But that soon started increasing reaching 200 a day at the peak in mid October before settled down to around 100 a day.  

About 40 per cent of cases are what are classed as unobtainable – in that they have incorrect contact details or have already refused to cooperate.   

But even once they have been discounted, Mr Lucy said the service has still had to prioritise who they have tried to contact. “We have had so many cases to deal with that we have had to think carefully where we have put our efforts. We spend time filtering the cases, prioritising those who have most recently tested positive.   

“You have to think where you will have the most public health benefit – we have had cases where it has been seven, eight or nine days since the test was taken. The potential benefit it tracing them is much less than a more recent case.”  

The team deals with about 60 cases a day, obtaining close contacts from about 10 on average. Many of the others are reached, some of which have previously provided information but have been recorded incorrectly on the CTAS system, some are unable to cooperate due to being in hospital, and some do not provide details of close contacts or have not had any.  

Lessons learned  

Mr Lucy said it is important to recognise it takes time to get these systems up-and-running.  

“The process of developing job descriptions, getting approvals recruiting etc moved more slowly than the spike in infection rates. Rates quickly exceeded even planned capacity, but alternative routes of support, including rapid redeployment of LcC staff enabled us to meet the challenge.” 

He also said while infection rates are high, the impact of contact tracing is diluted. 

But he said he believes the work done in recent months  

will stand the city in good stead. “When there is such high levels of infection there is limited value in contact tracing. But the systems and processes in place along with the experienced gained will serve us well when rates are lower and we are able to identify and act on new contacts rapidly.”  

Mr Lucy said the limited access to the CTAS system that councils have has also meant Liverpool has still had to also keep records on spreadsheets.  

“We are able to input to the system without a problem, but also have to record on our own system as we are unable to interrogate the CTAS system to identify what we have achieved locally.   

“Localised systems for cross referencing contact details have also needed to be developed and have been implemented from the beginning of November. Before this point elements of the process have been time consuming and overly reliant on individuals.”  

Next steps   

Liverpool has just started a pilot for the government which is seeing the whole population of the city offered testing. To help prepare for the increase in cases that is expected, 10 officers from the fire and rescue service have been made available to carry out contact tracing.  

The council is in the process of recruiting five test and trace project officers. They have been recruited from outside the council.  

Mr Lucy said: “We had a fantastic response – around 60 applications. People from all sorts of backgrounds applied, which was great to see. We are recruiting five of them.   

“There is a range of experience – people who worked in banking, community workers and someone who used to work with refugees and asylum seekers.   

“It is really good to have people with new skills and a broad range of experience – that is going to be invaluable in engaging the community and trying to slow the spread of the virus.   

“They will not be solely working as contact tracers – we wanted to keep the role more wide-ranging, including outbreak control.”  

Contact details  

John Lucy  

Public Health Consultant  

Liverpool City Council  

[email protected]