Contact Tracing for COVID-19 at the UCD School of Public Health, Physiotherapy and Sports Science (SPHSS), Dublin, Ireland
The first case of coronavirus in Ireland was reported on 29 February 2020. By 12 March there were 70 cases, school colleges and childcare centres were closed and outdoor gatherings of 500 or more were cancelled. This included the annual St. Patrick’s Day festivities on 17 March. Plans for all phases of the response were underway, including a much-needed increase in coronavirus swabbing and testing capacity nationally, engineering for anticipated acute hospital facilities and establishment of a national contact management programme by the Health Services Executive (HSE). Contact tracing centres (CTCs) were established in nine locations. The CTC at the UCD School of Public Health, Physiotherapy and Sports Science was the first of these satellite centres. Led by epidemiologist and Associate Dean of Public Health, Mary Codd, and Professor of Public Health, Patrick Wall, supported by President Andrew Deeks and the University Management Team, operations began in mid-March with recruitment of volunteers from across the university. Caller training materials, developed by HSE and a computerised data access and management system for identification of cases and documentation of call outcomes, were made available. In a matter of days over 240 volunteers at all levels in the university from professor to undergraduate, trained as callers and systems support personnel, were actively engaged in calling index cases, informing their test results, providing advice and guidance on recommended practices, self-isolation and return to work scenarios, establishing their contacts and calling close contacts of cases.
Notably, the volunteer corps at UCD comprises several faculty members from public health, nursing, occupational safety and health, physiotherapy, dietetics and nutrition, veterinary medicine and agricultural sciences. Their professional backgrounds have proven invaluable in handling complex clinical and situational issues that have emerged. Examples include: the competence of senior nursing colleagues with in-depth knowledge of the workings of acute hospitals and residential care settings such as nursing homes, hospice facilities and intellectual disability services; the breadth of knowledge and networking capacity of public health colleagues to engage with traveller communities, direct provision centres and homeless health services; the specialist knowledge of veterinary medicine and agricultural science colleagues of processes and work practices in the meat and other industries where workers are at risk. This on-site expertise has resulted in the UCD centre becoming a recognised specialist CTC for training and contact tracing. And it emphasises the value of co-location of specialist academic faculties and the pivotal role of Public Health in bringing the expertise together to address an unanticipated and multifaceted public health crisis. This has also been a significant learning experience for several of our current MPH class and other Master level students in Dietetics and Physiotherapy, who are actively engaged with contact tracing, systems support and mathematical modelling of the infection, thus witnessing ‘Public Health in Action’.
Running a CTC in the context of a pandemic necessitates rapid development of work practices and routines while adhering to national protective guidelines. Standard operating procedures (SOPs) for volunteers addressing personal and spatial hygiene practices, social distancing, self-care, illness reporting and availability of psychological support services were developed and continue to evolve. SOPs also extend to telephone and caller etiquette, confidentiality issues and policies on escalation of calls to specialist handlers. Daily briefings of volunteers appraise them of updates to national policies, changes to testing criteria and updates to work instructions for emerging scenarios. This is also the opportunity to encourage an investigative attitude towards establishing circumstances in which infection is acquired, while at all times maintaining empathy with the persons and situations encountered.
At the time of writing just under 25,000 cases of coronavirus have been documented in Ireland; 1,652 people infected with the virus have died (31 May 2020). Recognising that contact tracing is just one of the components of a comprehensive response to the coronavirus pandemic, a brief overview of lessons learned from this activity would include the following:
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Coordination is key and is best provided by public health professionals with appropriate training, experience and networking skills;
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Professional backgrounds, life skills, experience and training of callers matter;
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Oversight, monitoring and evaluation of call centre processes matter;
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Vigilance is paramount; early recognition of circumstances in which the virus is spreading rapidly is key; this may be known first to callers in a contact tracing centre; public health authorities need to be notified rapidly and need to act on such notifications;
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Time is of the essence in managing outbreaks. Anything that militates against the most rapid response possible has to be overcome.
As ASPHER engages with the next iteration of the Core Competencies for Public Health Professionals it is important to incorporate what we have learned as a community of public health schools and professionals about preparedness for emergencies and for communicable disease control in conjunction with agencies such as the European Centre for Disease Prevention and Control. While the COVID-19 pandemic is a catastrophic event for our societies it is important that Schools of Public Health step up and have their voices heard, showing the governments, decision makers and the public what public health can do. “( it) has presented us with a unique moment in time for public health to make itself more visible and show the world what Public Health is really about and how action is taken to protect the health of the population. If Public Health is to emerge stronger from this crisis, we must be able to have influence with decision makers, advocate for better funding for education and training, and recruit the best and the brightest of our young people to careers in Public Health” (Laurent Chambaud, Director of the EHESP School of Public Health).
