Public health leads ‘playing “whack-a-mole” blindfolded’

By Dr Lisa McNally | 06 July 2020

Call me a nerd, but I was genuinely excited when the first tranche of individual coronavirus testing data arrived in my inbox.  Finally, rather than just summaries of pooled testing data, I would be getting information on individuals who had tested positive.  Together with my team I could then use that information to spot outbreaks as soon as they emerge. 

Like a child unwrapping their ‘big present’ on Christmas morning, I eagerly entered the various usernames and passwords that would allow me to access this magical chamber of secrets. But on seeing the opened spreadsheet my first instinct was to throw the laptop through the window. 

There before me were lines of data showing ages, sex and postcode.  OK great, but where was the really useful stuff such as the place of work, college or school?

I looked along the headings at the top.  There was a column entitled ‘occupation’.  But, unless there is a company in Sandwell called ‘NULL’ having a major outbreak, it was completely unusable.

Why is this a problem?  Well think about who you have most contact with in an average day (outside of your household).  Is it your neighbours within the same postcode?   Or is it the people in your workplace, school or college?  Unless you’re lucky to live in an area that has regular street parties, it’s probably the latter.  Which means that this is where you are most likely to be caught up in an outbreak.

So, having directors of public health and their teams stare at a list of postcodes is going to be of very limited value.  Sure, we can map them, and we may see some areas have higher numbers of cases than others.  But it’s by seeing multiple cases emerge in the same workplace or college that will really enable us to get in early and break the chain of transmission.  

The Sandwell Local Outbreak Plan, like the plans in other areas, are built on this strategy.  As lockdown restrictions were lifted we rapidly scaled up systems for dealing with outbreaks in schools, colleges and workplaces.  These plans rely on early identification, rapid isolation of cases and then contact tracing to bring the outbreak under control.   It’s similar to what the Prime Minister referred to as a ‘whack-a-mole’ strategy, albeit on an organisational level rather across a whole local area.

Of course, you may think we don’t need data on place of work or education because the managers of those organisations would know if they had an outbreak and report it to us.  Unfortunately, we’ve already had examples in large workplaces where that hasn’t happened.  Multiple cases have emerged without anyone joining the dots.  You can imagine the same problem could quite easily occur when colleges and universities restart.  So, we need public health teams to be looking out for these links in the testing data and acting swiftly when they find them.

There are two possible explanations for why the testing data we receive does not include information on place of work or education. First, it may be someone further ‘up the chain’ has this data but thinks directors of public health don’t need it.  Or can’t be trusted with it.  Or both. 

The second explanation is far more frightening.  Maybe nobody has this data.  Maybe it’s not being consistently collected within the testing programme?  If that is true, then we are in serious trouble. 

The Government’s own figures show more than one in four people who test positive are not completing the contact tracing process.  So, with limited data from contact tracing, and no data being sent to directors of public health on place of work or education, we are essentially left playing ‘whack-a-mole’ blindfolded.

I’m hoping it’s the first explanation and that, as a director of public health, they just don’t see me as worthy of full initiation into the COVID-19 data inner circle.  However, if it’s the second reason, then I’m worried.  A lot of those moles the Prime Minister talked about will escape being whacked and go on to make an almighty mess of the garden.

Dr Lisa McNally is director of public health at Sandwell MBC

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